Active vaccination against Interleukin‐5 as long‐term treatment for insect bite hypersensitivity in horses

Abstract

Background

Insect‐bite hypersensitivity (IBH) in horses is a chronic allergic dermatitis caused by insect bites. Horses suffer from pruritic skin lesions, caused by type‐I/type‐IV allergic reactions accompanied by prominent eosinophil infiltration into the skin. Interleukin‐5 (IL‐5) is the key cytokine for eosinophils and we have previously shown that targeting IL‐5 by vaccination reduces disease symptoms in horses.

Objective

Here we analyzed the potential for long‐term therapy by assessing a second follow‐up year of the previously published study.

Methods

The vaccine consisted of equine IL‐5 (eIL‐5) covalently linked to a cucumber mosaic virus‐like particle (VLP) containing a universal T cell epitope (CuMV_TT) using a semi‐cross over design to follow vaccinated horses during a second treatment season. Thirty Icelandic horses were immunized with 300 μg of eIL‐5‐CuMV_TT without adjuvant.

Results

The vaccine was well tolerated and did not reveal any safety concerns throughout the study. Upon vaccination all horses developed reversible anti‐eIL‐5 auto‐antibody titers. The mean course of eosinophil levels was reduced compared to placebo treatment leading to significant reduction of clinical lesion scores. Horses in their second vaccination year showed a more pronounced improvement of disease symptoms when compared to first treatment year, most likely due to more stable antibody titers induced by a single booster injection. Hence, responses could be maintained over two seasons and the horses remained protected against disease symptoms.

Conclusion

Yearly vaccination against IL‐5 may be a long‐term solution for the treatment of IBH and other eosinophil‐mediated diseases in horses and other species including humans.

This article is protected by copyright. All rights reserved.

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Interleukin-4/interleukin-13 versus interleukin-5: a comparison of molecular targets in biologic therapy for the treatment of severe asthma

Purpose of review Asthma is a chronic, inflammatory disorder of the airways caused by a complex interplay of various biologic mechanisms. Several monoclonal antibody therapies targeting interleukin (IL)-4/IL-13 and IL-5 cytokine pathways have been developed for the treatment of severe eosinophilic asthma. As individuals can display biomarkers and clinical features characteristic of several asthma phenotypes, selection of anoptimal biologic can be difficult. Recent findings Dupilumab, a monoclonal antibody that binds to the α subunit of the IL-4 receptor (IL-4Rα) and has been approved for the treatment of adults with severe atopic dermatitis, has been shown in recent phase 3 trials to also have significant clinical benefits in the asthmatic population irrespective of baseline eosinophil counts. Summary As monoclonal antibodies targeting either IL-4 or IL-13 cytokines individually have failed to demonstrate significant clinical benefits, biologics that target cytokine receptors may be more efficacious compared to those that target cytokines. Furthermore, inhibition of the IL-4/IL-13 signaling cascades may disrupt a broader Th2 inflammatory response compared to a more selective impairment of eosinophil proliferation and activity via blockage of the IL-5 pathway. Future research with independently funded, head-to-head trials of approved biologics is needed to elucidate a favorable therapeutic option. Correspondence to Julia W. Tripple, MD, Allergy and Immunology Division, University of Texas Medical Branch, Galveston, TX 77555, USA. E-mail: jgwoodar@utmb.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Strategies to reduce corticosteroid-related adverse events in asthma

Purpose of review Severe asthmatics, despite the chronic use of high inhaled corticosteroids (ICS) doses and frequent intake of systemic corticosteroids, remains clinically and/or functionally uncontrolled. These patients are also often affected by rhinitis or chronic rhinosinusitis requiring frequent use of intranasal corticosteroids. Therefore, severe asthmatics are exposed to an overload of corticosteroids that is frequently associated with relevant and costly adverse events. This clinical problem and the strategies to overcome it are here summarized. Recent findings Different therapeutic options may help in reducing the corticosteroid load in asthmatics, ranging from allergy immunotherapy (nonsuitable for severe uncontrolled patients), immunosuppressant agents like methotrexate or cyclosporine, novel biologic drugs (mainly anti-IgE, anti-IL5 and anti-IL4-receptor-alpha), and aspirin desensitization (for patients with anti-inflammatory drugs exacerbated respiratory disease). Summary The evidence of even serious corticosteroid-related adverse events associated with consistent health-care costs, should prompt the entire scientific community and health regulatory authorities to promote actions to increase the use of well tolerated and effective strategies to reduce the corticosteroid need in asthmatics; the most promising option seems to be the add-on use of biologic agents. Correspondence to Professor Enrico Heffler, Personalized Medicine, Asthma and Allergy Unit, Istituto Clinico Humanitas, Humanitas Research Hospital, Via Alessandro Manzoni 56, Rozzano MI, Italy. Tel: +39 282247013; fax: +39 282246484; e-mail: enrico.heffler@hunimed.eu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Active vaccination against Interleukin‐5 as long‐term treatment for insect bite hypersensitivity in horses

Abstract

Background

Insect‐bite hypersensitivity (IBH) in horses is a chronic allergic dermatitis caused by insect bites. Horses suffer from pruritic skin lesions, caused by type‐I/type‐IV allergic reactions accompanied by prominent eosinophil infiltration into the skin. Interleukin‐5 (IL‐5) is the key cytokine for eosinophils and we have previously shown that targeting IL‐5 by vaccination reduces disease symptoms in horses.

Objective

Here we analyzed the potential for long‐term therapy by assessing a second follow‐up year of the previously published study.

Methods

The vaccine consisted of equine IL‐5 (eIL‐5) covalently linked to a cucumber mosaic virus‐like particle (VLP) containing a universal T cell epitope (CuMV_TT) using a semi‐cross over design to follow vaccinated horses during a second treatment season. Thirty Icelandic horses were immunized with 300 μg of eIL‐5‐CuMV_TT without adjuvant.

Results

The vaccine was well tolerated and did not reveal any safety concerns throughout the study. Upon vaccination all horses developed reversible anti‐eIL‐5 auto‐antibody titers. The mean course of eosinophil levels was reduced compared to placebo treatment leading to significant reduction of clinical lesion scores. Horses in their second vaccination year showed a more pronounced improvement of disease symptoms when compared to first treatment year, most likely due to more stable antibody titers induced by a single booster injection. Hence, responses could be maintained over two seasons and the horses remained protected against disease symptoms.

Conclusion

Yearly vaccination against IL‐5 may be a long‐term solution for the treatment of IBH and other eosinophil‐mediated diseases in horses and other species including humans.

This article is protected by copyright. All rights reserved.

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Global Differentiated Thyroid Cancer Therapeutics Market 2018 – Mylan pharmaceuticals, Baxter, Alara ...

Global Differentiated Thyroid Cancer Therapeutics Market 2018 – Mylan pharmaceuticals, Baxter, Alara ...  thestocknewsnow.comFull coverage

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Black bone MRI with 3D reconstruction for the detection of skull fractures in children with suspected abusive head trauma

Abstract

Purpose

The purpose of this study was to determine the accuracy of "black bone" (BB) MRI for the detection of skull fractures in children with potential abusive head trauma.

Methods

A total of 34 pediatric patients were evaluated for potential abusive head trauma. All patients had both a non-contrast head CT (HCT) with multiplanar reformatted images and 3D volumetric reformatted images where available (gold standard) for fracture diagnosis and BB of the head with multiplanar reformatted images and 3D volumetric images. BB was performed using an ultrashort TE pointwise encoding time reduction with radial acquisition (PETRA) sequence at 1.5 T or 3 T. BB datasets were post-processed and 3D images created using Fovia's High Definition Volume Rendering® software. Two board-certified pediatric neuroradiologists independently reviewed the HCT and BB imaging, blinded to the findings from the other modality.

Results

Median patient age was 4 months (range 1.2–30 months). A total of 20 skull fractures in six patients (18% incidence of skull fractures) were detected on HCT. BB demonstrated 83% sensitivity (95%[CI] 36–99%), 100% specificity (95%[CI] 88–100%), 100% PPV (95%[CI] 46–100%), 97% NPV (95%[CI] 82–99%), and 97% accuracy (95%[CI] 85–99%) for diagnosis of a skull fracture. BB detected 95% (19/20) of the skull fractures detected by CT.

Conclusion

A black bone MRI sequence may provide high sensitivity and specificity for detection of skull fractures in pediatric patients with abusive head trauma.

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Effect of bisphosphonate treatment on the jawbone: an exploratory study using periapical and panoramic radiographic evaluation

Abstract

Objective

This cross-sectional study aimed to explore potential jawbone changes secondary to bisphosphonate (BP) treatment of osteoporosis using digital panoramic and periapical radiography.

Methods

Thirty-nine women, previously examined with dual-energy X-ray absorptiometry, were radiographed by digital panoramic and/or periapical radiography. On periapical radiographs, trabecular bone structure and fractal dimension analyses of the mandibular first molar and edentulous regions were performed. On panoramic radiographs, the mandibular cortical width (MCW) was calculated, and trabecular bone structure and fractal dimension analyses of the trabecular bone in the alveolar and basal bones were performed. The results were compared between patients treated or not treated with BP using linear regression analysis to adjust for potential confounding factors.

Results

The analyses of periapical and panoramic radiological images showed no statistical differences in the jawbones between groups after bisphosphonate use for mean intervals of 4.3 and 5 years; respectively. Although the mandibular cortical width on panoramic radiography was correlated with BP use, it was not noted to be statistically significant.

Conclusions

The trabecular parts of the alveolar and basal bones and the MCW were not significantly altered by BP treatment in patients with osteoporosis over 4.3–5 years, as detected by digital periapical and panoramic radiography. The low dosages of bisphosphonates used in the treatment of osteoporosis may explain this lack of change in MCW. Dental radiographs should not be considered as a method to monitor BP-induced jaw bone alterations among osteoporotic patients.

