Background There is increasing interest in the use of noninvasive biomarkers to reduce the risks posed by invasive biopsy for monitoring of solid organ transplants (SOT). One such promising marker is the presence of donor-derived cell-free DNA (dd-cfDNA) in the urine or blood of transplant recipients. Methods We systematically reviewed the published literature investigating the use of cfDNA in monitoring of graft health following SOT. Electronic databases were searched for studies relating cfDNA fraction or levels to clinical outcomes, and data including measures of diagnostic test accuracy (DTA) were extracted. Narrative analysis was performed. Results 95 manuscripts from 47 studies met the inclusion criteria (18 kidney, 7 liver, 11 heart, 1 kidney-pancreas, 5 lung, and 5 multiorgan). The majority were retrospective and prospective cohort studies, with 19 reporting DTA data. Multiple techniques for measuring dd-cfDNA were reported, including many not requiring a donor sample. dd-cfDNA falls rapidly within 2 weeks, with baseline levels varying by organ type. Levels are elevated in the presence of allograft injury, including acute rejection (AR) and infection, and return to baseline following successful treatment. Elevation of cfDNA levels are seen in advance of clinically apparent organ injury. Discriminatory power was greatest for higher grades of T cell mediated and antibody-mediated AR, with high negative predictive values. Conclusions cfDNA is a promising biomarker for monitoring the health of solid-organ transplants. Future studies will need to define how it can be used in routine clinical practice and determine clinical benefit with routine prospective monitoring. Corresponding Author: Simon R Knight, Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Churchill Hospital, Old Road, Headington, OX3 7LE, United Kingdom. Tel: +44 (0) 1865 227131. E-mail: simon.knight@nds.ox.ac.uk Authorship SK conceived the study, authored the study protocol, developed and performed literature searches, screened references, analysed the data and wrote the manuscript. AT participated in study design, screened references, analysed the data and participated in the writing of the manuscript. MLF participated in study design and participated in the writing of the manuscript. Disclosures The authors declare no conflicts of interest relating to the content of this article. Funding This study received no external sources of funding. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2OROjgd
Πέμπτη 11 Οκτωβρίου 2018
A worldwide survey of Live liver donor selection policies at 24 centers with a combined experience of 19 009 adult living donor liver transplants
Background While surgical technique in LDLT has evolved with a focus on donor safety and recipient challenges, the donor selection criteria remain considerably disparate. Methods A questionnaire on donor selection was sent to 41 centers worldwide. 24 centers with a combined experience of 19009 LDLTs responded. Results Centers were categorized into predominantly LDLT (18) or DDLT (6), and high (10) or low volume (14) centers. At the majority of centers, the minimum acceptable GRWR was 1 features of metabolic syndrome. On biopsy, all considered macrovesicular and 50% considered microvesicular steatosis important. Nearly all (92%) rejected donors for early fibrosis, and minority for nonspecific granuloma or mild inflammation. Most anatomical anomalies except portal vein type D/E were acceptable at high volume centers. There was no standard policy for pre or peroperative cholangiogram. Conclusions This first large live liver donor survey provides insight into donor selection practices that may aid standardization between centers, with potential expansion of the donor pool without compromising safety. Corresponding author: Dr. AS Soin, Chairman, Chief Liver Transplant and Hepatobiliary Surgeon, Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, Haryana 122001, India. e-mail IDs: absoin@gmail.com, arvinder.soin@medanta.org Authorship Page 1 Dr. Arvinder Singh Soin. FRCS. Chairman, Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, Haryana 122001, India. e-mail ID: absoin@gmail.com. 2. Dr. Rohan Jagat Chaudhary. MS. Associate Consultant, Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, Haryana 122001, India. e-mail ID: rohanjc1@gmail.com. 3. Dr. Hirak Pahari. MS. Fellow, Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, Haryana 122001, India. e-mail ID: hirak.pahari@gmail.com. 4. Dr. Elizabeth Pomfret. MD. Division of Transplant Surgery, University of Colorado School of Medicine, 1635 Aurora Court, Aurora, CO, 80045, USA. E-mail ID: elizabeth.pomfret@ucdenver.edu Contributions: AS Soin: Conception of the work; data analysis and interpretation. Drafting the work, critical revision for important intellectual content and final approval of the version to be published. R J Chaudhary: Data acquisition, analysis and interpretation, drafting and final approval. H Pahari: Data acquisition, analysis and interpretation, drafting and final approval. E A Pomfret: Conception, critical revision and final approval of the version to be published. Disclosures: None. No conflict of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2ND0pVX
https://ift.tt/2ND0pVX
High-flow oxygen via tracheostomy facilitates weaning from prolonged mechanical ventilation in patients with restrictive pulmonary dysfunction: two case reports
Weaning from prolonged mechanical ventilation is extremely difficult in tracheostomized patients with restrictive pulmonary dysfunction. High-flow oxygen via tracheostomy supplies heated and humidified oxygen ...
https://ift.tt/2OhSbYx
Facets of Innate Immunity to Viral Infection
Viral Immunology, Ahead of Print.
https://ift.tt/2yu2s9g
Understanding the Role of Antiviral Cytokines and Chemokines on Neural Stem/Progenitor Cell Activity and Survival
Viral Immunology, Ahead of Print.
https://ift.tt/2OhdcCy
Seasonal patterns in alopecia areata, totalis, and universalis
To the Editor: Although seasonal patterns of pediatric alopecia areata (AA), totalis (AT), and universalis (AU) have been suspected clinically, there is limited research about whether disease flares follow a temporal pattern.1-3 Patients and families report increased hair loss during the winter, with cycles of regrowth in summer months. Through retrospective review of medical records, we sought to identify whether AA, AT, and AU flares show seasonal variation in pediatric patients and to characterize temporal patterns.
https://ift.tt/2OTpfWl
Lichen planus and lichenoid dermatoses
Having reviewed the diverse clinical subtypes of lichenoid disease and the postulated molecular basis thereof in the first article in this 2-part continuing medical education series, we discuss herein the existing and emerging treatment strategies in the most common clinical forms of lichenoid inflammation and provide an overview of their pharmacodynamics and evidence base. The scope of this review is not to exhaustively discuss treatment modalities for all lichenoid variants discussed in the previous article of this series.
https://ift.tt/2NCG1Ep
Lichen planus and lichenoid dermatoses
Deriving from the Greek word λειχήν for "tree moss" and the Latin word planus for "planar," lichen planus is a relatively uncommon and heterogeneous cutaneous disorder that typically develops in middle-aged adults. Despite the significant clinical burden associated with the disorder, little well-conducted molecular research has been undertaken, possibly because of heterogeneity impeding consistent and confident phenotyping. The multiple variants of lichenoid disease bear overlapping clinical and pathologic features despite manifesting as distinct clinical disorders.
https://ift.tt/2Nxbms9
Evaluation of accuracy and sensory outcomes of mandibular reconstruction using computer-assisted surgical simulation
To introduce a modified protocol for mandibular reconstruction and evaluate the protocol using a standardized assessment method.
https://ift.tt/2Okm7mQ
Using principal component analysis to describe the midfacial deformities in patients with craniofacial microsomia
Craniofacial microsomia (CFM) is the result of a disturbance in embryologic development and is characterised by an asymmetric, mostly unilateral facial underdevelopment. The aim of this study is to understand the midfacial involvement in CFM using principal component analysis (PCA).
https://ift.tt/2yxZLDz
Titanium mesh associated with rhBMP-2 in alveolar ridge reconstruction
A systematic review of the literature was performed regarding the use of titanium mesh in association with recombinant human bone morphogenetic protein (rhBMP) for alveolar ridge reconstruction. The PubMed, Scopus, and Cochrane databases were searched for articles in English published up until June 2017. The inclusion criteria encompassed studies in humans − randomized clinical trials, prospective and retrospective studies, and case series. The screening and selection process was performed by three independent reviewers, with verification by a senior researcher in the case of disagreement.
https://ift.tt/2CDKOEn
Response to comments on “Orofacial cleft management by short-term surgical missions in South America: literature review”
We thank the authors of the letter entitled "Five decades of orofacial cleft management and research in Brazil"1 for their comments on our article regarding short-term surgical missions for the management of orofacial clefts (OFCs) in South America2. It was certainly not our intention to minimize the efforts of the Brazilian cleft team; we are truly glad for the advancements they have made since 1967. We agree that there is a need to increase national efforts in South America and international collaborative support to provide specialized care for patients with OFCs.
https://ift.tt/2C87YSi
Occurrence of aflatoxins in rice and in cassava ( Manihot esculenta ) products (meal, bread) produced in Guyana
Abstract
A survey was conducted on Guyana's main staple foods, rice, cassava meal and cassava bread to determine the presence and concentration of aflatoxins (AFs) using enzyme-linked immunosorbent assay (ELISA) and high-performance liquid chromatography (HPLC) with fluorescence detection for concurrence. Aflatoxins are secondary metabolites of the fungus Aspergillus and can be a health risk to humans and animals. Results were compared with European Union Commission (EUC) maximum levels of total aflatoxins of 10 μg/kg. Various types of rice (paddy, steamed paddy, cargo rice, white rice and parboiled rice) were randomly collected either directly from the field and rice mills in Guyana during the November 2015/March 2016 season. Of the total 186 composite samples of rice fractions collected from field and mills, 10% (19) had AF concentrations greater than the maximum EUC level of 10 μg/kg. Fifteen samples had aflatoxin concentrations ranging from 10 to 171 μg/kg, mean 54.4 μg/kg; four samples were outliers. Since Guyanese consume mainly white and parboiled rice, composite samples were taken along the marketing chain at points of sale to determine the presence of AFs. Of the sixty samples of white rice collected, 6.7% (4) had AF concentrations greater than the EUC regulatory limits ranging from 31.9 to 131 μg/kg, mean 80.8 μg/kg. For the 57 samples of parboiled rice, 3.5% (2) samples exceeded the limit with values of 72.6 and 407 μg/kg. Forty (40) samples each of cassava meal and cassava bread were analysed fresh and after 2 months of storage, and no sample exceeded the ELISA detection limit of 0.5 μg/kg.
