Deep sequencing salivary proteins for periodontitis using proteomics

Abstract

Objectives

Saliva is a bodily fluid transuded from gingival crevice fluid and blood and contains many proteins. Proteins in saliva have been studied as markers for periodontal diseases. Mass spectrometric analysis is applied to investigate biomarker proteins that are related to periodontitis.

Material and methods

Saliva samples were collected from 207 participants including 36 pairs matched for age, sex, and smoking who joined Yangpyeong health cohort. Periodontitis was defined by 2005 5th European guideline. Shotgun proteomics was applied to detect proteins from saliva samples. Principal component analysis and Ingenuity Pathway Analysis for canonical pathway and protein pathway were applied. Protein-protein interaction was also applied. Enzyme-linked immunosorbent assay (ELISA) was used to verify the candidate protein markers among another matched participants (n = 80).

Results

Shotgun proteomics indicated that salivary S100A8 and S100A9 were candidate biomarkers for periodontitis. ELISA confirmed that both salivary S100A8 and S100A9 were higher in those with periodontitis compared to those without periodontitis (paired-t test, p < 0.05).

Conclusion

Our proteomics data showed that S100A8 and S100A9 in saliva could be candidate biomarkers for periodontitis. The rapid-test-kit using salivary S100A8 and S100A9 will be a practical tool for reducing the risk of periodontitis and promotion of periodontal health.

Clinical relevance

A rapid-test-kit using salivary biomarkers, S100A8 and S100A9, could be utilized by clinicians and individuals for screening periodontitis, which might reduce the morbidity of periodontitis and promote periodontal health.

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Initiation of methotrexate with or without a test dose: a retrospective toxicity study

https://ift.tt/2Eo31pz

Guselkumab in the Treatment of Hidradenitis Suppurativa: A Retrospective Chart Review

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Flush technique to minimize adverse reactions from syringe lubricant (silicone oil)

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British Association of Dermatologists guidelines for the management of hidradenitis suppurativa (acne inversa) 2018

Abstract

The overall objective of the guideline is to provide up‐to‐date, evidence‐based recommendations for the management of hidradenitis suppurativa (HS). The document aims to:.

offer an appraisal of all relevant literature up to July 2018, focusing on any key developments.

address important, practical clinical questions relating to the primary guideline objective.

provide guideline recommendations and if appropriate research recommendations.

This article is protected by copyright. All rights reserved.

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Effect of radiotherapy on the chemical composition of root dentin

Abstract

Background

The radiotherapy can directly affect the bond strength of the adhesive materials, interfering in the prognosis of restorative treatments, which may be caused by chemical changes in dentin structure.

Methods

Twenty inferior homologues premolars were distributed in 2 groups (in vitro study) (n = 10): nonirradiated and irradiated. The specimens were submitted to the analysis of phosphate (ν₁PO₄³⁻;ν₂PO₄³⁻;ν₄PO₄³⁻), carbonate (ν₃CO₃²⁻), amide I, CH₂, amide III, and amide I/III ratio by confocal Raman spectroscopy. Data were submitted to statistical analysis (T test, P < .05).

Results

In intracanal dentin, the irradiated group had lower ν₄PO₄³⁻ values (1.23 ± 0.06) compared to nonirradiated group (1.40 ± 0.18) (P < .05), with no difference for ν₁PO₄³⁻ and ν₂PO₄³ peaks (P > .05). The irradiated (1.56 ± 0.06) had lower carbonate, amide III (1.05 ± 0.19), and amide I/III ratio values (0.19 ± 0.06) compared to nonirradiated group (1.42 ± 0.10, 1.28 ± 0.24, and 0.31 ± 0.10, respectively) (P < .05). For medium dentin irradiated group (1.30 ± 0.12) had lower phosphate values compared to nonirradiated group (1.48 ± 0.22) (P < .05). In cementum, there was no statistical difference between the groups.

Conclusion

The radiotherapy was able to cause changes in ν₄PO₄³⁻, carbonate, and amide III peaks of root dentin.

https://ift.tt/2zZElky

Salivary gland tumors: Molecular characterization and therapeutic advances for metastatic disease

Abstract

Salivary gland cancers represent a rare group of tumors composed by over 20 histological subtypes. Initially treated as one single disease, its diagnosis, prognosis, and treatment are currently being stratified based on morphology. More recently, insight has been provided on the molecular characterization of each subtype, further improving diagnostic accuracy and paving the way for personalized therapy. In this article, we provide a comprehensive review of recent breakthroughs, preliminary results of novel therapy, and future directions on the treatment of these complex malignancies.

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Expression of CD44, EGFR, p16, and their mutual combinations in patients with head and neck cancer: Impact on outcomes of intensity‐modulated radiation therapy

Abstract

Background

Progress in radiation treatment of head and neck squamous cell carcinoma (HNSCC) deserves the studies focused on molecular predictors that would help to enhance individually tailored treatment.

Methods

p16/epidermal growth factor receptor (EGFR)/cluster of differentiation‐44 (CD44) was immunohistochemically analyzed in 165 HNSCC patients.

Results

In the entire group and the p16 negative cohort, better 3‐year overall survival and locoregional control correlated with p16 positivity, CD44, and EGFR negativity were observed. Combined analysis revealed the worst results in the CD44+/p16−, EGFR+/p16−, and EGFR+/CD44+ groups and in the EGFR+/CD44+ within p16 negative cohort. Multivariate analysis found tumor stage, Karnofsky index, p16, and CD44 as prognostic factors of overall survival and clinical stage, and p16 as a prognostic factor for locoregional control. Clinical stage and Karnofsky index affected overall survival and tumor stage. EGFR affected locoregional control in the p16 negative subgroup.

Conclusion

Our study confirmed the negative effect of CD44 and EGFR and the positive effect of p16 on radiotherapy results.

https://ift.tt/2A29bJ2

Reply to Letter to the Editor regarding “Carbon Dioxide Embolism during Transoral Robotic Thyroidectomy: A Case Report”

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Receptor tyrosine kinase MET as potential target of multi‐kinase inhibitor and radiosensitizer sorafenib in HNSCC

Abstract

Background

The multi‐kinase inhibitor sorafenib displays antitumoral effects in head and neck squamous cell carcinoma (HNSCC); however, the targeted kinases are unknown. Here we aimed to identify those kinases to determine the mechanism of sorafenib‐mediated effects and establish candidate biomarkers for patient stratification.

Methods

The effects of sorafenib and MET inhibitors crizotinib and SU11274 were analyzed using a slide‐based antibody array, Western blotting, proliferation, and survival assays. X‐rays were used for irradiations.

Results

Sorafenib inhibited auto‐phosphorylation of epidermal growth factor receptor and MET, which has not been described previously. MET expression in HNSCC cells was not always associated with activity/phosphorylation. Furthermore, sorafenib‐dependent cell kill and radiosensitization was not associated with MET level. Although MET inhibitors blocked proliferation, they caused only mild cytotoxicity and no radiosensitization.

Conclusion

We identified MET as a new potential target of sorafenib. However, MET inhibition is not the cause for sorafenib‐mediated cytotoxicity or radiosensitization.

https://ift.tt/2A1MlBs

Prospective instrumental evaluation of swallowing, tongue function, and QOL measures following transoral robotic surgery alone without adjuvant therapy

Abstract

Background

Transoral robotic surgery (TORS) has been utilized to deintensify treatment. No studies have measured swallow safety and efficiency, nor assessed the functional impact of TORS alone.

Methods

This prospective cohort underwent baseline and 1‐month postsurgery assessments including modified barium swallow evaluation, using the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) rating system, tongue range of motion assessment, the Performance Status Scale (PSS), and quality of life with the MD Anderson Dysphagia Inventory (MDADI).

Results

All DIGEST safety scores were 0 (normal) at both time points. DIGEST efficiency scores were mildly impaired in 2 of 10 patients postsurgery. PSS scores revealed all patients were on regular diets, were 100% understandable, and were eating in public at both time points. Tongue Range of Motion scores were 100 of 100 at both time points. MDADI scores were not significantly different across time points.

Conclusions

Careful identification of patients can result in excellent outcomes following TORS. Future studies will examine longer follow‐up of speech, swallowing, and tongue function in patients undergoing TORS surgery.

https://ift.tt/2S5oQOH

Masticatory function and related factors after oral oncological treatment: a 5‐year prospective study

Abstract

Background

Chewing ability is often compromised in patients with oral cancer. The aim of this study was to identify which factors affect masticatory performance in these patients.

Methods

Patients with primary oral cancer were assessed for up to 5 years after primary treatment. Healthy controls were assessed once. A mixed‐model analysis was performed, with masticatory performance as outcome measure.

Results

A total of 123 patients were included in the study. Factors positively associated with masticatory performance were number of occlusal units (OU), having functional dentures, and maximum mouth opening (MMO). The impact of tumor location and maximum bite force (MBF) differed per assessment moment. Masticatory performance declined for up to 1 year but recovered at 5 years after treatment.

Conclusion

Masticatory performance in patients treated for oral cancer is affected by MBF, MMO, number of OU, and dental status. These should be the focus of posttreatment therapy.

https://ift.tt/2zZ5V14

Prognostic value of C‐reactive protein/albumin ratio for patients with hypopharyngeal and laryngeal cancer undergoing invasive surgery involving laryngectomy

Abstract

Background

The C‐reactive protein/albumin (CRP/Alb) ratio has been recently established as a prognostic indicator in various cancer types. However, few reports regarding the prognostic value of the CRP/Alb ratio in head and neck cancer exist. This study aimed to investigate the significance of the CRP/Alb ratio in clinical outcomes after invasive surgery involving laryngectomy for hypopharyngeal and laryngeal cancer.

Methods

We evaluated 56 patients who underwent total laryngectomy or total pharyngolaryngectomy between 2003 and 2012. Univariate and multivariate analyses were retrospectively performed to examine the prognostic value of the CRP/Alb ratio in these patients.

Results

The optimal cutoff value of the CRP/Alb ratio was 0.32. Multivariate analysis showed that the CRP/Alb ratio was a significant and independent predictor of poor overall and disease‐free survival.

Conclusion

The CRP/Alb ratio may be a novel and useful indicator for predicting postoperative outcomes in patients with hypopharyngeal and laryngeal cancer.

https://ift.tt/2zZEmVE

Influence of comorbidity on therapeutic decision making and impact on outcomes in patients with head and neck squamous cell cancers: Results from a prospective cohort study

Abstract

Background

High prevalence of comorbidity in head and neck squamous cell carcinoma (HNSCC) often lead to suboptimal treatment. The presence study aims to evaluate the presence of comorbidity, its impact on therapeutic decision making, treatment compliance, and overall survival in HNSCC.