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Black bone MRI with 3D reconstruction for the detection of skull fractures in children with suspected abusive head trauma

Abstract

Purpose

The purpose of this study was to determine the accuracy of "black bone" (BB) MRI for the detection of skull fractures in children with potential abusive head trauma.

Methods

A total of 34 pediatric patients were evaluated for potential abusive head trauma. All patients had both a non-contrast head CT (HCT) with multiplanar reformatted images and 3D volumetric reformatted images where available (gold standard) for fracture diagnosis and BB of the head with multiplanar reformatted images and 3D volumetric images. BB was performed using an ultrashort TE pointwise encoding time reduction with radial acquisition (PETRA) sequence at 1.5 T or 3 T. BB datasets were post-processed and 3D images created using Fovia's High Definition Volume Rendering® software. Two board-certified pediatric neuroradiologists independently reviewed the HCT and BB imaging, blinded to the findings from the other modality.

Results

Median patient age was 4 months (range 1.2–30 months). A total of 20 skull fractures in six patients (18% incidence of skull fractures) were detected on HCT. BB demonstrated 83% sensitivity (95%[CI] 36–99%), 100% specificity (95%[CI] 88–100%), 100% PPV (95%[CI] 46–100%), 97% NPV (95%[CI] 82–99%), and 97% accuracy (95%[CI] 85–99%) for diagnosis of a skull fracture. BB detected 95% (19/20) of the skull fractures detected by CT.

Conclusion

A black bone MRI sequence may provide high sensitivity and specificity for detection of skull fractures in pediatric patients with abusive head trauma.

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Effect of bisphosphonate treatment on the jawbone: an exploratory study using periapical and panoramic radiographic evaluation

Abstract

Objective

This cross-sectional study aimed to explore potential jawbone changes secondary to bisphosphonate (BP) treatment of osteoporosis using digital panoramic and periapical radiography.

Methods

Thirty-nine women, previously examined with dual-energy X-ray absorptiometry, were radiographed by digital panoramic and/or periapical radiography. On periapical radiographs, trabecular bone structure and fractal dimension analyses of the mandibular first molar and edentulous regions were performed. On panoramic radiographs, the mandibular cortical width (MCW) was calculated, and trabecular bone structure and fractal dimension analyses of the trabecular bone in the alveolar and basal bones were performed. The results were compared between patients treated or not treated with BP using linear regression analysis to adjust for potential confounding factors.

Results

The analyses of periapical and panoramic radiological images showed no statistical differences in the jawbones between groups after bisphosphonate use for mean intervals of 4.3 and 5 years; respectively. Although the mandibular cortical width on panoramic radiography was correlated with BP use, it was not noted to be statistically significant.

Conclusions

The trabecular parts of the alveolar and basal bones and the MCW were not significantly altered by BP treatment in patients with osteoporosis over 4.3–5 years, as detected by digital periapical and panoramic radiography. The low dosages of bisphosphonates used in the treatment of osteoporosis may explain this lack of change in MCW. Dental radiographs should not be considered as a method to monitor BP-induced jaw bone alterations among osteoporotic patients.

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The pivot point in transposition flap planning: concept and surgical implications

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The pivot point in transposition flap planning: concept and surgical implications

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Relation between hysterectomy, oophorectomy and the risk of incident differentiated thyroid cancer: The E3N cohort

Relation between hysterectomy, oophorectomy and the risk of incident differentiated thyroid cancer: The E3N cohort  MD LinxFull coverage

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Relation between hysterectomy, oophorectomy and the risk of incident differentiated thyroid cancer: The E3N cohort

Relation between hysterectomy, oophorectomy and the risk of incident differentiated thyroid cancer: The E3N cohort  MD LinxFull coverage

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Predictive Value of Preoperative Volume-Based 18F-2-Fluoro-2-Deoxy- d -Glucose Positron Emission Tomography/Computed Tomography Parameters in Patients with Resectable Lung Adenocarcinoma

Abstract

Purpose

This study aimed to investigate the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG), which are volume-based PET parameters, using ¹⁸F-2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) in patients with surgically resectable lung adenocarcinoma.

Methods

We retrospectively evaluated 149 patients with lung adenocarcinoma who underwent ¹⁸F-FDG PET/CT before surgical resection. Maximum standardized uptake value (SUVmax), MTV, and TLG of the primary tumor with threshold value of SUVmax 30, 40, and 50% were calculated, respectively. To compare the predictive performance of volume-based PET parameters, recurrence-free survival was assessed using the Kaplan-Meier method.

Results

The study included 70 males and 79 females with an average age of 65.8 years. The median follow-up time was 45.4 months. Recurrence was observed in 53 patients (35.6%). The mean ± SD SUVmax, MTV_30%, and TLG_30% of the entire cohort were 4.79 ± 2.94, 19.45 ± 24.85, and 56.43 ± 101.88, respectively. The cut-off values of MTV_30% and TLG_30% for recurrence were 11.07 ad 30.56, respectively. The 1-year recurrence-free survival (RFS) rate was 96.5% in low-MTV_30% patients compared with 86.2% in high-MTV_30% patients (p = 0.018) and 96.0% in low-TLG_30% patients compared with 88.5% in high-TLG_30% patients (p < 0.001). On univariate and multivariate analysis, TLG_30% (HR, 2.828, p < 0.001; HR, 2.738, p < 0.001, respectively) was an independent prognostic factor for predicting recurrence-free survival (RFS).

Conclusion

TLG_30% value was observed to be a significant prognostic factor for RFS in patients with lung adenocarcinoma treated by surgical resection.

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Effectiveness and effect of non-vital bleaching on the quality of life of patients up to 6 months post-treatment: a randomized clinical trial

Abstract

Objectives

The aim of this study was to evaluate the esthetic perception of patients at 6 months after bleaching of non-vital teeth with 35% of hydrogen peroxide and 37% of carbamide peroxide using a walking bleach technique. We also assessed psychosocial impacts as well as the clinical effectiveness and stability of the color change.

Materials and methods

The teeth bleaching treatment was randomly assigned to two groups according to the bleaching agent used: G1 HP = 35% of hydrogen peroxide (n = 25) and G2 CP = 37% of carbamide peroxide (n = 25). The non-vital bleaching was performed in four sessions using the walking bleach technique. The color was objectively (ΔE) and subjectively (ΔSGU) evaluated. The esthetic perception and psychosocial factors were evaluated before treatment as well as one and 6 months post-treatment using Oral Health Impact Profile (OHIP) esthetics and Psychosocial Impact of Dental Esthetics Questionnaire (PIDAQ).

Results

The color change (ΔE) at 6 months (G1 = 14.53 ± 5.07 and G2 = 14.09 ± 6.61) for both color groups remained stable until the 6-month post-treatment (p > 0.05). There was a decrease in the values of OHIP esthetics and PIDAQ after treatment compared to the baseline (p < 0.05), and this effect was maintained 6 months post-treatment.

Conclusions

Both agents were highly effective and maintained the color stability at 6 months; this positively affected the esthetic perception and psychosocial impact of patients who also remained stable over time.

Clinical relevance

Non-vital bleaching produces a positive and stable impact on the esthetic perception and psychosocial factors at medium-term follow-ups.

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Bone mineralization and vascularization in bisphosphonate-related osteonecrosis of the jaw: an experimental study in the rat

Abstract

Objectives

Pathogenesis of bisphosphonate-related osteonecrosis of the jaws (BRONJ) is not fully explained. An antiangiogenic effect of bisphosphonates (BPs) or an altered bone quality have been advocated. The aims of the present study were to analyze alveolar mandibular vascularization and bone quality in rats with BRONJ.

Materials and methods

Thirty-eight Sprague-Dawley rats were randomized into two groups: zoledronic acid (ZA), n = 27, and control (CTRL) n = 11. The ZA group received a weekly IV injection of ZA (100 μg/kg) during 10 weeks. The CTRL group received saline. After 6 weeks, extraction of the right mandibular molars was performed. Rats were sacrificed after 14 weeks. Microtomography characterized bone lesions and vascularization after injection of a radio-opaque material. Raman microspectroscopy evaluated bone mineralization.

Results

Fifty-five percent of ZA rats presented bone exposure and signs of BRONJ. None sign was found at the left hemimandible in the ZA group and in the CTRL group. Vascular density appeared significantly increased in the right hemimandibles of the CTRL group compared to the left hemimandibles. Vascularization was reduced in the ZA group. A significantly increased of the mineral-to-amide ratio was found in the alveolar bone of ZA rats by Raman microspectroscopy.

Conclusions

In a rat model of BRONJ, microtomography evidenced osteonecrosis in BRONJ. Raman spectroscopy showed an increased mineralization. Vascularization after tooth extraction was impaired by ZA.

Clinical relevance

Prolonged BP administration caused an increase in the mineralization and a quantitative reduction of the vascularization in the alveolar bone; both factors might be involved concomitantly in the BRONJ pathophysiology.

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Cyclic fatigue resistance of R-Pilot, WaveOne Gold Glider, and ProGlider glide path instruments

Abstract

Objective

The aim of the present study was to compare the cyclic fatigue resistance of R-Pilot (VDW; Munich, Germany) with ProGlider (Denstply Sirona; Ballaigues, Switzerland) and WaveOne Gold Glider (Denstply Sirona; Ballaigues, Switzerland) glide path instruments.

Materials and methods

R-Pilot, ProGlider, and WaveOne Gold Glider instruments were collected (n = 15) and tested in a dynamic cyclic fatigue test device, which has an artificial canal with 60° angle of curvature and a 5-mm radius of curvature. All instruments were operated until fracture occurred, and both time to fracture (TF) and the lengths of the fractured fragments were recorded. Mean and standard deviations of TF and fragment length were calculated for each reciprocating system. TF data and fractured fragment length data were subjected to one-way ANOVA and post-hoc Tukey tests (P < 0.05). Also a Weibull analysis was performed on TF data.