https://ift.tt/2pQepSQ
Soluble CTLA-4 as a favorable predictive biomarker in metastatic melanoma patients treated with ipilimumab: an Italian melanoma intergroup study
Abstract
CTLA-4 blockade by means of ipilimumab (IPI) potentiates the immune response and improves overall survival (OS) in a minority of metastatic melanoma (MM) patients. We investigated the role of soluble CTLA-4 (sCTLA-4) as a possible biomarker for identifying this subset of patients. sCTLA-4 levels were analyzed at baseline in sera from 113 IPI-treated MM patients by ELISA, and the median value (200 pg/ml) was used to create two equally sized subgroups. Associations of sCTLA-4 with best overall response (BOR) to IPI and immune-related adverse events (irAEs) were evaluated through logistic regression. Kaplan–Meier and Cox regression methods were used to analyze OS. A remarkable association between sCTLA-4 levels and BOR was found. Specifically, the proportion of patients with sCTLA-4 > 200 pg/ml in irSD or irPD (immune-related stable or progressive disease) was, respectively, 80% (OR = 0.23; 95%CL = 0.03–1.88) and 89% (OR = 0.11; 95%CL = 0.02–0.71) and was lower than that observed among patients in irCR/irPR (immune-related complete/partial response). sCTLA-4 levels increased during IPI treatment, since the proportion of patients showing sCTLA > 200 pg/ml after 3 cycles was 4 times higher (OR = 4.41, 95%CL = 1.02–19.1) than that after 1 cycle. Moreover, a significantly lower death rate was estimated for patients with sCTLA-4 > 200 pg/ml (HR = 0.61, 95%CL = 0.39–0.98). Higher baseline sCTLA-4 levels were also associated with the onset of any irAE (p value = 0.029), in particular irAEs of the digestive tract (p value = 0.041). In conclusion, our results suggest that high sCTLA-4 serum levels might predict favorable clinical outcome and higher risk of irAEs in IPI-treated MM patients.
https://ift.tt/2pR1pfv
Duration of Antibiotic Therapy and Major Surgical Site Infection in Cochlear Implantation
This cohort study describes the rates of major surgical site infection for patients undergoing cochlear implantation who receive prolonged antibiotic treatment compared with those who receive a single perioperative dose of antibiotic prophylaxis.
https://ift.tt/2RKw8HQ
https://ift.tt/2RKw8HQ
Limitations to Association of Airway Disease Risk With Removal of Adenoids and Tonsils in Children
To the Editor Byars et al recently published a large case-control study based on data from Danish health registries. We believe that several important limitations in the study need to be addressed.
https://ift.tt/2EeL1Qg
https://ift.tt/2EeL1Qg
Association of Proton Pump Inhibitors With Hospitalization Risk in Children With Oropharyngeal Dysphagia
This retrospective cohort study of 293 children with oropharyngeal dysphagia examines hospitalization risk for those treated with proton pump inhibitors compared with those who were not.
https://ift.tt/2RGhnWF
https://ift.tt/2RGhnWF
Limitations to Association of Airway Disease Risk With Removal of Adenoids and Tonsils in Children—Reply
In Reply Four main issues were raised by Kitipornchai and Mackay and Lüscher et al. All of them appear invalid as challenges of our main results.
https://ift.tt/2Ecwl3S
https://ift.tt/2Ecwl3S
Empirical Proton Pump Inhibitor Therapy
For over a decade, publications in medical literature have raised several concerns regarding the use of proton pump inhibitors (PPIs). More recently, the pace of publication has quickened. This class of medications has been associated with pulmonary and gastrointestinal negative effects both in adults and children. For children, concern exists regarding elevated rates of viral and bacterial infections of the gastrointestinal tract, including Clostridium difficile, as well as increases in bacterial pneumonia. Changes in the microbiome may be related to these negative effects, and the length of PPI use may not matter. Although these concerns have been raised through studies that demonstrate correlation rather than cause and effect, word is getting out in gastroenterology, pediatrics, and neonatology. These findings have spread more slowly to those closely related fields of pulmonology and otolaryngology. These are fields in which physicians may be very comfortable and familiar with prescribing this class of medications to their pediatric patients, yet may be less aware of possible adverse effects than gastroenterologists and pediatricians.
https://ift.tt/2RHsFdh
https://ift.tt/2RHsFdh
Notice of Retraction for Schietroma et al
This Notice of Retraction is to retract an article by Schietroma et al.
https://ift.tt/2EcweFu
https://ift.tt/2EcweFu
Limitations to Association of Airway Disease Risk With Removal of Adenoids and Tonsils in Children
To the Editor The conclusion by Byars et al that the children who have had adenoidectomy and/or tonsillectomy are at a greater lifetime risk of airway disease may be supported by their data; however, their implication that surgery is causally related to this incidence is unfounded.
https://ift.tt/2RGS4nm
https://ift.tt/2RGS4nm
Comparison of Objective Outcomes in Dynamic Lower Facial Surgical Reanimation
This case series describes the use of temporalis tendon transfer or gracilis free muscle transfer to adjust the vector of smile and commissure position in patients with facial paralysis.
https://ift.tt/2EgBNTw
https://ift.tt/2EgBNTw
The clinical value of assays detecting antibodies against domain I of β2-glycoprotein I in the antiphospholipid syndrome
Publication date: Available online 11 October 2018
Source: Autoimmunity Reviews
Author(s): Dongmei Yin, Bas de Laat, Katrien M.J. Devreese, Hilde Kelchtermans
Abstract
As the clinical symptoms of the antiphospholipid syndrome (APS) frequently occur irrespective of the syndrome, diagnosis predominantly depends on the laboratory assays measuring the level or function of antiphospholipid antibodies (aPLs). β2-glycoprotein I (β2GPI) is increasingly accepted as the most important target of aPLs. Anti-β2GPI antibodies constitute a heterogeneous population, but current in vivo and in vitro evidence show that especially the first domain (DI) of β2GPI contains an important pathogenic epitope. This epitope containing Glycine40-Arginine43 (G40-R43) has proven to be cryptic and only exposed when β2GPI is in its open conformation. A previous study demonstrated a highly variable exposure of the cryptic epitope in commercial anti-β2GPI assays, with implications on correct patient classification. Unexpectedly, recent unpublished data revealed impaired exposure of the pathogenic epitope in the commercially available anti-DI chemiluminescence immunoassay (CIA) assay detecting specific antibodies directed to DI.
In this review we summarize the laboratory and clinical performance characteristics of the different anti-DI assays in published data and conclude with inconsistent results for both the correlation of anti-DI antibodies with clinical symptoms and the added value of anti-DI antibodies in the classification criteria of APS. Additionally, we hypothesize on possible explanations for the observed discrepancies. Finally, we highly advise manufacturers to use normal pooled plasma spiked with the monoclonal anti-DI antibodies to verify correct exposure of the cryptic epitope.
https://ift.tt/2CCS8A9
Effect of acute administration of nicotine and ethanol on tooth movement in rats
Abstract The aim of this study was to evaluate the effect of acute administration of nicotine and ethanol on tooth movement in rats. Two hundred rats were divided into eight groups: S: saline; N: nicotine; E: ethanol; NE: nicotine and ethanol; SM: saline with tooth movement; NM: nicotine with tooth movement; EM: ethanol with tooth movement; and NEM: nicotine and ethanol with tooth movement. All the solutions were applied for 32, 44, or 58 days, according to the subgroup. Orthodontic movement (25 cN) was initiated 30 days after solution administration in the groups with tooth movement. The rats were euthanized 2, 14, or 28 days after initiation of tooth movement. Tooth sections were stained using picrosirius and tartrate-resistant acid phosphatase (TRAP). The data were compared by ANOVA using Tukey's HSD and Games-Howell. On day 28 of tooth movement, the NEM group had a lower percentage of type I collagen compared to the SM group (p = 0.0448), and the S group had a higher number of osteoclasts/μm2 compared to the N group (p = 0.0405). Nicotine and ethanol did not affect the tooth movement rate, regardless of induction of orthodontic movement. Nicotine influenced the number of osteoclasts by decreasing their quantity when dental movement was not induced. When nicotine was associated with ethanol, it interfered in the maturation of collagen fibers during orthodontic movement.
https://ift.tt/2Pt6FRP
Pacifier use modifies the association between breastfeeding and malocclusion: a cross-sectional study
Abstract This study aimed to evaluate the influence of breastfeeding and pacifier use on the occlusal status of preschool children. A cross-sectional study was conducted with children (n = 489) aged 2–5 years in private and public schools in Pelotas, South Brazil. Mothers answered a questionnaire on demographic, socioeconomic and behavioral variables, including breastfeeding and non-nutritive sucking habits. Malocclusion was classified as normal/mild and moderate/severe, according to WHO criteria. The association between breastfeeding and pacifier use with malocclusion was tested using multivariate logistic regression. The prevalence of malocclusion was 37.83% (95%CI 33.52–42.14), and 57.87% of the children used a pacifier. A total of 46.01% of the sample was exclusively breastfed for 6 months, and 24.74% were never breastfed. Malocclusion was associated with pacifier use, and with both non-exclusively breastfed and never breastfed. After adjustments for demographic and socioeconomic variables, the children who used a pacifier and were never breastfed (OR = 19.08; 95%CI 8.54–42.63), or who used a pacifier and were not exclusively breastfed (OR = 13.74; 95%CI 6.11–30.92), showed worse occlusal conditions, compared with the children who were exclusively breastfed and never used a pacifier. Pacifier use modifies the relationship between breastfeeding and occlusal status.
https://ift.tt/2yechsx
Long-term bonding efficacy of adhesives containing benzodioxioles as alternative co-initiators
Abstract This study evaluated the three-year lifespan of the bond to dentin of experimental self-etch adhesives containing benzodioxole derivatives – 1,3-benzodioxole (BDO) and piperonyl alcohol (PA) – as co-initiator alternative to amines. Adhesive resins were formulated using Bis-GMA, TEGDMA, HEMA, camphorquinone and different co-initiators: BDO, PA or ethyl 4-dimethylamino benzoate (EDAB – amine). An experimental self-etch primer was used to complete the two-step, self-etch adhesive system. Clearfil SE Bond (CSE) was used as commercial reference. Bond strength to human dentin was assessed by microtensile bond strength (µTBS) test, and failure mode was classified. Morphology of the dentin bonding interface was assessed via scanning electron microscopy (SEM). Irrespective of the dental adhesives evaluated, µTBS was higher after 24 hours compared with that after 1.5 and 3 years (p ≤ 0.001). However, adhesives with BDO and PA as co-initiators showed significantly higher bond strength than the bonding resin with EDAB (p ≤ 0.002), independent of the time evaluated. The commercial adhesive CSE showed similar bond strength compared with the other groups (p ≥ 0.05). Mixed failures were mainly observed after 24 hours, while adhesive failures were more frequently observed after 1.5 and 3 years. No notable differences in homogeneity and continuity along the bonded interfaces were detected among the materials in the SEM analysis. In conclusion, benzodioxole derivatives are feasible alternative co-initiators to tertiary amine in camphorquinone-based self-etching dental adhesive formulations.
