Background: Prescription drug monitoring program are designed to reduce harms from prescription opioids; however, little is known about what populations benefit the most from these programs. We investigated how the relationship between implementation of online prescription drug monitoring programs and rates of hospitalizations related to prescription opioids and heroin overdose changed over time, and varied across county levels of poverty and unemployment, and levels of medical access to opioids. Methods: Ecologic county-level, spatiotemporal study, including 990 counties within 16 states, in 2001-2014. We modeled overdose counts using Bayesian hierarchical Poisson models. We defined medical access to opioids as the county-level rate of hospital discharges for non-cancer pain conditions. Results: In 2010-2014, online prescription drug monitoring programs were associated with lower rates of prescription opioid-related hospitalizations (rate ratio 2014 = 0.74; 95% credible interval: 0.69, 0.80). The association between online prescription drug monitoring programs and heroin-related hospitalization was also negative, but tended to increase in later years. Counties with lower rates of non-cancer pain conditions experienced a lower decrease in prescription opioid overdose, and a faster increase in heroin overdoses. No differences were observed across different county-levels of poverty and unemployment. Conclusions: Areas with lower levels of non-cancer pain conditions experienced the smallest decrease in prescription opioid overdose and the faster increase in heroin overdose following implementation of online prescription drug monitoring programs. Our results are consistent with the hypothesis that prescription drug monitoring programs are most effective in areas where people are likely to access opioids through medical providers. Funding: This study was supported by grants from the US National Institute on Drug Abuse (R01DA039962, primary investigator, Dr. Cerdá; T32DA031099, Fink). Dr. Castillo-Carniglia was supported by Becas Chile as part of the National Commission for Scientific and Technological Research (CONICYT) and a Robertson Fellowship in Violence Prevention Research. Acknowledgments: We thanks Dr. Stephen G. Henry for his contributions to this article Conflict of Interests: None. *Correspondence to: Alvaro Castillo-Carniglia, Society and Health Research Center, Facultad de Humanidades, Universidad Mayor. Badajoz 130, office 1305, Las Condes, Santiago, Chile. Phone (+56 2) 2518 9800. Email: alvacasti@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
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ΒΟΗΘΗΜΑΤΑ ΑΚΟΗΣ ΑΚΟΥΣΤΙΚΑ ΒΑΡΗΚΟΙΑΣ ΕΝΙΣΧΥΤΕΣ ΑΚΟΗΣ ΑΤΟΚΕΣ ΔΟΣΕΙΣ
ΒΟΗΘΗΜΑΤΑ ΑΚΟΗΣ ΑΚΟΥΣΤΙΚΑ ΒΑΡΗΚΟΙΑΣ ΕΝΙΣΧΥΤΕΣ ΑΚΟΗΣ ΑΤΟΚΕΣ ΔΟΣΕΙΣ
ΒΟΗΘΗΜΑΤΑ ΑΚΟΗΣ ΑΚΟΥΣΤΙΚΑ ΒΑΡΗΚΟΙΑΣ ΕΝΙΣΧΥΤΕΣ ΑΚΟΗΣ ΑΤΟΚΕΣ ΔΟΣΕΙΣ
ΒΟΗΘΗΜΑΤΑ ΑΚΟΗΣ ΑΚΟΥΣΤΙΚΑ ΒΑΡΗΚΟΙΑΣ ΕΝΙΣΧΥΤΕΣ ΑΚΟΗΣ ΑΤΟΚΕΣ ΔΟΣΕΙΣ
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Παρασκευή, 30 Νοεμβρίου 2018
The association between income and psychotropic drug purchases: individual fixed effects analysis of annual longitudinal data in 2003-2013.
Background: Previous cross-sectional studies show that low income is associated with poor mental health. However, longitudinal research has produced varying results. We assess whether low income is associated with increased psychotropic drug use after accounting for confounding by observed time-varying, and unobserved stable individual differences. Methods: The longitudinal register-based data comprises an 11% nationally representative random sample of Finnish residents aged 30-62 years between the years 2003 and 2013. The analytic sample includes 337,456 individuals (2,825,589 person–years). We estimate the association between annual income and psychotropic purchasing using ordinary-least-squares and fixed effects models, the latter controlling for all unobserved time-invariant individual characteristics. Results: The annual prevalence of psychotropic purchasing was 15%; 13% among men and 18% among women. Adjusted for age squared, sex and calendar year, the doubling of income decreased the probability of purchases by 4 percentage points (95% confidence interval: 4,4) in the ordinary-least-squares model. We observed no association after further adjusting for observed sociodemographic characteristics and unobserved individual differences in the fixed effects specification. Conclusions: Following adjustment for an extensive set of confounders, no contemporaneous association between variations in annual individual income and psychotropic drug purchasing was observed. Similar results were obtained irrespective of baseline income level and sex. The results imply that indirect selection based on pre-existing individual characteristics plays a major role in explaining the association between variations in income measured over the short term, and psychotropic drug purchases. The association appears largely attributable to unobserved, stable individual characteristics. The authors declare no conflicts of interest. Source of Funding: This work was supported by grants #1308247 and #1294861 from the Academy of Finland, #303615 from the Strategic Research Council PROMEQ project, and the Signe and Ane Gyllenberg Foundation. Due to data protection regulations of the national register-holders providing the data, we are not allowed to make the data available to third parties. Interested researchers have the possibility to obtain data access by contacting the following register-holding public institutions: Statistics Finland (https://ift.tt/2AFyFeP). Contact by email tutkijapalvelut(at)stat.fi, or by telephone +358 29 551 2220.The Social Insurance Institution of Finland (https://ift.tt/2TWIrSN). Contact by email tietopyynnot(at)kela.fi, or by telephone +358 20 634 1364. Conflict of interest: none declared Acknowledgments: Myrskylä, Mikko; for his helpful methodological comments. Corresponding author: Junna, Liina. Mailing address: Population Research Unit, Department of Social Research, Unioninkatu 37 (P.O. Box 54), 00014 University of Helsinki; Tel.: +358-44-9888 574; E-mail: liina.junna@helsinki.fi Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
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Rice consumption and incidence of bladder cancer in a United States population
No abstract available
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Psychosocial adversity in infancy and mortality rates in childhood and adolescence: A birth cohort study of 1.5 million individuals
Background: Childhood and adolescent mortality accounts for a substantial proportion of years lost prematurely. Reducing childhood and adolescent mortality relies on knowing characteristics of those at elevated risk of dying young. We therefore aimed to identify such characteristics; our main hypothesis is that psychosocial adversity in infancy is linked to increased mortality rates in childhood and adolescence. Methods: We conducted a register-based cohort study involving all 1,549,581 children born in Denmark between 1 January 1981 and 31 December 2010 to Danish-born parents. For each infant, we extracted data relevant to Rutter's indicators of adversity (low social class, parents not cohabiting, large family size, paternal criminality, maternal mental disorder, and placement in out-of-home care). Follow-up began on the cohort member's first birthday. We estimated the association between adversity score (the number of Rutter's indicators of adversity present in infancy) and death via Cox regression. Results: During follow-up (18,874,589 person–years), 2081 boys and 1420 girls died prior to or on their 18th birthday. The hazard ratios for death were 2.3 (95%CI: 1.9-2.9) and 2.1 (95%CI: 1.6-2.7) for boys and girls with adversity scores of 3-6, compared to those with a score of 0. These associations were driven by causes of death with known links to psychosocial adversity. Conclusions: While absolute mortality rates were low, infants with adversity scores of 3-6 were approximately twice as likely to die prematurely compared to infants with adversity scores of 0. Whether these associations generalize to other countries should be subjected to further study. Conflicts of interest: None declared Source of Funding: This work was supported by grants from the Lundbeck Foundation Data access: We used nationwide register-based data including personal identifiers. Our dataset contains information, which may allow for identification of individuals. Therefore, the dataset cannot be made publicly available according to Danish Law. To acquire access to the data used in this study, researchers must apply for permission at the Danish Data Protection Agency (www.datatilsynet.dk), the Danish National Board of Health (https://ift.tt/1zXYGzU) and Statistics Denmark (www.dst.dk). Only researchers affiliated with institutions approved by Statistics Denmark can access the data via their remote access system. Acknowledgments: None *Corresponding author: Søren Dinesen Østergaard, MD, PhD, Aarhus Institute of Advanced Studies, Aarhus University, Høegh-Guldbergs Gade 6B, 8000 Aarhus C, Denmark. Phone: + 45 61282753, Email: soeoes@rm.dk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
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Chronic Disease and Hearing Loss Require Customized Patient Care
No abstract availablehttps://ift.tt/2AN7U8z
Audiology Response to the FDA Reauthorization Act of 2017
No abstract availablehttps://ift.tt/2rfEmf9
Tres Hermanos Bakery Issues Allergy Alert on Undeclared Milk in Telera and Bolillo Breads
Tres Hermanos Bakery of Wyoming, MI is recalling its white Telera and Bolillo Mexican salt breads because they may contain undeclared milk. People who have allergies to milk run the risk of serious or life-threatening allergic reaction if they consume these products.
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Study on the influence of surface potential on the nitrate adsorption capacity of metal modified biochar
Abstract
Carbon materials, as effective adsorbents to numerous aqueous cationic contaminants, have been hardly applied to remove anions in wastewater. In this work, different modifying agents were used to modify corncob biochars (CC) and the surface potentials of these modified biochars were determined. Based on the findings, modification principle was determined to reveal the relationship between surface potentials of the biochars and their nitrate adsorption capacities. The surface potential was dominated by the metal cations and multivalent cations led to even positive zeta potential. The formation of metal oxide not only led to the augment in surface area but also increase the surface charge. FeCl3-modified biochar (Fe-CC) with the highest positive surface charge was utilized to remove anions (nitrate) from aqueous solutions. Characterization results confirm that Fe2O3 structure were successfully formed on biochar surface. This led to the formation of iron nitrate hydrate (Fe(NO3)3·9H2O), which enabled higher nitrate adsorption performance than that of pristine biochar. Batch experiments showed that nitrate adsorption on the Fe-CC was stable and almost independent of experimental pH and temperature. Based on the Langmuir model results, the maximum nitrate adsorption capacity of Fe-CC was 32.33 mg/g. Coexisting anions had negative influence on the adsorption performance. Findings of this work suggest that the modified biochar can be used in wastewater treatment to remove anions such as nitrate.