Results

The cyclic fatigue resistance values of the WaveOne Gold Glider and R-Pilot were significantly higher than those of the ProGlider (P < 0.05), with no significant difference between them (P > 0.05). Weibull analysis revealed that WaveOne Gold Glider showed the highest predicted TF value for 99% survival rate, which was followed by R-Pilot and ProGlider. Regarding the length of the fractured tips, there were no significant differences among the instruments (P > 0.05).

Conclusions

The reciprocating WaveOne Gold Glider and R-Pilot instruments had significantly higher cyclic fatigue resistance than rotary ProGlider instruments.

Clinical relevance

This study reported that novel reciprocating glide path instruments exhibited higher cyclic fatigue resistance than rotating glide path instrument.

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Double-blind, randomized controlled clinical trial on analgesic efficacy of local anesthetics articaine and bupivacaine after impacted third molar extraction

Abstract

Objective

The objective of this randomized controlled clinical trial (RCT) was to compare the effect of bupivacaine and articaine at habitual doses on pain intensity and the need for analgesics after lower third molar extraction.

Materials and methods

The final study sample comprised 50 Caucasian volunteers (26 males and 24 females; age range, 18–30 years) undergoing scheduled surgical extraction of impacted lower third molar. A computer-generated random sequence was used to allocate participants to the articaine (4%) or bupivacaine (0.5%) group. Surgeons and patients were blinded by labeling the articaine and bupivacaine carpules with numbers (1 and 2, respectively). Postoperative pain intensity (primary outcome) was evaluated with a visual analogue scale (VAS), while the requirement for and timing of rescue medication and the quality of intraoperative anesthesia were also measured (secondary outcomes).

Results

VAS-measured pain intensity was significantly higher (p < 0.05) in the articaine group than in the bupivacaine group at all time points except for 8 h post-surgery (p = 0.052). Rescue medication was required by 13 (52%) patients in the articaine group and 8 (32%) patients in the bupivacaine group, although the difference did not reach statistical significance (p = 0.252). The groups did not significantly differ (p = 0.391) in the quality of the intraoperative anesthesia.

Conclusions

Bupivacaine is a valid alternative to articaine in third molar surgery and may offer residual anesthesia as a means of reducing postoperative pain. However, further well-designed RCTs are required in larger study populations to verify the effectiveness of bupivacaine to achieve residual analgesia after oral surgery.

Clinical relevance

These findings suggest that bupivacaine may be useful as a coadjuvant to control acute postoperative pain.

Trial registration

ACTRN12617001138370

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Oral health in Alzheimer’s disease: a multicenter case-control study

Abstract

Objectives

The aim of this case-control study was to carry out an oral health assessment on a group of Alzheimer's patients and to establish a hypothesis regarding the implication of the characteristics of the disease and the treatment of oral health.

Materials and methods

A total of 70 Alzheimer's patients, residents at the Alzheimer Center Reina Sofia Foundation (Madrid, Spain) and at the Alzheimer State Reference Center (Salamanca, Spain), and 36 controls (companions/acquaintances), were studied by oral examination and saliva sampling. The oral health indices DMFT/DMFS, CPI, the prosthetic condition, oral hygiene, saliva volume, and pH, as well as the specific microbiological parameters governing the risk of developing caries were assessed.

Results

Alzheimer's patients exhibited, as compared to the control group, (1) fewer teeth (10.9 ± 10.5 vs 23.7 ± 6.5), (2) fewer obturations (2.2 ± 3.4 vs 6.6 ± 5.6), (3) fewer periodontally healthy sextants (0.1 ± 0.4 vs 1.4 ± 2.2), (4) worse oral hygiene (43.1 vs 72.2% brushed), (5) greater use of removable prostheses (47.8 vs 8.4%), (6) higher incidence of candida infection (11.8 vs 0.0%) and cheilitis (15.9 vs 0.0%), (7) lower salivary flow (0.6 ± 0.6 vs 1.1 ± 0.6), and (8) lower buffering capacity (46 vs 80%).

Conclusions

After taking into account the influence of age, Alzheimer's patients had worse oral health (caries and periodontal disease), more mucosal lesions (cheilitis and candidiasis), and worse saliva quantity and quality.

Clinical relevance

Clinicians should be aware of the implications of Alzheimer's disease in oral health, in order to stablish the effective preventive measures and the optimal treatment plan.

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The use of throat packs in pediatric cleft lip/palate surgery: a retrospective study

Abstract

Objectives

Throat packs are commonly used to prevent ingestion or aspiration of blood and other debris during cleft lip/palate surgery. However, dislodgement or (partial) retainment after extubation could have serious consequences. The aim of the present study was to investigate the effect of omitting pharyngeal packing during cleft lip/palate surgery on the incidence of early postoperative complications in children.

Materials and methods

A retrospective study was performed on all children who underwent cleft lip/palate surgery at the Wilhelmina Children's Hospital. This study compared the period January 2010 through December 2012 when pharyngeal packing was applied according to local protocol (group A) with the period January 2013 till December 2015 when pharyngeal packing was no longer applied after removal from the protocol (group B). Data were collected for sex, age at operation, cleft lip/palate type, type of repair, lateral incisions, length of hospital stay, and complications in the first 6 weeks after surgery. Early complications included wound dehiscence, postoperative bleeding, infection, fever, upper respiratory tract infection (URTI), and lower respiratory tract infection (LRTI).

Results

This study included 489 cleft lip/palate operations (group A n = 246, group B n = 243). A total of 39 (15.9%) early complications were recorded in group A and a total of 40 (16.5%) in group B. There were no significant differences (P = 0.902) in complications between the two groups; however, there was a significant difference (P < 0.001) in length of hospital stay between the two groups (group A 3.6 days vs group B 3.2 days).

Conclusion

Omitting routine placement of throat packs in cleft lip/palate surgery was not associated with an increased early postoperative complication rate. Therefore, the traditional, routine placement of a throat pack during cleft lip/palate surgery can be questioned.

Clinical relevance

The traditional, routine placement of a throat pack during cleft lip/palate surgery can be questioned.

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Influence of surface treatment on the performance of silorane-based composite resin in class I restorations: a randomized clinical trial

Abstract

Objectives

The aim of this study was to evaluate the clinical performance of silorane-based composite restorations applied after different surface treatments.

Materials and methods

This controlled and randomized clinical trial included 26 patients with class I restoration indications. The teeth were randomly assigned to the following treatments: control 1/G1, silorane specific self-etching adhesive (P90 self-etch primer and bond) + silorane-based composite resin (Filtek™ P90 low shrink posterior restorative); G2, 37% phosphoric acid + silorane specific self-etching adhesive + silorane-based composite resin; G3, blasting with aluminum oxide + silorane specific self-etching adhesive + silorane-based composite resin; and control 2/G4, self-etching adhesive (Adper™ SE Plus self-etch adhesive) + dimethacrylate-based composite resin (Filtek™ P60 posterior restorative). The clinical performance was evaluated at baseline and after 1 year.

Results

A total of 141 restorations were made and evaluated. For all clinical criteria evaluated, no significant difference was found between the surface treatments at baseline and after 1 year (p > 0.05). After 1 year, only the group with 37% phosphoric acid + silorane specific self-etching adhesive (G2) showed a significant reduction in marginal adaptation (p < 0.05).

Conclusion

In general, all surface treatments showed an adequate clinical performance for silorane-based composite resin in class I restorations. However, a reduction in the marginal adaptation after 1 year was found when additional phosphoric acid etching was used prior to silorane specific self-etching adhesive.

Clinical relevance

The use of phosphoric acid etching prior to specific self-etching adhesive can adversely affect the marginal adaptation of silorane-based restorations.

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Effect of multiple autoclave cycles on the surface roughness of HyFlex CM and HyFlex EDM files: an atomic force microscopy study

Abstract

Aim

To compare the effect of autoclave cycles on the surface topography and roughness of HyFlex CM and HyFlex EDM instruments using atomic force microscopy (AFM) analysis.

Methodology

Eight new files of each brand were subdivided into four subgroups (n = 2/each subgroup). One group was allocated as the control group and not subjected to autoclave sterilization. The other three groups were subjected to different numbers (1, 5, and 10) of autoclave sterilization cycles. After the cycle instruments were subjected to AFM analysis. Roughness average (Ra) and the root mean square (RMS) values were chosen to investigate the surface features of endodontic files. The data was analyzed using one-way ANOVA and post hoc Tamhane tests at 5% significant level.

Results

The lowest Ra and RMS values were observed in the HyFlex EDM files that served as the control and in those subjected to a single cycle of autoclave sterilization (P < 0.05). The highest Ra and RMS values were observed in the HyFlex CM and HyFlex EDM files that were subjected to 10 cycles of autoclave sterilization (P < 0.05). The surface roughness values of the HyFlex CM group showed a significant increase after ten autoclave cycles, whereas those of the HyFlex EDM group exhibited a significant change after five autoclave cycles (P < 0.05).

Conclusions

Although the initial surface roughness values of the HyFlex EDM files were lower than those of the HyFlex CM files, the surface roughness values of the EDM files showed a statistically significant increase after 5 cycles of autoclave sterilization. In contrast, the surface roughness values of the HyFlex CM files did not increase until 10 cycles of autoclave sterilization.

Clinical relevance

Present study indicated that autoclave sterilization negatively affected the surface roughness of the tested NiTi files.

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A randomized triple-blind crossover trial of a hydrocolloid-containing dentifrice as a controlled-release system for fluoride

Abstract

Objective

To evaluate retention of intraoral fluoride in biofilm and saliva, an experimental dentifrice containing hydrocolloid (tara gum) was used as a controlled-release system for fluoride (F).