https://ift.tt/2Polrcy
Nuclear metallothionein in oral squamous cell carcinoma: clinicopathological parameters and patient survival
Abstract The aim of this study was to identify the immunoexpression of methallothionein in oral squamous cell carcinoma as well as to address the correlation with clinical features, histological grade and patient survival. Samples were collected from 93 patients with tongue squamous cell carcinoma who presented for follow-up. Immunohistochemical expression of methallothionein in all groups was performed. The scoring system has previously been published by Tsurutani in 2005, which is based on intensity and distribution of staining. We used Kappa index to evaluate the degree of observers' agreement under metallothionein immunostaining and histological grade. Associations between methallothionein expression and clinical parameters (age, gender, smoking, tumor size, lymph node metastasis and disease stage) were examined for statistical significance using the chi-squared test. The overall survival rates were estimated by the Kaplan-Meier method and the relationship between protein expression and survival was compared using the log-rank test (p < 0.05). Our results showed no statistically significant association between methallothionein immunostaining and the selected clinicopathological variables. Immunohistochemistry results showed positive nuclear immunostaining for metallothionein in 62,37% (58/93) and negative for metallothionein 37,63% (35/93). The degree of examiners agreement by Kappa varied from substantial to perfect and both metallothionein immunostaining and histological grade were explored. The present study suggests that positive methallothionein expression found in tongue squamous cell carcinoma may not help to predict survival in the analyzed samples, as well as no relation between the protein and histological grade and clinical features was observed. In conclusion, the present study suggests that metallothionein is not associated with tongue squamous cell carcinoma clinicopathological characteristics and aggressiveness.
https://ift.tt/2yfLhci
Influence of a hydrophobic monomer on the physical and mechanical properties of experimental surface sealants
Abstract This study evaluated the effect of adding the hydrophobic monomer 1,12 dodecanediol dimethacrylate (DDDMA) to experimental sealants with and without thermocycling on degree of conversion (DC), water sorption (WS), water solubility (WSB), color stability (ΔE), and micro-shear bond strength (μSBS). Five experimental and one commercially available sealant (Bisco - BIS) were tested. The experimental sealants were formulated by mixing different percentages of DDDMA monomers and urethane dimethacrylate (UDMA). The photoinitiator system was composed by camphorquinone (CQ) and tertiary amine 4-ethyl benzoate dimetilamiono (EDBA). Ethanol was used as a solvent. The experimental groups were named sequentially according to the monomeric content (DDDMA/UDMA): S40/40 (40/40), S50/30 (50/30), S60/20 (60/20), S70/10 (70/10) and S80/0 (80/0). Data were analyzed separately by one-way ANOVA, followed by Tukey's test (p<0.05). The values of DC ranged from 94.59% (S40/40) to 54.02% (S80/10). BIS showed the highest WS value (p<0.05) and S40/40, S50/30, S60/20 and S80/0 showed the lowest WS values of all tested sealants. WSB values ranged from 7.88 µg/mm3 (BIS) to 13.27 µg/mm3 (S70/10). The highest ΔE value was 11.05±2.88 for BIS and the highest μSBS value was found for S60/20. No significant difference was observed in bond strength between sealants and bovine enamel after thermocycling. Adding DDDMA to the composition of surface sealants can improve its performance, once the monomer increased the degree of conversion and the color stability.
https://ift.tt/2Pt6plP
Influence of head and linear growth on the development of malocclusion at six years of age: a cohort study
https://ift.tt/2yfL7Se
Influence of ethanol-wet dentin, adhesive mode of application, and aging on bond strength of universal adhesive
Abstract The aim of this study was to evaluate the effect of ethanol on the bond longevity of a universal adhesive system to bovine dentin, under different modes of adhesive application and artificial aging. Bovine dentin was exposed, and the smear layer was standardized by sandpaper polishing. Specimens were randomly divided into 2 groups: ethanol (E) and non-ethanol (N). Groups were subdivided according to adhesive mode of application into etch-and-rinse (Er) and self-etching (S). Resin blocks were built onto the treated surface, and the specimens were stored in deionized water at 37°C for 48 h. Half of the specimens (n = 10) were subjected to thermomechanical aging (A for aged and Na for non-aged). Resin/dentin beams were obtained and subjected to microtensile test in a universal testing machine. Data were analyzed using a three-way ANOVA and Tukey's tests (α = 5%). There was interaction among the three factors (p=0.0003). The use of ethanol resulted in higher values, except for the Er and Na groups (E_Er_Na = N_Er_Na). The mode of application was similar, except for the N and A groups (N_S_A > N_Er_A). For the A groups, the values were lower, except in the cases using ethanol, in which the results were not affected. The study concluded that the use of ethanol resulted in higher microtensile bond strength values, even after aging. The mode of adhesive application did not influence the results.
https://ift.tt/2PsD6Qt
Experimental furcal perforation treated with mineral trioxide aggregate plus selenium: immune response
Abstract The aim of this study is to evaluate the expression of cytokines in response to mineral trioxide aggregate (MTA) plus selenium in germ-free mice with experimental furcal perforation. The first left maxillary molar was opened, and the furcal area was perforated and treated with post-MTA-Se (experimental group). The same surgical intervention was performed for the maxillary right first molar, which was treated with MTA (control group). Fifteen mice were sacrificed 7, 14, and 21 days after furcal perforation, and periapical tissue samples were collected. The mRNA expression levels of the cytokines TGF-β, TNF-α, IFN-γ, HPRT, IL-10, IL-4, RANK, RANKL, IL-1, and IL-17 were assessed by using real-time polymerase chain reaction. In the experimental group, at 21-days post-MTA-Se sealing, the mRNA levels of TNF-α and IL-10 were upregulated compared with those in the control group (p < 0.05). Futher assessment revealed basal mRNA expression levels of IL-1α, IFN-γ, RANK, RANKL, IL-17A, IL-4, and TGF-β, over long experimental times, in both the experimental and control groups (p > 0.05). In conclusion, MTA+Se sealing favoured increased expression of IL-10 and TNF-α at later time points (day 21).
https://ift.tt/2yfLtbw
The role of human milk and sucrose on cariogenicity of microcosm biofilms
Abstract This study investigated the effect of human milk, alone and associated with sucrose, in the cariogenicity of biofilms in a microcosm biofilm model and compared with the cariogenicity of sucrose and bovine milk. Microcosm biofilms were grown in enamel discs in 24-well plates. Six growth conditions were studied: DMM (chemically defined artificial saliva - negative control), DMM with 1% of sucrose (DMM+s) (positive control), human milk with DMM, human milk with DMM+s, bovine milk with DMM, and bovine milk with DMM+s. After 5 days, the outcome variables surface hardness change (%SHC), microbiological composition of biofilms, and pH of supernatant were analyzed. All groups had significantly lower hardness loss compared to the DMM group with 1% of sucrose. Human and bovine milk associated with sucrose showed higher hardness loss. The supernatant pH values after 6 hours of different treatments were similar for the groups sucrose and human milk associated with sucrose (p>0.05). After 18 hours at rest in pure DMM, an increase in the pH of the supernatant was observed. Higher values of total microorganisms count were found for sucrose and bovine milk groups compared to the group supplemented only by DMM. Bovine milk group showed greater amount of total aciduric microorganisms in comparison to human milk group. Within the limits of this study, it can be infered that both human and cow milks have some cariogenic potential, although differing from sucrose in terms of mineral loss.
https://ift.tt/2PrVZmp
Conditioned fear stress increases bone resorption in apical periodontitislesions in Wistar male rats
Publication date: Available online 10 October 2018
Source: Archives of Oral Biology
Author(s): Emisael Stênio Batista Gomes, Lucyana Conceição Farias, Luiz Henrique Silveira, Carlos Ícaro de Jesus, Rogério Gonçalves da Rocha, Guilherme Veloso Ramos, Hanna Thaynara Alves Teixeira Magalhães, Manoel Brito-Júnior, Sérgio Henrique Sousa Santos, Bruno Correia Jham, Alfredo Maurício Batista de Paula, André Luiz Sena Guimarães
Abstract
Objective
Because the impact of conditioned fear stress on apical bone resorption is unknown, the aim of the current studywas to use a rat model to evaluate the impact of conditioned fear stress on the bone resorption of inflammatory apical periodontitis lesions.
Methods
Twenty-five animals were divided into two groups. They underwent a surgical procedure in the first left lower molar tooth to expose the dental pulp and induce inflammatory apical periodontitis lesions through the retention of contamination (bacterial infection) during a 56-day period. The animals in the case group were stressed daily by using electrical stimuli (1.10 mA), whereas the animals in the control group were absent from the stressful stimuli (shocks). The open field test was performed to validate the stress methodology. The jaws were removed and collected for histological and radiographic analyses.
Results
Stressed animals presented increased levels of bone loss and inflammatory cells in the root apex in comparison with the control group (P = 0.0001). However, no radiographic differences were observed between the groups (P > 0.05).
Conclusions
Our results demonstrated that conditioned fear stress could modify a periapical lesion by increasing the size of bone loss there. Conditioned fear stress also increased the total number of inflammatory cells compared with the control group. Studies evaluating the impact of conditioned fear stress on human periapical inflammatory lesions should be encouraged.
https://ift.tt/2IP8uWV
Compensatory interactions between developing maxillary anterior teeth in a sample of twins
Publication date: Available online 10 October 2018
Source: Archives of Oral Biology
Author(s): Marianne Tadros, Alan H Brook, Sarbin Ranjitkar, Grant C Townsend
Abstract
Objectives
The objective of this study was to revisit the topic of compensatory interactions between maxillary anterior teeth during development advanced by Sofaer et al. (1971). We addressed the hypotheses listed by Sofaer and colleagues using data derived from our Australian twin sample to investigate whether final tooth size in permanent maxillary central incisors and canines showed evidence of developmental compensation for adjacent missing or microdont lateral incisors. Such compensation is one factor interacting in the complex system of dental development.
Materials and methods
A 2D image analysis system was used to measure crown height from the labial view, labiopalatal crown width from the incisal view, and mesiodistal crown width from both the labial (MDl) and incisal (MDi) views of the permanent maxillary central incisors and canines on the dental study model of twins enrolled in a longitudinal study of dental development.
Results
Developmental variations of maxillary lateral incisors influence the morphogenesis of the adjacent teeth. For example, individuals with one missing lateral incisor and one lateral incisor of average dimensions, had significantly larger central incisors than the control group for the MDl and MDi dimensions (p < 0.05). Of the 7 monozygotic twin pairs, 6 were discordant in maxillary anterior hypodontia and microdontia, and 13 out of 14 dizygotic twin pairs were discordant.