Methods

Five hundred eighteen patients with nonmetastatic HNSCC, elder than 18 years of age, without any prior history of cancer or anticancer treatment in the last 5 years were evaluated using Adult Comorbidity Evaluation 27 (ACE 27) index.

Results

Two hundred ninety three (56.6%) patients had comorbidity, and 20.6% had deviation from the ideal treatment plan. Higher grade of comorbidity led to less likely completion of guideline‐concordant therapy (moderate ACE 27 vs none: odds ratio [OR] 0.46, 95% confidence interval [CI] 0.26‐0.82, P < .01*; severe ACE 27 vs none: OR 0.23, 95% CI 0.08‐0.57, P < .01*). Patients who completed guideline‐concordant treatment had the best outcomes as compared to those who could not (median survival: not reached vs 9.56 months, hazard ratio 3.66, 95% CI: 2.8‐4.79; P < .01*).

Conclusion

Presence of increasing severity of comorbidity in HNSCC influences therapeutic decision making. Survival outcomes are poorer in patients receiving guideline‐discordant treatment.

https://ift.tt/2S5oHuD

Smoking and papillomavirus DNA in patients with p16‐positive N3 oropharyngeal squamous cell carcinoma

Abstract

Background

We investigated the survival of patients with a p16‐positive N3 oropharyngeal squamous cell carcinoma (OPSCC) and the prognostic significance of patient, tumor, and treatment characteristics.

Methods

We retrospectively reviewed the data of patients treated at our Cancer Center for a p16‐positive N3 OPSCC between 2003 and 2016. End points were overall survival (OS) and progression‐free survival (PFS).

Results

A total of 29 patients were included. The 5‐year OS and PFS were 67.5% and 59.1%, respectively. Smoking history above 10 pack‐years and the absence of human papillomavirus DNA were associated with worse OS (P = .02 and P = .03, respectively) and PFS (P = .02 and P = .02, respectively). Induction chemotherapy or radical neck dissection were not associated with different treatment outcomes.

Conclusion

Patients with an N3 p16‐positive oropharyngeal cancer in our series had a 5‐year OS rate of 67.5%. Smoking history and viral DNA were prognostic factors associated with survival.

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Regression of human immunodeficiency virus‐associated oral Kaposi sarcoma with combined antiretroviral therapy: A case report and literature review

Abstract

Background

Kaposi's sarcoma (KS) is the most prevalent malignant neoplasia in human immunodeficiency virus positive (HIV+) patients for which the primary mode of management was chemotherapy.

Methods

We have presented the case of a newly diagnosed HIV+ male patient who was diagnosed with a pedunculated nodule in the anterior region of the hard palate, measuring 3.5 cm in diameter and with 2 months of evolution.

Results

Histopathological examination confirmed the clinical hypothesis of KS. Soon after the diagnosis, the patient started using combined antiretroviral therapy (Biovir and Kaletra), presenting a significant reduction of the lesion after 4 weeks. With 1.5 cm in diameter, the lesion was surgically removed. The patient was followed‐up for 10 years without any recurrence.

Conclusion

In antiretroviral‐naive patients with a well‐preserved immune system, the use of cART may be efficient in reducing the progression of the KS lesions, thus avoiding the use of chemotherapeutic agents.

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The DAHANCA 32 study: Electrochemotherapy for recurrent mucosal head and neck cancer

Abstract

Background

Electrochemotherapy is an established treatment for cutaneous tumors. This study aimed at determining efficacy of electrochemotherapy in recurrent head and neck cancer.

Methods

Phase II clinical trial in patients with recurrent head and neck carcinomas with no curative treatment options. Electrochemotherapy was performed under general anesthesia. Primary endpoint was tumor response (CT scanning) evaluated at week 8. Secondary endpoints included biopsy results, MRI and fluorodeoxyglucose‐positron emission tomography scanning, safety, toxicity, pain score, and quality‐of‐life questionnaires.

Results

Of 26 patients treated, 5 (19%) achieved complete response, 10 (39%) partial response, resulting in an objective response of 58%. Two responders remain without recurrence. No serious adverse events occurred during treatment. Four events occurred posttreatment: one bleeding episode, two episodes with mucosal swelling, and one patient died due to disease progression.

Conclusion

Electrochemotherapy is efficient against local recurrence of head and neck cancer with an overall response rate of 58%.

https://ift.tt/2S3Jz5I

Tobacco smoking, alcohol drinking, betel quid chewing, and the risk of head and neck cancer in an East Asian population

Abstract

Background

The smoking prevalence among men in China is high, but the head and neck cancer incidence rates are low. This study's purpose was to investigate the impact of tobacco, betel quid, and alcohol on head and neck cancer risk in East Asia.

Methods

A multicenter case‐control study (921 patients with head and neck cancer and 806 controls) in East Asia was conducted. The odds ratio (OR) and 95% confidence interval (CI) were estimated using logistic regression.

Results

Head and neck cancer risks were elevated for tobacco (OR = 1.58), betel quid (OR = 8.23), and alcohol (OR = 2.29). The total attributable risk of tobacco and/or alcohol was 47.2%. Tobacco/alcohol appeared to account for a small proportion of head and neck cancer among women (attributable risk of 2.2%). Betel quid chewing alone accounted for 28.7% of head and neck cancer.

Conclusions

Betel quid chewing is the strongest risk factor for oral cavity cancer in this Chinese population. Alcohol may play a larger role for head and neck cancer in this population than in European or U.S. populations.

https://ift.tt/2S96bSt

Radiographic nodal prognostic factors in stage I HPV‐related oropharyngeal squamous cell carcinoma

Abstract

Background

The updated AJCC Cancer Staging Manual groups all p16‐positive oropharyngeal squamous cell carcinoma (OPSCC) with unilateral nodal involvement within 6 cm into the new clinical N1 classification, consolidating a heterogeneous group of disease with varying radiographic findings.

Methods

A central radiological review was conducted identifying 233 patients with stage I node‐positive (cT1‐2N1) disease who underwent definitive concurrent chemoradiation. Factors evaluated included lymph node size, low‐neck lymphadenopathy, retropharyngeal lymphadenopathy, overt radiographic extracapsular extension, and matted lymphadenopathy.

Results

On multivariate analysis adjusted for age, smoking history, and chemotherapy regimen, low‐neck lymphadenopathy (hazard ratio (HR) = 6.55; P < .001) and retropharyngeal lymphadenopathy (HR = 3.36; P = .009) predicted for inferior progression‐free survival (PFS). low‐neck lymphadenopathy (HR = 6.38; P = .001) and retropharyngeal lymphadenopathy (HR = 3.32; P = .02) also predicted for inferior overall survival (OS). All other radiographic characteristics showed no prognostic impact for PFS or OS.

Conclusions

This analysis suggests that caution should be advised against de‐intensification efforts among patients with stage I node‐positive p16‐positive OPSCC with low‐neck lymphadenopathy or retropharyngeal lymphadenopathy.

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Three prognostic indexes as predictors of response to adjuvant chemoradiotherapy in patients with oral squamous cell carcinoma after radical surgery: A large‐scale prospective study

Abstract

Background

To develop and validate practical prognostic indexes (PIs) for predicting the prognosis and response to postoperative adjuvant therapy in patients with oral squamous cell carcinoma (OSCC).

Methods

A large cohort of 1071 OSCC patients were randomized to either training set (N = 708) or validation set (N = 363). Three types of PIs were developed according to the nomogram scores, β coefficients and excess hazard ratios, respectively. Restricted cubic spline was used to demonstrate the relationship between PIs and the risks of death.

Results

First, a nomogram was developed incorporating age at diagnosis, smoking status, clinical stage, tumor differentiation, lymph node status, comorbidity, and neutrophil to lymphocyte ratio levels. Then, three PIs were established with high survival predictive ability, and were superior to AJCC staging system (all P < .05). The risks of death were escalated continuously with the increasing number of PIs. Interestingly, adjuvant chemoradiotherapy was positively associated with poor overall survival in patients with low PIs, but exerted a beneficial effect on patients with high PIs.

Conclusion

Combined nomogram with further established PIs not only predicts the survival probability of OSCC patients, but also continuously quantifies the risk of death. High PIs could predict a beneficial response to adjuvant chemoradiotherapy, whereas low PIs indicate an unfavorable response.

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Pancreatic carcinoma underlying a complex presentation in late pregnancy: a case report

Gestational diabetes mellitus is strongly related to the risk of pancreatic cancer in pregnant women, but gestational diabetes can precede a diagnosis of pancreatic cancer by many years. Women with a history o...

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Efficacy of allergen-blocker mechanical barrier gel on symptoms and quality of life in patients with allergic rhinitis

Abstract

Propose

Allergic rhinitis (AR) is a very common, chronic and global health problem. In the last two decades, the efficiency of barrier-enforcing measures in AR has been investigated. In this study, we aimed to evaluate the effect of allergen-blocker mechanical barrier gel (MBG) (AlerjiSTOP^®) treatment on symptoms and quality of life score (QoLS) in patients with seasonal and perennial allergic rhinitis.

Methods

A single-center, prospective study was conducted between January 2017 and May 2018. Patients diagnosed with allergic rhinitis with a visual analogue scale (VAS) of 5 or higher (moderate/severe) were enrolled in the study. Patients were evaluated in terms of VAS, nasal symptom score (NSS), ocular symptom score (OSS), total symptom score (TSS) and QoLS at baseline, 1 week and 1 month of MBG treatment.

Results

A total of 83 patients with AR were enrolled in the study. Clinical and laboratory examinations showed that 50 (60.2%) patients were mono-sensitized. Allergen-blocker mechanical barrier gel treatment was performed as monotherapy in 22 (26.5%) patients. Median VAS, NSS, OSS and TSS decreased from 7 to 4, 8 to 3, 4 to 0 and 12 to 4, respectively (p < 0.0001). Correlation analysis revealed positive correlations between lower pediatric rhinoconjunctivitis quality of life questionnaire scores for patients under 12 years of age and decrease in VAS, NSS and TSS (r = 0.380, p = 0.008; r = 0.544, p < 0.0001; r = 0.543, p < 0.0001). Positive correlations were detected between lower rhinoconjunctivitis quality of life questionnaire (self-administered) scores for patients ≥ 12 years of age and decrease in VAS, NSS, OSS and TSS (r = 0.703, p < 0.0001; r = 0.465, p = 0.005; r = 0.526, p = 0.001; r = 0.624, p < 0.0001).