Materials and methods

In a triple-blind randomized crossover trial with washout, 18 individuals used the following different dentifrices for a week: 100-TGF (sodium fluoride NaF associated with tara gum, 1100 mg/L), 50-TGF (50% NaF associated with tara gum + 50% free NaF, 1100 mg/L), PC (free NaF, 1100 mg/L), TG (with tara gum and without F), and placebo (without F or tara gum). On the seventh day of dentifrice use, biofilm was collected at 1 and 12 h, and saliva was collected up to 60 min and 12 h after the last toothbrushing. F concentrations were determined by physico-chemical analysis of fluoride using the hexamethyldisiloxane-facilitated diffusion technique. Data were subjected to two-way analysis of variance (repeated measures) and Spearman's correlation coefficient (p < 0.05) testing.

Results

No significant difference was observed with the same dentifrice regarding F retention in biofilm at 1 and 12 h after toothbrushing for the 100-TGF, placebo, and TG groups (p > 0.05). The highest area under the curve values in saliva were found for the 50-TGF, 100-TGF, and PC groups.

Conclusion

The dentifrice containing hydrocolloid as a controlled-release system for F promoted F retention in the oral cavity, even at 12 h after brushing.

Clinical relevance

Hydrocolloid added to dentifrices as a controlled-release system for F might contribute to a higher anti-caries effect.

Trial registration

NCT02809014

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Determination of nicotine content in teeth submitted to prophylaxis and in-office bleaching by gas chromatography–mass spectrometry (GC-MS)

Abstract

Objectives

The objective of this study was to evaluate the dental color exposed to acute cigarette smoke treatment and quantify the amount of nicotine in samples exposed to cigarette smoke, after dental prophylaxis and after in-office bleaching.

Materials and methods

Sixty-nine healthy human molars were subjected to cigarette smoke in a cigarette machine. The teeth were divided into three groups: positive control, prophylaxis, and bleaching. Forty cycles of smoke exposition with duration of 15 min each were performed using 10 cigarettes (positive control). Dental prophylaxis was performed with a rotating brush and prophylaxis paste; in-office bleaching was performed with 35% hydrogen peroxide, in two sessions of three 15-min applications, with a 1-week interval between sessions. The color was evaluated at the baseline, after exposure to cigarette smoke, after dental prophylaxis, and after in-office bleaching. Teeth from each group were powdered and analyzed by gas chromatography–mass spectrometry in order to measure the amount of nicotine present in each group. Data from quantification of nicotine and color change were analyzed by one-way ANOVA and Tukey's test (α = 0.05).

Data for subjective and objective color evaluation, a perceptible dental darkening occurred in teeth after exposure to cigarette smoke. Dental prophylaxis was able to recover the original color of teeth however, only after bleaching teeth became whiter than at the baseline (p < 0.001). The amount of nicotine was significantly different and higher in positive control group (3.3 ± 1.3 μg/g of tooth), followed by the prophylaxis group (2.1 ± 1.4 μg/g) and the bleaching group (0.8 ± 0.3 μg/g) (p < 0.001).

Conclusions

Cigarette smoke penetrates into the dental structure. Dental prophylaxis and bleaching with 35% hydrogen peroxide can partially remove the nicotine from tobacco smoke. However, when in-office bleaching was applied, a more significant nicotine removal was achieved.

Clinical significance

Dental prophylaxis could remove most of the external nicotine-staining on the tooth surfaces while bleaching could further reduce the external and internal nicotine-staining of teeth.

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Effectiveness and effect of non-vital bleaching on the quality of life of patients up to 6 months post-treatment: a randomized clinical trial

Abstract

Objectives

The aim of this study was to evaluate the esthetic perception of patients at 6 months after bleaching of non-vital teeth with 35% of hydrogen peroxide and 37% of carbamide peroxide using a walking bleach technique. We also assessed psychosocial impacts as well as the clinical effectiveness and stability of the color change.

Materials and methods

The teeth bleaching treatment was randomly assigned to two groups according to the bleaching agent used: G1 HP = 35% of hydrogen peroxide (n = 25) and G2 CP = 37% of carbamide peroxide (n = 25). The non-vital bleaching was performed in four sessions using the walking bleach technique. The color was objectively (ΔE) and subjectively (ΔSGU) evaluated. The esthetic perception and psychosocial factors were evaluated before treatment as well as one and 6 months post-treatment using Oral Health Impact Profile (OHIP) esthetics and Psychosocial Impact of Dental Esthetics Questionnaire (PIDAQ).

Results

The color change (ΔE) at 6 months (G1 = 14.53 ± 5.07 and G2 = 14.09 ± 6.61) for both color groups remained stable until the 6-month post-treatment (p > 0.05). There was a decrease in the values of OHIP esthetics and PIDAQ after treatment compared to the baseline (p < 0.05), and this effect was maintained 6 months post-treatment.

Conclusions

Both agents were highly effective and maintained the color stability at 6 months; this positively affected the esthetic perception and psychosocial impact of patients who also remained stable over time.

Clinical relevance

Non-vital bleaching produces a positive and stable impact on the esthetic perception and psychosocial factors at medium-term follow-ups.

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Bone mineralization and vascularization in bisphosphonate-related osteonecrosis of the jaw: an experimental study in the rat

Abstract

Objectives

Pathogenesis of bisphosphonate-related osteonecrosis of the jaws (BRONJ) is not fully explained. An antiangiogenic effect of bisphosphonates (BPs) or an altered bone quality have been advocated. The aims of the present study were to analyze alveolar mandibular vascularization and bone quality in rats with BRONJ.

Materials and methods

Thirty-eight Sprague-Dawley rats were randomized into two groups: zoledronic acid (ZA), n = 27, and control (CTRL) n = 11. The ZA group received a weekly IV injection of ZA (100 μg/kg) during 10 weeks. The CTRL group received saline. After 6 weeks, extraction of the right mandibular molars was performed. Rats were sacrificed after 14 weeks. Microtomography characterized bone lesions and vascularization after injection of a radio-opaque material. Raman microspectroscopy evaluated bone mineralization.

Results

Fifty-five percent of ZA rats presented bone exposure and signs of BRONJ. None sign was found at the left hemimandible in the ZA group and in the CTRL group. Vascular density appeared significantly increased in the right hemimandibles of the CTRL group compared to the left hemimandibles. Vascularization was reduced in the ZA group. A significantly increased of the mineral-to-amide ratio was found in the alveolar bone of ZA rats by Raman microspectroscopy.

Conclusions

In a rat model of BRONJ, microtomography evidenced osteonecrosis in BRONJ. Raman spectroscopy showed an increased mineralization. Vascularization after tooth extraction was impaired by ZA.

Clinical relevance

Prolonged BP administration caused an increase in the mineralization and a quantitative reduction of the vascularization in the alveolar bone; both factors might be involved concomitantly in the BRONJ pathophysiology.

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Cyclic fatigue resistance of R-Pilot, WaveOne Gold Glider, and ProGlider glide path instruments

Abstract

Objective

The aim of the present study was to compare the cyclic fatigue resistance of R-Pilot (VDW; Munich, Germany) with ProGlider (Denstply Sirona; Ballaigues, Switzerland) and WaveOne Gold Glider (Denstply Sirona; Ballaigues, Switzerland) glide path instruments.

Materials and methods

R-Pilot, ProGlider, and WaveOne Gold Glider instruments were collected (n = 15) and tested in a dynamic cyclic fatigue test device, which has an artificial canal with 60° angle of curvature and a 5-mm radius of curvature. All instruments were operated until fracture occurred, and both time to fracture (TF) and the lengths of the fractured fragments were recorded. Mean and standard deviations of TF and fragment length were calculated for each reciprocating system. TF data and fractured fragment length data were subjected to one-way ANOVA and post-hoc Tukey tests (P < 0.05). Also a Weibull analysis was performed on TF data.

Results

The cyclic fatigue resistance values of the WaveOne Gold Glider and R-Pilot were significantly higher than those of the ProGlider (P < 0.05), with no significant difference between them (P > 0.05). Weibull analysis revealed that WaveOne Gold Glider showed the highest predicted TF value for 99% survival rate, which was followed by R-Pilot and ProGlider. Regarding the length of the fractured tips, there were no significant differences among the instruments (P > 0.05).

Conclusions

The reciprocating WaveOne Gold Glider and R-Pilot instruments had significantly higher cyclic fatigue resistance than rotary ProGlider instruments.

Clinical relevance

This study reported that novel reciprocating glide path instruments exhibited higher cyclic fatigue resistance than rotating glide path instrument.

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Double-blind, randomized controlled clinical trial on analgesic efficacy of local anesthetics articaine and bupivacaine after impacted third molar extraction

Abstract

Objective

The objective of this randomized controlled clinical trial (RCT) was to compare the effect of bupivacaine and articaine at habitual doses on pain intensity and the need for analgesics after lower third molar extraction.

Materials and methods

The final study sample comprised 50 Caucasian volunteers (26 males and 24 females; age range, 18–30 years) undergoing scheduled surgical extraction of impacted lower third molar. A computer-generated random sequence was used to allocate participants to the articaine (4%) or bupivacaine (0.5%) group. Surgeons and patients were blinded by labeling the articaine and bupivacaine carpules with numbers (1 and 2, respectively). Postoperative pain intensity (primary outcome) was evaluated with a visual analogue scale (VAS), while the requirement for and timing of rescue medication and the quality of intraoperative anesthesia were also measured (secondary outcomes).

Results

VAS-measured pain intensity was significantly higher (p < 0.05) in the articaine group than in the bupivacaine group at all time points except for 8 h post-surgery (p = 0.052). Rescue medication was required by 13 (52%) patients in the articaine group and 8 (32%) patients in the bupivacaine group, although the difference did not reach statistical significance (p = 0.252). The groups did not significantly differ (p = 0.391) in the quality of the intraoperative anesthesia.

Conclusions

Bupivacaine is a valid alternative to articaine in third molar surgery and may offer residual anesthesia as a means of reducing postoperative pain. However, further well-designed RCTs are required in larger study populations to verify the effectiveness of bupivacaine to achieve residual analgesia after oral surgery.