Conclusions
This study provides further evidence of developmental interactions in the maxillary anterior region, partially supporting Sofaer and colleagues' hypotheses. These interactions are part of a complex adaptive system involving genetic, epigenetic and environmental factors.
https://ift.tt/2pVoEW9
Conditioned fear stress increases bone resorption in apical periodontitislesions in Wistar male rats
Publication date: Available online 10 October 2018
Source: Archives of Oral Biology
Author(s): Emisael Stênio Batista Gomes, Lucyana Conceição Farias, Luiz Henrique Silveira, Carlos Ícaro de Jesus, Rogério Gonçalves da Rocha, Guilherme Veloso Ramos, Hanna Thaynara Alves Teixeira Magalhães, Manoel Brito-Júnior, Sérgio Henrique Sousa Santos, Bruno Correia Jham, Alfredo Maurício Batista de Paula, André Luiz Sena Guimarães
Abstract
Objective
Because the impact of conditioned fear stress on apical bone resorption is unknown, the aim of the current studywas to use a rat model to evaluate the impact of conditioned fear stress on the bone resorption of inflammatory apical periodontitis lesions.
Methods
Twenty-five animals were divided into two groups. They underwent a surgical procedure in the first left lower molar tooth to expose the dental pulp and induce inflammatory apical periodontitis lesions through the retention of contamination (bacterial infection) during a 56-day period. The animals in the case group were stressed daily by using electrical stimuli (1.10 mA), whereas the animals in the control group were absent from the stressful stimuli (shocks). The open field test was performed to validate the stress methodology. The jaws were removed and collected for histological and radiographic analyses.
Results
Stressed animals presented increased levels of bone loss and inflammatory cells in the root apex in comparison with the control group (P = 0.0001). However, no radiographic differences were observed between the groups (P > 0.05).
Conclusions
Our results demonstrated that conditioned fear stress could modify a periapical lesion by increasing the size of bone loss there. Conditioned fear stress also increased the total number of inflammatory cells compared with the control group. Studies evaluating the impact of conditioned fear stress on human periapical inflammatory lesions should be encouraged.
https://ift.tt/2IP8uWV
Compensatory interactions between developing maxillary anterior teeth in a sample of twins
Publication date: Available online 10 October 2018
Source: Archives of Oral Biology
Author(s): Marianne Tadros, Alan H Brook, Sarbin Ranjitkar, Grant C Townsend
Abstract
Objectives
The objective of this study was to revisit the topic of compensatory interactions between maxillary anterior teeth during development advanced by Sofaer et al. (1971). We addressed the hypotheses listed by Sofaer and colleagues using data derived from our Australian twin sample to investigate whether final tooth size in permanent maxillary central incisors and canines showed evidence of developmental compensation for adjacent missing or microdont lateral incisors. Such compensation is one factor interacting in the complex system of dental development.
Materials and methods
A 2D image analysis system was used to measure crown height from the labial view, labiopalatal crown width from the incisal view, and mesiodistal crown width from both the labial (MDl) and incisal (MDi) views of the permanent maxillary central incisors and canines on the dental study model of twins enrolled in a longitudinal study of dental development.
Results
Developmental variations of maxillary lateral incisors influence the morphogenesis of the adjacent teeth. For example, individuals with one missing lateral incisor and one lateral incisor of average dimensions, had significantly larger central incisors than the control group for the MDl and MDi dimensions (p < 0.05). Of the 7 monozygotic twin pairs, 6 were discordant in maxillary anterior hypodontia and microdontia, and 13 out of 14 dizygotic twin pairs were discordant.
Conclusions
This study provides further evidence of developmental interactions in the maxillary anterior region, partially supporting Sofaer and colleagues' hypotheses. These interactions are part of a complex adaptive system involving genetic, epigenetic and environmental factors.
https://ift.tt/2pVoEW9
microRNA-199a may be involved in the pathogenesis of lupus nephritis via modulating the activation of NF-κB by targeting Klotho
Publication date: November 2018
Source: Molecular Immunology, Volume 103
Author(s): Hong Ye, Bofeng Su, Haizhen Ni, Linlin Li, Xuduan Chen, Xiaohan You, Huidi Zhang
Abstract
Klotho is considered to have renal protective effect by prohibiting the activation of the nuclear factor (NF)-κB pathway, while the role of microRNA-199a (miR-199a)/Klotho in lupus nephritis (LN) is still unknown. A single dose of pristane (0.5 ml) was intraperitoneally injected into 8 weeks-old female mice to establish the LN model. MiR-199a mimic or miR-199a inhibitor, Klotho plasmid or Klotho siRNA, and miR-199a inhibitor plus si-Klotho were transfected into lipopolysaccharides (LPS) stimulated human embryonic kidney 293 T (HEK293 T) cells. Western Blot was adopted to measure p-P65 expression. Tumor necrosis factor (TNF)-α and interleukin (IL)-1β in the supernatant were determined by enzyme-linked immunosorbent assay (ELISA). The expression of Klotho was suppressed by miR-199a through direct binding to the three prime untranslated regions (3'-UTR). The high miR-199a level was accompanied by low Klotho expression in the LN kidney. MiR-199a promoted LPS-induced NF-κB activation and improved the secretion of TNF-α and IL-1β by regulation of Klotho in HEK293 T cells. If miR-199a antagomir was administrated after 48 h of pristane administration, the expression of p-P65 and the secretion of TNF-α and IL-1β were significantly down-regulated in LN kidney. Although the direct involvement and detailed mechanism of miR-199a in LN still need further investigation, our data show that MiR-199a could regulate the activation of NF-κB by directly targeting Klotho.
https://ift.tt/2yukf05
Donor white blood cell survival and cytokine profiles following red blood cell transfusion in Australian major trauma patients
Publication date: November 2018
Source: Molecular Immunology, Volume 103
Author(s): Rena Hirani, Melinda M. Dean, Zsolt J. Balogh, Natalie J. Lott, Julie Seggie, Jeremy M. Hsu, Susan Taggart, Peter Maitz, Lesley Survela, Anthony Joseph, Mark Gillett, David O. Irving
Abstract
Background
The potential for the co-existence of genetically disparate cells (microchimerism) and associated cytokine profiles following red blood cell (RBC) transfusion in trauma patients has not been well characterized to date. This study investigated the incidence of surviving donor white blood cells (known as transfused-associated microchimerism (TAM)) and cytokine changes following blood transfusion in trauma patients.
Study design and methods
Trauma patients with an injury severity score (ISS) >12 who had been transfused between 2012–2016 with at least 5 units of RBC units over a 4 h period were recruited. Trauma patients with ISS > 12 who did not require blood transfusion were recruited as controls. The incidence of TAM was determined using a panel of insertion/deletion (InDel) bi-allelic polymorphisms. Selected pro- and anti-inflammatory cytokine profiles were analyzed using cytometric bead array.
Results
The transfused cohort (n = 40) had median ISS of 28 [12–66], received a median of 11 RBC units [4–114] and had median hospital length of stay of 35 days [1–152]. Only 11 (27.5%) patients returned for follow-up blood sampling after discharge. Of these, one patient showed an InDel pattern indicating the presence of TAM. No patients in the control cohort (n = 49) showed TAM. Cytokines IL-10 and IL-6 were found to be elevated in the transfused trauma patients.
Conclusion
In this cohort, TAM was found to occur in one patient of the 11 who received a blood transfusion. Elevated IL-6 and IL-10 cytokines were detected in those patients who were transfused. However, the incidence of TAM could not be correlated with the elevated cytokine profiles for this cohort.
https://ift.tt/2OkdUzb
Lesion of the thyroid cartilage
Publication date: Available online 10 October 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): Z. Cavallier, J. Sarini, V. Maisongrosse, A. Dupret-Bories
https://ift.tt/2IOCgen
Safety profile after prolonged C3 inhibition
Publication date: December 2018
Source: Clinical Immunology, Volume 197
Author(s): Edimara S. Reis, Nadja Berger, Xin Wang, Sophia Koutsogiannaki, Robert K. Doot, Justin T. Gumas, Periklis G. Foukas, Ranillo R.G. Resuello, Joel V. Tuplano, David Kukis, Alice F. Tarantal, Anthony J. Young, Tetsuhiro Kajikawa, Athena M. Soulika, Dimitrios C. Mastellos, Despina Yancopoulou, Ali-Reza Biglarnia, Markus Huber-Lang, George Hajishengallis, Bo Nilsson
Abstract
The central component of the complement cascade, C3, is involved in various biological functions, including opsonization of foreign bodies, clearance of waste material, activation of immune cells, and triggering of pathways controlling development. Given its broad role in immune responses, particularly in phagocytosis and the clearance of microbes, a deficiency in complement C3 in humans is often associated with multiple bacterial infections. Interestingly, an increased susceptibility to infections appears to occur mainly in the first two years of life and then wanes throughout adulthood. In view of the well-established connection between C3 deficiency and infections, therapeutic inhibition of complement at the level of C3 is often considered with caution or disregarded. We therefore set out to investigate the immune and biochemical profile of non-human primates under prolonged treatment with the C3 inhibitor compstatin (Cp40 analog). Cynomolgus monkeys were dosed subcutaneously with Cp40, resulting in systemic inhibition of C3, for 1 week, 2 weeks, or 3 months. Plasma concentrations of both C3 and Cp40 were measured periodically and complete saturation of plasma C3 was confirmed. No differences in hematological, biochemical, or immunological parameters were identified in the blood or tissues of animals treated with Cp40 when compared to those injected with vehicle alone. Further, skin wounds showed no signs of infection in those treated with Cp40. In fact, Cp40 treatment was associated with a trend toward accelerated wound healing when compared with the control group. In addition, a biodistribution study in a rhesus monkey indicated that the distribution of Cp40 in the body is associated with the presence of C3, concentrating in organs that accumulate blood and produce C3. Overall, our data suggest that systemic C3 inhibition in healthy adult non-human primates is not associated with a weakened immune system or susceptibility to infections.