Graphic abstract
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Correction to: Analysis of swale factors implicated in pollutant removal efficiency using a swale database
The original publication of this paper contains an error. Correct presentation of Equation 1 is presented in this paper.
https://ift.tt/2ADPxml
Organ Preservation Protocols in T4 Laryngeal Cancer: a Review of the Literature
Abstract
Population-based studies indicate that chemoradiation has become the most popular treatment for advanced laryngeal cancers; however, by extrapolating trial results to the general population, several issues have emerged, such as reduced overall survival, non-functional laryngeal preservation, and poor response to treatment. Although included in these trials, T4 laryngeal and hypopharyngeal cancers with cartilage invasion formed a small percentage of these patients and questions over whether they were appropriately staged remain unanswered. Literature on the use of chemoradiation in this set of patients, including the challenges, treatment considerations, and factors predicting response to treatment and outcomes, was reviewed. Current evidence indicates that all patients of T4 laryngeal and hypopharyngeal cancer are not suitable candidates for organ preservation; this modality should be offered only to select patients with good performance status and access to rehabilitative care and regular follow-up in order to achieve good results.
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Levothyroxine Replacement Therapy and Overuse: A Timely Diagnostic Approach
Thyroid, Ahead of Print.
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Levothyroxine Replacement Therapy and Overuse: A Timely Diagnostic Approach
Thyroid, Ahead of Print.
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Correction to: Anti-Müllerian hormone serum levels in systemic lupus erythematosus patients: influence of the disease severity and therapy on the ovarian reserve
The original version of this article unfortunately contained a mistake in given and family names of all the authors.
https://ift.tt/2RrzO0G
Split-mouth evaluation of connective tissue graft with or without enamel matrix derivative for the treatment of isolated gingival recession defects in dogs
Abstract
Objectives
The potential additive effect of an enamel matrix derivative (EMD) to a subepithelial connective tissue graft (CTG) for recession coverage is still controversially discussed. Therefore, the aim of this study was to histologically evaluate the healing of gingival recessions treated with coronally advanced flap (CAF) and CTG with or without EMD in dogs.
Materials and methods
Gingival recession defects (5 mm wide and 7 mm deep) were surgically created on the labial side of bilateral maxillary canines in 7 dogs. After 8 weeks of plaque accumulation and subsequent 2 weeks of chemical plaque control, the 14 chronic defects were randomized to receive either CAF with CTG (CAF/CTG) or CAF with CTG and EMD (CAF/CTG/EMD). The animals were sacrificed 10 weeks after reconstructive surgery for histologic evaluation.
Results
Treatment with CAF/CTG/EMD demonstrated statistically significantly better results in terms of probing pocket depth reduction (P < 0.05) and clinical attachment level gain (P < 0.001). The length of the epithelium was statistically significantly shorter in the CAF/CTG/EMD group than in the CAF/CTG group (1.00 ± 0.75 mm vs. 2.38 ± 1.48 mm, respectively, P < 0.01). Cementum formation was statistically significantly greater in the CAF/CTG/EMD group than following treatment with the CAF/CTG group (3.20 ± 0.89 mm vs. 1.88 ± 1.58 mm, respectively, P < 0.01). The CAF/CTG/EMD group showed statistically significantly greater complete periodontal regeneration (i.e., new cementum, new periodontal ligament, and new bone) than treatment with CAF/CTG (0.54 ± 0.73 mm vs. 0.07 ± 0.27 mm, respectively, P < 0.05).
Conclusion
Within their limits, the present findings indicate that the additional use of EMD in conjunction with CAF + CTG favors periodontal regeneration in gingival recession defects.
Clinical relevance
The present findings support the use of EMD combined with CTG and CAF for promoting periodontal regeneration in isolated gingival recession defects.
https://ift.tt/2E9eZV5
Correction to: Anti-Müllerian hormone serum levels in systemic lupus erythematosus patients: influence of the disease severity and therapy on the ovarian reserve
The original version of this article unfortunately contained a mistake in given and family names of all the authors.
https://ift.tt/2RrzO0G
Esthetic and functional rehabilitation of bilateral congenital absence of maxillary lateral incisors: Minimally invasive surgical and prosthetic approach
Abstract
Objective
Congenital absence of maxillary lateral incisors is a frequent clinical challenge which must be solved by a multidisciplinary approach in order to obtain an esthetic and functional restorative treatment. Noninvasive treatments, that are in accordance with the patients' expectations, should be the first therapeutic alternative. If the deciduous tooth is present, minimally invasive dental extraction followed by immediate dental implant placement and provisional restoration is indicated. In this restorative treatment, an adequate emergency profile can be achieved by peri‐implant soft‐tissue‐conditioning techniques. Moreover, the association of restorative materials, such as composite resins and dental ceramics, provides more predictable esthetic results.
Clinical Considerations
The present case report presents a rehabilitation of bilateral congenital absence of maxillary lateral incisors through a multidisciplinary approach. Dental implants, long‐term provisional restoration, tooth bleaching, minimally veneered high‐translucent monolithic zirconia crowns, feldspathic veneers, and composite restorations were used by the dental team to achieve the expected functional and esthetic outcomes.
Conclusions
Different treatment modalities are available for the rehabilitation of congenital absence of teeth. However, it is important that a dental team consider performing minimally invasive treatments, as many of these treatments are done on young patients.
Clinical Significance
Patient‐centered treatments involving minimally invasive approaches in a multidisciplinary environment would be appropriate in order to achieve predictable results.
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Comment on “Transitioning From Commission on Dental Accreditation to Accreditation Council for Graduate Medical Education Standards of Academic Productivity: A New Paradigm”
I read with great excitement the recent "Perspectives" article by Jazayeri and Chuang,1 "Transitioning From Commission on Dental Accreditation to Accreditation Council for Graduate Medical Education Standards of Academic Productivity: A New Paradigm." I have shared this same ideology since being a resident myself, when I struggled to find a research mentor. There was no emphasis on research by my clinical faculty, and given the mere half page of importance placed on research and academic productivity by the Commission on Dental Accreditation (CODA), it is not hard to see why.
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Split-mouth evaluation of connective tissue graft with or without enamel matrix derivative for the treatment of isolated gingival recession defects in dogs
Abstract
Objectives
The potential additive effect of an enamel matrix derivative (EMD) to a subepithelial connective tissue graft (CTG) for recession coverage is still controversially discussed. Therefore, the aim of this study was to histologically evaluate the healing of gingival recessions treated with coronally advanced flap (CAF) and CTG with or without EMD in dogs.
Materials and methods
Gingival recession defects (5 mm wide and 7 mm deep) were surgically created on the labial side of bilateral maxillary canines in 7 dogs. After 8 weeks of plaque accumulation and subsequent 2 weeks of chemical plaque control, the 14 chronic defects were randomized to receive either CAF with CTG (CAF/CTG) or CAF with CTG and EMD (CAF/CTG/EMD). The animals were sacrificed 10 weeks after reconstructive surgery for histologic evaluation.
Results
Treatment with CAF/CTG/EMD demonstrated statistically significantly better results in terms of probing pocket depth reduction (P < 0.05) and clinical attachment level gain (P < 0.001). The length of the epithelium was statistically significantly shorter in the CAF/CTG/EMD group than in the CAF/CTG group (1.00 ± 0.75 mm vs. 2.38 ± 1.48 mm, respectively, P < 0.01). Cementum formation was statistically significantly greater in the CAF/CTG/EMD group than following treatment with the CAF/CTG group (3.20 ± 0.89 mm vs. 1.88 ± 1.58 mm, respectively, P < 0.01). The CAF/CTG/EMD group showed statistically significantly greater complete periodontal regeneration (i.e., new cementum, new periodontal ligament, and new bone) than treatment with CAF/CTG (0.54 ± 0.73 mm vs. 0.07 ± 0.27 mm, respectively, P < 0.05).
Conclusion
Within their limits, the present findings indicate that the additional use of EMD in conjunction with CAF + CTG favors periodontal regeneration in gingival recession defects.
Clinical relevance
The present findings support the use of EMD combined with CTG and CAF for promoting periodontal regeneration in isolated gingival recession defects.
https://ift.tt/2E9eZV5
Split-mouth evaluation of connective tissue graft with or without enamel matrix derivative for the treatment of isolated gingival recession defects in dogs
Abstract
Objectives
The potential additive effect of an enamel matrix derivative (EMD) to a subepithelial connective tissue graft (CTG) for recession coverage is still controversially discussed. Therefore, the aim of this study was to histologically evaluate the healing of gingival recessions treated with coronally advanced flap (CAF) and CTG with or without EMD in dogs.
Materials and methods
Gingival recession defects (5 mm wide and 7 mm deep) were surgically created on the labial side of bilateral maxillary canines in 7 dogs. After 8 weeks of plaque accumulation and subsequent 2 weeks of chemical plaque control, the 14 chronic defects were randomized to receive either CAF with CTG (CAF/CTG) or CAF with CTG and EMD (CAF/CTG/EMD). The animals were sacrificed 10 weeks after reconstructive surgery for histologic evaluation.
Results
Treatment with CAF/CTG/EMD demonstrated statistically significantly better results in terms of probing pocket depth reduction (P < 0.05) and clinical attachment level gain (P < 0.001). The length of the epithelium was statistically significantly shorter in the CAF/CTG/EMD group than in the CAF/CTG group (1.00 ± 0.75 mm vs. 2.38 ± 1.48 mm, respectively, P < 0.01). Cementum formation was statistically significantly greater in the CAF/CTG/EMD group than following treatment with the CAF/CTG group (3.20 ± 0.89 mm vs. 1.88 ± 1.58 mm, respectively, P < 0.01). The CAF/CTG/EMD group showed statistically significantly greater complete periodontal regeneration (i.e., new cementum, new periodontal ligament, and new bone) than treatment with CAF/CTG (0.54 ± 0.73 mm vs. 0.07 ± 0.27 mm, respectively, P < 0.05).
Conclusion
Within their limits, the present findings indicate that the additional use of EMD in conjunction with CAF + CTG favors periodontal regeneration in gingival recession defects.