Conclusion

In conclusion, we found significant decrease in all symptom scores and improvement in QoLS of patients treated with MBG as monotherapy and combination therapy.

https://ift.tt/2PHi1AW

Influence of patient-specific anatomy on medical computed tomography and risk evaluation of minimally invasive surgery at the otobasis

Abstract

Purpose

With the increasing use of new minimally invasive approaches in temporal bone surgery, the need arises for evaluation of the risk of injury to sensitive anatomical structures. The factors that influence the measurement uncertainty (variation in representation of position and shape of anatomical structures) of imaging are of relevance. We investigate the effect of patients' anatomy on the measurement uncertainty of medical CT.

Methods

Six formalin-fixed temporal bones were used, fiducial markers were bone-implanted, and 20 CT scans of each temporal bone were generated. Surgically threatened anatomical structures of importance were defined. Manual segmentation was performed to create 3D surface models, and different Gaussian filters were applied. Analysis points were established along the border of the superior semicircular canal to determine the deviation between the 3D images of the labyrinth. The standard uncertainty was calculated, and one-way analysis of variance was performed (significance level = 5%) to evaluate the effect of certain factors (patient, side, Gaussian filter) on the measurement uncertainty.

Results

The influence of patient-specific anatomy on the measurement uncertainty of medical CT (p = 0.049) was demonstrated for the first time. The applied Gaussian filter (p = 0.622) and the patient's side (p = 0.341) showed no significant effect.

Conclusion

The applied method and the results of the statistical analysis suggest that the patient's individual anatomical conditions affect the measurement uncertainty of medical CT. Thus, the patient's anatomy must be considered as an important influencing factor during risk evaluation concerning minimally invasive and image-guided surgery.

https://ift.tt/2zWgcLu

An internal carotid artery pseudoaneurysm with neck hematoma: A rare cause of a life-threatening neck mass mimicking an abscess

Publication date: Available online 14 December 2018

Source: Auris Nasus Larynx

Author(s): Ana Penezić, Luka Ljubešić, Tomislav Gregurić, Krešo Zurak, Davor Vagić, Dijana Zadravec

Abstract

A neck mass has a broad and complex differential diagnosis, generally divided into neoplastic, congenital and inflammatory categories. An internal carotid artery hemorrhage with pseudoaneurysm formation is a very rare entity that may resemble other common conditions in the differential diagnosis. Large, expanding or symptomatic pseudoaneurysm is critical to efficiently diagnose and manage, due to risk of life-threatening hemorrhage. We present a case of an adult male patient with clinical and laboratory signs of severe neck cellulitis and a large gradually increasing neck mass, primarily suggestive of an abscess. Neck CT and MRI imaging revealed the presence of a disruption of the internal carotid artery resulting in a large hematoma and formation of pseudoaneurysm. A multidisciplinary team of interventional radiologists and ENT surgeons successfully treated the patient by endovascular placement of stents and subsequent surgical drainage. Awareness of such a rare, life-threatening condition and efficient multidisciplinary teamwork are essential for patient management.

https://ift.tt/2SNmBzF

Polymorphisms associated with oral clefts as potential susceptibility markers for oral and breast cancer

Publication date: Available online 14 December 2018

Source: Archives of Oral Biology

Author(s): Edimilson Martins de Freitas, Renato Assis Machado, Edilmar de Moura Santos, Felipe Rodrigues de Matos, Hébel Cavalcanti Galvão, Priscila Bernardina Miranda Soares, Roseana de Almeida Freitas, Hercílio Martelli

ABSTRACT

Objective

To evaluate the association of single nucleotide polymorphisms (SNPs) in genes/loci consistently altered in nonsyndromic oral clefts in patients with oral and breast cancer in a Brazilian population.

Design

This case-control study evaluated the association of SNPs in IRF6 (rs642961), WNT3A (rs708111), GSK3β (rs9879992), 8q24 (rs987525) and WNT11 (rs1533767), representing regions consistently identified as of susceptibility for oral clefts, with oral cancer (oral squamous cell carcinoma) and breast cancer. Logistic regression analyses were used for confounding adjustments, and p values ≤0.01 were considered statistically significant (Bonferroni correction = 0.05 / 5 polymorphic markers).

Results

The minor G allele of rs9879992 in GSK3β was associated with oral cancer risk (p = 0.02), whereas rs1533767 in WNT11 showed a protective effect against it (p = 0.04). Several SNP-SNP interactions containing GSK3β rs9879992 were significantly associated with oral cancer after 1,000 permutation test. To breast cancer, the A allele of rs987525 was associated with increase risk in early stage (p = 0.02) and SNP-SNP interactions involving the 5 SNPs were significantly observed, with the most significant interaction among rs708111, rs1533767, rs9879992 and rs642961 (p_{1000permutation}<0.001).

Conclusion

Our results reveal associations of SNPs consistently altered in oral cleft with oral and breast cancer risk, raising interesting possibilities to identify risk markers for those tumors.

https://ift.tt/2rF9cOo

Polymorphisms associated with oral clefts as potential susceptibility markers for oral and breast cancer

Publication date: Available online 14 December 2018

Source: Archives of Oral Biology

Author(s): Edimilson Martins de Freitas, Renato Assis Machado, Edilmar de Moura Santos, Felipe Rodrigues de Matos, Hébel Cavalcanti Galvão, Priscila Bernardina Miranda Soares, Roseana de Almeida Freitas, Hercílio Martelli

ABSTRACT

Objective

To evaluate the association of single nucleotide polymorphisms (SNPs) in genes/loci consistently altered in nonsyndromic oral clefts in patients with oral and breast cancer in a Brazilian population.

Design

This case-control study evaluated the association of SNPs in IRF6 (rs642961), WNT3A (rs708111), GSK3β (rs9879992), 8q24 (rs987525) and WNT11 (rs1533767), representing regions consistently identified as of susceptibility for oral clefts, with oral cancer (oral squamous cell carcinoma) and breast cancer. Logistic regression analyses were used for confounding adjustments, and p values ≤0.01 were considered statistically significant (Bonferroni correction = 0.05 / 5 polymorphic markers).

Results

The minor G allele of rs9879992 in GSK3β was associated with oral cancer risk (p = 0.02), whereas rs1533767 in WNT11 showed a protective effect against it (p = 0.04). Several SNP-SNP interactions containing GSK3β rs9879992 were significantly associated with oral cancer after 1,000 permutation test. To breast cancer, the A allele of rs987525 was associated with increase risk in early stage (p = 0.02) and SNP-SNP interactions involving the 5 SNPs were significantly observed, with the most significant interaction among rs708111, rs1533767, rs9879992 and rs642961 (p_{1000permutation}<0.001).

Conclusion

Our results reveal associations of SNPs consistently altered in oral cleft with oral and breast cancer risk, raising interesting possibilities to identify risk markers for those tumors.

https://ift.tt/2rF9cOo

Comparison of 3 Indices for Assessing the Severity of Bronchial Asthma Exacerbations in Children

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 215-220, December 2018.


https://ift.tt/2BwbioH

Relationship Between Health Literacy in Parents and Asthma Control in Their Children: A Prospective Study in a Diverse Suburban Population

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 221-225, December 2018.


https://ift.tt/2Br6MYe

Angiopoietin-1, Angiopoietin-2, and Periostin Levels in Children with Recurrent Wheeze

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 230-235, December 2018.


https://ift.tt/2UNsbnh

Making the Case for Sesame: A Major U.S. Food Allergen

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 241-242, December 2018.


https://ift.tt/2UNsfDx

Pediatric Spontaneous Pneumothorax: Our Experience and a Review of the Literature

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 208-214, December 2018.


https://ift.tt/2BpFjGj

Looking Towards the Future

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 207-207, December 2018.


https://ift.tt/2ULZjfn

Role of the Airway Microbiome in Respiratory Infections and Asthma in Children

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 236-240, December 2018.


https://ift.tt/2ULzr3g

Direct Observed Therapy of Inhaled Corticosteroids for Asthma at School or Daycare

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 226-229, December 2018.


https://ift.tt/2Bog9rX

Highlights from the U.S. Asthma Summit 2018

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 4, Page 243-244, December 2018.


https://ift.tt/2UMvgUT

Intestinal absorption of the wheat allergen gliadin in rats

Publication date: Available online 15 December 2018

Source: Allergology International

Author(s): Tomoharu Yokooji, Takahiro Fukushima, Koh Hamura, Naoki Ninomiya, Ryo Ohashi, Takanori Taogoshi, Hiroaki Matsuo

Abstract

Background

Aspirin enhances food allergy symptoms by increasing absorption of ingested allergens. The objective of this study is to elucidate the role of aspirin in facilitating intestinal absorption of the wheat allergen, gliadin, in rats.

Methods

Plasma concentrations of gliadin were determined after oral administration by gavage or administration into a closed intestinal loop in rats. We used an in situ intestinal re-circulating perfusion experiment to examine the effect of pepsin on aspirin-facilitated gliadin absorption. Fluorescein isothiocyanate (FITC)-labeled dextran-40 (FD-40) was used as a marker of non-specific absorption. The molecular size of gliadin and its allergenicity in plasma were examined using immunoblot analysis and intradermal reaction tests with Evans blue dye (EBD) extravasation, respectively.

Results

Aspirin increased plasma concentrations of gliadin after oral administration but had no effect in the closed intestinal loop study. An in situ intestinal re-circulating perfusion study showed that FITC-labeled gliadin was absorbed similarly to FD-40. Aspirin increased absorption of both intact and pepsin-digested gliadin, with a more significant effect on absorption of pepsin-treated gliadin. Immunoblotting showed that most gliadin was absorbed in intact form. When the gliadin fraction was extracted from rat plasma after gavage and injected intradermally into gliadin-sensitized rats, EBD extravasation was observed at injection sites in a gliadin dose-dependent manner.

Conclusions

Aspirin increased the absorption of intact and pepsin-digested gliadin via the paracellular pathway, maintaining their allergenicity. Moreover, the effect of aspirin on gliadin absorption was enhanced by modification and digestion of gliadin in the stomach.

https://ift.tt/2QO2YdB

Iatrogenic meningoencephalocele after traumatic perforation of the cribriform plate during nasal intubation of a preterm infant

Publication date: Available online 15 December 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): M. Renaud, L. Fath, M. Cheptou, L. Dillenseger, S. Riehm, A. Venkatasamy, C. Debry, I. Djennaoui

Abstract

Traumatic iatrogenic meningoencephaloceles infants are rare and there is no consensus on management in the literature. This article presents a case of a meningoencephalocele diagnosed 15 months after a traumatic perforation of the cribriform plate due to a difficult intubation of a preterm infant that was treated by an endoscopic endonasal surgery. A close collaboration between pediatricians and ENT surgeons appears essential for early diagnosis and management. Endoscopic endonasal approach for meningoencephalocele management has several advantages and is a safe procedure when performed by an experienced surgeon.

https://ift.tt/2PF3bLs

Bruce Neil Procter Benjamin AO OBE MBBS (Syd) FRACS FACS (Hon) 1931–2018

Publication date: Available online 14 December 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Nancy M. Bauman

https://ift.tt/2Ghp2Jj

Home Environment and Diseases in Early Life are Associated with Allergic Rhinitis

Publication date: Available online 14 December 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Xue Kang, Hailuo Tu, Tengfei Tian, Zhiqun Huang, Liping Luo, Li Shen, Jing Ye

Abstract

Objective

Risk factors in relation to allergic rhinitis (AR) remain unclear despite considerable interest. This study aimed to analysis the relationship between home environment and diseases in early life and AR.