https://ift.tt/2EgbU6b
Implant stability using piezoelectric bone surgery compared with conventional drilling: a systematic review and meta-analysis
Publication date: November 2018
Source: International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 11
Author(s): S. García-Moreno, J. González-Serrano, R.M. López-Pintor, B. Pardal-Peláez, G. Hernández, J.M. Martínez-González
Abstract
The aim of this systematic review was to assess the primary and secondary stability of dental implants placed at sites prepared with piezoelectric bone surgery (PBS) and conventional drilling (CD). The PubMed/MEDLINE and Cochrane Library databases were searched without date or language restriction up to June 2017. Controlled clinical trials in which each patient received implants placed at sites prepared with both PBS and CD were selected. Implant stability had to be measured on day 0 and during the osseointegration period. Methodological quality was assessed using the Cochrane Collaboration tool. A meta-analysis was performed to compare primary stability (on day 0) and secondary stability (after 2 and 3 months) between the two groups. The studies included were determined to have a high risk of bias. There was no significant difference between the two groups for primary stability (on day 0) (P = 0.51). After 2 and 3 months, secondary stability was statistically higher in implants placed with PBS preparation (P = 0.04 and P = 0.01, respectively). The implant survival rate was 97.5% in the CD group and 100% in the PBS group. PBS preparation improves secondary stability after 2 and 3 months in comparison to CD, with similar implant survival rates. Further studies are needed to determine whether implant osseointegration periods could be shortened with PBS preparation.
https://ift.tt/2CCg9aI
Editorial Board/Reviewing Committee
Publication date: November 2018
Source: International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 11
Author(s):
https://ift.tt/2C6qH0N
Predicting the therapeutic effect of carbamazepine in trigeminal neuralgia by analysis of neurovascular compression utilizing magnetic resonance cisternography
Publication date: Available online 11 October 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): T. Tanaka, S. Shiiba, N. Yoshino, N. Harano, T. Sago, S. Kito, S. Matsumoto-Takeda, N. Wakasugi-Sato, M. Oda, T. Joujima, Y. Miyamura, Y. Imamura, Y. Morimoto
Abstract
The aim of this study was to determine whether the evaluation of neurovascular compression (NVC) using new criteria on magnetic resonance (MR) cisternography improves the prediction of the curative effects of carbamazepine (CBZ) in trigeminal neuralgia (TN). In this study, a new analysis of NVC using MR cisternography was performed retrospectively for 280 patients with clinical signs and symptoms suggesting TN. The new analysis examined whether the site of the NVC was less than 3 mm from the edge of the exit point and within the first third of the root entry zone on MR cisternography. Prediction of the curative effects of CBZ using the new evaluation of distance to the NVC improved on the predictive ability of the previous method of calculating the NVC volume (Mantel–Haenszel coefficient, P < 0.01). In particular, initial treatment with CBZ 100 mg/day for 2 weeks appeared more effective for patients with NVC volumes of ≤5 mm3 plus a distance to the NVC of ≤3 mm, than for those with NVC volumes >5 mm3. The evaluation of NVC on MR cisternography using this new approach appears to be more useful than the previous method for predicting the initial treatment response in patients with TN.
https://ift.tt/2CAOas5
Current applications of ultrasound-guided wire localization in head and neck surgery
Publication date: Available online 11 October 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): E. Samara, M. Williams, D.C. Howlett
Abstract
Ultrasound-guided wire localization (USGWL) was originally developed for the removal of impalpable breast lesions. More recently, USGWL has been described in head and neck surgical practice and it has a number of applications in this field, with the potential to guide surgical exploration and the benefits of reducing operative time and morbidity. This technical note describes the use of preoperative USGWL to facilitate the removal of an impalpable neck node. A review of the current literature relating to the present applications of this technique in head and neck surgery is reported, highlighting its advantages and disadvantages.
https://ift.tt/2C8G0G5
Intraoperative augmented reality with heads-up displays in maxillofacial surgery: a systematic review of the literature and a classification of relevant technologies
Publication date: Available online 11 October 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): R. Bosc, A. Fitoussi, B. Hersant, T.-H. Dao, J.-P. Meningaud
Abstract
Although the term augmented reality appears increasingly in published studies, the real-time, image-guided (so-called 'hands-free' and 'heads-up') surgery techniques are often confused with other virtual imaging procedures. A systematic review of the literature was conducted to classify augmented reality applications in the fields of maxillofacial surgery. Publications containing the terms 'augmented reality', 'hybrid reality', and 'surgery' were sought through a search of three medical databases, covering the years 1995–2018. Thirteen publications containing enough usable data to perform a comparative analysis of methods used and results obtained were identified. Five out of 13 described a method based on a hands-free and heads-up augmented reality approach using smart glasses or a headset combined with tracking. Most of the publications reported a minimum error of less than 1 mm between the virtual model and the patient. Augmented reality during surgery may be classified into four categories: heads-up guided surgery (type I) with tracking (Ia) or without tracking (Ib); guided surgery using a semi-transparent screen (type II); guided surgery based on the digital projection of images onto the patient (type III); and guided surgery based on the transfer of digital data to a monitor display (type IV).
https://ift.tt/2CBUnUp
Prevention and detection of prosthetic temporomandibular joint infections—update
Publication date: Available online 11 October 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): L.G. Mercuri
Abstract
Prosthetic joint infections are not only distressing complications for patients and surgeons, but also have an enormous financial impact on healthcare systems. The reported incidence of prosthetic joint infection is likely underestimated due to difficulties in their diagnosis. This unfortunate complication has challenged joint replacement surgeons for years, despite all the advances made in this surgical discipline. Since eradication of these infections can be very difficult, prevention remains the primary objective. Identifying recipient risk factors, adopting a proper surgical technique, appropriate wound care, optimizing the operating room environment, and appropriate postoperative care have become some of the core elements that can help to minimize the overall incidence of this complication. The purpose of this article is to provide the temporomandibular joint replacement surgeon with an update on the prevention and detection of prosthetic joint infections based on a review of the most recent information published in the orthopedic and surgical literature.
https://ift.tt/2C6pTJj
Significance of IgG4-positive cells in severe eosinophilic chronic rhinosinusitis
Publication date: Available online 11 October 2018
Source: Allergology International
Author(s): Takahisa Koyama, Shin Kariya, Yasuharu Sato, Yuka Gion, Takaya Higaki, Takenori Haruna, Tazuko Fujiwara, Akira Minoura, Soshi Takao, Yorihisa Orita, Kengo Kanai, Masami Taniguchi, Kazunori Nishizaki, Mitsuhiro Okano
Abstract
Background
IgG4 production is regulated by type 2 (IL-4 and IL-13) and regulatory (IL-10) cytokines involved in the pathophysiology of chronic rhinosinusitis (CRS). We sought to determine the pathophysiological characteristics of IgG4-positive cells in sinonasal tissues in CRS, especially eosinophilic CRS (ECRS).
Methods
IgG4-positive cells in uncinate tissues (UT) and nasal polyps (NP) were examined by immunohistochemistry. Associations between the number of IgG4-positive cells and clinicopathological factors were analyzed. Receiver operating characteristics (ROC) analysis was performed to determine the cut-off value of IgG4-positive cells in tissue that can predict the post-operative course.
Results
IgG4 was mainly expressed in infiltrating plasma and plasmacytoid cells, and the number of IgG4-positive cells was significantly higher in NP, especially those from severe ECRS patients, than in UT. In CRS patients, the number of IgG4-positive cells significantly and positively correlated with blood and tissue eosinophilia, radiological severity, and serum level of total IgE. The number of infiltrating IgG4-positive cells was significantly higher in patients with a poor post-operative course (sustained sinus shadow 6 months after surgery) than in those with a good one. The number of IgG4-positive cells in NP could discriminate patients with a good or a poor post-operative course (area under the curve: 0.769). Also, 73.3% sensitivity and 82.5% specificity were achieved when the cut-off value was set at 17 cells/high-power field.
Conclusions
Our results suggest that the local expression of IgG4 on cells may be used as a biomarker that reflects the pathophysiology of CRS, including the post-operative course.
https://ift.tt/2QDKNDA
A successful microsurgical approach to treating penile amputation following genital self mutilation
Abstract
We present the case of a 33-year-old male who presented to the Emergency Department having amputated his penis as a result of auditory hallucinations triggered by cannabis use. A successful microsurgical technique involving anastomosing the individual structures of the penile shaft enabled a successful cosmetic and functional outcome including restoration of erectile function.https://ift.tt/2A44ij2
Complete unilateral ureteral duplication encountered during intersphincteric resection for low rectal cancer
Abstract
Complete duplication of ureters is a very rare clinical entity that may either be asymptomatic or present with a variety of clinical findings. In the presented case a 51-year-old Caucasian female underwent an intersphincteric resection for low rectal cancer. Intraoperatively, during the standard bilateral recognition and mobilization of the ureters, complete unilateral duplication of the left ureter was incidentally detected, deriving from a single renal parenchyma. Such a congenital abnormality though constitutes a major risk-factor of accidental ureteral injury during operations including pelvis. Conclusively, meticulous exposure of both ureters combined with surgeons' unceasing awareness constitute the cornerstone of a safe operation.https://ift.tt/2QHHs6A
High-grade angiosarcoma presenting with cytology-negative hemorrhagic ascites
Abstract
Angiosarcomas are a rare subtype of soft-tissue sarcomas originating from the vascular endothelium. Both retroperitoneal and omental angiosarcomas tend to be aggressive and rapidly fatal if not amenable to early intervention. In this report, we describe an unusual case of high-grade angiosarcoma with cytology-negative hemorrhagic ascites and diffuse omental invasion. Multiple investigations into the origin of the hemorrhagic ascites, including cytological analysis, tumor marker measurements, serum-ascites albumin gradient calculation and frozen section pathological examination, failed to reveal a diagnosis. We conclude that malignancy should be considered in the differential diagnosis in the presence of suspicious cytology-negative hemorrhagic ascites and concomitant retroperitoneal and abdominal findings.https://ift.tt/2A4j21y
Distraction osteogenesis for brachymetatarsia using initial circular fixator and early trans-fixation metatarsal K—wires—a series of three cases†
Abstract
Brachymetatarsia is a rare forefoot deformity predominantly affecting the fourth metatarsal. Current treatment include gradual lengthening by distraction osteogenesis using an external fixator or single-stage lengthening with bone grafting or a combination of the above two procedures. Our aim was to assess outcomes and complications of a novel technique for gradual metatarsal lengthening using a circular fixator. The procedure was performed on three female patients with unilateral congenital shortening of the fourth ray. All participants reported aesthetic dissatisfaction as well as pressure related complications of the deformity and opted for lengthening and distraction osteogenesis using a frame. Mean duration of the treatment was 122 days and average length gained was 12 mm. The desired metatarsal length was achieved in all three patients with no significant complications. This method of treatment of brachymetatarsia is effective and reproducible. This a promising technique, owing to its low complication rates and efficacy in lengthening.https://ift.tt/2QHHcVa
Pachyonychia congenita: A case report of a successful treatment with rosuvastatin in a patient with a KRT6A mutation
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2EfFEA8
Advances in mechanisms of allergic disease 2017
Publication date: Available online 11 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Chrysanthi Skevaki, Harald Renz
Abstract
This review highlights advances in mechanisms of allergic disease, particularly type 2 innate lymphoid cells; TH2 lymphocytes; B cells; dendritic cells: microbiome and barrier function; eosinophils, mast cells. During the last year, considerable progress has been made in the further characterization of type 2 inflammation controlled by both adaptive (TH2) as well as innate (ILC2) effector cells. New pathways of lymphocyte activation, trafficking and recruitment, and effector cell mechanisms have been discovered. The plasticity of lymphocyte effector cell responses is another area where major progress has been achieved. Accumulating evidence will influence both our understanding of allergic disease but also our efforts for allergy prevention and treatment.
https://ift.tt/2IS0aW4
The specificity and definition of blood eosinophil
Publication date: Available online 10 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Yan-Fang Xing, Yan-Hong Zhou, Ting Liu, Ding-Yun Feng, Jian-Hua Ren, Cong Wang, Si-Lu Tan, Wen-Hui Jiang
https://ift.tt/2pOKTww
Neuroplastic changes in the olfactory bulb associated with nasal inflammation in mice
Publication date: Available online 10 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Sanae Hasegawa-Ishii, Atsuyoshi Shimada, Fumiaki Imamura
Abstract
Background
Rhinitis and rhinosinusitis are olfactory disorders caused by inflammation of the nasal passage and paranasal sinuses. Although chronic rhinosinusitis patients have smaller olfactory bulbs (OBs), there is limited knowledge regarding the influence of chronic nasal inflammation on OB neurons.