Clinical relevance

These findings suggest that bupivacaine may be useful as a coadjuvant to control acute postoperative pain.

Trial registration

ACTRN12617001138370

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Oral health in Alzheimer’s disease: a multicenter case-control study

Abstract

Objectives

The aim of this case-control study was to carry out an oral health assessment on a group of Alzheimer's patients and to establish a hypothesis regarding the implication of the characteristics of the disease and the treatment of oral health.

Materials and methods

A total of 70 Alzheimer's patients, residents at the Alzheimer Center Reina Sofia Foundation (Madrid, Spain) and at the Alzheimer State Reference Center (Salamanca, Spain), and 36 controls (companions/acquaintances), were studied by oral examination and saliva sampling. The oral health indices DMFT/DMFS, CPI, the prosthetic condition, oral hygiene, saliva volume, and pH, as well as the specific microbiological parameters governing the risk of developing caries were assessed.

Results

Alzheimer's patients exhibited, as compared to the control group, (1) fewer teeth (10.9 ± 10.5 vs 23.7 ± 6.5), (2) fewer obturations (2.2 ± 3.4 vs 6.6 ± 5.6), (3) fewer periodontally healthy sextants (0.1 ± 0.4 vs 1.4 ± 2.2), (4) worse oral hygiene (43.1 vs 72.2% brushed), (5) greater use of removable prostheses (47.8 vs 8.4%), (6) higher incidence of candida infection (11.8 vs 0.0%) and cheilitis (15.9 vs 0.0%), (7) lower salivary flow (0.6 ± 0.6 vs 1.1 ± 0.6), and (8) lower buffering capacity (46 vs 80%).

Conclusions

After taking into account the influence of age, Alzheimer's patients had worse oral health (caries and periodontal disease), more mucosal lesions (cheilitis and candidiasis), and worse saliva quantity and quality.

Clinical relevance

Clinicians should be aware of the implications of Alzheimer's disease in oral health, in order to stablish the effective preventive measures and the optimal treatment plan.

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The use of throat packs in pediatric cleft lip/palate surgery: a retrospective study

Abstract

Objectives

Throat packs are commonly used to prevent ingestion or aspiration of blood and other debris during cleft lip/palate surgery. However, dislodgement or (partial) retainment after extubation could have serious consequences. The aim of the present study was to investigate the effect of omitting pharyngeal packing during cleft lip/palate surgery on the incidence of early postoperative complications in children.

Materials and methods

A retrospective study was performed on all children who underwent cleft lip/palate surgery at the Wilhelmina Children's Hospital. This study compared the period January 2010 through December 2012 when pharyngeal packing was applied according to local protocol (group A) with the period January 2013 till December 2015 when pharyngeal packing was no longer applied after removal from the protocol (group B). Data were collected for sex, age at operation, cleft lip/palate type, type of repair, lateral incisions, length of hospital stay, and complications in the first 6 weeks after surgery. Early complications included wound dehiscence, postoperative bleeding, infection, fever, upper respiratory tract infection (URTI), and lower respiratory tract infection (LRTI).

Results

This study included 489 cleft lip/palate operations (group A n = 246, group B n = 243). A total of 39 (15.9%) early complications were recorded in group A and a total of 40 (16.5%) in group B. There were no significant differences (P = 0.902) in complications between the two groups; however, there was a significant difference (P < 0.001) in length of hospital stay between the two groups (group A 3.6 days vs group B 3.2 days).

Conclusion

Omitting routine placement of throat packs in cleft lip/palate surgery was not associated with an increased early postoperative complication rate. Therefore, the traditional, routine placement of a throat pack during cleft lip/palate surgery can be questioned.

Clinical relevance

The traditional, routine placement of a throat pack during cleft lip/palate surgery can be questioned.

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Effect of multiple autoclave cycles on the surface roughness of HyFlex CM and HyFlex EDM files: an atomic force microscopy study

Abstract

Aim

To compare the effect of autoclave cycles on the surface topography and roughness of HyFlex CM and HyFlex EDM instruments using atomic force microscopy (AFM) analysis.

Methodology

Eight new files of each brand were subdivided into four subgroups (n = 2/each subgroup). One group was allocated as the control group and not subjected to autoclave sterilization. The other three groups were subjected to different numbers (1, 5, and 10) of autoclave sterilization cycles. After the cycle instruments were subjected to AFM analysis. Roughness average (Ra) and the root mean square (RMS) values were chosen to investigate the surface features of endodontic files. The data was analyzed using one-way ANOVA and post hoc Tamhane tests at 5% significant level.

Results

The lowest Ra and RMS values were observed in the HyFlex EDM files that served as the control and in those subjected to a single cycle of autoclave sterilization (P < 0.05). The highest Ra and RMS values were observed in the HyFlex CM and HyFlex EDM files that were subjected to 10 cycles of autoclave sterilization (P < 0.05). The surface roughness values of the HyFlex CM group showed a significant increase after ten autoclave cycles, whereas those of the HyFlex EDM group exhibited a significant change after five autoclave cycles (P < 0.05).

Conclusions

Although the initial surface roughness values of the HyFlex EDM files were lower than those of the HyFlex CM files, the surface roughness values of the EDM files showed a statistically significant increase after 5 cycles of autoclave sterilization. In contrast, the surface roughness values of the HyFlex CM files did not increase until 10 cycles of autoclave sterilization.

Clinical relevance

Present study indicated that autoclave sterilization negatively affected the surface roughness of the tested NiTi files.

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The potential association between periodontitis and non-alcoholic fatty liver disease: a systematic review

Abstract

Objectives

Many animal and human studies have shown associations between periodontitis and non-alcoholic fatty liver disease (NAFLD). Hence, the present systematic review sought to investigate such a potential association.

Methods

PubMed/Medline, Scopus, Embase, and Web of Science databases were thoroughly searched to identify all relevant studies. The eligibility criteria were all observational (cross-sectional studies, case-control, cohort studies, and case reports) and interventional studies that assessed the relationship between periodontitis and NAFLD in humans. Due to remarkable heterogeneity and inconsistency among the included studies, no statistical analyses were conducted.

Results

A total of 12 studies comprising 53,384 patients were included in the present systematic review. The sample size in the individual studies ranged from 52 to 24,470 patients. All studies except one found significant associations between clinical and/or microbial periodontal parameters and NAFLD. Eight studies found significant associations between clinical periodontal parameters and NAFLD. Four microbial studies found a significant association between periodontal pathogens, especially Porphyromonas gingivalis and NAFLD development and progression.

Conclusions

The available evidence suggests that periodontitis may be a risk factor for development and progression of NAFLD. However, due to limited number of prospective cohort studies included in this review along with the substantial heterogeneity among the included studies, further well-designed prospective cohort studies are highly warranted.

Clinical relevance

Given the potential association between periodontitis and NAFLD, it can be assumed that healthy periodontium may be essential for liver health.

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A randomized triple-blind crossover trial of a hydrocolloid-containing dentifrice as a controlled-release system for fluoride

Abstract

Objective

To evaluate retention of intraoral fluoride in biofilm and saliva, an experimental dentifrice containing hydrocolloid (tara gum) was used as a controlled-release system for fluoride (F).

Materials and methods

In a triple-blind randomized crossover trial with washout, 18 individuals used the following different dentifrices for a week: 100-TGF (sodium fluoride NaF associated with tara gum, 1100 mg/L), 50-TGF (50% NaF associated with tara gum + 50% free NaF, 1100 mg/L), PC (free NaF, 1100 mg/L), TG (with tara gum and without F), and placebo (without F or tara gum). On the seventh day of dentifrice use, biofilm was collected at 1 and 12 h, and saliva was collected up to 60 min and 12 h after the last toothbrushing. F concentrations were determined by physico-chemical analysis of fluoride using the hexamethyldisiloxane-facilitated diffusion technique. Data were subjected to two-way analysis of variance (repeated measures) and Spearman's correlation coefficient (p < 0.05) testing.

Results

No significant difference was observed with the same dentifrice regarding F retention in biofilm at 1 and 12 h after toothbrushing for the 100-TGF, placebo, and TG groups (p > 0.05). The highest area under the curve values in saliva were found for the 50-TGF, 100-TGF, and PC groups.

Conclusion

The dentifrice containing hydrocolloid as a controlled-release system for F promoted F retention in the oral cavity, even at 12 h after brushing.

Clinical relevance

Hydrocolloid added to dentifrices as a controlled-release system for F might contribute to a higher anti-caries effect.

Trial registration

NCT02809014

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Head and Neck Cancer Treatment Market by 2021 Types, Applications, Challenges, and Development Factors

Head and Neck Cancer Treatment Market by 2021 Types, Applications, Challenges, and Development Factors  And More NewsGlobal Head and Neck Cancer Treatment Market Report, Trends, Size, Share, Analysis, Estimations and Forecasts to ...  Digital JournalHead and Neck Cancer Treatment Market Competition by Key Manufacturers Analysis with Forecast to 2025  The RealZIMAFull coverage

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Head and Neck Cancer Treatment Market by 2021 Types, Applications, Challenges, and Development Factors

Head and Neck Cancer Treatment Market by 2021 Types, Applications, Challenges, and Development Factors  And More NewsGlobal Head and Neck Cancer Treatment Market Report, Trends, Size, Share, Analysis, Estimations and Forecasts to ...  Digital JournalHead and Neck Cancer Treatment Market Competition by Key Manufacturers Analysis with Forecast to 2025  The RealZIMAFull coverage

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Prospective evaluation of psychological burden in patients with oral cancer

Publication date: Available online 7 November 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): K. Kumar, S. Kumar, D. Mehrotra, S.C. Tiwari, V. Kumar, S. Khandpur, R.C. Dwivedi

Abstract

The high morbidity and mortality that is associated with oral cancer places a huge psychological burden on patients. The purpose of this prospective study was to evaluate levels of depression, anxiety, and stress, at three time points using DASS-21 (Depression, Anxiety and Stress Scale-21). We also compared DASS-21 with HADS (Hospital Anxiety and Depression Scale). A total of 111 patients were enrolled and 75 of them completed the questionnaires at diagnosis, one month after treatment, and three months after discharge. Scores were high for stress at diagnosis, and for depression at the other time points, but were low for anxiety at all three. The results of Friedman's ANOVA showed that mean ranks for depression and stress were significant (p < 0.05). Scores for depression and stress rose significantly between diagnosis and three months after operation, but those for anxiety (which had increased between diagnosis and operation p > 0.05), were stable three months postoperatively. The DASS-21 was a useful method of evaluating stress. Correlation of the results from the two questionnaires showed a strongly positive association. We therefore recommend psychological intervention to improve overall outcome.