Methods

In a case-control survey, 242 AR patients and 258 healthy persons responded to questionnaires designed to capture pre-pregnancy/pregnancy diseases, maternal medication usage, diseases in early life of participants, family allergic history and home environmental factors. Forty risk factors potentially connected with AR were investigated and analyzed with chi-square test and logistic regression.

Results

There was no correlation between mother's disorders such as periodontitis, chronic rhinitis, diabetes etc. and AR (p>0.05). A logistic regression analysis showed that neonatal jaundice (p<0.001), respiratory system infection (p<0.001), diarrhea (p<0.01), eczema (p<0.01) in the early life and home environmental factors such as house decoration (p<0.01), mold environment (p<0.001), keeping flowers and plants (p<0.001), passive smoking (p<0.01) were associated with AR.

Conclusion;Diseases in early life and home environment are closely associated with AR.

https://ift.tt/2rBuJYr

TP53 inactivation and expression of methylation-associated proteins in gastric adenocarcinoma with enteroblastic differentiation

Abstract

Gastric adenocarcinoma with enteroblastic differentiation (GAED) is a rare variant of aggressive adenocarcinoma. We demonstrated previously that GAED is genetically characterized by frequent TP53 mutation. In this study, we aimed to further clarify the mechanism of inactivation of TP53 in GAED in the light of promoter methylation of TP53, and expression of methylation-associated proteins such as Ten-eleven translocation (TET) 1 and 5-hydroxymethylcytosine (5-hmc) in addition to ATM mutations. We analyzed 51 cases of GAED. The ATM mutation was detected in only one case. Promoter methylation of TP53 was detected in 18% and frequency of loss of heterozygosity (LOH) at TP53 locus was 37.2%. Reduced TET1 expression was found in 29 cases (56.9%) and was significantly associated with advanced stage (p = 0.01), lymph node metastasis (p = 0.04), and macroscopic type (p = 0.01). Reduced 5-hmc expression was found in 28 cases (54.9%) and was significantly associated with advanced stage (p = 0.01), gender (p = 0.01), tumor location (p = 0.03), tumor size (p = 0.01), and lymph node metastasis (p = 0.01). Among 9 cases with TP53 promoter methylation, reduced expression of TET1 was observed in 6 cases, and reduced expression of 5-hmc was observed in 5 cases. Reduced expression of both TET1 and 5-hmc was significantly associated with adverse clinical outcomes. In summary, promoter methylation of TP53 is partly involved in loss of p53 expression. Aberrant methylation by reduced TET1 and 5-hmc may be involved in the development of aggressive GAED.

https://ift.tt/2LkHzTP

Updated Sniffin’ Sticks normative data based on an extended sample of 9139 subjects

Abstract

Purpose

To provide up-to-date and detailed normative data based on a large-scale sample, increasing diagnostic validity by reference to narrow age groups as previous normative values were based upon smaller sample sizes—especially in the group of older subjects.

Method

Data were obtained from 9139 healthy subjects (4928 females aged 5–96 years and 4211 males aged 5–91 years). The standard "Sniffin' Sticks" test was applied, comprising threshold (T), discrimination (D) and identification (I) subtests, and yielding a TDI sum score.

Results

Hyposmia was established at a TDI score of less than 30.75. Age-related changes were found in each domain, most pronounced for thresholds. Individuals aged 20–30 years performed best, whereas children below the age of 10 and adults above the age of 71 scored only half as well. Sex-related differences were in favor of women.

Conclusions

Data provide guidance for assessing individual olfactory performance in relation to specific age groups. Significant gender and age effects were observed, with a most pronounced increase of olfactory test scores between age 5 through 20 years and a dramatic decrease at the age of 60 through 71 years.

https://ift.tt/2BpEKg2

Regulation of TIM-3 expression in a human T cell line by tumor-conditioned media and cyclic AMP-dependent signaling

Publication date: January 2019

Source: Molecular Immunology, Volume 105

Author(s): Su Jin Yun, Bokyoung Lee, Kuniharu Komori, Mi Jin Lee, Byoung Gill Lee, Kyongmin Kim, Sun Park

Abstract

T cell immunoglobulin and mucin domain-3 (TIM-3) expression increases in exhausted T cells, which inhibits T cell function. TIM-3 expression is supposedly up-regulated in tumor-bearing individuals via chronic antigenic stimulation of T cells. Considering the immunosuppressive nature of the tumor microenvironment, we investigated whether tumor-secreted molecules might enhance TIM-3 expression in Jurkat T cells. We observed that TIM-3 expression was increased by the activation of prostaglandin (PG) E₂ and cyclic AMP (cAMP) signaling pathways. Adenylate cyclase activation led to protein kinase A (PKA)-dependent upregulation of the TIM-3 minimal promoter region and of upstream conserved non-coding sequences. TIM-3 expression in Jurkat T cells was increased by the exposure to breast tumor cell-conditioned media partially through the interaction between PGE₂ and its receptor, EP4. Our results propose that tumor-secreted molecules such as PGE₂, which activates PKA and EPAC, may regulate TIM-3 expression in T cells.

https://ift.tt/2UNpjXC

Chlamydia trachomatis ct143 stimulates secretion of proinflammatory cytokines via activating the p38/MAPK signal pathway in THP-1 cells

Publication date: January 2019

Source: Molecular Immunology, Volume 105

Author(s): Lina Jia, Feng Sun, Jie Wang, Ding Gong, Lina Yang

Abstract

Chlamydia trachomatis (Ct) infections can cause bacterial sexually-transmitted and preventable blindness. The Ct infections induced excessive cytokines generation which attributed to pathologic changes in host cells. However, the precise mechanisms of Ct-induced cytokines production are still unclear.CT143 protein was identified as a novel Ct specific protein with high immunogenicity. In the present study. The CT143 fusion protein was recombined and purified. The mice immune serum was prepared by immunizing BALB/c mice with the purified fusion protein. The specificity of the antibody was confirmed using Immunoblotting. Indirect immunoflurescence assay (IFA) and Immunoblotting assays were performed to detect the temporal and spatial characteristics of CT143 in Ct infected cells. ELISA was performed to analyze the secretion of proinflammatory cytokines IL-1β, IL-8 and TNF-α by human macrophages under the stimulation of CT143 protein. Finally, the involvement of p38 signaling in CT143-induced cytokine secretion was validated. CT143 protein was located in the inclusion body and represented an Elementary body (EB)-related protein, which may be encoded by the mid- and late-stage expressing genes. CT143 protein could stimulate the secretion of inflammatory cytokines in macrophages which differentiated from THP-1 This induction may be mediated by the activation of p38 signaling. In summary, CT143 protein is involved in inflammatory processes during Ct infection.

https://ift.tt/2BoNSkG

IgE blockade in autoimmunity: Omalizumab induced remission of bullous pemphigoid

Publication date: Available online 14 December 2018

Source: Clinical Immunology

Author(s): Talia James, Sam Salman, Brittany Stevenson, Christine Bundell, Gavin Kelly, David Nolan, Mina John

Abstract

Bullous pemphigoid (BP) is a blistering dermopathy and a prototypic antibody-mediated autoimmune disease. Detection of IgG autoantibodies against hemidesmosomal proteins BP180 and/or BP230 are diagnostic and levels can correlate with disease activity. Therapies include corticosteroids and oral immunosuppressants, while intravenous immunoglobulin and rituximab are reserved for treatment resistant cases. Here we describe a patient with severe BP which was refractory to standard first line therapy, intravenous immunoglobulin and rituximab induced depletion of peripheral B cells. Use of the monoclonal anti-IgE antibody omalizumab resulted in rapid resolution of blistering despite ongoing high levels of anti-skin IgG antibodies. To our knowledge this is the first case of BP responsive to omalizumab after failure of rituximab to be reported. This case adds to emerging data on omalizumab as a novel BP treatment as well as providing new evidence of an independent role for autoreactive IgE-mediated inflammation in the formation of BP skin lesions.

https://ift.tt/2UQ7tDF

Taxonomy and phylogeny of Cutibacterium (formerly Propionibacterium) acnes in inflammatory skin diseases

Publication date: Available online 15 December 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): S. Corvec, M.-A. Dagnelie, A. Khammari, B. Dréno

Summary

Since its discovery, Propionibacterium acnes has undergone various name changes, and has been known since 2016, as Cutibacterium acnes. Herein we set out the history and rational of these taxonomic changes together with a description of a new genus, Cutibacterium, which includes five species within the cutaneous ecosystem. Modern microbiological techniques allow finer distinction between species and subspecies while also enabling the identification of separate subtypes within the population of Cutibacterium acnes. Phylogeny and molecular typing techniques thus provide a better understanding of the subtypes involved in certain inflammatory skin diseases, including acne, folliculitis and progressive macular hypomelanosis.

Résumé

Depuis sa découverte, Propionibacterium acnes a subi différents changements de noms. Désormais appelé Cutibacterium acnes depuis 2016, nous présentons l'histoire et les bases de ces changements taxonomiques avec la description, au sein d'un nouveau genre Cutibacterium, de cinq espèces de l'écosystème cutané. En effet, les techniques microbiologiques modernes ont permis de mieux distinguer les espèces et sous-espèces mais elles ont aussi permis de séparer des sous-types au sein de la population de Cutibacterium acnes. La phylogénie et les techniques de typage moléculaire permettent ainsi une meilleure compréhension des sous-types impliqués dans certaines pathologies inflammatoires cutanées, notamment l'acné, les folliculites ou l'hypomélanose maculeuse progressive.

https://ift.tt/2LmNw2Y

Histoire du psoriasis

Publication date: Available online 14 December 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): B. Halioua

https://ift.tt/2Ces1y1

THE ENDODONTIC RADIOLUCENCY INDEX: CBCT-ERI

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): D.D. RICE, K. ABRAMOVITCH, M. TORABINEJAD, O. MAKTABI

Background

Objective quantification of periapical disease on radiographs has evolved since the 1980s.^1-3 The periapical index (PAI)¹ was developed for classifying findings on periapical radiographs to assist in the diagnosis of pulpal disease. The PAI uses subjective, descriptive terminology that is too broad for the degree of detail present with cone beam computed tomography (CBCT) imaging.