Objective
Repeated intranasal administration of lipopolysaccharide (LPS) that induced persistent nasal inflammation in mice caused a loss of olfactory sensory neurons (OSNs) and gliosis and synaptic loss in the OB within three weeks. The present study aimed to clarify the effects of long-term LPS treatment on the OB neurocircuit.
Methods
LPS was repeatedly administered into a mouse nostril for up to 24 weeks. For the recovery analyses, the mice received LPS for 10 weeks and were subsequently maintained without additional treatment for another 10 weeks. The effects of these treatments on the OB were histologically examined. Three or more mice were analyzed per group.
Results
Long-term repeated LPS administration caused OB atrophy, particularly in the layers along which OSN axons travel and in the superficial external plexiform layer (sEPL), in which tufted cells form synapses with interneurons. Interestingly, the OB recovered from atrophy following the cessation of LPS administration: the OB volume and sEPL thickness returned to the pretreatment level after the nontreatment period. In contrast, the regeneration of OSN was incomplete.
Conclusion
These results suggest that chronic nasal inflammation induces structural changes in a specific OB circuit related to tufted cells, while tufted cells retain a high degree of plasticity that enables recovery from structural damages after inflammation subsides.
Graphical abstract
https://ift.tt/2QMbF4r
Identification of bee venom Api m 1 IgE epitopes and characterization of corresponding mimotopes
Publication date: Available online 10 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Abida Zahirović, Ana Koren, Peter Kopač, Borut Štrukelj, Peter Korošec, Mojca Lunder
https://ift.tt/2A4KJHv
Epithelial acid imbalance in eosinophilic esophagitis
Publication date: Available online 10 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): David A. Hill, Jonathan M. Spergel
https://ift.tt/2QIypC6
Reply
Publication date: Available online 10 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Jeong H. Yun, Craig P. Hersh
https://ift.tt/2A4qOIQ
Multivariable model for predicting acute oral mucositis during combined IMRT and chemotherapy for locally advanced nasopharyngeal cancer patients
Publication date: November 2018
Source: Oral Oncology, Volume 86
Author(s): Ester Orlandi, Nicola Alessandro Iacovelli, Tiziana Rancati, Alessandro Cicchetti, Paolo Bossi, Emanuele Pignoli, Cristiana Bergamini, Lisa Licitra, Carlo Fallai, Riccardo Valdagni, Anna Cavallo
Abstract
Introduction/objective
Oral and oropharyngeal mucositis (OM) represents a multifactorial and complex interplay of patient-, tumor-, and treatment-related factors. We aimed to build a predictive model for acute OM for locally advanced nasopharyngeal carcinoma (NPC) patients by combining clinical and dosimetric factors.
Materials/methods
A series of consecutive NPC patients treated curatively with IMRT/VMAT + chemotherapy at 70 Gy (2–2.12 Gy/fr) was considered. For each patient, clinical- tumor- and treatment-related data were retrospectively collected. oral cavity (OC) and parotid glands (PG, considered as a single organ) were selected as organs-at-risk (OARs). Acute OM was assessed according to CTCAE v4.0 at baseline and weekly during RT. Two endpoints were considered: grade ≥3 and mean grade ≥1.5. DVHs were reduced to Equivalent Uniform Dose (EUD). Dosimetric and clinical/treatment features selected via LASSO were inserted into a multivariable logistic model. Goodness of fit was evaluated through Hosmer-Lemeshow test and calibration plot.
Results
Data were collected for 132 patients. G ≥ 3 and mean G ≥ 1.5 OM were reported in 40 patients (30%). Analyses resulted in a 3-variables model for G ≥ 3 OM, including OC EUD with n = 0.05 (OR = 1.02), PG EUD with n = 1 (OR = 1.06), BMI ≥ 30 (OR = 3.8, for obese patients), and a single variable model for mean G ≥ 1.5 OM, i.e. OC EUD with n = 1 (mean dose) (OR = 1.07). Calibration was good in both cases.
Conclusion
OC mean dose was found to impact most on OM duration (mean G ≥ 1.5), while G ≥ 3 OM was associated to a synergic effect between PG mean dose and high dose received by small OC volumes, with BMI acting as a dose-modifying factor.
https://ift.tt/2A4h0hG
A novel scoring model to predict benefit of additional induction chemotherapy to concurrent chemoradiotherapy in stage II–IVa nasopharyngeal carcinoma
Publication date: November 2018
Source: Oral Oncology, Volume 86
Author(s): Liang Peng, Yu-Pei Chen, Cheng Xu, Ling-Long Tang, Lei Chen, Ai-Hua Lin, Xu Liu, Ying Sun, Jun Ma
Abstract
Objectives
Induction chemotherapy (IC) is gaining recognition for the treatment of nasopharyngeal carcinoma (NPC). We aimed to develop a model to predict benefit from additional IC to concurrent chemoradiotherapy (CCRT).
Materials and methods
From an NPC-specific database, 7413 patients with stage II–IVa disease who received CCRT with or without IC were included. Distant metastasis-free survival (DMFS) was the primary outcome and benefit from IC was evaluated by adjusted hazard ratio. Interaction terms between IC and other prognostic factors were identified in multivariate Cox model, and IC benefit score (ICBS) was calculated based on β coefficients from the Cox model.
Results
Nodal category, overall stage, and pre-treatment plasma Epstein–Barr virus DNA (log transformed as continuous variable) interacted with IC and determined ICBS. ICBS could discriminate patients who benefited differently from IC in terms of DMFS well, especially for patients with high and low ICBS. As for patients with medium ICBS, predictive performance of ICBS seemed reduced.
Conclusions
Based on the ICBS model, we proposed a decision-making process to help in clinical practice. Multi-institutional and prospective studies are warranted to further validate our findings.
https://ift.tt/2QJCsyi
Changing sexual practices: A possible link to oral cancer
Publication date: Available online 11 October 2018
Source: Oral Oncology
Author(s): Sameep S. Shetty, U.S. Vishal Rao
https://ift.tt/2CbllkY
Pooled Analysis of Clinical Data From Six GSK Studies to Investigate the Efficacy of a Dentifrice Containing 67% Weight by Weight (w/w) Sodium Bicarbonate on Gingivitis and Plaque Accumulation
Conditions: Gingivitis; Plaque Accumulation
Interventions: Other: Sodium bicarbonate; Other: Control Dentifrice
Sponsor: GlaxoSmithKline
Not yet recruiting
https://ift.tt/2NzrU2B
Interventions: Other: Sodium bicarbonate; Other: Control Dentifrice
Sponsor: GlaxoSmithKline
Not yet recruiting
https://ift.tt/2NzrU2B
Liquid Biopsy Evaluation and Repository Development at Princess Margaret
Conditions: Cancer; Breast Cancer; Lung Cancer; Colon Cancer; Ovarian Cancer; Melanoma; Lymphoma; Leukemia; Mutation; Lynch Syndrome; Cowden Syndrome; BRCA1 Mutation; BRCA2 Mutation; Uterine Cancer; Myeloma; Kidney Cancer; Head and Neck Cancer; Meningioma
Intervention:
Sponsor: University Health Network, Toronto
Recruiting
https://ift.tt/2OQW71S
Intervention:
Sponsor: University Health Network, Toronto
Recruiting
https://ift.tt/2OQW71S
This is what scientific societies are for. The CIBAL consensus
Publication date: November–December 2018
Source: Allergologia et Immunopathologia, Volume 46, Issue 6
Author(s): L. Garcia-Marcos
https://ift.tt/2NBtO2H
Cooking influence in tolerance acquisition in egg-induced acute food protein enterocolitis syndrome
Publication date: Available online 11 October 2018
Source: Allergologia et Immunopathologia
Author(s): S. Miceli Sopo, A. Romano, G. Bersani, C. Fantacci, L. Badina, G. Longo, G. Monti, S. Viola, S. Tripodi, G. Barilaro, I.D. Iacono, C. Caffarelli, C. Mastrorilli, S. Barni, F. Mori, L. Liotti, B. Cuomo, F. Franceschini, D. Viggiano, S. Monaco
Abstract
Background
Few studies on the age of resolution of Food Protein Induced Enterocolitis Syndrome (FPIES) induced by solid foods are available. In particular, for FPIES induced by egg, the mean age of tolerance acquisition reported in the literature ranges from 42 to 63 months.
Objective
We have assessed whether the age of tolerance acquisition in acute egg FPIES varies depending on whether the egg is cooked or raw.
Methods
We conducted a retrospective and multicentric study of children with diagnosis of acute egg FPIES seen in 10 Italian allergy units between July 2003 and October 2017. The collected data regarded sex, presence of other allergic diseases, age of onset of symptoms, kind and severity of symptoms, cooking technique of the ingested egg, outcome of the allergy test, age of tolerance acquisition.
Results
Sixty-one children with acute egg FPIES were enrolled, 34 (56%) males and 27 (44%) females. Tolerance to cooked egg has been demonstrated by 47/61 (77%) children at a mean age of 30.2 months. For 32 of them, tolerance to raw egg has been demonstrated at a mean age of 43.9 months. No episodes of severe adverse reaction after baked egg ingestion have been recorded.