Clinical relevance
The present findings support the use of EMD combined with CTG and CAF for promoting periodontal regeneration in isolated gingival recession defects.
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The South Asian Facial Anthropometric Profile: A Systematic Review
Craniofacial anatomy, as measured by facial anthropometric data, varies significantly between races. South Asia, comprised of eight countries, represents a large proportion of the global population and is the fastest-growing region of the world. This systematic review presents the facial anthropometric data collected for populations from this region.
https://ift.tt/2rbAk7C
Semiautomatic device for in vitro/ experimental bone perforation in dental implant research
The present study presents a semiautomatic device developed to perform in vitro experiments using surgical drills for assisting dental implant research. It was built to perform tests independent of human direct contact, and contains an adjustable toolholder for engaging different types of implant contra angle hand pieces, in which different drills can be adapted. The researcher is able to make a range of adjustments on the machine, such as controlling the drilling force and depth.
https://ift.tt/2FZGDpg
The South Asian Facial Anthropometric Profile: A Systematic Review
Craniofacial anatomy, as measured by facial anthropometric data, varies significantly between races. South Asia, comprised of eight countries, represents a large proportion of the global population and is the fastest-growing region of the world. This systematic review presents the facial anthropometric data collected for populations from this region.
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Semiautomatic device for in vitro/ experimental bone perforation in dental implant research
The present study presents a semiautomatic device developed to perform in vitro experiments using surgical drills for assisting dental implant research. It was built to perform tests independent of human direct contact, and contains an adjustable toolholder for engaging different types of implant contra angle hand pieces, in which different drills can be adapted. The researcher is able to make a range of adjustments on the machine, such as controlling the drilling force and depth.
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Distinct transcriptomic profiles of early-onset atopic dermatitis in blood and skin of pediatric patients
Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. The pipeline of novel targeted treatments for AD is expanding, largely based on our growing knowledge of disease mechanisms, with new therapeutics particularly focused on immune modulation.1 Most of our understanding of AD is derived from profiling tissues and blood of longstanding AD in adults, due to the difficulty of obtaining samples from infants and young children. However, initiation of AD typically happens very early in life, and the disease is already chronically established in the majority of patients by 5yrs of age.
https://ift.tt/2KKrFC9
Neutrophil to lymphocyte ratio is a novel independent predictor of severe exacerbation in asthma patients
Severe exacerbations are well-known complications of asthma, which increase the total and asthma-related health care costs1 and decrease the quality of life of patients2. Although some exacerbation predictors have been reported3,4, it is difficult to predict and prevent severe exacerbations in a large percentage of patients affected by asthma.
https://ift.tt/2BI6IVo
SERPING1 mutation in a rare hereditary angioedema with skin blisters
Hereditary Angioedema (HAE) is a rare, autosomal dominant disease characterized clinically by recurrent episodes of edema that may affect the skin and internal organs. The pathophysiological background of HAE is primarily an increased vascular permeability reaction to a local overproduction of bradykinin1. The most frequent dermatological manifestation is angioedema, which may occur on any part of the body and erythema marginatum is sometimes seen as symptomatic of the onset of an attack. The formation of blisters, described by some authors2-5, is an infrequent cutaneous manifestation of HAE.
https://ift.tt/2FNCd4B
Multiple calcifying hyperplastic dental follicles: a case report
Multiple calcifying hyperplastic dental follicles (MCHDF) is a rare condition of calcification in follicles of multiple impacted teeth. Radiologically it appears as multiple pericoronal radiolucencies with radiopaque foci. This report presents a case of MCHDF in a 22-year-old male.
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Buccinator and Mandibular Node Metastases in Oral Squamous Cell Carcinoma
The buccinator and mandibular nodes both belong to the facial lymph node group, and metastasis of oral cancer to these nodes is extremely rare. The purpose of this study was to indicate the particular rare metastasis cases wherein we administered treatment for the buccinator or mandibular nodes.
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Commentary: Propofol Versus Remifentanil: Which One Is More Effective in Reducing Blood Loss During Orthognathic Surgery? A Randomized Clinical Trial
We recently read the article by Eshghpour et al., "Propofol versus Remifentanil: Which One is More Effective in Reducing Blood Loss During Orthognathic Surgery? A Randomized Clinical Trial."1 As a center that performs a high volume of orthognathic surgical procedures annually, we were very interested in this work as it purports to present high-level evidence for minimizing blood loss during these operations. However, upon critically evaluating the work, we identified several issues that may preclude acceptance of the authors' stated conclusions.
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Industry payments in oral and maxillofacial surgery: a review of 112,478 payments from a national disclosure program
The purpose of this study was to characterize the sources, amounts, and nature of general industry payments to oral and maxillofacial surgeons (OMSs).
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Foreign bodies in the ear, nose, and throat in Japan: association with sociocultural and geographical conditions
Foreign bodies (FBs) in ear, nose, and throat (ENT) are common ENT emergencies but are sometimes life-threatening. However, FBs could be avoidable by the efficient announcement about the risk of these occurrence to the public. Fish bones are commonly found as throat FBs, and small toys are commonly found as pediatric ear and nose FBs. We hypothesized that there were relationships between the occurrence of FBs and sociocultural/geographical conditions. The purpose of this study is to clarify the risk factors of FBs in ENT regions related to eating customs and weather conditions.
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Foreign bodies in the ear, nose, and throat in Japan: association with sociocultural and geographical conditions
Foreign bodies (FBs) in ear, nose, and throat (ENT) are common ENT emergencies but are sometimes life-threatening. However, FBs could be avoidable by the efficient announcement about the risk of these occurrence to the public. Fish bones are commonly found as throat FBs, and small toys are commonly found as pediatric ear and nose FBs. We hypothesized that there were relationships between the occurrence of FBs and sociocultural/geographical conditions. The purpose of this study is to clarify the risk factors of FBs in ENT regions related to eating customs and weather conditions.
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LC3A, LC3B and Beclin-1 Expression in Gastric Cancer
Background: The current study examined the key proteins involved in autophagosome formation and their prognostic role in gastric cancer. Materials and Methods: Paraffin-embedded tissues from 121 consecutive patients treated with surgery for gastric cancer were analyzed immunohistochemically for the expression of autophagic proteins microtubule-associated proteins 1A/1B light chain 3A and 3B (LC3A, LC3B) and beclin-1 (encoded by BECN1 gene). Assessment of proliferative index using E3 ubiquitin-protein ligase (MIB1) and correlations with histopathological parameters and overall survival were performed. Results: Strong cytoplasmic expression was noted for all studied proteins, although to a varying proportion, the median percentage being 30% for LC3A, and 40% for LC3B and beclin-1. The median score of LC3A+ stone-like structures (SLS) was 0.2 (range 0-1) and the median proliferative index was 30% (range=0-95%). A significant association between LC3A, LC3B and beclin-1 expression was confirmed (p<0.01). SLS score was higher in tumors of the gastro-esophageal junction (p=0.009), and beclin-1 was overexpressed in intestinal-type tumors (p=0.001). High SLS score (p=0.008) was significantly related to poor prognosis, and this finding persisted in multivariate analysis (hazard ratio(HR)=2.01, p=0.003). Conclusion: Intense autophagic activity, as assessed by LC3A immunostaining and SLS quantification, is a strong prognostic marker in gastric cancer and can be useful for clinical application.
https://ift.tt/2FRD18G
Efficacy of Enteral Access in Patients with Esophageal Squamous Cell Carcinoma Under Neoadjuvant Therapy
Background: Enteral feeding tubes used to manage the nutritional status of esophageal cancer were evaluated regarding their effectiveness in patients receiving neoadjuvant therapy. Patients and Methods: A retrospective study evaluating patients with esophageal squamous cell carcinoma undergoing neoadjuvant therapy between 2001 and 2014 was conducted at a medical center. Hospital patients' records for enteral access (EA) insertion and treatment outcomes were statistically analyzed. Results: Patients with EA at initial diagnosis had lower body mass index than the group without EA (p=0.012). Chemotherapy-related adverse events with grade 3-4 mucositis were significantly less frequent in the EA group (p=0.008), and grade 3-4 anemia was significantly more frequent (p=0.012). The 4-year mortality rate was 63.0% in the EA group and 67.7% in the group without EA (pnon-inferiority=0.035), which met the non-inferiority criterion with a non-inferiority margin of 10%. Conclusion: Patients with esophageal squamous cell carcinoma with malnutrition status undergoing neoadjuvant therapy with EA showed an improved outcome at maintaining nutritional status, reduced severity of mucositis and improved survival rate.
https://ift.tt/2rd7LH3
Application of Artificial Intelligence-based Technology in Cancer Management: A Commentary on the Deployment of Artificial Neural Networks
Artificial intelligence was recognised many years ago as a potential and powerful tool to predict disease outcome in many clinical situations. The conventional approaches using statistical methods have provided much information, but are subject to limitations imposed by the complexity of medical data. The structures of the important variants of the machine learning system artificial neural networks (ANN) are discussed and emphasis is given to the powerful analytical support that could be provided by ANN for the prediction of cancer progression and prognosis. The predictive ability of the cellular markers, DNA ploidy and cell-cycle profiles, and molecular markers, such as tumour promoter and suppressor gene, and growth factor and steroid hormone receptors in breast cancer management were also analysed. ANN systems have been successfully deployed to evaluate microRNA profiles of tumours which saliently sway cancer progression and prognosis of the disease, thus counteracting the negative implications of their numerical abundance. Finally, in this setting, the prospective technical improvements in artificial neural networks, as hybrid systems in combination with fuzzy logic and artificial immune networks were also addressed.