The CBCT-PAI² uses measurable objective findings. However, the measurement intervals are large and do not distinguish the fine details of smaller or early-stage lesions seen on CBCT, thus limiting the ability to categorize early periapical disease or healing. The revised CBCT-PAI³ defines in more detail how to position the tooth in 3 fixed and reproducible planes.

Tsai⁴ showed that small-volume, high-resolution CBCT scans could distinguish periapical radiolucencies measuring less than 0.5 mm. Therefore, the CBCT–endodontic radiolucency index (CBCT-ERI) is presented as an objective, repeatable index, with higher sensitivity to documentation of subtle radiographic findings.

Objectives

The objective was to describe the scoring technique and provide statistical validation of the CBCT-ERI as an objective measurement tool. A second objective was to classify periapical disease early in its progression and to quantify subtle changes in the healing process.

Materials and Methods

This study was approved by the Loma Linda University institutional review board (#5140049). CBCT data (voxel 0.125 mm³) of 119 endodontically treated roots were classified by using the CBCT-ERI by 2 calibrated radiology faculty. The cases were classified independently and blindly. In the multiplanar reconstructions, the long axis of the selected teeth were uprighted parallel to the sagittal and coronal planes of imaging according to a specific protocol. Roots were evaluated in all planes until the widest area of the periodontal ligament was identified. The linear width of the widest radiolucent area perpendicular to the root surface was measured and assigned a CBCT-ERI numerical score/rank.

Results

The examiners' interclass correlation coefficient for the 119 root measurements was 0.96 at a 95% confidence interval. Reliability, using Cronbach's alpha, was 0.981.

Conclusions

The CBCT-ERI offers a highly sensitive and reproducible tool for evaluating developing or resolving periapical lesions.

https://ift.tt/2rBeFWN

Part 1: CBCT EVALUATION OF ATLANTOAXIAL/ATLANTO-OCCIPITAL JOINTS FOR CERVICAL INSTABILITY RISK ASSESSMENT

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): A. MANCIA, S. ROZMAN, S.R. SINGER, M. MUPPARAPU

Background

In dental radiography, the vertical atlantoaxial index (VAAI)¹ measures the vertical relationship of the atlas and the axis. Based on prior studies, value less than 0.8 might present a predisposition toward cervical instability. The Powers ratio (PR) is the ratio between the distance of 2 lines: (B–P): from basion to posterior arch of C1 (O–A): from opisthion to the anterior arch of atlas. The normal ratio is 1:1, if the ratio exceeds 1, it indicates atlanto-occipital instability. The basion–axial interval (BAI) is the horizontal distance between basion and posterior dens.⁴ The basion–dens interval (BDI) is the distance between the basion and the tip of the dens.⁴

Objective

The objective of this study was to determine the potential risk for atlantoaxial/atlanto-occipital instability² in patients who underwent cone beam computed tomography (CBCT) imaging of the head. The research was conducted at the Oral and Maxillofacial Radiology clinic of the University of Pennsylvania School of Dental Medicine (Philadelphia, PA).

Materials and Methods

After institutional review board approval, a preliminary study was performed on patients undergoing either preimplantation assessment of jaws or evaluation of atypical facial pain, and measurements were recorded. A total of 50 CBCT volumes were identified for the selected craniocervical cephalometric measurements. Analysis of the CBCT volumes and cephalometry were performed to record various craniocervical measurements and determine the potential risk of atlantoaxial atlanto-occipital instability. The measurements were done by using the midsagittal-view CBCT images. These measurements included BAI, BDI, VAAI, and PR. It was anticipated that these measurements would provide a risk estimate for cervical instability that could potentially result in spinal cord injury. All CBCT volumes were acquired by using the Carestream CS9300 machine (Carestream, Atlanta, GA).

Results

Based on the preliminary results, the average VAAI measurement was 0.7626, the average BAI was 4.970 mm, the average BDI was 5.043 mm, and the average PR was 0.6961.

Discussion

Apart from VAAI, BDI, and BAI, the PR³ was utilized in this study to find out the atlantoaxial dissociation (normal PR = 1:1). A ratio over 1 indicates atlanto-occipital dissociation (AOD. BAI is the horizontal distance between basion and the posterior cortex of the axis (normal ≤12 mm). BDI is the distance between the basion and the tip of the dens (normal ≤8.5 mm). Both BAI and BDI are used to diagnose AOD injuries.

https://ift.tt/2GrZpWa

QUANITATION OF PULP/PERIAPICAL INFLAMMATION USING PET MARKER 11C-MK-4232 CALCITONIN-GENE-RELATED PEPTIDE RECEPTOR: A PILOT STUDY

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): D.D. RICE, B. HOLSHOUSER, M. TORABINEJAD, U. GANGADHARMATH, K. ABRAMOVITCH, E.L. CHRISTIANSEN

Background

This study aimed to establish a quantitative method for measuring dental pulp disease in vivo. Current clinical examinations of the dental pulp use thermal (hot/cold), (percussive/palpatory), and electric pulp testing to evaluate tooth vitality. These tests offer some utility, but the results are extremely variable and subjective. Standard radiography has also been used, but it lacks diagnostic sensitivity until the disease process is advanced.

Objective

The study combines 2 novel areas of contemporary medical research: positron emission tomography (PET) and immune pathway modulation to develop a noninvasive diagnostic tool that can be used for the detection and localization of dental pulp disease. The calcitonin-gene-related peptide (CGRP), a neuropeptide released when the peripheral nervous system, regulates the immune system by activating the inflammatory process. We used a specific PET-tracer, [11C]MK-4232, a CGRP receptor marker to locate and quantify CGRP released and bound to the receptor at specific times in response to the progression of induced pulp disease.

Materials and Methods

This study used [11C]-CGRP-R produced in the Loma Linda University radiochemistry laboratory to quantitate the uptake of the PET tracer in diseased teeth of 6 ferrets after pulpal irritation of canines to induce pulp disease. Conjoint histopathologic studies were performed to quantitate cellular response to inflammation. These values were then compared with the PET tracer uptake.

Preliminary Results

Previous studies using the [11C]-CGRP-R marker in mini-pigs had reported promising results quantifying the CGRP pathway.

Future Directions

It is anticipated that investigations of the PET tracer [11C]MK-4232 (CGRP-R) to localize and monitor pulp disease will prove to be a dependable, objective, quantifiable, and repeatable diagnostic tool.

https://ift.tt/2GrZRDQ

ANATOMIC VARIATIONS OF THE MANDIBLE MIMICKING RADIOLUCENT LESIONS IN THE JAW

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): S. PALACIOS, A. LAMFON, D. KASHTWARI, S. BARGHAN

Background

The mandible can present marked anatomic variations that mimic lytic lesions radiographically. Most of the variations are well known in the posterior region but can represent diagnostic challenges when located in the unusual anterior area. We present 2 cases of anterior morphologic variants of the mandible incidentally identified after evaluation of panoramic radiographs. Previous multidetector computed tomography (MDCT) images were utilized for the confirmation of our interpretations.

Clinical and Radiologic Findings

First case: A 65-year-old man came to our department for dental treatment. A panoramic radiograph of the patient revealed a well-defined, corticated, unilocular, oval-shaped, radiolucent entity inferior to teeth #27 to #28, mimicking an apical radicular cyst, traumatic bone cyst, or keratocystic odontogenic tumor. However, the vitality of the involved teeth and the thick cortical border of this entity led to our interpretation of the lesion as an anterior Stafne defect, which was confirmed with a prior MDCT made from a previous oral cancer screening. Second case: A 34-year-old male came to the hospital for extraction of infected retained roots. A panoramic radiograph was made, and it demonstrated a large cyst-like radiolucent area in the anterior mandible, with apparent scalloping margins, possible root resorption, and divergence of the involved teeth. However, the prior MDCT image revealed that the radiolucent area in the mandibular anterior region was a result of marked facial and lingual undercuts, with no evidence of pathosis.

Differential or Definitive Interpretation

Case #1: anterior Stafne bone defect. Case #2: facial and lingual anterior undercuts.

Discussion/Conclusions

Panoramic radiographs can demonstrate that any localized marked anatomic depression in the mandible could mimic a cystic lesion and, in some cases, more aggressive pathosis. It is important to recognize the specific radiographic features and the location of the morphologic variants of the mandible and utilize other available imaging studies before making any interpretation and/or initiating unnecessary invasive diagnostic procedures.

https://ift.tt/2rExMPw

QUANTIFYING PHOTOSTIMULABLE PHOSPHOR (PSP) PLATE ARTIFACTS TO STANDARDIZE RADIOLOGIC QUALITY ASSURANCE

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): T. THANG, S.E. PERSCHBACHER

Background

With every use, photostimulable phosphor (PSP) plates accumulate physical artifacts (i.e., scratches, dents) that negatively affect image quality. Dental clinicians are responsible for monitoring these artifacts and discard plates they have deemed undiagnostic. Currently, at our institution, this is accomplished by direct visual inspection of plates for signs of wear. This arbitrary process has no objective validation leading to variability in radiologic image quality and may impair diagnostic value.

Objective

This study aimed to develop a metric to objectively quantify the severity of physical artifacts on PSP plates. This metric will be compared against the current standard of direct visual inspection to determine the validity of this approach for PSP quality assurance.

Materials and Methods

Sixty random PSP plates (CS 7600; Carestream Dental, Rochester, NY) were chosen for analysis: 36 were determined to be undiagnostic by using the current quality control standard, 20 were in active circulation, and 4 brand-new plates were used as controls. The selected plates were exposed to obtain the equivalent of a posterior bitewing image (Belmont PHOT-X II s Model 505 at 70 kV, 6 mA, 0.22 seconds), scanned, and raw DICOM images exported. A custom computer algorithm (MATLAB; Mathworks, Natick, MA) was developed to measure the inhomogeneity of the image to calculate the artifact metric. By using these, the selected plates were sorted and compared against the current quality assurance standard.

Preliminary Results

Preliminary results showed poor correlation between plates that were selected to be discarded by direct visual inspection and artifact metrics. Many plates that were chosen to be discarded with the current standard had a lower artifact metric compared with plates that were still in circulation.

