Κυριακή, 4 Ιουνίου 2017

Hypoesthesia associated with mandibular movement after sagittal split ramus osteotomy

Abstract

Purpose

This retrospective study investigated the relationship between the degree of neurosensory disturbance (NSD) and mandibular movement distance after sagittal split ramus osteotomy (SSRO) and assessed sensory recovery.

Methods

Lower lip hypoesthesia was evaluated at 1 week, 1 month, and 2 months after SSRO in 38 patients categorized according to the distance of mandibular movement: S group (0–7 mm; n = 17, 4 males and 13 females) and L group (7–14 mm; n = 21, 7 males, 14 females). Symptoms were evaluated by visual analog scale (VAS), tactile-threshold (SW) test, static 2-point discrimination (s-2PD) test, and current perception threshold (CPT) test.

Results

The two groups did not differ significantly in gender and age. The Aβ fiber results of the CPT test differed significantly between the groups at 1 week and 1 month postsurgery (P < 0.05). There were no significant differences between the groups throughout the period in terms of VAS, SW, s-2PD, Aδ fiber, and C fiber of CPT.

Conclusions

Post-SSRO, the incidence of NSD in terms of tactile sensation may be greater in the L group early postoperatively. This may assist surgeons in explaining postoperative hypoesthesia to patients preoperatively.



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Heme oxygenase-1 directly binds STAT3 to control the generation of pathogenic Th17 cells during neutrophilic airway inflammation

Abstract

Background

Specific JAK/STAT pathways play a critical role in the functional differentiation of distinct Th subsets. Previously, we showed that HO-1, a stress-inducible protein, inhibits Th17 cell differentiation and alleviates neutrophilic airway inflammation, but the responsible molecular basis remains unclear.

Methods

We employed Th17-skewing differentiation and NEA mouse models to study the role of HO-1 regulating IL-6-STAT3-RORγt/SOCS3 signaling pathway to control Th17 cell-mediated neutrophilic airway inflammation. The levels of cytokines and expressions of relative signaling molecular were measured by ELISA, western blot and qPCR, respectively. Frequency of CD4+IL-17A+, CD4+IL-6R+ and CD4+IL-23R+ cells was analyzed by FCM. The interaction between HO-1 and signaling pathway-related proteins was determined by Co-Immunoprecipitation and western blot.

Results

Here, we show that hemin-induced HO-1 over-expression is required to mediate this process. Specifically, HO-1 decreased STAT3 phosphorylation but not IL-6R/IL-23R expression or JAK1/JAK2 activation in CD4+ T cells. The effect was accompanied by co-inhibition of SOCS3, a negative feedback factor of STAT3 activation. HO-1 bound to three domains on STAT3, (DNA-binding, linker and transactivation domains) to directly regulate STAT3 activation. Conversely, either forced expression of a constitutively active STAT3 mutant or application of small interfering RNA (siRNA) for HO-1 reversed these effects.

Conclusions

Our data suggest that HO-1 exerts its inhibitory effect on Th17 cell differentiation by directly associating and blocking STAT3 phosphorylation. We speculate that hemin may be a potential therapeutic candidate for the treatment of other types of immune and pulmonary inflammatory-related diseases.

This article is protected by copyright. All rights reserved.



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BacterioFiles 296 - Predator Permits Pathogen Penetration

bf296cyclops.jpg

This episode: Tiny crustaceans eat paramecia, allowing viruses to infect algae inside them!

(9.1 MB, 9.9 minutes)

Show notes: 


Follow-up to episode 259:

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Interactions between human endogenous and exogenous retroviruses

Abstract

Retrovirus genes have become inserted into the human genome for more than one million years. These retroviruses are now inactivated due to mutation, such as deletions or nonsense mutations. After mutation, retroviruses eventually become fixed in the genome in the endogenous form and exist as traces of ancient viruses. These retroviruses are called human endogenous retroviruses (HERVs). HERVs cannot make fully active viruses, but a number of viral proteins (or even virus particles) are expressed under various conditions. By comparison with ERVs, some exogenous retroviruses are still infectious and cause serious diseases threatening human life. Recent studies have shown that some elements of HERVs are closely related to other exogenous retroviruses, including human immunodeficiency virus (HIV). This review will describe the regulation and interaction between HERVs and other active viral infections. In addition, we introduce the development of vaccines and therapeutic agents against these viral infections through the use of HERV elements.



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The Plight of Veterans

As I listen to the sounds of the VA emergency department I realize the plight of many veterans is

tragic and some have lived through hard times not commonly recognized. There are so many headlines about veteran suicides, homelessness, post-traumatic stress disorder and injuries from explosive devices.

This article is protected by copyright. All rights reserved.



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Laparoscopic harvest of the gastro-omental free flap for reconstruction after total pharyngolaryngectomy: Operative technique

Abstract

Circumferential defects following salvage pharyngolaryngectomy present significant challenges in reconstructive surgery. The gastro-omental free flap has been shown to reduce the incidence of major fistula and catastrophic complications. The current technique for harvest of the flap requires laparotomy, which is potentially associated with significant post-operative complications. Laparoscopic harvest of the gastro-omental free flap can negate some of the risks associated with open surgery. We describe here the operative technique for laparoscopic gastro-omental free flap harvest for use in reconstruction following total pharyngolaryngectomy. © 2017 Wiley Periodicals, Inc. Head Neck, 2017



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Prognostic value of lymphovascular invasion of the primary tumor in hypopharyngeal carcinoma after total laryngopharyngectomy

Abstract

Background

We aimed to determinate the prognostic value of lymphovascular invasion in the specimens resected during total laryngopharyngectomy for hypopharyngeal carcinoma.

Methods

Patients who underwent total laryngopharyngectomy at our institution between 2004 and 2014 were included in this study and retrospectively analyzed. We then discriminated for vascular invasion and lymphatic invasion of the primary tumor in all cases.