https://ift.tt/2FLXU4W
Prognostic Significance of Survivin Expression and Combined Analysis with Cancer Stem Cell and Epithelial-Mesenchymal Transition-related Markers in Patients with Rectal Cancer Undergoing Preoperative Chemoradiotherapy
Aim: To identify the candidate marker predicting treatment response and survival outcome in rectal cancer patients who received preoperative chemoradiotherapy (CRT). Patients and Methods: Between 2000 and 2015, 159 patients with histologically-confirmed rectal adenocarcinoma underwent preoperative CRT followed by surgery. Among them, 70 patients were enrolled and the expression of survivin, cancer stem cell markers (CD44 and CD133) and epithelial–mesenchymal transition markers (E-cadherin and TWIST1) in pretreatment biopsy specimens were evaluated by immunohistochemistry. Associations between the expression of markers and clinical outcomes were evaluated. Results: The median follow-up period of all patients was 71 (range=15-203) months. Five-year overall (OS), disease-free (DFS), locoregional recurrence-free (LRRFS) and distant metastasis-free (DMFS) survival were 80.5%, 60.2% 90.1% and 76.5%, respectively. A significant association between survivin overexpression and worse treatment outcome was shown on univariate analyses for OS, DFS and DMFS (p=0.022, 0.002, and 0.005, respectively). On multivariate analysis, survivin overexpression was an adverse prognosticator for DFS and DMFS (p=0.007 and 0.015, respectively), with a borderline significant trend towards a shorter OS (p=0.069). Four other single biomarkers were not associated with survival outcomes. However, overexpression of both survivin and CD44 was significantly associated with worse OS on multivariate analysis (p=0.003). Conclusion: Survivin combined with CD44 might be a candidate biomarker for the prediction of recurrence and survival in patients who received preoperative CRT for rectal cancer. Further research with a larger population is needed to validate these results.
https://ift.tt/2reV3aQ
Does Transdermal Testosterone Increase the Risk of Developing Breast Cancer? A Systematic Review
Background/Aim: Hypoactive sexual desire disorder (HSDD) is hypothesised to manifest in postmenopausal women at onset of menopause due to decreased oestrogen levels. Transdermal testosterone is a potential treatment option. This systematic review explores the relationship between the incidence of breast cancer and transdermal testosterone use. Materials and Methods: Searches were conducted on the PubMed and Ovid databases. In Ovid, the advanced search function was used: 'transdermal testosterone not male'. In PubMed, the following search terms were used: 'transdermal, testosterone, menopausal, women, breast cancer, women'. Abstracts that fitted our initial criteria were further investigated. Results: A total of 25 publications from PubMed and 192 publications from Ovid were initially assessed. Three randomised control trials were judged to have sufficiently met our inclusion criteria. However, these trials were too heterogeneous for a meta-analysis. A systematic review was deemed the most appropriate analysis of the data available. Conclusion: The publications examined in this systematic review suggest that the use of transdermal testosterone to treat HSDD in postmenopausal women does not increase breast cancer incidence. However, further research in the form of adequately powered randomised controlled trials with breast cancer incidence being the primary end point is required in order to confirm this.
https://ift.tt/2G31oQX
Chemotherapy in Patients with Hereditary Angioedema
Background: Hereditary angioedema (HAE) is an autosomal dominant hereditary disorder characterized by episodic swelling of many body regions (especially throat and abdomen), potentially triggered by medication. No data are available for HAE in patients with cancer assigned to standard chemotherapy. The aim of our study was to identify circulating mediators potentially predictive of acute HAE attacks during chemotherapy. Patient and Methods: Repeated blood testing (approximately every week) for complement system members (C3, C4, CH50, C1 inhibitor, C1-inhibitor functional C1Q), D-dimers and for routine haematochemistry were performed in a 42-year-old male affected by type 2 HAE during standard adjuvant oxaliplatin/fluorouracil-based chemotherapy administered for stage III radically resected rectal cancer. Pre-medication with 1,000 U Berinert inhibitor C1 was administered every week throughout treatment. Mann–Whitney U-test was used to determine statistical differences in measures between the first 30 days of therapy and beyond day 30 of therapy. Results: Pre-chemotherapy values of tested variables (day 0) were: C3: 101 mg/dl, C4: 5.71 mg/dl, CH50: 74%, C1 inhibitor: 43.4 mg/dl, C1-inhibitor functional: 18%, C1Q: 150 mg/dl, and D-dimers: 113 g/ml. A significant change in circulating values was observed for C3, D-dimers and C1-inhibitor functional. Four HAE attacks were observed, they started from the forth cycle of treatment and all were manageable. Changes in C3, D-dimers and C1-inhibitor functional preceded the attacks. Conclusion: The stress induced by chemotherapy such a standard oxaliplatin/fluorouracil increases the risk of attacks in patients with HAE. However, circulating biomarkers such as D-dimers, C3 and C1-inhibitor functional may serve as early predictors of acute HAE crisis.
https://ift.tt/2rd7y6J
Potent Antitumor T-Cell Memory Is Generated by Curative Viral Oncolytic Immunotherapy But Not Curative Chemotherapy
Background: Late developing breast cancer metastases are common and lethal despite treatment with adjuvant chemotherapy at the time of primary tumor excision. Stimulation of an antitumor immune response is an alternative strategy for preventing this devastating development. Materials and Methods: A mouse model of the human epidermal growth factor receptor 2 (HER2/neu)-positive mammary cancer was used to compare the antitumor memory T-cell response following tumor cure by viral oncolytic immunotherapy, chemotherapy, surgical excision, or surgical excision plus virus infection. Memory T-cell response was assessed by functional in vivo assays. Results: Antitumor T-cell memory was generated most powerfully by curative viral oncolytic immunotherapy and poorly by curative chemotherapy. Cure by surgical excision generated an immune antitumor response which was increased by neo-adjuvant virus infection. CD4 memory T-cells were most potent. Conclusion: Virus infection of tumor generates an antitumor memory immune response and chemotherapy suppresses this response. Clinical trials testing adjuvant immune stimulation instead of chemotherapy may be worth exploring because memory antitumor T-cells have the unique potential to find and eliminate small nests of metastatic cancer cells in sanctuary sites and prevent emergence of tumors from dormant cancer cells.
https://ift.tt/2FNSpCQ
Prognostic Significance of 14-3-3{varepsilon}, Aldo-keto Reductase Family 1 B10 and Metallothionein-1 in Hepatocellular Carcinoma
Background/Aim: Expression of 14-3-3 is associated with prognostic outcomes of hepatocellular carcinoma (HCC) patients. Metallothionein-1 (MT-1) proteins and aldo-keto-reductase family 1 B10 (AKR1B10) are considered potential tumor regulators of HCC. The aim of this study, was to examine the prognostic value of 14-3-3, MT-1 and AKR1B10 expression in HCC. Materials and Methods: The expression levels of 14-3-3, MT-1 and AKR1B10 in HCC cell lines and paraffin-embedded tissues were examined by western blotting and immunohistochemical analysis. Results: 14-3-3 positivity was significantly associated with decreased MT-1 expression in HCC. Patients with decreased MT-1 expression had worse survival rates and a higher risk of metastasis than 14-3-3-positive HCC patients with unchanged MT-1 expression. Distinct expression patterns of 14-3-3/MT-1/AKR1B10 were significantly associated with the metastatic incidence and survival rates of HCC patients. Patients with negative 14-3-3 staining in primary tumors had better prognostic outcomes. In contrast, patients with positive 14-3-3 staining, decreased MT-1 expression and no increase in AKR1B10 expression in primary tumors had the worst overall and disease-free survival rates and the highest metastatic risk. Conclusion: 14-3-3, AKR1B10, and MT-1 act as potential prognostic biomarkers of HCC.
https://ift.tt/2rmQ6wJ
Cytolytic Activity (CYT) Score Is a Prognostic Biomarker Reflecting Host Immune Status in Hepatocellular Carcinoma (HCC)
Background/Aim: The cytolytic activity (CYT) score is a new index of cancer immunity calculated from the mRNA expression levels of GZMA and PRF1. We assessed the clinical significance of the CYT score in HCC. Materials and Methods: The calculated CYT scores of peripheral blood cells (GSE24759), cell lines (CCLE) and HCC tissues (TCGA, GSE14520 and Kyushu cohorts) were assessed. Then, immunohistochemical analysis (IHC) of GZMA and PRF1 was performed. Results: The CYT scores of HCC tissues were lower than those of non-cancerous tissues. The 5-year recurrence-free survival of patients with low CYT scores was significantly shorter than that of patients with high CYT scores. Multivariate analysis indicated that the CYT score was an independent prognostic factor for RFS in TCGA and GSE14520 cohorts. Conclusion: CYT score could be a useful prognostic biomarker in HCC, possibly through reflecting the host immune status.
https://ift.tt/2FLXOu6
A Phase II Study of Tri-weekly Low-dose Nab-paclitaxel Chemotherapy for Patients with Advanced Gastric Cancer
Background/Aim: Nanoparticle albumin-bound (nab)-paclitaxel has demonstrated antitumor activity against advanced gastric cancer. However, gastric cancer patients can be difficult to treat with the recommended dose because of the high incidence of adverse toxicities. The aim of this study was to evaluate the safety and effectiveness of low-dose nab-paclitaxel in a multicenter, single-arm, phase II study. Patients and Methods: Treatment included low doses of 180 mg/m2 nab-paclitaxel administered on day 1 of each 21-day cycle. The primary endpoint was defined as the overall response rate (ORR). The secondary endpoints included progression-free survival (PFS), safety, and overall survival (OS). A total of 34 patients were enrolled in the full-analysis set. Results: The ORR was 5.9%. The median PFS and OS were 2.4 months and 9.2 months, respectively. The most common grade 3/4 toxicities were anemia (8.8%), neutropenia (5.9%), appetite loss (5.9%) and peripheral sensory neuropathy (5.9%). No treatment-related deaths occurred. Conclusion: The tri-weekly low dose of nab-paclitaxel therapy is effective towards advanced gastric cancer patients with good tolerability and an acceptable margin of safety.