Future Directions

Future studies aim to validate this metric by comparing the artifact score with qualitative grading of PSP plate artifacts and to determine a threshold for when radiologic diagnosis is impeded.

https://ift.tt/2rDGfCx

A 2D VS 3D EVALUATION AND PROGNOSIS OF INVASIVE CERVICAL RESORPTION

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): L. AL MATNY, A. DIOGENES, M. LEVIN, N. RUPAREL, M. NOUJEIM

Background

Invasive cervical resorption (ICR) is a progressive, dynamic, external inflammatory process. The full extent of this resorptive process is often difficult to establish using 2-dimensional radiographic techniques. Small-volume cone beam computed tomography (CBCT) has become an important tool to evaluate additional factors that influence clinical decisions and outcomes.

Objective

Our objectives were to detect the impact of 3-dimensional evaluation on diagnosis, treatment planning, and prognosis from periapical (PA) radiographs.

Materials and Methods

A total of 27 cases of ICR with matching PA and CBCT images were included in the study. All images were individually assessed by 3 board certified endodontists in a blinded manner. Examiners were required to classify each case based on the Heithersay classification, provide a suitable treatment plan based on their own radiographic interpretation, and estimate a long-term prognosis based on both PA and CBCT assessments done separately.

Results

There was a low to moderate rate of agreement regarding resorption classification, surgical treatment decision, and prognoses, regardless of the imaging modality.

Discussion

The use of CBCT allows for the evaluation of ICR characteristic features and eventually leads to better agreement on diagnosis, surgical treatment decision, and prognosis.

https://ift.tt/2rBpecf

Announcing

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s):

https://ift.tt/2Gk0vU2

SEGMENTING ROOT CANAL SYSTEMS USING AN OPEN SOURCE SLICER SOFTWARE

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): S. VIJAYAN, S.L. SOUSA MELO, S. ANAMALI-ALLAREDDY, F.B. TEIXEIRA, V. ALLAREDDY

Background

The development of 3-dimensional (3D) imaging provides exciting opportunities in oral and maxillofacial radiology and endodontics, specifically in regenerative endodontic therapies.¹

Objectives

The aim of this study was to explore the feasibility of creating a virtual 3D model of a molar root canal system by using micro-CT images to produce scaffolds with similar shapes with an open source slicer software.

Materials and methods

An extracted molar tooth was scanned by using the Bruker Skyscan micro-CT (Kontich, Belgium), at 10 µm resolution, 16 bits depth, and 360 degrees rotation, using a step-and-shoot detector motion at 80 kV. The images were reconstructed by using NRecon software and initially stored as TIFF (tagged Image File Format) files and later converted to DICOM (Digital Imaging and Communications in Medicine). The converted DICOM files were imported into the 3D slicer software. There were difficulties with segmenting these images as the file size was in excess of 1 gigabyte (GB), and the computer was not compatible. The segmentation was done by using 3D slicer software^2,3 by selecting the region of interest (ROI) and then using the threshold tool to segment the root canal. All 3D models were stored as STL (stereolithography) files. For these kinds of files, it is recommended that extremely fast computers with a minimum random access memory (RAM) of 32 GB be used for the images to even be displayed.

Preliminary results

Preliminary results indicate that root canal systems can be segmented accurately from micro-CT images by using segmentation software.

Future directions

Future research will be expanded to validate these finding by measuring and comparing images of sectioned teeth and 3D printed models of root canals.

https://ift.tt/2rDGiyd

A UNIQUE CASE OF AMELOBLASTOMA MIMICKING A MALIGNANT LESION

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): S. VIJAYAN, S.M. STEWARD-THARP, S.L. SOUSA MELO, V. ALLAREDDY, S. ANAMALI-ALLAREDDY

Background

Ameloblastoma is a true neoplasm of odontogenic epithelium.^1,2 It is a locally invasive, slow-growing, and persistent tumor.^1-4 It is among the most common odontogenic tumors.^1,2 Ameloblastoma can arise from dental lamina, dental organ, epithelial lining of odontogenic cyst, or basal cells of oral mucosa.^1,2

Clinical and Radiologic Findings

A 56-year-old female patient was referred for evaluation of a slow-growing, long-standing right mandibular swelling. The area was painful at times, with paresthesia of right lower lip. The patient lived in an assisted home and had a poor recall of her history because of mental illnesses. Axial computed tomogrphy (CT) of the head and neck region was performed after administration of 50 mL of Isovue-370 IV contrast. There was a large, well-defined, mixed entity on the right side of the mandible, extending approximately from the second molar region and crossing the midline to the left mandibular canine region. In the anterior region of the mandible, the entity presented a fine sunray appearance.

Differential or Definitive Interpretation

On the basis of radiographic findings osteosarcoma, ameloblastoma, keratocystic odontogenic tumor, and giant cell granuloma were considered in the differential diagnosis. Osteosarcoma was determined to be the diagnosis because of the unique sunray appearance, history of smoking (0.5 pack/day for 40 years [20 pack-years]), pain, and paresthesia. Initial biopsy analyses were inconclusive because of the nonpathognomonic features. Findings on analysis of the final excisional biopsy specimen, however, were consistent with an ameloblastoma, with an acanthomatous pattern.^1,3

Discussion/Conclusions

The imaging findings, such as the classic sunray appearance; location of the expansile, destructive lesion in the anterior portion of the mandible; and clinical findings of paresthesia of lip, intermittent pain, and history of smoking led to the formation of an aggressive neoplastic entity. However, the slow-growing nature of the lesion favored diagnosis of a benign neoplastic entity. Ameloblastomas may often mimic other benign lesions, but this is a unique case of an ameloblastoma presenting malignant features, in particular the acanthomatous pattern, is one of the rare types.³

https://ift.tt/2GfjzTm

RELATIONSHIP OF MANDIBULAR THIRD MOLARS TO THE SURROUNDING STRUCTURES

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): Z. VAITSIDIS, C. THEODORIDIS, C. ANGELOPOULOS

Background

Surgical extraction of the mandibular third molar is the most common procedure in oral surgery. Panoramic radiography and cone beam computed tomography (CBCT) are the imaging modalities used for preoperative planning.

Objective

The aim of the study was to evaluate the position of the mandibular third molar and its relationship to the surrounding structures, mainly the mandibular canal.

Materials and methods

CBCT images of 712 adult patients with third molars were selected in a specific period. Most of the scans were conducted for routine examination or for preimplantation screening, and some of them were performed for the assessment of the relationship between the third molar and the mandibular canal. The molars were classified on the basis of the following parameters: (1) patient gender, (2) presence of an adjacent second molar, (3) impaction angle, (4) depth of impaction, (5) parietal–lingual localization, (6) number of roots, (7) roots of molars in relationship to the mandibular canal, and (8) shape changes of the mandibular canal in relationship to the third molar.

Results

The vertical angulation is the most frequent location of impacted and semi-impacted third molars. The mandibular canal is identified most frequently under the buccal roots of the molars, and this is has been confirmed by various studies reported in the literature. There is also a large number of cases with mandibular canal narrowing and cortical plate loss, close to the third molar.

Discussion

CBCT is essential for the topographic evaluation of wisdom teeth because of the anatomic particularity they may present. The information CBCT offers on the relationship between various types of impaction and the mandibular canal may be helpful in the formulation of the preoperative plan and in avoiding potential risks during extraction.

https://ift.tt/2rDdsOv

INCIDENTAL FINDINGS ON CBCT AND CLASSIFICATION ACCORDING TO THEIR SIGNIFICANCE

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): C. THEODORIDIS, Z. VAITSIDIS, C. ANGELOPOULOS

Background

In the future, 3-dimensional diagnostic imaging will certainly be the preferred imaging method in dentistry, with cone beam computed tomography (CBCT) featuring prominently in the management of many cases. Nevertheless, increased information that advanced imaging techniques can result in increased amounts of findings that are unrelated to the reason the examination was conducted. The prevalence rate of these occult entities on CBCT varies widely among reported studies and may exceed 50%, depending mainly on demographic factors and field of view (FOV). Additionally, utilization of incidental findings, which may give rise to both medical and legal concerns, has to be based on their clinical significance.

Objective

The objective of this study was to determine the prevalence of incidental radiologic findings on CBCT examinations. Furthermore, we attempted to classify these findings according to their clinical significance.

Materials and Methods

We retrospectively evaluated 741 CBCT examinations with extended FOV for incidental findings. Incidental radiologic findings were identified, recorded, classified on the basis of their locations and ranked according to clinical significance.

Results

The vast majority of CBCT examinations presented with at least1 incidental radiologic finding, resulting in a surprisingly high prevalence in total. If extreme anatomic variants are taken into account (nasal septum deviation, sinus septations, etc.), the cumulative prevalence exceeds 99%. The frequency of incidental entities of major significance that may require immediate attention was greater than 10%.

Discussion

Random incidental radiologic findings occur at a high frequency in CBCT examinations of patients referred for routine dental assessment. Inflammatory changes in the paranasal sinuses, as well as benign entities in the neck and the cervical spine (tonsillar calcifications and degenerative changes), are among the most frequent findings. Although the number of findings that may need immediate attention is relatively low, in a considerable number of cases, periodic evaluation is required.

https://ift.tt/2GfSdN6

RADIOGRAPHIC PREDICTORS OF BONE EXPOSURE IN PATIENTS WITH STAGE 0 ONJ

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): A. SOUNDIA, T. AGHALOO, S. MALLYA, S. TETRADIS

Background

Osteonecrosis of the jaws (ONJ) is a severe adverse effect of antiresorptive medications. Although the diagnosis of ONJ is based on the presence of necrotic bone in the oral cavity, patients at the initial phase of the disease (stage 0 ONJ) can present without bone exposure.¹ Approximately 50% of stage 0 ONJ patients develop bone exposure within 6 to 12 months of initial presentation.² However, diagnostic predictors of stage 0 ONJ progressing to clinical ONJ are absent.

Objectives

The aim of this study was to investigate stage 0 ONJ radiographic features associated with subsequent clinical exposure.

Materials and Methods

Files from 14 patients with stage 0 ONJ (history of antiresorptive medication and nonspecific clinical symptoms) were utilized. Imaging included panoramic radiographs and CBCT scans. Additionally, clinical photos were obtained. Cortical erosion, sclerosis, sequestration, periosteal reaction and crater-like defects were assessed as localized or extensive. Patients were followed up for 6 months to 2 years and absence or presence of clinical exposure was noted.

Results

Two patients reported a history of recent extraction, 3 were edentulous and 9 were dentate. Of the patients, 50% (7 of 14) presented with cortical erosion, 43% (6 of 14) showed bony sequestration or bony spicules, 50% (7 of 14) demonstrated crater-like defect, 50% (7 of 14) had extensive sclerosis, and 36% (5 of 14) presented with periosteal reaction. In follow-up, 50% (7 of 14) of patients with stage 0 ONJ developed clinical exposure during the observation period. Patients with subsequent exposure presented more frequently with abnormal radiographic findings. Interestingly, 6 of these patients presented with sequestration or bony spicules at the initial appointment. All patients with sequestrum advanced to clinical ONJ.