Results

We reviewed 135 records (120 men and 15 women; age range, 36–84 years). Tumors with lymphatic invasion tended to be associated with more metastatic lymph nodes and extracapsular spread (ECS) of metastatic lymph nodes. Tumors with vascular invasion tended to be associated with nonpyriform sinus locations. In a multivariate analysis, nonpyriform sinus locations, >3 metastatic lymph nodes, and vascular invasion remained significant prognostic factors for overall survival (OS); in recursive partitioning analysis, ECS and vascular invasion remained important categorical variables for OS.

Conclusion

Vascular invasion is a strong prognostic biomarker for advanced hypopharyngeal carcinoma. © 2017 Wiley Periodicals, Inc. Head Neck, 2017



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Multiple single nucleotide polymorphism analysis and association of specific genotypes in FHIT, SAMD4A, and ANKRD17 in Indian patients with oral cancer

Abstract

Background

Oral cancer has a high incidence primarily because of tobacco chewing habits. However, a small proportion of habitués develop oral cancer, implying a role for genomic variants in its susceptibility.

Methods

Thirteen single nucleotide polymorphisms (SNPs) in an Indian cohort comprising patients with oral cancer (n = 500) and healthy controls (n = 500) were genotyped using allelic discrimination real-time polymerase chain reaction (PCR).

Results

Prevalence of SNPs rs11130760, rs1957358, rs2306058, rs4883543, rs12637722, rs1457115, rs2353292, rs709821, rs2194861, rs4789378, rs3827538, rs2667552, and rs2886093 was determined in the Indian cohort. A significant association of rs11130760 GG (odds ratio [OR] 1.41; 95% confidence interval [CI] 1.08-1.84) and rs1957358 TT (OR 1.44; 95% CI 1.10-1.90) indicated increased risk; whereas rs1957358 TC (OR 0.67; 95% CI 0.53-0.87) and rs2306058 CT (OR 0.72; 95% CI 0.56-0.93) reflected decreased risk. The SNP rs11130760 wild-type (WT) allele G indicated an increased risk for oral cancer (OR 1.38; 95% CI 1.09-1.73), whereas SNP allele T indicated a decreased risk (OR 0.73; 95% CI 0.58-0.92) for oral cancer.

Conclusion

Our study identified SNPs with susceptibility to oral cancer in high-risk populations.



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Functional outcomes of fasciocutaneous free flap and pectoralis major flap for salvage total laryngectomy

Abstract

Background

Pectoralis major muscle flaps (PMMFs) and fasciocutaneous free flaps (FFFs) are commonly used for reconstruction of the surgical defect after salvage total laryngectomy. This study compared swallowing function in patients who underwent reconstruction with either PMMF or FFF.

Methods

This study was based on a retrospective cohort of patients treated at the CHU de Québec between January 2000 and March 2015. Demographics, chemoradiation data, surgical protocol, pathologic results, complications, evolution, esophageal dilation, diet intake, and feeding tube dependence were documented.

Results

A total of 126 patients were analyzed (93 PMMFs and 33 FFFs). Of the patients who received PMMFs, 38.7% had a limited oral intake compared to 15.2% of patients who received FFFs (odds ratio [OR] 3.54; 95% confidence interval [CI] 1.25-9.99; P = .02). The need for esophageal dilation tended to be greater for PMMF patients (25% vs 9%; OR 3.38; 95% CI 0.94-12.13; P = .06). Complication rates were similar.

Conclusion

The FFF reconstruction led to better results in terms of swallowing function than PMMF reconstruction.



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AHNS Series – Do you know your guidelines? Lip cancer

Abstract

Background

Lip cancer is one of the most curable primary head and neck malignancies, as the prominent location typically lends to an early diagnosis. The incidence of lip cancer varies by sex, ethnicity, and region, but is estimated to be up to 2.5/100 000 in the United States (squamous cell carcinoma [SCC]).

Methods

This article will review the current literature and National Comprehensive Cancer Network practice guidelines in the treatment of lip cancer.

Results

Resection of lip cancer with negative margins remains the mainstay of therapy. Positive nodal disease should be treated with neck dissection and adjuvant radiotherapy.

Conclusion

Lip cancer remains highly curable when diagnosed at an early stage. A multidisciplinary approach is crucial to treating patients with advanced-stage lip cancer.



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Morphologic and topographic radiologic features of human papillomavirus–related and unrelated oropharyngeal carcinoma

Abstract

Background

The purpose of this study was to compare the clinicoradiologic characteristics of human papillomavirus (HPV)-related (HPV-positive) and HPV-unrelated (HPV-negative) oropharyngeal carcinoma (OPC).

Methods

Primary tumor and lymph node features of HPV-positive and HPV-negative OPCs from 2008 to 2013 were compared on pretreatment CT/MRI. Intrarater/interrater concordance was assessed. Multivariable analyses identified factors associated with HPV-positivity to be used in nomogram construction.

Results

Compared to HPV-negative (n = 194), HPV-positive (n = 488) tumors were more exophytic (73% vs 63%; p = .02) with well-defined border (58% vs 47%; p = .033) and smaller axial dimensions; lymph node involvement predominated (89% vs 69%; p < .001) with cystic appearance (45% vs 32%; p = .009) but similar topography. Intrarater/interrater concordance varied (fair to excellent). Nomograms combining clinical (age, sex, smoking pack-years, subsite, T/N classification) and/or radiologic (nonnecrotic tumor and cystic lymph node) features were used to weigh the likelihood of HPV-driven tumors (area under the curve [AUC] = 0.84).

Conclusion

HPV-positive OPC has different radiologic tumor (exophytic/well-defined border/smaller axial dimension) and lymph node (cystic) features but similar lymph node topography.



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Is 3D Bioprinting the Future of Reconstructive Surgery?