https://ift.tt/2rmQ1sV
Evaluation of the Usefulness of FDG-PET/CT for Nodal Staging of Breast Cancer
Background/Aim: Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) has recently been used to investigate lymph node (LN) metastases and several predictive features in patients with breast cancer (BC). The aim of this study was to assess the value of this non-invasive imaging procedure for axillary staging. Patients and Methods: Fifty patients with early primary unilateral, locally advanced, or recurrent invasive operable BC were enrolled. All patients underwent preoperative 18F-FDG PET/CT, and the results were compared with the histopathology of dissected axillary LNs and their biological and immunohistochemical characteristics. The diagnostic performance of 18F-FDG PET/CT in detecting LN metastases from primary or recurrent BC was analyzed. The mean values of the initial PET/CT parameters, including the primary tumour (SUV T) and ipsilateral axillary LNs (SUV LN), were compared with the clinicopathological features of patients to determine their usefulness for predicting clinical interactions. Results: The sensitivity, specificity, overall accuracy, positive predictive value, and negative predictive value of 18F-FDG PET/CT for axillary LN staging were 87%, 90%, 88%, 93%, and 82%, respectively. Bivariate analyses showed strong interactions of nuclear grade (p=0.05), progesterone receptor expression (p=0.001), Ki-67 index (0.027), and local relapse with the SUV T. A high SUV LN value was significantly correlated with a higher nuclear grade score (p=0.05), oestrogen receptor negativity (p=0.001), progesterone receptor negativity (p=0.014), a high Ki-67 index (>20%; p=0.048), LN metastasis (p<0.001), a basal tumour (p=0.04), and locoregional recurrence (p<0.001). Conclusion: PET/CT is a reproducible, non-invasive imaging modality that is useful for evaluating a primary BC mass and its relationship with metastatic axillary LNs, thereby predicting tumour behaviour and guiding clinical practice.
https://ift.tt/2G31mZl
Targeted Therapies for Pancreatic Cancer and Hurdles Ahead
Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive and lethal cancers with a median survival of 6 months after diagnosis. Intrinsic resistance to chemotherapeutics and lack of effective targeted therapies are the major factors contributing to dismal prognosis. Several important genetic alterations (i.e., mutations, deletions) have been identified to be involved in the initiation and progression of pancreatic cancer, including KRAS and inactivation of tumor suppressors, such as TP53, SMAD4 and CDKN2A. Unique tumor microenvironment with excessive stroma due to desmoplastic reaction is one of the major characteristics of PDAC, promoting tumor growth and leading to treatment failures. In addition, tumor stroma represents an important biological barrier for drug delivery and successful treatment of PDAC. Small interfering RNA (siRNA) has recently emerged as a potential and targeted therapeutic approach which is now evaluated in clinical trials. However, siRNA-based therapeutics face important challenges, including rapid serum degradation, poor tumor cell uptake and cellular uptake, leading to off-target effects. Therefore, there is a great need for the development of safe and effective nanoparticles for better tumor-specific delivery of anti-cancer therapeutics. In this article, the main challenges in the treatment of pancreatic cancer and recent advancements on nano delivery systems of chemotherapeutics and gene-targeted agents, used both in preclinical and clinical trials are reviewed.
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Effect of Combined Epigenetic Treatments and Ectopic NIS Expression on Undifferentiated Thyroid Cancer Cells
Background: Poorly differentiated (PDTC) and anaplastic thyroid (ATC) cancer cells are characterized by the acquisition of epigenetic abnormalities, leading to the silencing of both the sodium iodide co-transporter and the Coxsackie adenovirus receptor. As aberrant histone acetylation and DNA methylation represent epigenetic mechanisms involved in neoplastic transformation, our study investigated the anticancer properties of epigenetic modifiers in thyroid carcinoma. Materials and Methods: The cytotoxicity and gene expression modulation of histone deacetylase and DNA methyltransferase inhibitors were evaluated in both PDTC and ATC. Results: Epigenetic treatments were cytotoxic to tumor thyrocytes and restored sodium iodide co-transporter and Coxsackie adenovirus receptor, expression as well as radioiodine uptake, in PDTC but not in ATC. However, ectopic expression sodium iodide co-transporter re-activated radioiodine incorporation in ATC. Conclusion: The ability of epigenetic treatments to interfere with tumor proliferation and induce Coxsackie adenovirus receptor expression, coupled with the ability of ectopic sodium iodide co-transporter to restore radioiodine uptake, raise the possibility that these therapeutic approaches may provide clinical benefit to patients with thyroid carcinoma refractory to radioiodine treatment.
https://ift.tt/2FQlkGu
Outcomes of Stereotactic Body Radiotherapy for Hepatocellular Carcinoma with Severe Cirrhosis and Ineligibility for Transplant
Background/Aim: Our study reviewed the results of patients with hepatocellular carcinoma and Child–Pugh score 8-11 cirrhosis treated with stereotactic body radiotherapy when liver transplant was not an option. Patients and Methods: A retrospective review was performed on 15 patients with Child–Pugh class B and C cirrhosis treated with stereotactic body radiotherapy. The median total dose was 35 Gy in 4-5 fractions. None were listed for a liver transplant due to either being outside of the Milan criteria or to medical contraindications. Results: The overall survival was 26.7% at 6 months, with a mean survival of 152 days. The mean survival with and without ascites was 3.3 months and 8.3 months, respectively. Conclusion: For hepatocellular carcinoma with cirrhosis of Child–Pugh score 8 or more, prognosis after liver stereotactic body radiotherapy was suboptimal. While irradiation achieved local tumor control, progressive cirrhosis was a common cause of death. Patients without ascites at the time of radiotherapy had the best prognosis.
https://ift.tt/2rcAk7n
Embryonal Origin of Metanephric Adenoma and its Differential Diagnosis
Background/Aim: The association of Wilms' tumor (WT), papillary renal cell tumor (PRCT) and mucinous tubular and spindle cell carcinoma (MTSCC) with embryonal rests has already been documented, but the cellular origin of metanephric adenoma (MA) is not yet known. The aim of this study was to understand their developmental evolution and find diagnostic markers. Materials and Methods: CD57, KRT7, AMACR, SCEL, WT1 and CDH17 expression was analysed by immunohistochemistry in the four types of tumors and the associated pre-neoplastic lesions. Results: Immunohistochemistry was able to differentiate WT, MA, MTSCC and PRCT. A phenotypic correlation between MA and perilobar nephrogenic rest associated with WT was identified. Conclusion: Perilobar nephrogenic rest and MA arise from differentiation arrested cells of the proximal domain of the S-shape body. We propose that WT1, MA, MTSCC and PRCT derive from different forms of maturation arrested embryonal rests.
https://ift.tt/2FRJ2C3
Prognostic Factors and a Survival Score in Patients Irradiated for Metastatic Epidural Spinal Cord Compression from Urothelial Carcinoma Cancer of the Bladder
Background/Aim: Prognoses of patients with metastatic epidural spinal cord compression (MESCC) from urothelial carcinoma of the bladder are generally poor. This study aimed to identify prognostic factors that can facilitate personalized care of these patients. Patients and Methods: In 46 patients, 10 factors were evaluated for overall response (OR), post-radiotherapy (RT) ambulatory status, local control of MESCC and overall survival (OS). Independent predictors of OS were incorporated in a scoring system. Results: Being ambulatory post-RT was associated with pre-RT ambulatory status (p<0.001) and better performance score (p<0.001). No factor was significantly associated with OR and local control. On multivariate analyses, lack of visceral metastases (p=0.002), being ambulatory pre-RT (p=0.001) and performance score 1-2 (p=0.004) were associated with improved OS. Based on these factors, there were three distinct prognostic groups with 0, 1-2 and 3 points and median OS times of 2, 4 and 11.5 months, respectively. Conclusion: Prognostic factors were identified and a new survival score was created that will help physicians aiming to personalize treatment for patients with MESCC from urothelial carcinoma of the bladder.
https://ift.tt/2rfjWmt
Cell Harvesting Methods Affect Cellular Integrity of Adherent Cells During Apoptosis Detection
Background/Aim: Annexin V and propidium iodide (PI) dual staining is commonly applied in bioscience as a method to detect apoptosis. However, excessive handling of adherent cells may interfere with the integrity of plasma membrane and hence impede the accuracy of this method. Here, we exploited PI uptake as an indicator of cell integrity and investigated how cell harvesting methods and solutions involved in common apoptosis detection techniques affected measurement results. Materials and Methods: Different cell harvesting techniques, staining with PI and flow cytometry were performed. Results: Non-fixed scrapped cells revealed significantly higher fractions of PI-positive staining compared to non-fixed trypsinized cells. In the case of harvesting cells by scrapping, samples stained in binding buffer (68.30±3.55%) showed consistently higher PI-positive staining than samples stained in PBS (36.37±5.90%) in a significant manner (p=0.015). Conclusion: Enzymatic harvesting using 0.25% trypsin instead of mechanical harvesting by rubber scraper caused less damage of cell integrity. Furthermore, the binding buffer used in the apoptosis detection protocol aggravated the existing plasma membrane damage caused by the rubber scraper.
https://ift.tt/2G0nMtQ
No Renal Toxicity After Repeated Treatment with Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) in Patients with Unresectable Peritoneal Metastasis
Background/Aim: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a recent approach for intraperitoneal chemotherapy with promising results for patients with peritoneal metastasis (PM). The aim of this study was to report renal toxicity for patients who received at least 3 repeated PIPAC procedures. Patients and Methods: All patients who underwent at least 3 PIPAC cycles of cisplatin (7.5 mg/m2) and doxorubicin (1.5 mg/m2) for unresectable PM from December 2015 to September 2017, were analysed regarding postoperative renal toxicity. Results: Among 103 patients registered in a prospective single center database, 43 patients underwent at least 3 PIPAC cycles representing a total of 175 PIPAC. Median age was 59.8 years, 24 (55.8%) patients were female and median BMI was 22.2 kg/m2. Most common origins of PM were gastric 22 (51.1%) and ovarian 11 (25.6%) cancer. Median peritoneal cancer index (PCI) was 17 (range=5-39). For 39 (90.1%) patients, systemic chemotherapy was performed in addition to PIPAC. Forty-three (100%), 17 (39.5%), 14 (32.5%), 8 (18.6%), 3 (7%), 2 (4.7%) and 2 (4.7%) patients underwent three, four, five, six, seven, eight and nine PIPAC procedures, respectively. Repeated PIPAC did not induce significant acute nor cumulative renal toxicity in any patients. Conclusion: Repeated PIPAC did not induce clinically relevant renal toxicity. This study confirms the previous published results in a larger group of patients.