Discussion

Our data show an association of radiographic findings, in particular of sequestration, with development of bone exposure, and emphasize the importance of a thorough radiographic assessment in patients with suspected stage 0 ONJ. Currently, we are expanding our patient population to increase the statistical power of our studies.

https://ift.tt/2GfR8op

LUND-MACKAY STAGING COMPARED WITH A SINO-NASAL QUALITY OF LIFE TOOL (SNOT)

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): B. DASARI, R. VYAS, A.G. CREANGA, S.R. SINGER, M. STRICKLAND

Background

Computed tomography (CT) is the imaging modality of choice for evaluating disease of the paranasal sinuses.¹ The Lund-Mackay staging system measures stages of chronic rhinosinusitis (CRS). The sino-nasal outcome test (SNOT) covers a range of health-related quality of life problems associated with sinus disease, including physical problems, functional limitations, and emotional consequences.² Both tools were found to be reliable and valid.^2,3

Objective

The objective of this study was to determine a relationship between quantitative measures (Lund-Mackay) and a qualitative tool (SNOT).

Materials and Methods

Institutional review board approval was granted, and 300 patients who had previously undergone CBCT imaging studies were invited to participate. Lund-Mackay scoring was assessed for completely clear, partly opaque, or completely opaque sinuses visualized on CBCT examinations. The SNOT consists of 20 questions pertaining to rhinologic symptoms and psychological function. All patients signed an informed consent form before taking the survey. Using ordinal scales from 0 to 5, patient symptoms were scored for both rhinologic and psychological function: no problem = 0; very mild problem = 1; mild or slight problem = 2; moderate problem = 3; severe problem = 4; and, finally, problem as bad as can be = 5. Higher scores represent worse symptoms and poorer quality of life. The American Society of Anesthesiologists (ASA) and seasons categories were also collected.⁴

Results

Seven (63.6%) males and 4 (36.82%) females participated in the survey. Mean age of the patients was 55.82 ± 17.9. The Mann-Whitney test was used to compare the median result for the survey questions. Patients' response for "Wake up at night?" was significant (P = .012). Spearman rho correlation showed age as being highly correlated to sinusitis (r = 0.894; P = .0001).

Discussion

Because both the Lund-McKay system and the SNOT have been demonstrated to be effective for assessment of sinus disease, the Lund-McKay staging system may be appropriate for quantitative assessment where imaging is otherwise required. The SNOT can be used for correlation of patients' qualitative experiences.

https://ift.tt/2rDGdup

GUBERNACULUM DENTIS IN A TRANSMIGRATING CANINE: CASE REPORT AND LITERATURE REVIEW

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): L. ALMUFLEH, S. GHORI, R. VYAS, K. VAGISHA, M. MUPPARAPU, A.G. CREANGA, M. STRICKLAND, S.R. SINGER

Background

Gubernaculum dentis (GD) is an anatomic structure, described in the literature as an eruption pathway from the dental follicle to the gingiva for permanent teeth.¹ This is the first reported case of a GD associated with a transmigrating canine.²

Clinical and Radiologic Findings

A 60-year-old female of Indian origin presented for evaluation for implant placement to replace a clinically missing lower canine tooth. Her medical history was unremarkable. Cone beam computed tomography (CBCT) of the mandible was performed, and the image demonstrated the presence of a corticated tract of low density, contiguous with the dental follicle of the horizontally displaced and impacted mandibular left canine. The tract extended from the pericoronal space around the impacted tooth toward the alveolar crest. The structure measured 2 cm long and 2 mm wide.

Differential or Definitive Interpretation

On the basis of the clinical and radiographic findings, this structure was diagnosed as GD and had to be differentiated from bone trabeculae, medullary spaces, neurovascular bundles, or sinus tracts. Because this is considered a normal anatomic structure, no biopsy was indicated.¹

Discussion

Histologically, GD consists of a fibrous band running in the bony channel that connects the pericoronal follicular tissue of the successional tooth with the overlying gingiva. Typically, GD opens on the alveolar bone crest behind the deciduous teeth. Radiographically, GD appears as a corticated tract of low density, contiguous with the dental follicle of an unerupted tooth on CBCT.³ It would be difficult to visualize the very thin and round radiolucent structures with a diameter of only 1 to 3 mm on 2-dimensional radiographs. In addition, the structure lies in the spongy bone of the maxilla and the mandible. Therefore, GD has not received adequate attention in dental fields, including oral and maxillofacial radiology.

https://ift.tt/2GrZQQi

MAXILLARY CANINE FOLLICULAR SPACE AND LATERAL INCISOR ROOT RESORPTION: A CBCT STUDY

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): J.V. KRACKE, S. GHOLAM, L. PERES, N. SHAHABUDDIN, S.R. SINGER, M. MUPPARAPU

Background

It has been shown that the dental follicle is necessary for signaling osteoclasts to induce resorption of bone in the direction of the eruption.¹ A dental follicle can also induce resorption of nearby anatomic structures, including adjacent teeth, if there is insufficient space for the tooth to emerge.

Objective

The objective of this study was to identify patterns of resorption in maxillary lateral incisor roots and investigate a relationship to the width of the follicular space of the adjacent erupting canines.

Methods

Three hundred and thirty cone beam computed tomography (CBCT) volumes were obtained from an orthodontic practice, and identifying data were removed according to institutional review board guidelines. Each volume was analyzed for the presence of unerupted canines and lateral incisor.

Results

From the sagittal, the range of follicle sizes was 0.5 to 4.9 mm. From the axial, the range of follicle sizes was 0.5 to 4.9 mm. From the coronal, the range of follicle sizes was 0.5 to 5.4 mm. At a cutoff point of 2.03 mm, there was 76%, and sensitivity was 72%.

Discussion

The study included 252 canine teeth with enlarged follicular spaces. Fifty-two lateral incisors showed radiographic evidence of resorption, almost always on the distal–palatal aspect of the root. The statistical model predicted that if the follicle has an average size of 2.03 mm or greater, the patient has a higher predisposition of having lateral incisor root resorption on the same side.

https://ift.tt/2rDG8H7

Part 2: CBCT EVALUATION OF ATLANTOAXIAL/ATLANTO-OCCIPITAL JOINTS FOR CERVICAL INSTABILITY RISK ASSESSMENT

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): A. MANCIA, S. ROZMAN, S.R. SINGER, M. MUPPARAPU

Background

The VAAI¹ index measures the vertical relationship of the atlas and axis. Based on prior studies, value less than 0.8 might present a predisposition towards cervical instability.

Objective

The objective of this study was to determine the potential risk for atlantoaxial/atlanto-occipital instability² in patients who underwent CBCT imaging of the head at a University-based Maxillofacial Radiology clinic.

Material and Methods

After an IRB approval, a preliminary study was performed on patients undergoing either pre-implant assessment of jaws or reported for evaluation of atypical facial pain and measurements were recorded. A total of 100 CBCT volumes of patients were identified for the selected craniocervical measurements. It is anticipated that these measurements would provide a risk estimate for cervical instability that could potentially result in spinal cord injury. All CBCT volumes were acquired using Carestream CS9300 machine (Carestream, Atlanta, GA)

Results

Based on the preliminary results, the average VAAI measurement was 0.7626, the average BAI was 4.970 mm; the average BDI was 5.043 mm and the average PR was 0.6961.

Discussion

Apart from VAAI, BDI and BAI, the Powers³ ratio was utilized in this study to see atlantoaxial dissociation of subjects (normal Powers ratio= 1:1) A ratio over 1 indicates an Atlanto-Occipital Dissociation (AOD). Basion-axial interval (BAI) is the horizontal distance between basion and the posterior cortex of the axis(normal=<12mm). Basion-dens interval (BDI) is the distance between the basion and the tip of the dens(normal=<8.5mm). Both BAI and BDI are used to diagnose atlanto-occipital dissociation injuries.

Conclusions

Based on the preliminary results of this CBCT study, it was clear that the VAAI, BAI, BDI and Powers ratios are all useful markers for early diagnosis of potential atlanto-occipital dissociation injuries. Since the cervical vertebrae are captured on CBCT taken for other purposes, it is an added advantage to be able to assess AOD using these volumes.

https://ift.tt/2Gi9sgI

WIDENED PDL SPACE: MALIGNANCY OR FRACTURED TOOTH? SHAHBAZI

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): J.C. KATS, L. AL MATNY, M. NOUJEIM

Background

Despite the development of several modern imaging modalities, radiography remains the first and the most important mode of investigation for evaluating jaw lesions. Osteosarcoma is the most common primary malignant bone tumor, accounting for approximately 20% of the sarcomas, but only 5% of the osteosarcomas occur in the jaws. Malignant lesions are known to quickly grow downward into the periodontal ligament (PDL) space, resulting in an irregular widening and destruction of the lamina dura. Often, root fractures can result in a similar radiographic appearance of the surrounding periodontium. We present a case series of 2 patients with vertical root fractures and 1 case of osteosarcoma of the jaw.

Clinical and Radiographic Findings

The 3 patients portrayed similar radiographic findings. Cone beam computed tomography (CBCT) images and panoramic radiography images revealed osseous defects resembling periodontal destruction, periradicular radiolucency, and irregular widening of the surrounding PDL space. Clinically, the 3 patients did not suffer from pain. However, the last of the three patients presented with tooth mobility.

Differential or Definitive Interpretation

Biopsy and histologic analysis revealed case #1 to have osteosarcoma and cases #2 and #3 to have a periodontal defect resulting from a root fracture.

Discussion/Conclusions

Localized swelling, with or without pain, is the characteristic feature of osteosarcoma. A purely osteolytic lesion demonstrates a radiolucency with "moth-eaten" or irregular borders that seem to infiltrate into the surrounding bone. Early-stage osteosarcoma of the jaw can also appear as symmetric widening of the PDL space. Therefore, when there is suspicion, biopsy should be performed to rule out malignancy.

https://ift.tt/2rDG36h

NEUROFIBROMATOSIS TYPE 1

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): S. PALACIOS, D. KASHTWARI, S. BARGHAN

Background

Neurofibromatosis type 1 (NF1), a complex multisystemic disorder caused by a genetic mutation on chromosome 17, causes uncontrolled tumor growths (called neurofibromas) in the nervous system. There are numerous conditions and complications associated with this disorder, which can affect the skin, eye, muscle, bone, and nervous system. We are presenting 2 cases of NF1 evaluated by using advanced imaging modalities.