The emergence of 3D bioprinting provides exciting new options for reconstructive surgery.
Plastic Reconstructive Surgery-Global Open (PRS Global Open)

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Ventricular Perforation After Deep Sternal Wound Infection

Learn more about the identification, management, and prevention of ventricular rupture associated with the use of a vacuum-assisted closure device in patients with deep sternal wound infection.
ePlasty, Open Access Journal of Plastic Surgery

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Early ovariectomy reveals the germline encoding of natural anti-A- and Tn-cross-reactive immunoglobulin M (IgM) arising from developmental O-GalNAc glycosylations. (Germline-encoded natural anti-A/Tn cross-reactive IgM)

Abstract

While native blood group A-like glycans have not been demonstrated in prokaryotic microorganisms as a source of human “natural” anti-A isoagglutinin production, and metazoan eukaryotic N-acetylgalactosamine O-glycosylation of serine or threonine residues (O-GalNAc-Ser/Thr-R) does not occur in bacteria, the O-GalNAc glycan-bearing ovarian glycolipids, discovered in C57BL/10 mice, are complementary to the syngeneic anti-A-reactive immunoglobulin M (IgM), which is not present in animals that have undergone ovariectomy prior to the onset of puberty. These mammalian ovarian glycolipids are complementary also to the anti-A/Tn cross-reactive Helix pomatia agglutinin (HPA), a molluscan defense protein, emerging from the coat proteins of fertilized eggs and reflecting the snail-intrinsic, reversible O-GalNAc glycosylations. The hexameric structure of this primitive invertebrate defense protein gives rise to speculation regarding an evolutionary relationship to the mammalian nonimmune, anti-A-reactive immunoglobulin M (IgM) molecule. Hypothetically, this molecule obtains its complementarity from the first step of protein glycosylations, initiated by GalNAc via reversible O-linkages to peptides displaying Ser/Thr motifs, whereas the subsequent transferase depletion completes germ cell maturation and cell renewal, associated with loss of glycosidic bonds and release of O-glycan-depleted proteins, such as complementary IgM revealing the structure of the volatilely expressed “lost” glycan carrier through germline Ser residues. Consequently, the evolutionary/developmental first glycosylations of proteins appear metabolically related or identical to that of the mucin-type, potentially “aberrant” monosaccharide GalNAcα1-O-Ser/Thr-R, also referred to as the Tn (T “nouvelle”) antigen, and explain the anti-Tn cross-reactivity of human innate or “natural” anti-A-specific isoagglutinin and the pronounced occurrence of cross-reactive anti-Tn antibody in plasma from humans with histo-blood group O. In fact, A-allelic, phenotype-specific GalNAc glycosylation of plasma proteins does not occur in human blood group O, affecting anti-Tn antibody levels, which may function as a growth regulator that contributes to a potential survival advantage of this group in the overall risk of developing cancer when compared with non-O blood groups.

Thumbnail image of graphical abstract

In mouse and man, the complementarity of the nonimmune anti-A/Tn cross-reactive IgM most likely occurs in a process of rapid glycosylations/deglycosylations, called “single cycle event”, which causes the release of an antibody molecule that displays a predetermined breaking point through the hydroxyl (–OH) functional group of terminal serine/threonine residues. The germline encoded anti-Tn cross-reactivity of the anti-A-specific isoagglutinin and the pronounced occurrence of anti-Tn reactivity in plasma from humans with histo (blood) group O(H), could contribute to the potential, currently discussed survival advantage of this group in the overall risk of developing cancer when compared with non-O blood groups.



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Cervical cancer screening in a low-resource setting: a pilot study on an HPV-based screen-and-treat approach

Abstract

Cervical cancer (CC) is the leading cause of cancer-related death among women in sub-Saharan Africa, primarily because of limited access to effective screening and preventive treatment. Our aim was to assess the feasibility of a human papillomavirus (HPV)-based CC screen-and-treat approach in a low-resource context. We recruited 1012 women aged 30–49 years through a CC screening campaign conducted in the District Hospital of Dschang, Cameroon. Participants performed HPV self-sampling, which was tested for high-risk HPV (HR-HPV) DNA using the point-of-care Xpert HPV assay. All HPV-positive women were invited for visual inspection with acetic acid and Lugol's iodine (VIA/VILI) to exclude CC or enable triage. A cervical sample for histological analysis was also collected. Women positive for HPV 16/18/45 and for other HR-HPV with pathological VIA/VILI were selected to undergo treatment with thermocoagulation. The HPV prevalence in the study population was 18.5% (n = 187); of these cases, 20 (10.6%), 42 (22.3%) and 140 (74.9%) were positive for HPV16, HPV18/45 and other HR-HPV types, respectively. Overall, 107/185 (57.8%) VIA/VILI examinations were classified as pathological and 78 (42.2%) as normal. Women positive for HPV16/18/45 were 4.2 times more likely to harbor cervical intraepithelial neoplasia grade 2 or worse (CIN2+) than those with other HPV types. The specificity of HPV 16/18/45 genotypes for detection of high-grade lesions among HR-HPV positive women was higher than that of VIA/VILI in all age groups. The sensitivity and specificity of VIA/VILI in detecting CIN2+ among HPV positive women were 80% and 44%, respectively. Overall, 110/121 screen-positive women (90.9%) were eligible for, and were treated with, thermocoagulation. An HPV-based screen-and-treat approach is feasible in a low-resource context and may contribute to improving the effectiveness of CC prevention programs. Immediate thermocoagulation treatment for women who are HPV16- and/or HPV18/45-positive is a practical approach for the treatment of CIN2+. The combination of HPV-testing and VIA/VILI for CC screening might reduce overtreatment.

Thumbnail image of graphical abstract

This study assesses the feasibility of a cervical cancer (CC) screen-and-treat 1-day approach including vaginal self-sampling and point-of-care HPV testing in a developing country. This approach may contribute to improving the effectiveness of CC prevention programs and decrease CC mortality in low-resource countries.