Conclusions
It is possible to perform an OFC with baked egg, to verify the possible acquisition of tolerance, at about 30 months of life in children with acute egg FPIES.
https://ift.tt/2OQVNQI
Focus group parental opinions regarding treatment with topical corticosteroids on children with atopic dermatitis
Publication date: Available online 10 October 2018
Source: Allergologia et Immunopathologia
Author(s): S. Veenje, H. Osinga, I. Antonescu, B. Bos, T.W. de Vries
Abstract
Introduction and objectives
Atopic dermatitis is common among children of 0–5 years old. Treatment consists of emollients and topical corticosteroids. Due to corticophobia, however, adherence to topical corticosteroids is low. Our aim was to find factors that influence opinions about topical corticosteroids among parents of children with atopic dermatitis.
Methods
A qualitative focus group study in secondary care with parents of children with atopic dermatitis. Questions concerned opinions, attitude, sources of information, and the use of topical corticosteroids.
Results
The parents indicated that they lack knowledge about the working mechanism and side effects of topical corticosteroids. Dermatologists and paediatricians emphasise the beneficial effects, whereas other healthcare workers and lay people often express a negative attitude.
Conclusions
This study gives a complete overview of factors influencing adherence. Treatment with topical corticosteroids can be improved by better informing parents about the working mechanisms, the use, and how to reduce the dose. Healthcare professionals need to be aware of the consequences of their negative attitude concerning topical corticosteroids.
https://ift.tt/2Ny5K0M
Development of a Donor Tissue Holding Technique for Descemet’s Membrane Endothelial Keratoplasty Using a 25-Gauge Graft Manipulator
Purpose: To report a modified surgical technique called the "donor tissue holding technique for Descemet's membrane endothelial keratoplasty (DMEK)" using a newly developed 25-gauge graft manipulator. Methods: Six consecutive patients exhibiting endothelial dysfunction were enrolled and treated by DMEK. In brief, after insertion of a DMEK donor into the anterior chamber, the edge of the roll was grasped using a graft manipulator and this grasp was maintained throughout the centering and opening of the roll (holding technique). The following parameters were evaluated in comparison to the previous 10 consecutive DMEK cases in which the no touch technique was used: time of graft unfolding, incidence of intra-/postoperative complications, and best spectacle-corrected visual acuity (BCVA) and endothelial cell density (ECD) 6 months after the procedure. Results: In both technique groups, neither intra- nor postoperative complications were noted in any case. No differences were observed between the two groups in postoperative BCVA (p = 0.88). Also, no differences were observed between the two groups in postoperative ECD (holding technique group: 2,108.3 cells/mm2, no touch technique group: 1,491.7 cells/mm2) (p = 0.08) Most notably, the time of graft unfolding prior to filling with air was significantly reduced in the holding technique group (305.5 s) compared to that of the no touch technique group (1,310.0 s; p = 0.01). Conclusions: This donor tissue holding technique enabled rapid and safe DMEK in a reproducible manner, even in Asian eyes with shallow anterior chambers with high vitreous pressure.
Case Rep Ophthalmol 2018;9:431–438
https://ift.tt/2PABdkw
Case Rep Ophthalmol 2018;9:431–438
https://ift.tt/2PABdkw
Multi-wavelength laser treatments of spider nevi
Abstract
Spider nevi (SN) are one of common vascular diseases. Different treatment techniques have been described for SN previously, including electrocoagulation, argon laser, pulsed dye lasers (PDL), pulsed potassium titanylphosphate laser (KTP), and 1064-nm neodymium yttrium-aluminum-garnet (Nd:YAG) laser. These methods are effective but may require good technical management, multiple treatments, and often result in scarring or pigmentation. Multi-wavelength laser combined with 595-nm PDL followed by 1064-nm Nd:YAG and can be selectively absorbed by hemoglobin in vessels. The 595-nm laser can target shallow vessels whereas the 1064-nm laser may target deeper vessels due to the different penetration capacities of these wavelengths. Moreover, Nd:YAG absorption is remarkable increased following by PDL treatment. Multi-wavelength laser treatments have been successfully used for vascular diseases but there is little experience in SN therapy. Consequently, these treatment parameters have not been established for SN, particularly in Asian patients with Fitzpatrick skin type (FST) IV. Report experience with using multi-wavelength laser for SN treatment in Asian patients with FST IV. Forty-three SN lesions received multi-wavelength laser treatments via a PDL followed by an Nd:YAG laser. The treatment was performed at 7 mm spot size at 9.5–11 J/cm2, 10 ms with PDL, followed by Nd:YAG at 40–50 J/cm2, 15 ms. The laser treatments were performed with a single pass without overlap. Complete resolution was observed in 40 lesions and an 80–90% improvement in the other three lesions after one treatment session. One patient had superficial scarring. Four patients had hyperpigmentation that resolved within 3 months. Multi-wavelength laser treatments are fast and effective interventions for SN treatment in Asian patients with minimal adverse effects when appropriate parameters are set.
https://ift.tt/2C8iw40
Nasal Symptom Questionnaire: Our Proposed Scoring System and Prognostic Factors in Chronic Rhinosinusitis
ORL
https://ift.tt/2QH0cCY
Increased IL17‐expressing γδ T Cells in Seborrheic Dermatitis‐like Lesions of the Mpzl3 Knockout Mice
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yewVsN
Sequential cyclic changes of hair roots revealed by dermoscopy demonstrate a progressive mechanism of diffuse alopecia areata over time
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2Pst41P
CIC fusion-positive sarcoma of the spermatic cord
Abstract
In addition to germ cell tumors and tumors of the sex cord stroma, the WHO classification of testis and paratesticular tumors also contains malignant soft tissue tumors. Among them, liposarcomas of the spermatic cord are the most common entities. Other mesenchymal tumors with smooth muscle, skeletal muscle, fibroblastic/myofibroblastic, or nerve sheath differentiation are rare. Ewing sarcoma is composed of uniform small round cells and typically characterized by translocations of the EWSR1 gene. In rare cases, Ewing sarcoma-like tumors lack an EWSR1 gene fusion. Some of these tumors harbor a specific CIC translocation. However, Ewing-like sarcoma has up to now never been described in the testis or spermatic cord. The present case describes the first EWSR1-negative, undifferentiated round cell sarcoma with CIC translocation of the spermatic cord. Potential differential diagnoses are discussed.
https://ift.tt/2OgunnX
CCR4 expression is associated with poor prognosis in patients with early stage (pN0) oral tongue cancer
Publication date: Available online 11 October 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Lei Wang, Mei Zhang, Yuntao Zhu, Xin Zhang, Yongmei Yang, Chuanxin Wang
Abstract
Purpose
Chemokine receptors are well known to be involved in tumor metastasis and may predict poor prognosis; however, the expression and clinicopathological significance of chemokine receptors in early-stage cancer patients remain largely unknown. In this study, we measured the association between CCR4 expression and prognosis in patients with histologically node-negative (pN0) oral tongue cancer.
Methods
We conducted a retrospective analysis of CCR4 expression data from a consecutive case series of patients with pN0 oral cancer tongue. We investigated the expression of CCR4 by immunohistochemistry (IHC) and evaluated the association between CCR4 expression and clincopathological variables as well as overall and disease-free survivals using Kaplan-Meier analysis and a Cox regression model.
Results
CCR4 expression was examined in 128 human tongue cancerous (109 TSCC and 19 other types) and 10 normal tongue tissues, which was found to be highly expressed in tumor tissues compared to normal tissues. CCR4 expression was observed in 64.2% patients with TSCC and showed a significant association with T-stage (P=0.037). Patients with CCR4 positive expression exhibited poorer overall and disease-free survivals compared to those with CCR4 negative expression (P<0.001 and P=0.001), and CCR4 positive expression was an independent factor of unfavorable overall and disease-free survivals (P=0.002 and P=0.007).
Conclusions
This study identified CCR4 as a potential prognostic biomarker for recurrence and survival of patients with pN0 oral tongue cancer. Thus, CCR4 might be a possible therapy target for early stage cancer patients.
https://ift.tt/2ONqQgn
High density of intratumor CD45RO+ memory tumor-infiltrating lymphocytes predicts favorable prognosis in patients with oral squamous cell carcinoma
Publication date: Available online 11 October 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Chen Zhou, Jin Li, Yaping Wu, Pengfei Diao, Jianrong Yang, Jie Cheng
Abstract
Purpose
While tumor-infiltrating lymphocytes (TILs) have been increasingly appreciated as novel biomarkers for prognostic prediction in cancer, little attention has been paid to the CD45RO+ memory TILs and its associations with clinical outcomes in oral squamous cell carcinoma (OSCC). The purpose of this study was to determine the associations between CD45RO+ TILs and clinicopathological parameters and prognosis in OSCC.
Methods
Tissue sections of primary OSCC from two independent tertiary referral cancer centers (Nanjing and Wuxi) were retrospectively collected and subjected to immunohistochemical staining for CD45RO. The densities of CD45RO+ TILs in the tumor center (CT) and invasive margin (IM) were calculated. The optimal cutoff values of CD45RO+ TILs for patients' stratification were generated by X-tile software. Kaplan-Meier and Cox regression analyses were performed to assess the associations between CD45RO+ TILs and overall survival as well as recurrence-free survival. Prognostic prediction of CD45RO+ TILs was estimated by receiver operating characteristic curve.
Results
A total number of 169 eligible OSCC patients were included. No significant associations between CD45RO+ TIL and clinicopathological parameters were identified. Kaplan-Meier analyses indicated that high density of CD45RO CT was significantly associated with favorable overall and recurrence-free survival (P=0.0018, 0.0007, Log-rank test). Cox proportional regression analyses revealed that CD45RO CT was an independent prognostic factor for OSCC overall survival. ROC curves revealed that CD45RO CT was comparable to clinical stage in predicting patient survival, while their combination was superior to either individual parameter.
Conclusions
Our findings indicate that intratumor density of CD45RO TILs is a viable and independent prognostic predictor for OSCC.
https://ift.tt/2NFAddu
What is the Safety Zone for palatal soft tissue graft harvesting based upon the locations of the Greater Palatine Artery and Foramen? A systematic review
Publication date: Available online 11 October 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Lorenzo Tavelli, Shayan Barootchi, Andrea Ravidà, Tae-Ju Oh, Hom-Lay Wang
ABSTRACT
Objective
Palatal soft tissue graft harvesting is a common procedure in periodontal and implant dentistry. However, most of the complications following this procedure are associated with the underestimation of anatomical structures, such as the greater palatine artery (GPA). Therefore, the aim of the present study was to provide guidelines for a safety palatal harvesting.