Clinical and Radiographic Findings

Case #1: 20-year-old female, who had been referred to our department at age 15 years for preradiation therapy dental screening. Computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography–CT (PET-CT) studies were performed, and they demonstrated aggressive invasive nasopharyngeal carcinoma, metastatic cervical and retropharyngeal lymphadenopathy, and numerous plexiform neurofibromas along the expected course of cranial nerves (CNs) VII, IX, X, XI, and XII, and along the peripheral path of CN V. Throughout the neck, the NFs virtually involved all of the cervical nerve root sheaths and extended to the mediastinum. Case #2: 53-year-old female, who presented to the University of Florida Emergency Department complaining of right facial swelling, pain, and hearing impairment. CT and MRI of the head were performed, and they demonstrated suspicious right preauricular thrombosis of an enlarged facial vein versus evolution of hematoma, multiple skin/subcutaneous NFs, plexiform NF in the distribution of the trigeminal nerve on the right side with related atrophy of the muscles of mastication, enophtalmos, and dysplasia of the skull base, mandible, and facial bones.

Definitive Interpretation

Neurofibromatosis type 1.

Discussion/Conclusions

Patients with NF1 are at risk of eventual development of malignancy. For this reason, patients with NF1 need to be evaluated periodically by multiple specialists, using advanced imaging modalities, and it is important for dental professionals to recognize this disorder and be proactive in its interdisciplinary management.

https://ift.tt/2GrZwRA

DENTAL RADIOGRAPHIC PRESCRIBING PRACTICES: SURVEY OF DENTAL HYGIENISTS IN THE U.S.

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): K.B. MUZZIN, D.J. FLINT, E. SCHNEIDERMAN

Background

Potential harm from ionizing radiation has led to the development of guidelines to protect patients and practitioners from unnecessary radiation exposure; however, these guidelines may or may not be followed in practice.

Objective

This study surveyed U.S. dental hygienists with regard to radiology policies in the workplace.

Methods

The survey, consisting of 62 knowledge and practice items regarding use of dental radiography, was based on the 2012 publication by the American Dental Association (ADA) and the U.S. Food and Drug Administration (FDA): "Dental Radiographic Examinations: Recommendations for Patient Selection & Limiting Radiation Exposure." The study was granted exempt status by the Texas A&M University–Baylor College of Dentistry (TAMU-BCD) institutional review board. The survey link was emailed to 10,000 subscribers of the Dimensions of Dental Hygiene magazine and posted on the magazine's Facebook page.

Results

Five hundred and seventeen dental hygienists completed the survey. Data analysis included descriptive statistics, cross-tabulations, and χ² analyses. Approximately 46% of the respondents reported that the dentist determined the need for radiography, and 42% reported that the decision was made by the dental hygienist. The majority of respondents (82%) reported that a clinical examination was not performed before imaging, and 70% reported that images were ordered on the basis of a set time interval. Approximately 36% reported that images were requested on the basis of the patient's insurance reimbursement. For adult recall patients with no clinical caries or low caries risk, general and corporate dental practices made bitewing radiographs more frequently (every 12 months) compared with educational institutions (P < .05). In the case of children and adolescent recall patients without caries or low caries risk, for children, corporate dental practices made bitewing radiographs more frequently (every 6 months) compared with educational institutions (P < .05); for adolescent patients, corporate and general dental practices preferred to make bitewing images every 12 months, whereas educational institutions preferred to make bitewing images every 18 months (P < .05).

Conclusions

The findings of this study suggest that some dental practices are not strictly following the ADA/FDA guidelines with regard to frequency of radiographic exposures.

https://ift.tt/2GrZucq

ASSOCIATION BETWEEN INTERNAL AND EXTERNAL CAROTID ARTERY CALCIFICATIONS IN PATIENTS UNDERGOING DENTAL IMPLANT THERAPY

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): S. MUTALIK, A. TADINADA

Background

Vascular calcifications are often carefully assessed by oral and maxillofacial (OMF) radiologists on cone beam computed tomography (CBCT) scans. This is done because of the risk for cerebral ischemia and legal liabilities. Scans with a large field of view (FOV) often depict both extra- and intracranial carotid calcifications. Because of radiation dose concerns, the FOV is often reduced in certain examinations that tend to show extracranial carotid calcifications more often than intracranial vessels. It is valuable to predict the presence of intracranial carotid calcifications, which often pose a higher risk for cerebral ischemia in the presence of extracranial carotid calcification. Therefore, the current study aimed to assess the association between extra- and intracranial carotid calcifications.

Materials and Methods

Retrospective evaluation of 1000 CBCT scans of patients referred for dental implant therapy was done, and on the basis of FOV, 450 CBCT scans that included both the intra- and extracranial carotid calcifications were chosen for evaluation. The scans were evaluated for the presence/absence of vascular calcifications. The association between intra- and extracranial carotid calcifications was evaluated by using the χ² test.

Results

Overall, 171 (38%) extracranial and 172 (38.2%) intracranial calcifications were detected. Of the 171 extracranial findings, 74 were bilateral, 45 were on the left, and 52 were on the right. Of the 172 intracranial findings, 112 were bilateral, 29 were on the left, and 31 were on the right. When extracranial calcification was present, intracranial calcifications were also noted in 61.9% cases. There was a strong association between extra- and intracranial calcifications (Pearson χ² 107.643; P < .0001).

Conclusions

In this patient population, there is a significant association between extra- and intracranial carotid artery calcifications. Future studies should be performed on a larger patient population to better understand this association.

https://ift.tt/2rEjazM

Mast Cell Granules: Modulating adaptive immune response remotely

Publication date: Available online 14 December 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Rohit Jain, Shweta Tikoo, Wolfgang Weninger

https://ift.tt/2CelF1T

Effect of hyaluronic acid on the osseointegration of dental implants

Publication date: Available online 14 December 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): M. Yazan, I.D. Kocyigit, F. Atil, U. Tekin, Z.B. Gonen, M.E. Onder

Abstract

The mechanism of osseointegration is related to many factors, including the quality of the bone, the biocompatibility and surface characteristics of the implant material, the surgical technique, and functional loading. The purpose of this study was to investigate the effects of hyaluronic acid gel on the osseointegration of implants placed in defined areas of the mandible in rabbits. Hyaluronic acid is known to have an osteoinductive effect during regeneration of bony defects, and we thought that it might also have a favourable effect on osseointegration, a specialised mechanism to heal bone. Ten New Zealand rabbits aged 10 weeks and weighing 2.5–3.0 kg were used, and sites for implants that were far enough from the apices of the teeth in the mandibular molar area were chosen. Two cavities were prepared in each rabbit, one (anterior) for the control implant, and one (posterior) for the implant with hyaluronic acid gel (Medical Instinct GmbH, Bovenden). New bone and the osteoid matrix content around the dental implants were evaluated histologically and histomorphometrically two months after the operation, and no significant difference was found between the two groups.

https://ift.tt/2zZDFva

Refining the tumor-node-metastasis staging system for individualized treatment of differentiated thyroid carcinoma

Publication date: February 2019

Source: Oral Oncology, Volume 89

Author(s): Young Nam Kim, Mijin Kim, Hyeon Seon Ahn, Kyunga Kim, So Young Park, Hye In Kim, Min Ji Jeon, Won Gu Kim, Sun Wook Kim, Won Bae Kim, Jae Hoon Chung, Young Kee Shong, Tae Yong Kim, Tae Hyuk Kim

Abstract

Background

Patients with differentiated thyroid carcinoma (DTC) are staged according to the single age cut point in addition to anatomic extent. A novel staging system is needed to properly show the character and prognosis of DTC by considering age as a continuous variable. We aimed to refine stage and prognostic groups of the eighth edition tumor-node-metastasis (TNM-8) staging system for DTC and to suggest a possible revision.

Methods

We conducted a retrospective data abstraction study of patients with newly diagnosed DTC who were treated at one of two tertiary referral centres in Seoul, Korea between 1994 and 2005. We used recursive partitioning analysis to derive a new staging classification (TNM-RPA) and compared its prediction of cancer-specific survival with that of TNM-8.

Results

The cohort comprised 6342 patients with DTC who were followed up for a median of 11.4 years. Higher TNM-RPA groups were associated with increased risk of death (10-year cancer-specific survival for stages IA, IB, IIA, IIB, III, and IV: 99.6%, 98.1%, 93.0%, 92.4%, 75.1%, and 56.6%, respectively; P < 0.001). The C-index values were 0.869 (95% CI, 0.833–0.905) for the TNM-RPA and 0.819 (0.789–0.850) for TNM-8. The proportions of variance explained for the ability of the TNM-RPA and TNM-8 stages to predict cancer-specific survival were 7.1% and 5.7%, respectively.

Conclusion

This study presents a RPA-based TNM stage groupings that incorporate multiple age cutoffs and essential anatomic information, which can be conveniently used to facilitate the individual prediction of long-term cancer-specific survival in patients with DTC.

https://ift.tt/2QUjV5Y

FDG‐PET/CT for diagnosis and follow‐up of necrotizing (malignant) external otitis

Objective

Imaging is important for the diagnosis and follow‐up of necrotizing external otitis (NEO). The best imaging modality is controversy. To suggest 2‐deoxy‐2‐[fluorine‐18] fluoro‐D‐glucose‐positron emission tomography/computed tomography (18F‐FDG‐PET/CT) as an alternative to technetium‐99m and gallium‐67 scans for diagnosis and assessment of response to treatment for patients with NEO.

Study Design

Case series.

Methods

Tertiary referral center. From 2013 through 2017, 12 patients were diagnosed with NEO based on clinical features and positive FDG uptake within the temporal bone on PET/CT. Mean age was 74 ± 11.5; 83% of the patients were male; and 83% had diabetes.

Results

PET/CT scans were reviewed independently by two nuclear medicine specialists. Imaging located osteomyelitis in external ear canal, mastoid, temporomandibular joint, and nasopharyngeal region (100%, 50%, 16%, 8%, respectively).

Mean follow‐up was 16 months. Eight patients (67%) underwent a second PET/CT scan after active otitis resolved and after at least 6 weeks of antibiotic treatment. The scan demonstrated no or substantially reduced FDG uptake and treatment was stopped. The patients had no NEO symptoms at the end of follow‐up. One patient had significant uptake, and antibiotic treatment was continued until a third scan demonstrated no FDG uptake. Two patients died before the second PET/CT, and two were lost to follow‐up.

Conclusion

18F‐FDG‐PET/CT is a reliable imaging modality for diagnosis, disease localization, and decision making regarding treatment cessation. 18F‐FDG‐PET/CT should be considered as the imaging modality of choice for initial diagnosis and follow‐up in NEO patients. Larger, controlled studies are warranted.

Level of Evidence

4. Laryngoscope, 2018

https://ift.tt/2QSADTq