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B lymphocytes repress hepatic tumorigenesis but not development in Hras12V transgenic mice

Abstract

Increasing reports show non-inflammation underlying HCC, challenging our understanding of the roles of the immune system in hepatocarcinogenesis. By exploring a mouse model of hepatic tumor induced by hepatocyte-specific expression of the Hras12V oncogene without obvious inflammation, we found that the proportion of B cells, but not T cells, progressively and significantly decreased in 3, 5-month-old transgenic mice (Tg) compared with non-transgenic mice. Notably, the proportions of total and activated B and T cells all significantly decreased in 9-month-old Tg with multiple massive hepatic tumors. Together with the decreased B cell proportion, serum IgG1/2 also significantly decreased in 5, 9-month-old Tg. Interestingly, homozygous Tg showed significantly higher B cell proportion and IgG2 levels, accompanied by significantly lower incidences of liver nodules but not adenomas and carcinomas compared with heterozygous Tg. Treatment of Tg with PCI-32765, a potent Bruton's tyrosine kinase (BTK) inhibitor for suppressing B cell proliferation and activation, significantly decreased the B cell proportion and IgG2 levels, accompanied by a significantly higher incidence of liver nodules, but had no effects on adenoma and carcinoma. Treatment of Tg with insulin-like growth factor 1(IGF-1) significantly increased the B cell proportion and IgG2 levels, accompanied by a significantly lower incidence of liver nodules and carcinoma, but had no effects on adenoma. Conclusively, B cells and IgG2 may play important roles in suppressing hepatic tumorigenesis, but not development. In addition, hepatocyte-specific expression of the ras oncogene may play roles in suppressing B cells, while developed hepatic tumors suppress both B and T cells. This article is protected by copyright. All rights reserved.



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A classifier integrating plasma biomarkers and radiological characteristics for distinguishing malignant from benign pulmonary nodules

Abstract

Lung cancer is primarily caused by cigarette smoking and the leading cancer killer in the USA and across the world. Early detection of lung cancer by low-dose CT (LDCT) can reduce the mortality. However, LDCT dramatically increases the number of indeterminate pulmonary nodules (PNs), leading to overdiagnosis. Having a definitive preoperative diagnosis of malignant PNs is clinically important. Using microarray and droplet digital PCR to directly profile plasma miRNA expressions of 135 patients with PNs, we identified 11 plasma miRNAs that displayed a significant difference between patients with malignant versus benign PNs. Using multivariate logistic regression analysis of the molecular results and clinical/radiological characteristics, we developed an integrated classifier comprising two miRNA biomarkers and one radiological characteristic for distinguishing malignant from benign PNs. The classifier had 89.9% sensitivity and 90.9% specificity, being significantly higher compared with the biomarkers or clinical/radiological characteristics alone (All P <0.05). The classifier was validated in two independent sets of patients. We have for the first time shown that the integration of plasma biomarkers and radiological characteristics could more accurately identify lung cancer among indeterminate PNs. Future use of the classifier could spare individuals with benign growths from the harmful diagnostic procedures, while allowing effective treatments to be immediately initiated for lung cancer, thereby reduces the mortality and cost. Nevertheless, further prospective validation of this classifier is warranted. This article is protected by copyright. All rights reserved.



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Plant genetics: Branching out for crop improvement



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Predispositions to Leukemia in Down Syndrome and Other Hereditary Disorders

Opinion statement

Leukemia is the most common pediatric cancer and accounts for approximately one third of childhood malignancies. There are germline genetic alterations that significantly increase the risk of developing hematopoietic malignancies in childhood. In this review, we describe a number of these hereditary disorders and their clinical features. These predispositions to cancer syndromes can be attributed to DNA repair/genetic instability, RAS pathway dysfunction, bone marrow failure, telomeropathies, immunodeficiencies, transcription factor abnormalities, pure familial leukemia, and aneuploidy. We focus especially on acute myeloid leukemia associated with Down syndrome, but also include other hereditary syndromes in this review. Recent advances in high-throughput genotyping technology have identified new genetic variations prone to human leukemia. Understanding of the mechanism of leukemia development in these hereditary syndromes allows us to gain insight into leukemogenesis in general and suggests therapeutic strategies based on these findings.



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Predispositions to Leukemia in Down Syndrome and Other Hereditary Disorders

Opinion statement

Leukemia is the most common pediatric cancer and accounts for approximately one third of childhood malignancies. There are germline genetic alterations that significantly increase the risk of developing hematopoietic malignancies in childhood. In this review, we describe a number of these hereditary disorders and their clinical features. These predispositions to cancer syndromes can be attributed to DNA repair/genetic instability, RAS pathway dysfunction, bone marrow failure, telomeropathies, immunodeficiencies, transcription factor abnormalities, pure familial leukemia, and aneuploidy. We focus especially on acute myeloid leukemia associated with Down syndrome, but also include other hereditary syndromes in this review. Recent advances in high-throughput genotyping technology have identified new genetic variations prone to human leukemia. Understanding of the mechanism of leukemia development in these hereditary syndromes allows us to gain insight into leukemogenesis in general and suggests therapeutic strategies based on these findings.



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Inflammatory myofibroblastic tumor of the right frontal lobe

Abstract

Background

We aim to present an unique case of inflammatory myofibroblastic tumor (IMT) of the brain parenchyma and study the clinical presentation, imagine characteristic, intraoperative findings, and histopathology features of IMT in the brain parenchyma.

Case Presentation

A 36-year-old female with IMT come to see doctor presented with a 3-month history of progressively worsening weakness in the left upper limb along with alalia. Serial magnetic resonance imaging studies revealed a lesion within the right frontal lobe. The lesions were locally clear boundary with peripheral tissues. A right frontotemporal craniotomy was performed and the specimens were detected by immunohistochemical staining and light microscopy. Through the microscope, the tumor was composed of large number of chronic inflammatory cells and spindle cells. From immunohistochemical stains, it demonstrated CD34 (+), SMA (+), Vimentin (+), and actin (+) were positive meanwhile S-100(-) was negative.

Conclusion

IMT of the right frontal lobe is a rare lesions. Surgical resection is the best and the most effective treatment.