Material and Methods
A systematic searching was conducted to identify cadaver and CBCT/CT studies assessing the location of the greater palatine foramen (GPF) and the path of the GPA in relation to the maxillary teeth. The effect of age, sex, cadaver or CBCT/CT studies on the location of the GPF and on the course of GPA was also assessed.
Results
Twenty-six studies, investigating 5768 hemipalates were included in the present systematic review. The most common location of the GPF was in the mid-palatal aspect of the third molar (57.08%). As it traverses the palate anteriorly, the distance from the GPA to the maxillary teeth gradually decreases, except in the second premolar region where it has the tendency to increase (13.8 ± 2.1 mm). The least distance from the GPA to the teeth was found in the canine area (9.9 ± 2.9 mm), while the greatest distance was in the second molar region (13.9 ± 1 mm). A safety zone for palatal harvesting was proposed based on the anatomical findings.
Conclusions
The present study provides guidelines for identifying the position of the GPF and defines a safety zone for harvesting an FGG/CTG, minimizing the risk of GPA injury.
https://ift.tt/2OOF5S9
Both the Observer’s Expertise and the Subject’s Facial Symmetry Can Affect Anatomical Position of the Head
Publication date: Available online 11 October 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Peter H. Sutton, Jamie Gateno, Jeryl D. English, Jaya Paranilam, John F. Teichgraeber, James J. Xia
ABSTRACT
Purpose
It is easier for us to judge facial deformity when the patient's head is in anatomic position. The purposes of this study were to determine: 1) if a group of expert observers agree more than a group of non-experts on what is the correct anatomical position of the head, 2) whether there is more variation in the alignment of an asymmetrical face compared with a symmetrical one, and 3) whether the alignments of experts are more repeatable than those of non-experts.
Subjects
and Methods: Thirty-one orthodontists (experts) and 31 dental students (non-experts) were recruited in this mixed-model study. They were shown randomly oriented three-dimensional head photographs of a symmetrical adult and an asymmetrical adolescent. In a viewing software, the observers oriented the images into anatomical position. They repeated the orientations 4 weeks later. The data was analyzed using a Generalized Linear Model and Bland-Altman plots. The primary predictor variables were experience and symmetry status. The outcome variable was anatomical position of the head. The other variables of interest included time, and orientational direction.
Results
There was a statistically significant difference between the measurements completed by experts and non-experts [F(1,60)=14.83, P<0.01]. The interaction between expertise and symmetrical status showed that there was a statistically significant difference between symmetrical and asymmetrical faces in both expert and non-expert groups [F(1,60)=9.93, P=0.003]. The interaction between expertise and time showed a statistically significant difference in measurement over time in both the expert and non-expert groups [F(1,60)=4.66, P=0.03].
Conclusions
The study shows that experts can set a head into anatomical position better than non-experts. Besides, facial asymmetry has a profound effect on the ability of an observer to align a head in the correct anatomical position. Finally, observer-guided alignment is not reproducible.
https://ift.tt/2NydqjH
Evaluation of the parotid gland function before and after endoscopy-assisted stone removal
Publication date: Available online 11 October 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Ya-Qiong Zhang, Xin Ye, Yuan Meng, Ya-Ning Zhao, Deng-Gao Liu, Guang-Yan Yu
Purpose
To quantify the gland function before and after endoscopy-assisted lithectomy for patients with parotid stones, and to analyze the correlations among different evaluation modalities.
Materials and Methods
The study was undertaken among 58 patients (27 males and 31 females) with >5mm or multiple parotid stones who underwent successful endoscopy-assisted surgery at our center from August 2007 through September 2017. Meticulous postoperative manipulations were administered routinely for 3-6 months to promote function recovery of the affected gland. Gland function was evaluated preoperatively and 6-36 months (mean, 12 months) postoperatively by sialography, scintigraphy and sialometry. Statistical analyses were conducted to quantify gland function recovery and to distinguish the correlations among three objective tests.
Results
Preoperative sialograms exhibited ductal ectasia at stone site with ductal stenosis anterior to the stone (n=53), or duct interruption at stone site (n=5). Postoperative sialograms in 45 stone-free patients were categorized as: I approximately normal (n=17); II ectasia or stenosis of the main duct, without persistent contrast on the functional film (n=16); III ectasia or stenosis of the main duct with mild contrast retention (n=6); IV poor ductal shape with evident contrast retention (n=6). Both scintigraphy of 23 preoperative and 12 postoperative patients and sialometry of 24 preoperative and 12 postoperative patients indicated severe preoperative impairment and postoperative improvement of gland function. Postoperatively, though no significant differences of saliva flow rate were found between two sides, scintigraphy showed lower function of the affected gland than the control side. Statistical data showed positive correlations among three methods. Sialography intuitively reflected the ductal shape, while sialometry and scintigraphy were more sensitive for evaluating gland function.
Conclusion
For patients with parotid stones, minimally invasive endoscopic surgery and meticulous postoperative manipulations help preserve the glands and facilitate recovery of gland function. Three evaluating modalities have a certain extent of positive correlations.
https://ift.tt/2OOF14R
Efficacy of photodynamic therapy (PDT) in minimizing bisphosphonate-related osteonecrosis of the jaws (BRONJ) after dental extraction: a preliminary animal study
Publication date: Available online 11 October 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Farzin Sarkarat, Alireza Modarresi, Nasim Chiniforush, Lilia Yazdanparast, Vahid Rakhshan
Abstract
Introduction
Except few case reports, there is no study on the efficacy of photodynamic therapy (PDT) in reducing or preventing bisphosphonate-related osteonecrosis of the jaws (BRONJ). This preliminary animal study assessed the effectiveness of this clinical treatment.
Methods
Zoledronic acid was administered to 20 rats for 5 weeks. Two weeks later, a first molar was extracted from each rat. The rats were randomized into control and PDT groups. PDT was performed in the experimental group following the surgery and at the weeks 1, 2, 3, 4, 5, 6, and 7 post-surgery. In the 8th week, BRONJ signs were evaluated by an observer blinded to the randomization. Rats were euthanized and underwent histopathologic and histomorphometric evaluation. Clinical signs were compared using Fisher test. Histomorphometric parameters were compared using Mann-Whitney U test (α=0.05).
Results
Two rats were lost from each group. Bone exposure was reduced from seven rats in the control to one in the PDT (P=0.010). The stage of BRONJ reduced significantly from seven stage-1 rats to only one stage-1 rat (P=0.010). PDT reduced inflammation considerably in terms of gingival eosinophils and lymphocytes and bone neutrophils, eosinophils, and lymphocytes. A higher percentage of live bone and a lower percentage of necrotic bone, empty lacunae, and neovascularization were observed in the PDT group. PDT also maintained bone remodeling, indicated by a high number of osteoclasts (all Mann-Whitney P values≤0.001).
Conclusions
Within the limitation of this preliminary animal study, PDT was found to be considerably effective clinically and histopathologically in reducing or preventing BRONJ in rats. Future human studies are needed to verify our results.
https://ift.tt/2NCTADQ
Patient-controlled analgesia and length of hospital stay in orthognathic surgery: A randomized control trial
Publication date: Available online 11 October 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Frank Sheng-Chun Chang, Dieter Paul Gebauer, Sally Burrows
Abstract
Objectives
The objective of this prospective randomized controlled pilot study for patients undergoing orthognathic surgery was to compare the hospital length of stay (LOS) in patients using intravenous patient-controlled analgesia (PCA) to those patients on scheduled and as needed (pro re nata; prn) oral analgesia.
Study Design
Forty patients (19 male, 21 female) aged 15 to 56 (mean 20.73, SD 6.87) were recruited prospectively and randomised to PCA and non PCA groups of equal size. Patient self-recorded pain score using visual analogue scale (VAS) was commenced at 8:00 am on day one following surgery until discharge. The pain score during routine nursing observations from postoperative period was recorded until patient was discharged from hospital.
Results
Randomisation resulted in approximately equal proportions of males (45% vs 50%) and median age (18.5 vs 20) for PCA vs non-PCA groups however the PCA group was noted to have a higher proportion of double jaw surgeries (65% vs 40%). The median LOS was 2 days for both PCA and non-PCA group (p=0.06),. There was no statistically significant difference in pain scores between the two groups either at rest or on movement (p=0.27, p=0.13 respectively).
Conclusion
No evidence was found to indicate the superiority of either PCA or non-PCA regimes with respect to LOS and pain scores however this is not evidence of equivalence of the two pain management approaches.
https://ift.tt/2OOEGPD
Positive Association between Neutrophil-Lymphocyte Ratio and Presence of Panoramically Imaged Carotid Atheromas Among Men
Publication date: Available online 11 October 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Arthur H. Friedlander, Urie K. Lee, John C. Polanco, Hoang-Anh Tran, Tina I. Chang, Robert S. Redman
Abstract
Objective
Heightened levels of systemic inflammation documented by elevated neutrophil-lymphocyte ratios (NLRs) characterize robust atherosclerosis processes evidenced by carotid and coronary artery plaques on ultrasound and angiography with associated strokes and myocardial infarctions (MIs). Therefore, we sought to determine if calcified carotid artery plaques (CCAP) on panoramic images (PIs), known to herald future stroke and MI, are associated with elevated NLRs.
Study Design
Utilizing a cross-sectional study design, we reviewed electronic medical records and PIs of non-Hispanic White males ≥55 years, treated by Dental Service (January 1, 2017 – December 31, 2017). Two groups of patients (N = 50 each) with plaque (CCAP+) and without plaque (CCAP–) were constituted. The predictor variable was CCAP+ and outcome variable was the NLR. A t-test analyzed the differences in mean NLRs between groups. Other variables of interest, that is atherogenic risk factors (hypertension, hyperlipidemia, and diabetes mellitus) were included in a logistic regression analysis to assess their influencing the association of CCAP with NLR. Significance set at 0.05 for all tests.
Results
The study group of 50 CCAP+ males (mean age 71.7 ± 7.47) evidenced a mean NLR of 3.07 ± 1.43. The control group of 50 CCAP– males (mean age 69.8 ± 9.29) evidenced a mean NLR of 2.13 ± 0.68. T-test analysis comparison demonstrated a significant (P = 0.00007) difference (95% CI: 0.49-1.39). Logistic regression failed to show any significant relationship of NLR with the covariate/other variables of interest.
Conclusion
There is a strong association between the presence of CCAP seen on PIs of older non-Hispanic White males and extent of systemic inflammation as evidenced by elevated NLRs. These plaques are "risk factors/indicators" for future stroke and MI. Therefore, maxillofacial surgeons providing care for patients having CCAP on their PI, should consider referring them for a comprehensive cerebrovascular and cardiovascular workup.
https://ift.tt/2NButBj
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