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Prospective evaluation of psychological burden in patients with oral cancer

Publication date: Available online 7 November 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): K. Kumar, S. Kumar, D. Mehrotra, S.C. Tiwari, V. Kumar, S. Khandpur, R.C. Dwivedi

Abstract

The high morbidity and mortality that is associated with oral cancer places a huge psychological burden on patients. The purpose of this prospective study was to evaluate levels of depression, anxiety, and stress, at three time points using DASS-21 (Depression, Anxiety and Stress Scale-21). We also compared DASS-21 with HADS (Hospital Anxiety and Depression Scale). A total of 111 patients were enrolled and 75 of them completed the questionnaires at diagnosis, one month after treatment, and three months after discharge. Scores were high for stress at diagnosis, and for depression at the other time points, but were low for anxiety at all three. The results of Friedman's ANOVA showed that mean ranks for depression and stress were significant (p < 0.05). Scores for depression and stress rose significantly between diagnosis and three months after operation, but those for anxiety (which had increased between diagnosis and operation p > 0.05), were stable three months postoperatively. The DASS-21 was a useful method of evaluating stress. Correlation of the results from the two questionnaires showed a strongly positive association. We therefore recommend psychological intervention to improve overall outcome.

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Inflammation in Schizophrenia: Pathogenetics and Therapeutics Inflammation in Schizophrenia: Pathogenetics and Therapeutics

This paper explores the potential involvement of a neuroinflammatory, immunological process in schizophrenia pathogenesis.Schizophrenia Bulletin (Source: Medscape Today Headlines)

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Inflammation in Schizophrenia: Pathogenetics and Therapeutics Inflammation in Schizophrenia: Pathogenetics and Therapeutics

This paper explores the potential involvement of a neuroinflammatory, immunological process in schizophrenia pathogenesis.Schizophrenia Bulletin (Source: Medscape Today Headlines)

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Progress in research on the role of circular RNAs in lung cancer

Circular RNA (circRNA), as a covalently closed circular RNA molecule, is widely present, which is recognized as a competing endogenous RNA. A large number of differentially expressed circRNAs have been identif...

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Progress in research on the role of circular RNAs in lung cancer

Circular RNA (circRNA), as a covalently closed circular RNA molecule, is widely present, which is recognized as a competing endogenous RNA. A large number of differentially expressed circRNAs have been identif...

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Inflammation in Schizophrenia: Pathogenetics and Therapeutics Inflammation in Schizophrenia: Pathogenetics and Therapeutics

This paper explores the potential involvement of a neuroinflammatory, immunological process in schizophrenia pathogenesis.Schizophrenia Bulletin (Source: Medscape Today Headlines)

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Inflammation in Schizophrenia: Pathogenetics and Therapeutics Inflammation in Schizophrenia: Pathogenetics and Therapeutics

This paper explores the potential involvement of a neuroinflammatory, immunological process in schizophrenia pathogenesis.Schizophrenia Bulletin (Source: Medscape Today Headlines)

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Biomarkers of Systemic Inflammation and Risk of Incident Hearing Loss

Background: Chronic inflammation may lead to cochlear damage, and the only longitudinal study that examined biomarkers of systemic inflammation and risk of hearing loss found an association with a single biomarker in individuals

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Cochlear Reflectance and Otoacoustic Emission Predictions of Hearing Loss

Objectives: Cochlear reflectance (CR) is the cochlear contribution to ear-canal reflectance. CR is a type of otoacoustic emission (OAE) that is calculated as a transfer function between forward pressure and reflected pressure. The purpose of this study was to compare wideband CR to distortion-product (DP) OAEs in two ways: (1) in a clinical-screening paradigm where the task is to determine whether an ear is normal or has hearing loss and (2) in the prediction of audiometric thresholds. The goal of the study was to assess the clinical utility of CR. Design: Data were collected from 32 normal-hearing and 124 hearing-impaired participants. A wideband noise stimulus presented at 3 stimulus levels (30, 40, 50 dB sound pressure level) was used to elicit the CR. DPOAEs were elicited using primary tones spanning a wide frequency range (1 to 16 kHz). Predictions of auditory status (i.e., hearing-threshold category) and predictions of audiometric threshold were based on regression analysis. Test performance (identification of normal versus impaired hearing) was evaluated using clinical decision theory. Results: When regressions were based only on physiological measurements near the audiometric frequency, the accuracy of CR predictions of auditory status and audiometric threshold was less than reported in previous studies using DPOAE measurements. CR predictions were improved when regressions were based on measurements obtained at many frequencies. CR predictions were further improved when regressions were performed on males and females separately. Conclusions: Compared with CR measurements, DPOAE measurements have the advantages in a screening paradigm of better test performance and shorter test time. The full potential of CR measurements to predict audiometric thresholds may require further improvements in signal-processing methods to increase its signal to noise ratio. CR measurements have theoretical significance in revealing the number of cycles of delay at each frequency that is most sensitive to hearing loss. ACKNOWLEDGMENTS: Assistance with the calibration software provided by Matthew Waid is gratefully acknowledged. This research was supported by grants R01 DC008318 and P30 DC004662 from the National Institute of Health The authors have no conflicts of interest to disclose. Received March 27, 2018; accepted September 18, 2018. Address for correspondence: Stephen T. Neely, Center for Hearing Research, Boys Town National Research Hospital, 555 N 30th St. Omaha, NE 68131, USA. E-mail: Stephen.Neely@boystown.org Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Biomarkers of Systemic Inflammation and Risk of Incident Hearing Loss

Background: Chronic inflammation may lead to cochlear damage, and the only longitudinal study that examined biomarkers of systemic inflammation and risk of hearing loss found an association with a single biomarker in individuals

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Cochlear Reflectance and Otoacoustic Emission Predictions of Hearing Loss

Objectives: Cochlear reflectance (CR) is the cochlear contribution to ear-canal reflectance. CR is a type of otoacoustic emission (OAE) that is calculated as a transfer function between forward pressure and reflected pressure. The purpose of this study was to compare wideband CR to distortion-product (DP) OAEs in two ways: (1) in a clinical-screening paradigm where the task is to determine whether an ear is normal or has hearing loss and (2) in the prediction of audiometric thresholds. The goal of the study was to assess the clinical utility of CR. Design: Data were collected from 32 normal-hearing and 124 hearing-impaired participants. A wideband noise stimulus presented at 3 stimulus levels (30, 40, 50 dB sound pressure level) was used to elicit the CR. DPOAEs were elicited using primary tones spanning a wide frequency range (1 to 16 kHz). Predictions of auditory status (i.e., hearing-threshold category) and predictions of audiometric threshold were based on regression analysis. Test performance (identification of normal versus impaired hearing) was evaluated using clinical decision theory. Results: When regressions were based only on physiological measurements near the audiometric frequency, the accuracy of CR predictions of auditory status and audiometric threshold was less than reported in previous studies using DPOAE measurements. CR predictions were improved when regressions were based on measurements obtained at many frequencies. CR predictions were further improved when regressions were performed on males and females separately. Conclusions: Compared with CR measurements, DPOAE measurements have the advantages in a screening paradigm of better test performance and shorter test time. The full potential of CR measurements to predict audiometric thresholds may require further improvements in signal-processing methods to increase its signal to noise ratio. CR measurements have theoretical significance in revealing the number of cycles of delay at each frequency that is most sensitive to hearing loss. ACKNOWLEDGMENTS: Assistance with the calibration software provided by Matthew Waid is gratefully acknowledged. This research was supported by grants R01 DC008318 and P30 DC004662 from the National Institute of Health The authors have no conflicts of interest to disclose. Received March 27, 2018; accepted September 18, 2018. Address for correspondence: Stephen T. Neely, Center for Hearing Research, Boys Town National Research Hospital, 555 N 30th St. Omaha, NE 68131, USA. E-mail: Stephen.Neely@boystown.org Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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“Pseudo” T1-weighted appearance of the brain on FLAIR: unmasking the extent of gray matter involvement on susceptibility-weighted imaging in chronic toluene abuse

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“Pseudo” T1-weighted appearance of the brain on FLAIR: unmasking the extent of gray matter involvement on susceptibility-weighted imaging in chronic toluene abuse

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Dual-energy computed tomography for prediction of loco-regional recurrence after radiotherapy in larynx and ...

Dual-energy computed tomography for prediction of loco-regional recurrence after radiotherapy in larynx and ...  MD LinxFull coverage

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Hepcidin mediated iron homeostasis as immune regulator in visceral leishmaniasis patients

ConclusionThe iron homeostasis by hepcidin can serves as one of the crucial determinants for regulating immune cell signaling therefore, targeting iron metabolism, specifically hepcidin alone or in combination with agonists can serve to clear infection.This article is protected by copyright. All rights reserved. (Source: Parasite Immunology)

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Dual-energy computed tomography for prediction of loco-regional recurrence after radiotherapy in larynx and ...