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Efficacy of low-level laser therapy in carpal tunnel syndrome management: a systematic review and meta-analysis

Abstract

We performed this meta-analysis to investigate the efficacy of low-level laser therapy (LLLT), a physiotherapy modality with anti-inflammatory and analgesic effects, in the management of mild-to-moderate carpal tunnel syndrome (CTS). We searched PubMed, Web of Knowledge, Scopus, Cochrane Central, and Virtual Health Library for randomized controlled trials (RCTs) that compared the effects of LLLT with or without splinting versus placebo on functional and electromyographic outcomes in CTS. All outcomes were pooled as mean differences (MD) under the inverse variance or random effects model, using the statistical add-in (MetaXL, version 5.0). Eight RCTs (473 patients/631 wrists) were eligible for the final analysis. The overall effect estimates did not favor LLLT therapy group over placebo in all primary outcomes: visual analogue scale (MD −1.11, 95% CI [−2.58, 0.35]), symptom severity scale score (MD −1.41, 95% CI [−5.12, 2.29]), and functional status scale score (MD −1.33, 95% CI [−3.27, 0.61]). However, LLLT was superior to placebo in terms of grip strength (MD 2.19, 95% CI [1.63, 2.76]) and inferior to placebo in terms of sensory nerve action potential (MD −2.74, 95% CI [−3.66, −1.82]). Laser therapy is superior to placebo in terms of improving the grip strength; however, no significant difference was found between both groups in terms of functional status improvement, pain reduction, or motor electrodiagnostic evaluations. Further high-quality trials with longer follow-up periods are required to establish the efficacy of LLLT for CTS treatment.



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Posterior teeth angulation in non-extraction and extraction treatment of anterior open-bite patients

This study cephalometrically evaluated the posterior teeth angulation changes of anterior open-bite non-extraction and extraction treatment in the permanent dentition, with anterior vertical elastics.

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Ethical Responsibilities of the Authors



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Myeloperoxidase-antineutrophil cytoplasmic antibody causes different renal diseases by immune-complex formation and pauci-immune mechanism: A case report

Antineutrophil cytoplasmic antibody (ANCA) has been known to cause pauci-immune crescentic glomerulonephritis. In addition, several reports described membranous glomerulonephritis (MN) concurrent with ANCA-associated glomerulonephritis. Because the two glomerular diseases simultaneously appear in an ANCA-positive patient, the mechanisms whereby ANCA causes the two different glomerular diseases remain ambiguous. Herein, we report a case of 19-year-old man who presented with hematuria, pre-nephrotic proteinuria, and high titer of myeloperoxidase (MPO)-ANCA. The first renal biopsy revealed MN with chronic glomerular scar lesions of unknown etiology. Predominant immunoglobulin (Ig) G1 subclass and negative phospholipase-A2 receptor staining, together with granular-positive glomerular capillary co-localization of MPO and IgG staining, suggested secondary MN due to MPO-MPO-ANCA immune-complex. Five years later, the patient presented with fever, severe renal dysfunction, and alveolar hemorrhage with high titer of MPO-ANCA that indicated pulmonary renal syndrome due to ANCA-associated vasculitis. The second renal biopsy revealed pauci-immune crescentic glomerulonephritis without either apparent MN-lesion or glomerular IgG staining. This is the first reported case showing that MPO-ANCA caused two different glomerular diseases, MN and pauci-immune crescentic glomerulonephritis, in the same patient at the different time points. Our case indicated that common MPO-ANCA might cause different glomerular diseases by different immune mechanisms.



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Oral Complications of Dermatologic Disorders

Publication date: Available online 3 June 2017
Source:Atlas of the Oral and Maxillofacial Surgery Clinics
Author(s): Paolo G. Arduino




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Qualitative correlation between postoperatively increased vertical dimension and mandibular position in skeletal class III using partial-least-square path modeling

Abstract

Background

This study constructed a partial-least-square path-modeling (PLS-PM) model and found the pathway by which the postsurgical vertical dimension (VD) affects the extent of the final mandibular setback on the B point at the posttreatment stage for the skeletal class III surgery-first approach (SFA).

Methods

This study re-analyzed the data from the retrospective study by Lee et al. on 40 patients with skeletal class III bimaxillary SFA. Variables were obtained from cone beam computed tomography (CBCT)-generated cephalograms. Authors investigated all variables at each time point to build a PLS-PM model to verify the effect of the VD on the final setback of the mandible.

Results

From PLS-PM, an increase in VD10 was found to decrease the absolute value of the final setback amount of the mandible, which reflects the postsurgical physiological responses to both surgery and orthodontic treatment, which, in turn, can be interpreted as an increase in postoperative mandibular changes.

Conclusions

To resolve the issue of collinear cephalometric data, the present study adopted PLS-PM to assess the orthodontic treatment. From PLS-PM, it was able to summarize the effect of increased postsurgery occlusal vertical dimension on the increased changeability of the B point position at the posttreatment stage.



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Qualitative correlation between postoperatively increased vertical dimension and mandibular position in skeletal class III using partial-least-square path modeling

Abstract

Background

This study constructed a partial-least-square path-modeling (PLS-PM) model and found the pathway by which the postsurgical vertical dimension (VD) affects the extent of the final mandibular setback on the B point at the posttreatment stage for the skeletal class III surgery-first approach (SFA).

Methods

This study re-analyzed the data from the retrospective study by Lee et al. on 40 patients with skeletal class III bimaxillary SFA. Variables were obtained from cone beam computed tomography (CBCT)-generated cephalograms. Authors investigated all variables at each time point to build a PLS-PM model to verify the effect of the VD on the final setback of the mandible.

Results

From PLS-PM, an increase in VD10 was found to decrease the absolute value of the final setback amount of the mandible, which reflects the postsurgical physiological responses to both surgery and orthodontic treatment, which, in turn, can be interpreted as an increase in postoperative mandibular changes.

Conclusions

To resolve the issue of collinear cephalometric data, the present study adopted PLS-PM to assess the orthodontic treatment. From PLS-PM, it was able to summarize the effect of increased postsurgery occlusal vertical dimension on the increased changeability of the B point position at the posttreatment stage.