https://ift.tt/2reUXQw
Expression of CK7 and CDKN2 in Cervical Intraepithelial Neoplasia and Correlation with Clinical Outcome
Aim: To evaluate cyclin-dependent kinase inhibitor 2A (CDKN2A) and cytokeratin 7 (CK7) expression in cervical intraepithelial neoplasia (CIN) formalin-fixed samples. Materials and Methods: Staining with antibody clones G175-405 for CDKN2A and OV-TL 12/30 for CK7 were evaluated and the detection of protein expressions were compared in 147 patients with CIN. Results: Clinical follow-up of patients with CIN1 and CIN2 showed that most patients had a favorable outcome. Single CDKN2A or CK7 expression and their combined expression had a greater sensitivity and negative predictive value in CIN1, corresponding to the non-development of the disease. The positive predictive value of CDKN2A was greater than that of CK7. Combined expression of CDKN2A and CK7 showed that the sensitivity, specificity, positive predictive values, and negative predictive values had their maximum index in the CIN1 group. Analysis of combined expression of CDKN2A and CK7 showed that 85.7% of patients presented unfavorable clinical outcomes, with positive expression for both markers identified in CIN2. Conclusion: Combined expression of CK7 and CDKN2A was associated with a better diagnosis of CIN, and negative expression in CIN1/2 groups had a greater negative predictive value for patient clinical outcome.
https://ift.tt/2FPHWqt
Outcomes After Radiotherapy Alone for Metastatic Spinal Cord Compression in Patients with Oligo-metastatic Breast Cancer
Background/Aim: Patients with oligo-metastatic breast cancer are a unique patient subgroup with more favourable outlook than most patients with metastatic disease. Prognostic factors in these patients with metastatic spinal cord compression (MSCC) were evaluated. Patients and Methods: In 159 patients irradiated for MSCC from oligo-metastatic breast cancer, seven characteristics were retrospectively analyzed including age, interval between breast cancer diagnosis and irradiation of MSCC, time developing motor deficits, ambulatory status, involved vertebrae, performance score (ECOG-PS) and radiotherapy regimen. Results: Improvement of motor function was significantly associated with time developing motor deficits (p=0.017), post-radiotherapy ambulatory status with pre-radiotherapy ambulation (p=0.012) and ECOG-PS 1-2 (p=0.029). Radiation doses of 39-40 Gy (equivalent doses) resulted in 1- and 2-year local control of 100% and 95%. On multivariate analyses, higher doses were associated with local control (p=0.011). Pre-radiotherapy ambulatory status (p=0.001) and ECOG-PS 1-2 (p=0.002) were associated with survival. Conclusion: Significant prognostic factors were identified for patients with MSCC from oligo-metastatic breast cancer. Higher radiation doses improved local control.
https://ift.tt/2re1Otf
Changes in the clinical and histological characteristics of Chinese chronic rhinosinusitis with nasal polyps over 11 years
Background
Traditionally, it was believed that chronic rhinosinusitis with nasal polyps (CRSwNP) demonstrated less eosinophilic and more neutrophilic inflammation in China compared to North America and Europe. However, inflammatory patterns may change over time. The study aimed to analyze the changing trends in the clinical and histological characteristics of CRSwNP over time in China.
Methods
A total of 115 consecutive CRSwNP patients from 2003 to 2005 and 114 consecutive CRSwNP patients from 2014 to 2016 were enrolled in this retrospective study. The clinical and histological data were compared between patients from the 2 time periods.
Results
The percentage of eosinophils in nasal polyp tissue increased, and the percentage of neutrophils and total inflammatory cell count decreased, over 11 years. The proportion of eosinophilic CRSwNP significantly increased from 59.1% to 73.7% over 11 years. The proportion of neutrophils and the total inflammatory cell count in nasal polyps decreased, and the proportion of eosinophilic CRSwNP patients using intranasal corticosteroids 1 month before surgery increased remarkably over 11 years. Moreover, eosinophilic CRSwNP patients had better compliance with intranasal corticosteroid use than non‐eosinophilic CRSwNP patients, and patients with comorbid allergic rhinitis and asthma had better compliance with intranasal corticosteroid use than patients without those conditions.
Conclusion
Eosinophilic CRSwNP, which was previously a minor subtype in East Asians, has increased remarkably in incidence to become the predominant CRSwNP subtype in Beijing, China, indicating that rhinologists should place greater emphasis on its diagnosis and treatment.
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Ebola Virus Infection Associated with Transmission from Survivors
S. Den Boon et al.
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Contact of the incisive canal and upper central incisors causing root resorption after retraction with orthodontic mini-implants: A CBCT study.
| Related Articles |
Contact of the incisive canal and upper central incisors causing root resorption after retraction with orthodontic mini-implants: A CBCT study.
Angle Orthod. 2018 Nov 28;:
Authors: Pan Y, Chen S
Abstract
OBJECTIVES:: To explore risk factors for contact between the incisive canal (IC) and upper central incisors (U1) and to evaluate the relationship between contact and root resorption using cone-beam computer tomography (CBCT).
MATERIALS AND METHODS:: This retrospective study used CBCT data of 33 patients treated by a senior orthodontist. Anterior teeth were retracted with mini-implants, and CBCT scans were taken before and after retraction. IC height and width, U1 lingual movement, and U1-IC distance and root length decrease were compared between contact and noncontact groups.
RESULTS:: Sixteen U1 roots in 11 patients touched the IC. The contact group had lower positioned ICs (2.86 ± 1.10 mm) than the noncontact group (4.07 ± 1.72 mm). The middle of the U1 roots showed more lingual movement to ICs in the contact group (2.30 ± 1.20 mm) than in the noncontact group (1.07 ± 1.16 mm). Right central incisors were closer to the IC than were the left. Root length decreased significantly more in the contact group (2.63 ± 0.93 mm) than in the noncontact group (1.14 ± 0.83 mm).
CONCLUSIONS:: There is a risk for the U1 root to contact the IC during anterior retraction when the IC is lower positioned. This contact might cause external apical root resorption.
PMID: 30484326 [PubMed - as supplied by publisher]
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Long-term stability of maxillary protraction therapy in Class III patients with complete unilateral cleft lip and palate.
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Long-term stability of maxillary protraction therapy in Class III patients with complete unilateral cleft lip and palate.
Angle Orthod. 2018 Nov 28;:
Authors: Zhang Y, Fu Z, Jia H, Huang Y, Li X, Liu H, Li W
Abstract
OBJECTIVES:: This study evaluated the long-term stability of maxillary protraction (MP) in patients with complete unilateral cleft lip and palate (UCLP) and identified factors influencing relapse and long-term outcomes.
MATERIALS AND METHODS:: Twenty-three adolescents with UCLP who underwent MP therapy were recalled when craniofacial growth was close to completion. Subjects exhibiting reverse/positive overjets were assigned to unstable/stable groups. Lateral cephalometric measurements were made before treatment (T0), after active treatment (T1), and at the end of the growth spurt (T2).
RESULTS:: About 63% of the subjects exhibited positive overjets during follow-up. The unstable group demonstrated higher B-x and Co-Gn distances than the stable group (both P < .05) at T0. More short-term (T0-T1) sagittal advancement of point A (A-y) was evident in the unstable group than in the stable group ( P < .05), but no long-term difference was apparent between the two groups ( P = .481). During the posttreatment period (T1-T2), the SNA angle and maxillary incisor protrusion (U1-SN angle) were considerably lower in the unstable group than in the stable group (both P < .05). Overall, the unstable group exhibited a lower increase in the vertical extent of point A (A-x) than the stable group from T0 to T2 ( P < .05).
CONCLUSIONS:: In the long term, MP affords favorable maxillary advancement in patients with UCLP. A mandibular excess at T0 and vertical maxillary hypoplasia may contribute to the long-term relapse of a reverse overjet.
PMID: 30484325 [PubMed - as supplied by publisher]
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Atomic layout of an orthodontic titanium mini-implant in human tissue: Insights into the possible mechanisms during osseointegration.
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Atomic layout of an orthodontic titanium mini-implant in human tissue: Insights into the possible mechanisms during osseointegration.
Angle Orthod. 2018 Nov 28;:
Authors: Kim JS, Ahn JP, Kim YH, Seo KW, Zadeh H, Kim SH
Abstract
OBJECTIVES:: To evaluate nanoscale molecular interactions in the interface between human bone and orthodontic titanium implants.
MATERIALS AND METHODS:: An orthodontic implant (sandblasted with large grit and with an acid-etched surface treated with Ti6A14V alloy) retrieved from the mandible of human after 2 months of healing was used to analyze the molecular interactive mechanism between the implant and the surrounding bone tissue. To preserve the natural state of the sample as much as possible, cryofixation and scanning electron microscope/focused ion beam milling without any chemical treatment were used during sample preparation. Atom probe tomography was used to investigate the chemical composition and structure at the interface between the implant and human bone tissue.
RESULTS:: Three-dimensional (3D) reconstruction of the whole sample revealed a 20 × 50-nm2 plate-like bony element diffusion layer in the sample. The iso concentration analysis of the diffusion layer indicated that the bony element, calcium, and the implant element, titanium oxide, were interspersed with each other. Detailed ionic distribution was illustrated by 3D reconstruction with partial region of interest and one-dimensional concentration profiles of the implant-bone interface.
CONCLUSIONS:: The study results advance nanoscale understanding of osseointegration and suggest a potential nanostructure for increasing bond strength of biomaterials to bone.
PMID: 30484324 [PubMed - as supplied by publisher]
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Challenges in diffusion MRI tractography – Lessons learned from international benchmark competitions
Publication date: Available online 29 November 2018
Source: Magnetic Resonance Imaging
Author(s): Kurt G. Schilling, Alessandro Daducci, Klaus Maier-Hein, Cyril Poupon, Jean-Christophe Houde, Vishwesh Nath, Adam W. Anderson, Bennett A. Landman, Maxime Descoteaux
Abstract
Diffusion MRI (dMRI) fiber tractography has become a pillar of the neuroimaging community due to its ability to noninvasively map the structural connectivity of the brain. Despite widespread use in clinical and research domains, these methods suffer from several potential drawbacks or limitations. Thus, validating the accuracy and reproducibility of techniques is critical for sound scientific conclusions and effective clinical outcomes. Towards this end, a number of international benchmark competitions, or "challenges", has been organized by the diffusion MRI community in order to investigate the reliability of the tractography process by providing a platform to compare algorithms and results in a fair manner, and evaluate common and emerging algorithms in an effort to advance the state of the field. In this paper, we summarize the lessons from a decade of challenges in tractography, and give perspective on the past, present, and future "challenges" that the field of diffusion tractography faces.
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Overexpression of ADAR1 into the cytoplasm correlates with a better prognosis of patients with oral squamous cells carcinoma.