Dual-energy computed tomography for prediction of loco-regional recurrence after radiotherapy in larynx and ...  MD LinxFull coverage

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Hepcidin mediated iron homeostasis as immune regulator in visceral leishmaniasis patients

ConclusionThe iron homeostasis by hepcidin can serves as one of the crucial determinants for regulating immune cell signaling therefore, targeting iron metabolism, specifically hepcidin alone or in combination with agonists can serve to clear infection.This article is protected by copyright. All rights reserved. (Source: Parasite Immunology)

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Perioperative Considerations and Positioning for Neurosurgical Procedures: A Clinical Guide

No abstract available

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Comparison of Invasive and Noninvasive Blood Pressure Measurements for Assessing Signal Complexity and Surgical Risk in Cardiac Surgical Patients

BACKGROUND: Continuous arterial blood pressure (ABP) is typically recorded by placement of an intraarterial catheter. Recently, noninvasive ABP monitors have been shown to be comparable in accuracy to invasive measurements. In a previous study, we showed that the fluctuations in beat-to-beat ABP measurements were not random variations but had a complex dynamical structure, and that ABP dynamical complexity was inversely associated with surgical risk estimated using the Society of Thoracic Surgeons (STS) index. Dynamical complexity is a mathematical construct that reflects the capacity of a physiological system to adapt to stimuli. The objectives of present study were to: (1) determine whether noninvasive beat-to-beat ABP measurements also exhibit a complex temporal structure; (2) compare the complexity of noninvasive versus invasive ABP time series; and (3) quantify the relationship between the complexity of noninvasive ABP time series and the STS risk scores. METHODS: Fifteen adult patients undergoing coronary artery bypass graft, valve, or combined coronary artery bypass graft/valve surgery ;were enrolled in this observational study. Preoperative ABP waveforms were simultaneously recorded for ≥15 minutes using a radial artery catheter (invasive) and a continuous noninvasive arterial pressure monitor. Beat-to-beat systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP) time series were extracted from the continuous waveforms. Complexity was assessed using the multiscale entropy method. The Wilcoxon signed-rank test was used to compare the mean ranks of indices derived from invasive versus noninvasive ABP time series. Spearman correlation coefficients were used to quantify the relationship between invasive and noninvasive indices. Linear regression analysis was used to quantify the association between each of the complexity indices and the STS risk scores. RESULTS: Beat-to-beat fluctuations in noninvasive ABP measurements were not random but complex; however, their degree of complexity was lower than that of fluctuations in invasively obtained ABP signals (SBP: 7.05 vs 8.66, P

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In Response

No abstract available

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Drug Diversion in the Anesthesia Profession: How Can Anesthesia Patient Safety Foundation Help Everyone Be Safe? Report of a Meeting Sponsored by the Anesthesia Patient Safety Foundation

No abstract available

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Syringocystadenoma Papilliferum of the Anogenital Area and Buttocks: A Report of 16 Cases, Including Human Papillomavirus Analysis and HRAS and BRAF V600 Mutation Studies

Abstract: Syringocystadenoma papilliferum (SCAP) is a benign tumor most commonly located on the head and neck area often associated with nevus sebaceus. In its usual location, the human papillomavirus (HPV) DNA and mutations in the RAS/mitogen-activated protein kinase signaling pathway have been detected in SCAP. We studied 16 cases of SCAP in the anogenital areas and buttock where this neoplasm is rare and attempted to find out whether SCAP in these sites have different histopathological and molecular biological features. It seems that there is no significant difference between the morphology of anogenital SCAP and SCAP in other locations. Several tumors in our cohort demonstrated features resembling those seen in warts, but HPV DNA was not found in these lesions. On the contrary, we identified DNA of HPV high-risk types in some tumors without HPV-related morphology. Our study confirms the role of HRAS and BRAF V600 mutations in the pathogenesis of SCAP, including SCAP in the anogenital areas and buttock. Correspondence: Dmitry V. Kazakov, MD, PhD, Sikl's Department of Pathology, Charles University Medical Faculty Hospital, Alej Svobody 80, 304 60 Pilsen, Czech Republic (e-mail: kazakov@medima.cz). Supported in part by the Charles University Research Fund (Project number SVV-2018 - 260 391). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Examination of Tar-Induced Verrucous Growths Reveals Absence of Human Papillomavirus

No abstract available

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Neutropenic Fever and a Diffuse Hyperpigmented Papular Rash: Challenge

No abstract available

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Cytoimmunofluorescence Diagnosis in Surgically Induced Pemphigus Foliaceus

Abstract: Pemphigus foliaceus is an autoimmune bullous disease with autoantibodies against desmoglein 1. Case reports of pemphigus after surgery have also been described, which may simulate an infection of the surgical wound, a contact dermatitis, or even a tumor recurrence. Cytoimmunofluorescence can help to establish a rapid diagnosis. Correspondence: Jorge Magdaleno-Tapial, MD, Department of Dermatology, Hospital General Universitario de Valencia, Avenue Tres Creus, 2, 46014 Valencia, Spain (e-mail: jormagta@gmail.com). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Multiple Pilomatricomas: A Retrospective Study and Literature Review

Abstract: Pilomatricoma is usually a single lesion. However, some patients present with more than one, a fact that has been reported in association with several systemic diseases. The aim of this analysis is to determine the prevalence of multiple pilomatricomas (MP) in our institution as well as to describe their clinical features and associated comorbidities. This is a retrospective analysis reviewing patients with a histological diagnosis of pilomatricoma registered in the database of the Pathology Department of our institution, from January 2005 to March 2017. One hundred ninety-five patients with histological criteria for pilomatricoma were registered. Fourteen (0.7%) of those patients suffered from MP. Among them, the most relevant findings were: 9 (64%) patients were women and 5 (36%) were men. The median age at diagnosis was 16 years. Seven (50%) had 2 pilomatricomas and 7 (50%) had more than 2. Two (14%) suffered from Steinert myotonic dystrophy (SMD). Regarding family background, 3 of them had relatives with pilomatricomas, one of them with pancreatic cancer, and another one with SMD. A total of 36 pilomatricomas were excised from those 14 patients with the following characteristics: The mean lesion size was 12 mm. The majority of the lesions (53%) were located on the head and neck. There was no recurrence or malignant transformation in any patient. Articles reporting on MP are scarce. We communicate 2 new familial MP without associated comorbidities. We would like to highlight that 2 of our patients with MP also developed SMD, an association previously reported. Thus, a thorough physical examination and inquiring about family history are of utmost importance for an early diagnosis of possible associated diseases. Correspondence: Laura Mesa-Álvarez, MD, Dermatology Department, Pontevedra University Hospital, EOXI, c/Simón Bolivar (Mollabao), s/n 36003, Pontevedra, Spain (e-mail: l.mesa.alvarez@gmail.com). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Serum Concentrations of Lidocaine During Bariatric Surgery

Lidocaine has been shown to be clinically beneficial during bariatric surgery. However, information about lidocaine serum concentrations in this setting is scarce. This prospective clinical trial included 42 obese patients undergoing laparoscopic bariatric surgery. They received lidocaine based on adjusted body weight. Administration began with a 1.5 mg·kg−1 bolus of intravenous lidocaine followed by a continuous infusion of 2 mg·kg−1·hour−1. After skin closure, administration was decreased to 1 mg·kg−1·hour−1 until discharge from the recovery room. No serum concentrations of lidocaine were outside the usual accepted range (1.5–5 µg·mL−1). Accepted for publication October 3, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Clinical trial number: NCT02525016. https://ift.tt/2ST81HK. Reprints will not be available from the authors. Address correspondence to Jean-François Carabalona, MD, Département d'Anesthésie Réanimation, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, 5 place d'Arsonval, 69003, Lyon, France. Address e-mail to jeffcarabalona@gmail.com. © 2018 International Anesthesia Research Society

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In Response

No abstract available

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Drug Diversion in the Anesthesia Profession: How Can Anesthesia Patient Safety Foundation Help Everyone Be Safe? Report of a Meeting Sponsored by the Anesthesia Patient Safety Foundation

No abstract available

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Syringocystadenoma Papilliferum of the Anogenital Area and Buttocks: A Report of 16 Cases, Including Human Papillomavirus Analysis and HRAS and BRAF V600 Mutation Studies

Abstract: Syringocystadenoma papilliferum (SCAP) is a benign tumor most commonly located on the head and neck area often associated with nevus sebaceus. In its usual location, the human papillomavirus (HPV) DNA and mutations in the RAS/mitogen-activated protein kinase signaling pathway have been detected in SCAP. We studied 16 cases of SCAP in the anogenital areas and buttock where this neoplasm is rare and attempted to find out whether SCAP in these sites have different histopathological and molecular biological features. It seems that there is no significant difference between the morphology of anogenital SCAP and SCAP in other locations. Several tumors in our cohort demonstrated features resembling those seen in warts, but HPV DNA was not found in these lesions. On the contrary, we identified DNA of HPV high-risk types in some tumors without HPV-related morphology. Our study confirms the role of HRAS and BRAF V600 mutations in the pathogenesis of SCAP, including SCAP in the anogenital areas and buttock. Correspondence: Dmitry V. Kazakov, MD, PhD, Sikl's Department of Pathology, Charles University Medical Faculty Hospital, Alej Svobody 80, 304 60 Pilsen, Czech Republic (e-mail: kazakov@medima.cz). Supported in part by the Charles University Research Fund (Project number SVV-2018 - 260 391). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Neutropenic Fever and a Diffuse Hyperpigmented Papular Rash: Challenge

No abstract available

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Cytoimmunofluorescence Diagnosis in Surgically Induced Pemphigus Foliaceus