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Amnion Membrane in Diabetic Foot Wounds: A Meta-analysis

imageBackground: Amniotic membrane is tissue obtained from human placenta rich in cytokines, growth factors, and stem cells that possess the ability to inhibit infection, improve healing, and stimulate regeneration. Methods: A meta-analysis was performed examining randomized controlled trials comparing amniotic tissue products with standard of care in nonhealing diabetic foot ulcers including PubMed, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews. Results: A search of 3 databases identified 596 potentially relevant articles. Application of selection criteria led to the selection of 5 randomized controlled trials. The 5 selected randomized controlled trials represented a total of 311 patients. The pooled relative risk of healing with amniotic products compared with control was 2.7496 (2.05725–3.66524, P

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Plastic and Reconstructive Surgery in Global Health: Let’s Reconstruct Global Surgery

imageSummary: Since the inception of the Lancet Commission in 2013 and consequent prioritization of Global Surgery at the World Health Assembly, international surgical outreach efforts have increased and become more synergistic. Plastic surgeons have been involved in international outreach for decades, and there is now a demand to collaborate and address local need in an innovative way. The aim of this article was to summarize new developments in plastic and reconstructive surgery in global health, to unify our approach to international outreach. Specifically, 5 topics are explored: current models in international outreach, benefits and concerns, the value of research, the value of international surgical outreach education, and the value of technology. A “Let’s Reconstruct Global Surgery” network has been formed using Facebook as a platform to unite plastic and reconstructive surgeons worldwide who are interested in international outreach. The article concludes with actionable recommendations from each topic.

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Rebamipide reduces amyloid-β 1–42 (Aβ42) production and ameliorates Aβ43-lowered cell viability in cultured SH-SY5Y human neuroblastoma cells

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Publication date: Available online 3 June 2017
Source:Neuroscience Research
Author(s): Kenta Fukui, Kazuma Yachi, Hidemi Yoshida, Kunikazu Tanji, Tomoh Matsumiya, Ryo Hayakari, Kazushi Tsuruga, Hiroshi Tanaka, Tadaatsu Imaizumi
Amyloid-beta (Aβ) peptides, Aβ 1–42 (Aβ42) and Aβ43, in particular, have been implicated in the pathophysiology of neurodegenerative disease such as Alzheimer’s disease (AD). Rebamipide (REB), a gastrointestinal protective drug, can cross the blood-brain barrier after oral administration; however, the effects of REB on neuronal cells have not yet been reported. In this study, we investigated the effects of REB on Aβ43-induced cytotoxicity (monomers, 10μM) in cultured SH-SY5Y human neuroblastoma cells. Addition of REB (10–1000nM) into the media partially ameliorated the reduced cell viability observed after Aβ43 treatment, which was determined by the MTT assay. REB reduced the levels of intracellular Aβ oligomers (100–150kDa) that were formed from the exogenous addition of Aβ43 monomers. In addition, REB (30nM) reduced endogenous Aβ42 secretion, which was analyzed by the enzyme-linked immunosorbent assay. Furthermore, REB enhanced the expression of tumor necrosis factor-α-converting enzyme/a disintegrin and metalloproteinase-17, neprilysin, matrix-metalloproteinase-14 (MMP-14)/membrane type-1 MMP, cyclooxygenase-2, and sirtuin 1, even in cells challenged with Aβ43. These results suggest that REB improves the cell viability by inducing genes that regulate Aβ levels and also genes that are cytoprotective. The secondary use of REB may have potential in the prevention of Aβ-mediated diseases, particularly AD.



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Genotoxicity of metal based engineered nanoparticles in aquatic organisms: a review

Publication date: Available online 4 June 2017
Source:Mutation Research/Reviews in Mutation Research
Author(s): N. Mahaye, M. Thwala, D.A. Cowan, N. Musee
Engineered nanoparticles (ENPs) are an emerging class of environmental contaminants, but are generally found in very low concentrations and are therefore likely to exert sub-lethal effects on aquatic organisms. In this review, we: (i) highlight key mechanisms of metal-based ENP-induced genotoxicity, (ii) identify key nanoparticle and environmental factors which influence the observed genotoxic effects, and (iii) highlight the challenges involved in interpreting reported data and provide recommendations on how these challenges might be addressed. We review the application of eight different genotoxicity assays, where the Comet Assay is generally preferred due to its capacity to detect low levels of DNA damage. Most ENPs have been shown to cause genotoxic responses; e.g., DNA or/and chromosomal fragmentation, or DNA strand breakage, but at unrealistic high concentrations. The genotoxicity of the ENPs was dependent on the inherent physico-chemical properties (e.g. size, coating, surface chemistry, e.tc.), and the presence of co-pollutants. To enhance the value of published genotoxicity data, the role of environmental processes; e.g., dissolution, aggregation and agglomeration, and adsorption of ENPs when released in aquatic systems, should be included, and assay protocols must be standardized. Such data could be used to model ENP genotoxicity processes in open environmental systems.



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Programmable cells of monocytic origin as a source of osteochondroprogenitors: Effect of growth factors on osteogenic differentiation

We have demonstrated previously that peripheral blood monocytes can be converted in vitro to a multipotent stem cell−like cell termed programmable cell of monocytic origin (PCMO) and subsequently into cells with chondrocyte-like phenotype. Here, we investigated whether PCMO could also be differentiated into osteoblast-like cells using growth factors with known osteoinductive potency. Following stimulation with BMP-2, BMP-7, IGF-1 or TGF-β1 for 7 and 14 days, PCMOs were analysed for mRNA expression of collagen types I and V, alkaline phosphatase, osteocalcin, runt-related transcription factor-2 (Runx2) and Osterix (Osx) by quantitative RT-PCR (qPCR) and the levels of collagen I in culture supernatants by ELISA.

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The impact of glucocorticosteroids administered for systemic diseases on the osseointegration and survival of dental implants placed without bone grafting—a retrospective study in 31 patients

To evaluate the impact of glucocorticosteroids, administered for the treatment of systemic diseases, on the osseointegration and survival of dental implants placed without bone grafting.

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The impact of surgical intervention and antibiotics on MRONJ stage II and III – retrospective study

Metastatic bone disease and osteoporosis are the main indications for bisphosphonates and anti-resorptive agent therapy. Inhibition of bone turnover and angiogenesis are mainly responsible for the development of Medication Related Osteonecrosis of Jaws (MRONJ) as therapeutic side-effect. Yet, the role of infection for the development and recurrence of MRONJ is not fully elucidated. The aim of this retrospective study is to explore if a difference in antibiotic regimes has an impact on the surgical intervention needed to achieve a painless stable stage of the disease.

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Alice in Bundleland

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Alice in Bundleland

EMCrit by Paul Marik.