Overexpression of ADAR1 into the cytoplasm correlates with a better prognosis of patients with oral squamous cells carcinoma.
J Oral Pathol Med. 2018 Nov 29;:
Authors: Caponio VCA, Troiano G, Botti G, Pedicillo MC, Lo Russo L, Mastrangelo F, Ciavarella D, Losito NS, Aquino G, Nocini R, Santoro R, Santoro A, Lo Muzio L, Pannone G
Abstract
BACKGROUND: ADAR1 is an enzymatic protein, which catalyzes a RNA-editing reaction by converting Adenosine to Inosine and its expression has been found to be dysregulated in many cancer types. The aim of this study was to analyze the expression of ADAR1 in oral squamous cells carcinoma.
METHODS: In order to analyze the ADAR1 mRNA expression, data from The Cancer Genome Atlas (TCGA) database were downloaded and analyzed. In addition, immunohistochemistry analysis was performed on an institutional database including 46 samples of oral squamous cell carcinoma in a tissue microarray (TMA).
RESULTS: No statistically significant correlation linked the mRNA ADAR1 expression to any clinic-pathological variables in the TCGA database. Immunohistochemistry analysis of ADAR1 showed different expression between normal mucosa and tumor tissue. Focusing on the subcellular localization, the nuclear expression of ADAR1 correlated with higher grading of differentiation (ρ = 0,442 p-value = 0,002); the general expression of ADAR1 either in cytoplasm or in nuclei, correlated with the Gender of patients (Cytoplasm expression: ρ = -0,295; p-value = 0,049; while for nuclear expression: ρ = +0,374 p = 0,011); cytosol expression resulted to be an independent protective prognostic factor (HR = 0,047; C.I. 95% 0,007-0,321; p-value = 0,002).
CONCLUSION: Higher expression of ADAR1 into the cytoplasm resulted to be an independent prognostic factor. In order to understand ADAR1 role in cancer, further studies should be performed, in bigger cohort and under a bio-molecular point of view. This article is protected by copyright. All rights reserved.
PMID: 30489667 [PubMed - as supplied by publisher]
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Advancements in MAPK signaling pathways and MAPK-targeted therapies for ameloblastoma: A review.
Advancements in MAPK signaling pathways and MAPK-targeted therapies for ameloblastoma: A review.
J Oral Pathol Med. 2018 Nov 29;:
Authors: You Z, Shao-Peng L, Jing D, Yi-Hua WU, Zhang SZ
Abstract
Numerous signal transduction pathways are closely associated with the occurrence, development, and prognosis of ameloblastoma(AM). Mitogen-activated protein kinase (MAPK) is a serine/threonine-specific protein kinase that transduces intracellular signals in critical cellular phenomena. A number of recent analyses have reported that the MAPK signaling pathway contributes significantly to AM. High-throughput DNA sequencing methods, such as next-generation sequencing using Illumina have yielded advancements in studies on MAPK signaling pathways and their association with AM; in particular, BRAF V600E is mediated by the activation of the Ras/Raf/MAPK pathway. This review discusses advancements in studies on MAPK signaling pathways and MAPK-targeted inhibitors or antibodies, along with the merits and demerits of MAPK-targeted therapies, finally followed by a discussion regarding more efficient potential MAPK-targeted therapies to treat AM with few side effects, thereby providing novel insights into targeted therapy for AM. This article is protected by copyright. All rights reserved.
PMID: 30489659 [PubMed - as supplied by publisher]
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Corrigendum to “Applying circular statistics can cause artefacts in the calculation of vector coding variability: A bivariate solution” [Gait Posture 65 (2018) 51–56]
Publication date: Available online 30 November 2018
Source: Gait & Posture
Author(s): Holly Stock, Richard van Emmerik, Cassie Wilson, Ezio Preatoni
https://ift.tt/2QqDEtW
When Net Loss Threatens Safety Net Loss
Publication date: December 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12
Author(s): Thomas B. Dodson
https://ift.tt/2PbMhUv
Histologic Improvements in Irradiated Bone Through Pharmaceutical Intervention in Mandibular Distraction Osteogenesis
Publication date: December 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12
Author(s): Kevin M. Urlaub, Jeremy V. Lynn, Edward G. Carey, Noah S. Nelson, Yekaterina Polyatskaya, Alexis Donneys, Amanda C. Mazzoli, Steven R. Buchman
Purpose
Despite the relative surgical ease and reduced donor-site morbidity of distraction osteogenesis (DO) in comparison with free tissue transfer, DO is currently precluded as a reconstructive option for head and neck cancer (HNC) patients because of the destructive effects of radiotherapy (XRT). This study investigates the ability of a novel combined therapy (CT) of radioprotective amifostine (AMF) and angiogenic deferoxamine (DFO) to mitigate XRT-induced bone injury in a murine model of DO.
Materials and Methods
Thirty male Sprague-Dawley rats were divided into 5 groups: DO (primary control), XRT (secondary control), AMF, DFO, and CT. With the exclusion of the DO group, all rats were administered a fractionated, human-equivalent XRT dose of 35 Gy, comparable with 70 Gy administered to HNC patients clinically. All groups underwent mandibular osteotomy and distraction to 5.1 mm. After euthanasia administration on postoperative day 40, the mandibles were sectioned and stained with Gomori trichrome. Osteocyte number, bone volume, and osteoid volume were compared between all groups by analysis of variance (P < .05).
Results
All rats survived and were included in the final analysis. The XRT group exhibited substantial bone injury, evidenced by a decreased osteocyte number and bone volume, as well as an increase in immature osteoid volume, compared with DO controls. The AMF, DFO, and CT groups showed significant increases in osteocyte proliferation compared with the XRT group and were not statistically different from the DO group. Notably, the CT group showed remediation of XRT-induced impairment of bone maturation and exhibited significantly greater bone volume and reduced osteoid volume in comparison with all groups.
Conclusions
Combined AMF and DFO treatment showed the capacity to remediate the deleterious effects of XRT, restore cellularity to nonirradiated levels, and surpass all groups in mature bone formation. Although further investigations of AMF and DFO are warranted, this study provides preliminary support for the potential use of DO in HNC patients through pharmaceutical facilitation of irradiated bone healing.
https://ift.tt/2ztXL0s
Is There a Difference in Orbital Volume Between Affected and Unaffected Sides in Patients With Unilateral Craniofacial Microsomia?
Publication date: December 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12
Author(s): Maria N. Gribova, Britt I. Pluijmers, Cory M. Resnick, Cornelia J.J.M. Caron, Alessandro Borghi, Maarten J. Koudstaal, Bonnie L. Padwa
Purpose
Craniofacial microsomia (CFM) is characterized by malformations of structures derived from the first and second pharyngeal arches. The orbit is variably affected. The purpose of this study was to determine whether there is a difference in orbital volume between affected and unaffected sides in patients with unilateral CFM. The specific aims were to 1) measure orbital volume, 2) compare affected and unaffected sides, 3) evaluate the correlation between clinical evaluation of orbital size and volumetric measurement, and 4) determine whether there is a correlation between orbital volume and severity of mandibular deformity.
Materials and Methods
This study is a retrospective case series of patients with unilateral CFM from Boston Children's Hospital (Boston, MA) who had a computed tomographic (CT) scan. Manual segmentation of the orbit using Mimics software (Materialise, Leuven, Belgium) was performed on CT images of the 2 orbits. The predictor variable was laterality (affected vs unaffected side) and the primary outcome variable was orbital volume. Wilcoxon signed rank test was used to compare these measurements and determine whether the affected side differed from the unaffected side. The correlation between orbital volume and Pruzansky-Kaban type of mandibular deformity, as documented in the medical record, was determined using the Spearman rank correlation coefficient.
Results
Thirty-nine patients were included. Orbital volume was 10% smaller on the affected side (P = .001) in 80% of patients. There was no correlation between orbital size and severity of mandibular involvement.
Conclusion
The results of this study showed a marked difference in orbital volume between affected and unaffected sides in patients with unilateral CFM. These differences were small and might not be clinically relevant. Orbital volume did not correlate with severity of mandibular deformity.
https://ift.tt/2PbMo2n
Surgical Accuracy in Inferior Maxillary Reposition
Publication date: December 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12
Author(s): Kasper Stokbro, Torben Thygesen
Purpose
Inferior maxillary repositioning is among the least stable and least predictable orthognathic procedures. The purpose of this study was to investigate whether posterior movement occurred with inferior maxillary repositioning and to analyze potential causes.
Materials and Methods
This retrospective observational study evaluated all consecutive patients treated at the Department of Oral and Maxillofacial Surgery of the Odense University Hospital (Odense, Denmark) with inferior maxillary repositioning from 2011 to 2013. The obtained repositioning was compared with the virtual surgical plan to determine surgical accuracy. Measurements were performed at 3 dental reference points. Linear and rotational measurements were performed along and around the right, anterior, and superior axes. Measurements were compared by paired t tests. Internal correlations and confounding variables were analyzed by mixed model regression analysis.
Results
Twenty patients were included for analysis. On average, the maxilla was positioned 1 mm posterior and 0.4 mm superior to the planned position. The virtual surgically planned reposition was statistically correlated with surgical accuracy. No other confounding variable influenced the outcome.
Conclusion
The correlation between planned advancement and inferior repositioning suggests that inferior repositioning destabilizes the maxillary position and that a perioperative or early postoperative relapse occurs in response to the advancement. This immediate relapse of 1 mm should be considered in the virtual surgical plan to ensure that the maxilla is placed closer to the desired position. Thus, this procedure could still benefit from increased surgical precision and stability based on technologic advancements, such as positioning guides or printed patient-specific plates.
https://ift.tt/2zz03vb
Use of Nasal Conformer After Birth Effectively Improves Nostril Symmetry in Patients With Unilateral Incomplete Cleft Lip
Publication date: December 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12
Author(s): Spencer C.H. Kuo, Jui-Pin Lai, Ching-Hua Hsieh, Tzu-Ying Chen, Yu-Jen Chang, Faye Huang
Purpose
To investigate the clinical effects of preoperative nasoalveolar molding (NAM) and nasal conformer use in patients with unilateral incomplete cleft lip on the basis of their medical records and images.