Abstract: Pemphigus foliaceus is an autoimmune bullous disease with autoantibodies against desmoglein 1. Case reports of pemphigus after surgery have also been described, which may simulate an infection of the surgical wound, a contact dermatitis, or even a tumor recurrence. Cytoimmunofluorescence can help to establish a rapid diagnosis. Correspondence: Jorge Magdaleno-Tapial, MD, Department of Dermatology, Hospital General Universitario de Valencia, Avenue Tres Creus, 2, 46014 Valencia, Spain (e-mail: jormagta@gmail.com). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Multiple Pilomatricomas: A Retrospective Study and Literature Review

Abstract: Pilomatricoma is usually a single lesion. However, some patients present with more than one, a fact that has been reported in association with several systemic diseases. The aim of this analysis is to determine the prevalence of multiple pilomatricomas (MP) in our institution as well as to describe their clinical features and associated comorbidities. This is a retrospective analysis reviewing patients with a histological diagnosis of pilomatricoma registered in the database of the Pathology Department of our institution, from January 2005 to March 2017. One hundred ninety-five patients with histological criteria for pilomatricoma were registered. Fourteen (0.7%) of those patients suffered from MP. Among them, the most relevant findings were: 9 (64%) patients were women and 5 (36%) were men. The median age at diagnosis was 16 years. Seven (50%) had 2 pilomatricomas and 7 (50%) had more than 2. Two (14%) suffered from Steinert myotonic dystrophy (SMD). Regarding family background, 3 of them had relatives with pilomatricomas, one of them with pancreatic cancer, and another one with SMD. A total of 36 pilomatricomas were excised from those 14 patients with the following characteristics: The mean lesion size was 12 mm. The majority of the lesions (53%) were located on the head and neck. There was no recurrence or malignant transformation in any patient. Articles reporting on MP are scarce. We communicate 2 new familial MP without associated comorbidities. We would like to highlight that 2 of our patients with MP also developed SMD, an association previously reported. Thus, a thorough physical examination and inquiring about family history are of utmost importance for an early diagnosis of possible associated diseases. Correspondence: Laura Mesa-Álvarez, MD, Dermatology Department, Pontevedra University Hospital, EOXI, c/Simón Bolivar (Mollabao), s/n 36003, Pontevedra, Spain (e-mail: l.mesa.alvarez@gmail.com). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Resveratrol reverses the negative effect of smoking on peri‐implant repair in the tibia of rats

Abstract

Objectives

Innovative approaches capable to improve peri‐implant bone repair are relevant in the presence of smoking, a risk factor for healing around implants. This study investigated the effect of resveratrol (RESV) on peri‐implant repair and its influence on bone‐related markers in rats submitted to cigarette smoking inhalation (CSI).

Materials and Methods

One titanium implant was inserted in each tibiae of rats assigned to: CSI+RESV(n:18); CSI+ placebo(n:18); Non‐CSI(n:18). One implant was removed for counter‐torque and the peri‐implant tissue was collected for mRNA quantification of BMP‐2, OPN, Runx2, Lrp‐5, Osx, β‐catenin, Dkk1, OPG, and RANKL. The other tibia was submitted to MicroCT to measure: bone volume, bone porosity, trabecular spacing, trabecular thickness and bone‐implant contact (BIC).

Results

No differences were detected between counter‐torque in CSI+RESV and Non‐CSI group (p>0.05), whereas CSI+placebo group presented lower values when compared to the others (p<0.05). RESV improved the BIC in CSI rats without differences when compared to non‐CSI group (p>0.05), whereas CSI+placebo showed reduced BIC when compared to the other groups (p<0.05). RESV reduced RANKL/OPG and Lrp‐5 levels and increased β‐catenin in CSI rats when compared to CSI+placebo (p<0.05).

Conclusion

Although further investigations should be considered using oral models of dental implants, within the limits of the present study, it was concluded that RESV reverses the negative effects of smoking in the peri‐implant repair, benefiting the modulation of bone‐related markers.

This article is protected by copyright. All rights reserved.

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Resveratrol reverses the negative effect of smoking on peri‐implant repair in the tibia of rats

Abstract

Objectives

Innovative approaches capable to improve peri‐implant bone repair are relevant in the presence of smoking, a risk factor for healing around implants. This study investigated the effect of resveratrol (RESV) on peri‐implant repair and its influence on bone‐related markers in rats submitted to cigarette smoking inhalation (CSI).

Materials and Methods

One titanium implant was inserted in each tibiae of rats assigned to: CSI+RESV(n:18); CSI+ placebo(n:18); Non‐CSI(n:18). One implant was removed for counter‐torque and the peri‐implant tissue was collected for mRNA quantification of BMP‐2, OPN, Runx2, Lrp‐5, Osx, β‐catenin, Dkk1, OPG, and RANKL. The other tibia was submitted to MicroCT to measure: bone volume, bone porosity, trabecular spacing, trabecular thickness and bone‐implant contact (BIC).

Results

No differences were detected between counter‐torque in CSI+RESV and Non‐CSI group (p>0.05), whereas CSI+placebo group presented lower values when compared to the others (p<0.05). RESV improved the BIC in CSI rats without differences when compared to non‐CSI group (p>0.05), whereas CSI+placebo showed reduced BIC when compared to the other groups (p<0.05). RESV reduced RANKL/OPG and Lrp‐5 levels and increased β‐catenin in CSI rats when compared to CSI+placebo (p<0.05).

Conclusion

Although further investigations should be considered using oral models of dental implants, within the limits of the present study, it was concluded that RESV reverses the negative effects of smoking in the peri‐implant repair, benefiting the modulation of bone‐related markers.

This article is protected by copyright. All rights reserved.

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The relationship between the morphological axis and the kinematic axis of the proximal radius

Abstract

Purpose

Surgical procedures for impaired forearm rotation such as for chronic radial head dislocation remain controversial. We hypothesized that the morphological axis of the proximal radius is important for stable forearm rotation, and we aimed to clarify the relationship between the morphological axis and the kinematic axis of the proximal radius using four-dimensional computed tomography (4DCT).

Methods

Ten healthy volunteers were enrolled. Four-dimensional CT of the dominant forearm during supination and pronation was obtained. The rotation axis of forearm rotation was calculated from all frames during supination and pronation. The principle axis of inertia, which represents the most stable rotation axis of a rigid body, was calculated for the proximal radius by extending its surface data incrementally by 1% from the proximal end. The angle between the kinematic rotation axis and the morphological rotation axis of each length was calculated.

Results

The rotation axis of the forearm was positioned on the radial head 0.0 mm radial and 0.4 mm posterior to the center of the radial head proximally and 2.0 mm radial and 1.2 mm volar to the fovea of the ulnar head distally. The principle axis at 15.9% of the length of the proximal radius coincided with the forearm rotation axis (kinematic axis). Individual differences were very small (SD 1.4%).

Conclusion

Forearm rotation was based on the axis at 16% of the length of the proximal radius. This portion should be aligned in cases of severe morphological deformity of the radial head that cause "rattling motion" of the radial head after reduction procedures.

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The relationship between the morphological axis and the kinematic axis of the proximal radius

Abstract

Purpose

Surgical procedures for impaired forearm rotation such as for chronic radial head dislocation remain controversial. We hypothesized that the morphological axis of the proximal radius is important for stable forearm rotation, and we aimed to clarify the relationship between the morphological axis and the kinematic axis of the proximal radius using four-dimensional computed tomography (4DCT).

Methods

Ten healthy volunteers were enrolled. Four-dimensional CT of the dominant forearm during supination and pronation was obtained. The rotation axis of forearm rotation was calculated from all frames during supination and pronation. The principle axis of inertia, which represents the most stable rotation axis of a rigid body, was calculated for the proximal radius by extending its surface data incrementally by 1% from the proximal end. The angle between the kinematic rotation axis and the morphological rotation axis of each length was calculated.

Results

The rotation axis of the forearm was positioned on the radial head 0.0 mm radial and 0.4 mm posterior to the center of the radial head proximally and 2.0 mm radial and 1.2 mm volar to the fovea of the ulnar head distally. The principle axis at 15.9% of the length of the proximal radius coincided with the forearm rotation axis (kinematic axis). Individual differences were very small (SD 1.4%).

Conclusion

Forearm rotation was based on the axis at 16% of the length of the proximal radius. This portion should be aligned in cases of severe morphological deformity of the radial head that cause "rattling motion" of the radial head after reduction procedures.

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Natural killer cells might adapt their inhibitory receptors for memory [Immunology and Inflammation]

Traditional teaching in immunology tells us that antigen-specific recall responses are the realm of adaptive immunity. However, over the past decade, there has been increasing evidence and interest in the concept of innate immune memory. Natural killer (NK) cells are the founding member of the innate lymphocyte family, initially recognized... (Source: Proceedings of the National Academy of Sciences)

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Paracrine costimulation of IFN-{gamma} signaling by integrins modulates CD8 T cell differentiation [Immunology and Inflammation]

The cytokine IFN-γ is a critical regulator of immune system development and function. Almost all leukocytes express the receptor for IFN-γ, yet each cell type elicits a different response to this cytokine. Cell type-specific effects of IFN-γ make it difficult to predict the outcomes of the systemic IFN-γ blockade and... (Source: Proceedings of the National Academy of Sciences)

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Critical role for the Ly49 family of class I MHC receptors in adaptive natural killer cell responses [Immunology and Inflammation]

Adaptive natural killer (NK) cell memory represents a new frontier in immunology. Work over the last decade has discovered and confirmed the existence of NK cells with antigen-specific memories, which had previously been considered a unique property of T and B cells. These findings have shown that antigen-specific NK cells... (Source: Proceedings of the National Academy of Sciences)

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Identification and validation of a tumor-infiltrating Treg transcriptional signature conserved across species and tumor types [Immunology and Inflammation]

FoxP3+ T regulatory (Treg) cells are central elements of immunologic tolerance. They are abundant in many tumors, where they restrict potentially favorable antitumor responses. We used a three-pronged strategy to identify genes related to the presence and function of Tregs in the tumor microenvironment. Gene expression profiles were generated from... (Source: Proceedings of the National Academy of Sciences)

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