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Metabolomic analysis with 1H-NMR for non-invasive diagnosis of hepatic fibrosis degree in patients with chronic hepatitis C

The assessment of fibrosis degree in liver diseases is based on several non-invasive techniques, but none has been accurate.

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Metabolomic analysis with 1H-NMR for non-invasive diagnosis of hepatic fibrosis degree in patients with chronic hepatitis C

The assessment of fibrosis degree in liver diseases is based on several non-invasive techniques, but none has been accurate.

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Does the Powers™ strap influence the lower limb biomechanics during running?

Publication date: Available online 3 June 2017
Source:Gait & Posture
Author(s): Henrike Greuel, Lee Herrington, Anmin Liu, Richard K. Jones
Previous research has reported a prevalence of running related injuries in 25.9% to 72% of all runners. A greater hip internal rotation and adduction during the stance phase in running has been associated with many running related injuries, such as patellofemoral pain. Researchers in the USA designed a treatment device ‘the Powers™ strap' to facilitate an external rotation of the femur and to thereby control abnormal hip and knee motion during leisure and sport activities. However, to date no literature exists to demonstrate whether the Powers™ strap is able to reduce hip internal rotation during running.22 healthy participants, 11 males and 11 females (age: 27.45±4.43 years, height: 1.73±0.06m, mass: 66.77±9.24kg) were asked to run on a 22m track under two conditions: without and with the Powers™ strap. Three-dimensional motion analysis was conducted using ten Qualisys OQUS 7 cameras (Qualisys AB, Sweden) and force data was captured with three AMTI force plates (BP600900, Advanced Mechanical Technology, Inc.USA). Paired sample t-tests were performed at the 95% confidence interval on all lower limb kinematic and kinetic data.The Powers™ strap significantly reduced hip and knee internal rotation throughout the stance phase of running. These results showed that the Powers™ strap has the potential to influence hip motion during running related activities, in doing so this might be beneficial for patients with lower limb injuries. Future research should investigate the influence of the Powers™ strap in subjects who suffer from running related injuries, such as patellofemoral pain.



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A procedure to detect abnormal sensorimotor control in adolescents with idiopathic scoliosis

Publication date: Available online 4 June 2017
Source:Gait & Posture
Author(s): Jean-Philippe Pialasse, Pierre Mercier, Martin Descarreaux, Martin Simoneau
This work identifies, among adolescents with idiopathic scoliosis, those demonstrating impaired sensorimotor control through a classification procedure comparing the amplitude of their vestibular-evoked postural responses. The sensorimotor control of healthy adolescents (n=17) and adolescents with idiopathic scoliosis (n=52) with either mild (Cobb angle≥15° and ≤30°) or severe (Cobb angle >30°) spine deformation was assessed through galvanic vestibular stimulation. A classification procedure sorted out adolescents with idiopathic scoliosis whether the amplitude of their vestibular-evoked postural response was dissimilar or similar to controls. Compared to controls, galvanic vestibular stimulation evoked larger postural response in adolescents with idiopathic scoliosis. Nonetheless, the classification procedure revealed that only 42.5% of all patients showed impaired sensorimotor control. Consequently, identifying patients with sensorimotor control impairment would allow to apply personalized treatments, help clinicians to establish prognosis and hopefully improve the condition of patients with adolescent idiopathic scoliosis.



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Effects of hip joint centre mislocation on gait kinematics of children with cerebral palsy calculated using patient-specific direct and inverse kinematic models

Publication date: Available online 4 June 2017
Source:Gait & Posture
Author(s): Hans Kainz, Christopher P. Carty, Sheanna Maine, Henry P.J. Walsh, David G. Lloyd, Luca Modenese
Joint kinematics can be calculated by Direct Kinematics (DK), which is used in most clinical gait laboratories, or Inverse Kinematics (IK), which is mainly used for musculoskeletal research. In both approaches, joint centre locations are required to compute joint kinematics. The hip joint centre (HJC) in DK models can be estimated using predictive or functional methods, while in IK models can be obtained by scaling generic models. The aim of the current study was to systematically investigate the impact of HJC location errors on lower limb joint kinematics of a clinical population using DK and IK approaches. Subject-specific kinematic models of eight children with cerebral palsy were built from magnetic resonance images and used as reference models. HJC was then perturbed in 6mm steps within a 60mm cubic grid, and then kinematic waveforms were calculated for the reference and perturbed models. HJC perturbations affected only hip and knee joint kinematics in a DK framework, but all joint angles were affected when using IK. In the DK model, joint constraints increased the sensitivity of joint range-of-motion to HJC location errors. Mean joint angle offsets larger than 5° were observed for both approaches (DK and IK), which were larger than previously reported for healthy adults. In the absence of medical images to identify the HJC, predictive or functional methods with small errors in anterior-posterior and medial-lateral directions and scaling procedures minimizing HJC location errors in the anterior-posterior direction should be chosen to minimize the impact on joint kinematics.



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Gait performance of children and adolescents with sensorineural hearing loss

Publication date: Available online 3 June 2017
Source:Gait & Posture
Author(s): Renato de Souza Melo
BackgroundSeveral studies have demonstrated that children with sensorineural hearing loss (SNHL) may exhibit balance disorders, which can compromise the gait performance of this population.ObjectiveCompare the gait performance of normal hearing (NH) children and those with SNHL, considering the sex and age range of the sample, and analyze gait performance according to degrees of hearing loss and etiological factors in the latter group.MethodThis is a cross-sectional study that assessed 96 students, 48 NH and 48 with SNHL, aged between 7 and 18 years. The Brazilian version of the Dynamic Gait Index (DGI) was used to analyze gait and the Mann-Whitney test for statistical analysis.ResultsThe group with SNHL obtained lower average gait performance compared to NH subjects (p=0.000). This was also observed when the children were grouped by sex female and male (p=0.000). The same difference occurred when the children were stratified by age group: 7-18 years (p=0.000). The group with severe and profound hearing loss exhibited worse gait performance than those with mild and moderate loss (p=0.048) and children with prematurity as an etiological factor demonstrated the worst gait performance.ConclusionThe children with SNHL showed worse gait performance compared to NH of the same sex and age group. Those with severe and profound hearing loss and prematurity as an etiological factor demonstrated the worst gait performances.