Patients and Methods
Data and images of 16 patients born with unilateral incomplete cleft lip who were hospitalized between January 2015 and August 2017 were retrieved from the medical records. The primary outcome was the extent of improvement in columella height (CH) before cheiloplasty. Other outcome measurements included the CH, nostril width, and nostril height, which were measured by ImageJ image processing software (version 1.4; National Institutes of Health, Bethesda, MD) and presented as ratios. Mann-Whitney U tests were used to compare the non–normally distributed data.
Results
Patients in the NAM group and those in the nasal conformer group showed significantly improved (P < .05) preoperative cleft-side CH–to–normal-side CH ratios compared with the corresponding ratios at birth. There was no significant difference in terms of the extent of improvement in CH between the groups.
Conclusions
Preoperative use of nasal conformers in patients with unilateral incomplete cleft lip not only corrects the deformed nasal cartilage but also increases the CH and improves the overall preoperative nasal symmetry. In addition, compared with NAM, this method costs less, is more straightforward, and requires fewer outpatient clinic visits.
https://ift.tt/2Pc9mpR
A History of Orthognathic Surgery in North America
Publication date: December 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12
Author(s): R. Bryan Bell
This review highlights the contributions of American oral and maxillofacial surgeons to the field of orthognathic surgery. The present state of the art and science of orthognathic surgery is the harvest of yesterday's innovation and research. An improved understanding of the biological and surgical principles and the routine involvement of orthodontics have fueled widespread adoption of a coordinated approach to the treatment of dentofacial problems. Technologic advances in rigid internal fixation, virtual surgical planning with computer-aided manufacturing of occlusal splints and cutting guides, custom implants, and worldwide interest in the correction of dentofacial and craniofacial deformities have resulted in highly predictable, efficient, and safe treatment, which scarcely resembles the situation 70 years ago.
https://ift.tt/2zwfdla
AAOMS Author Disclosure forms
Publication date: December 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12
Author(s):
https://ift.tt/2zxzzdQ
Table of Contents
Publication date: December 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12
Author(s):
https://ift.tt/2P7T8OI
Editorial Board Page
Publication date: December 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12
Author(s):
https://ift.tt/2zxeIqY
Journal of Oral and Maxillofacial Surgery
Publication date: December 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12
Author(s):
https://ift.tt/2PbM5Vh
Histologic Improvements in Irradiated Bone Through Pharmaceutical Intervention in Mandibular Distraction Osteogenesis
Publication date: December 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12
Author(s): Kevin M. Urlaub, Jeremy V. Lynn, Edward G. Carey, Noah S. Nelson, Yekaterina Polyatskaya, Alexis Donneys, Amanda C. Mazzoli, Steven R. Buchman
Purpose
Despite the relative surgical ease and reduced donor-site morbidity of distraction osteogenesis (DO) in comparison with free tissue transfer, DO is currently precluded as a reconstructive option for head and neck cancer (HNC) patients because of the destructive effects of radiotherapy (XRT). This study investigates the ability of a novel combined therapy (CT) of radioprotective amifostine (AMF) and angiogenic deferoxamine (DFO) to mitigate XRT-induced bone injury in a murine model of DO.
Materials and Methods
Thirty male Sprague-Dawley rats were divided into 5 groups: DO (primary control), XRT (secondary control), AMF, DFO, and CT. With the exclusion of the DO group, all rats were administered a fractionated, human-equivalent XRT dose of 35 Gy, comparable with 70 Gy administered to HNC patients clinically. All groups underwent mandibular osteotomy and distraction to 5.1 mm. After euthanasia administration on postoperative day 40, the mandibles were sectioned and stained with Gomori trichrome. Osteocyte number, bone volume, and osteoid volume were compared between all groups by analysis of variance (P < .05).
Results
All rats survived and were included in the final analysis. The XRT group exhibited substantial bone injury, evidenced by a decreased osteocyte number and bone volume, as well as an increase in immature osteoid volume, compared with DO controls. The AMF, DFO, and CT groups showed significant increases in osteocyte proliferation compared with the XRT group and were not statistically different from the DO group. Notably, the CT group showed remediation of XRT-induced impairment of bone maturation and exhibited significantly greater bone volume and reduced osteoid volume in comparison with all groups.
Conclusions
Combined AMF and DFO treatment showed the capacity to remediate the deleterious effects of XRT, restore cellularity to nonirradiated levels, and surpass all groups in mature bone formation. Although further investigations of AMF and DFO are warranted, this study provides preliminary support for the potential use of DO in HNC patients through pharmaceutical facilitation of irradiated bone healing.
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Is There a Difference in Orbital Volume Between Affected and Unaffected Sides in Patients With Unilateral Craniofacial Microsomia?
Publication date: December 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12
Author(s): Maria N. Gribova, Britt I. Pluijmers, Cory M. Resnick, Cornelia J.J.M. Caron, Alessandro Borghi, Maarten J. Koudstaal, Bonnie L. Padwa
Purpose
Craniofacial microsomia (CFM) is characterized by malformations of structures derived from the first and second pharyngeal arches. The orbit is variably affected. The purpose of this study was to determine whether there is a difference in orbital volume between affected and unaffected sides in patients with unilateral CFM. The specific aims were to 1) measure orbital volume, 2) compare affected and unaffected sides, 3) evaluate the correlation between clinical evaluation of orbital size and volumetric measurement, and 4) determine whether there is a correlation between orbital volume and severity of mandibular deformity.
Materials and Methods
This study is a retrospective case series of patients with unilateral CFM from Boston Children's Hospital (Boston, MA) who had a computed tomographic (CT) scan. Manual segmentation of the orbit using Mimics software (Materialise, Leuven, Belgium) was performed on CT images of the 2 orbits. The predictor variable was laterality (affected vs unaffected side) and the primary outcome variable was orbital volume. Wilcoxon signed rank test was used to compare these measurements and determine whether the affected side differed from the unaffected side. The correlation between orbital volume and Pruzansky-Kaban type of mandibular deformity, as documented in the medical record, was determined using the Spearman rank correlation coefficient.
Results
Thirty-nine patients were included. Orbital volume was 10% smaller on the affected side (P = .001) in 80% of patients. There was no correlation between orbital size and severity of mandibular involvement.
Conclusion
The results of this study showed a marked difference in orbital volume between affected and unaffected sides in patients with unilateral CFM. These differences were small and might not be clinically relevant. Orbital volume did not correlate with severity of mandibular deformity.
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Surgical Accuracy in Inferior Maxillary Reposition
Publication date: December 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12
Author(s): Kasper Stokbro, Torben Thygesen
Purpose
Inferior maxillary repositioning is among the least stable and least predictable orthognathic procedures. The purpose of this study was to investigate whether posterior movement occurred with inferior maxillary repositioning and to analyze potential causes.
Materials and Methods
This retrospective observational study evaluated all consecutive patients treated at the Department of Oral and Maxillofacial Surgery of the Odense University Hospital (Odense, Denmark) with inferior maxillary repositioning from 2011 to 2013. The obtained repositioning was compared with the virtual surgical plan to determine surgical accuracy. Measurements were performed at 3 dental reference points. Linear and rotational measurements were performed along and around the right, anterior, and superior axes. Measurements were compared by paired t tests. Internal correlations and confounding variables were analyzed by mixed model regression analysis.
Results
Twenty patients were included for analysis. On average, the maxilla was positioned 1 mm posterior and 0.4 mm superior to the planned position. The virtual surgically planned reposition was statistically correlated with surgical accuracy. No other confounding variable influenced the outcome.
Conclusion
The correlation between planned advancement and inferior repositioning suggests that inferior repositioning destabilizes the maxillary position and that a perioperative or early postoperative relapse occurs in response to the advancement. This immediate relapse of 1 mm should be considered in the virtual surgical plan to ensure that the maxilla is placed closer to the desired position. Thus, this procedure could still benefit from increased surgical precision and stability based on technologic advancements, such as positioning guides or printed patient-specific plates.
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Use of Nasal Conformer After Birth Effectively Improves Nostril Symmetry in Patients With Unilateral Incomplete Cleft Lip
Publication date: December 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12
Author(s): Spencer C.H. Kuo, Jui-Pin Lai, Ching-Hua Hsieh, Tzu-Ying Chen, Yu-Jen Chang, Faye Huang
Purpose
To investigate the clinical effects of preoperative nasoalveolar molding (NAM) and nasal conformer use in patients with unilateral incomplete cleft lip on the basis of their medical records and images.
Patients and Methods
Data and images of 16 patients born with unilateral incomplete cleft lip who were hospitalized between January 2015 and August 2017 were retrieved from the medical records. The primary outcome was the extent of improvement in columella height (CH) before cheiloplasty. Other outcome measurements included the CH, nostril width, and nostril height, which were measured by ImageJ image processing software (version 1.4; National Institutes of Health, Bethesda, MD) and presented as ratios. Mann-Whitney U tests were used to compare the non–normally distributed data.
Results
Patients in the NAM group and those in the nasal conformer group showed significantly improved (P < .05) preoperative cleft-side CH–to–normal-side CH ratios compared with the corresponding ratios at birth. There was no significant difference in terms of the extent of improvement in CH between the groups.
Conclusions
Preoperative use of nasal conformers in patients with unilateral incomplete cleft lip not only corrects the deformed nasal cartilage but also increases the CH and improves the overall preoperative nasal symmetry. In addition, compared with NAM, this method costs less, is more straightforward, and requires fewer outpatient clinic visits.
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via IFTTT
A History of Orthognathic Surgery in North America
Publication date: December 2018
Source: Journal of Oral and Maxillofacial Surgery, Volume 76, Issue 12
Author(s): R. Bryan Bell
This review highlights the contributions of American oral and maxillofacial surgeons to the field of orthognathic surgery. The present state of the art and science of orthognathic surgery is the harvest of yesterday's innovation and research. An improved understanding of the biological and surgical principles and the routine involvement of orthodontics have fueled widespread adoption of a coordinated approach to the treatment of dentofacial problems. Technologic advances in rigid internal fixation, virtual surgical planning with computer-aided manufacturing of occlusal splints and cutting guides, custom implants, and worldwide interest in the correction of dentofacial and craniofacial deformities have resulted in highly predictable, efficient, and safe treatment, which scarcely resembles the situation 70 years ago.
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