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Burrowing as a Novel Voluntary Strength Training Method for Mice: A Comparison Of Various Voluntary Strength or Resistance Exercise Methods

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Publication date: Available online 3 June 2017
Source:Journal of Neuroscience Methods
Author(s): P. Roemers, P.N. Mazzola, P.P. De Deyn, W.J. Bossers, M.J.G van Heuvelen, E.A. van der Zee
BackgroundVoluntary strength training methods for rodents are necessary to investigate the effects of strength training on cognition and the brain. However, few voluntary methods are available.New methodThe current study tested functional and muscular effects of two novel voluntary strength training methods, burrowing (digging a substrate out of a tube) and unloaded tower climbing, in male C57Bl6 mice. To compare these two novel methods with existing exercise methods, resistance running and (non-resistance) running were included. Motor coordination, grip strength and muscle fatigue were measured at baseline, halfway through and near the end of a fourteen week exercise intervention. Endurance was measured by an incremental treadmill test after twelve weeks.ResultsBoth burrowing and resistance running improved forelimb grip strength as compared to controls. Running and resistance running increased endurance in the treadmill test and improved motor skills as measured by the balance beam test. Post-mortem tissue analyses revealed that running and resistance running induced Soleus muscle hypertrophy and reduced epididymal fat mass. Tower climbing elicited no functional or muscular changes.Comparison with existing methodsAs a voluntary strength exercise method, burrowing avoids the confounding effects of stress and positive reinforcers elicited in forced strength exercise methods. Compared to voluntary resistance running, burrowing likely reduces the contribution of aerobic exercise components.ConclusionsBurrowing qualifies as a suitable voluntary strength training method in mice. Furthermore, resistance running shares features of strength training and endurance (aerobic) exercise and should be considered a multi-modal aerobic-strength exercise method in mice.



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Comparison of estimates of neuronal number obtained using the isotropic fractionator method and unbiased stereology in day old chicks (Gallus domesticus)

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Publication date: Available online 3 June 2017
Source:Journal of Neuroscience Methods
Author(s): Ayanda Ngwenya, Janae Nahirney, Ben Brinkman, Lauren Williams, Andrew N. Iwaniuk
BackgroundThe relative size and neuronal density of brain regions are important metrics in both comparative and experimental studies in neuroscience. Consequently, it is imperative to have accurate, reliable and reproducible methods of quantifying cell number.New methodThe isotropic fractionator (IF) method estimates the number of neurons and non-neurons in the central nervous system by homogenizing tissue into discrete nuclei and determining the proportion of neurons from non-neurons using immunohistochemistry (Herculano- Herculano-Houzel and Lent, 2005).Comparison with existing methodOne of the advantages of IF is that it is considerably faster than stereology. However, as the method is relatively new, concerns about its accuracy remain, particularly whether homogenization results in underestimation of cell number. In this study, we compared estimates of neuronal number in the telencephalon and ‘rest of brain’ (i.e. the diencephalon and brainstem excluding the optic lobes) of day old chicks using the IF method and stereology.ResultsIn the telencephalon, there was a significant difference in estimates of neuronal number between the 2 methods, but not estimates of neuronal density (neurons/mg of tissue). Whereas in the ‘rest of brain’, there was a significant difference in estimates of neuronal density, but not neuronal number. In all cases, stereological estimates were lower than those obtained using the IF method.ConclusionDespite the statistically significant differences, there was considerable overlap (all estimates were within 16% of one another) between estimates obtained using the two methods suggesting that the two methods provide comparable estimates of neuronal number in birds.



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A novel operant task to assess social reward and motivation in rodents

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Publication date: Available online 3 June 2017
Source:Journal of Neuroscience Methods
Author(s): Johnathan M. Borland, Kyle J. Frantz, Lauren M. Aiani, Kymberly N. Grantham, Zhimin Song, H. Elliott Albers
BackgroundSocial reward plays a critical role in the development of beneficial social relationships, and disorders of the mechanisms controlling social reward are involved in the etiology of many psychiatric diseases.New methodWe present a novel operant social preference task to quantify social reward in rodents using an apparatus with three chambers separated by one-way vertical-swing doors. The experimental animal is placed in the larger chamber while the two smaller chambers either remain empty or contain a stimulus animal or other potential reward stimulus. Adding weights to the door can alter effort required for rewards.ResultsHamsters (Mesocricetus auratus) entered the chamber containing a stimulus hamster significantly more frequently than an empty chamber. When the reinforcing effects of social interactions were compared to food reward under progressive cost requirements, the reinforcing effects of social interaction and sunflower seeds were similar. Progressively increasing the door weight decreased number of entries, but increased time spent attempting to open the doors.Comparison with existing methodsThe quantification of the rewarding properties of social interactions has almost exclusively used the conditioned place preference (CPP) paradigm. Although robust and reliable, CPP includes a memory component, because it relies on the association of place with the social interaction while the operant task presented here does not.ConclusionsThis task allows for detailed and direct assessment of social and non-social rewards that may serve as effective behavioral reinforcers in this operant conditioning model, and it can be used to investigate the neural mechanisms regulating motivation.



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The efficacy of ultrasound, mammography and magnetic resonance imaging in detecting breast implant rupture: a retrospective study of 175 reconstructive and aesthetic sub-pectoral breast augmentation cases

Publication date: Available online 3 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Alessio Stivala, Kessara Rem, Sara Leuzzi, Vivien Moris, Caroline François, Marc Revol, Sarra Cristofari
The effectiveness of radiological imaging in detecting silicone breast implant rupture is, to this day, uncertain. The purpose of this study is to retrospectively evaluate the effectiveness of radiological imaging when diagnosing a rupture.The population taken into exam comprised 175 patients with 242 implants, among which 168 were used for breast reconstruction and 74 for aesthetic augmentation. All patients who underwent revision surgery, between January 2015 and June 2016, following breast augmentation or reconstruction, were included, regardless of any preoperative diagnosis of rupture had been made. The diagnosis of intracapsular rupture was verified intraoperatively and compared to the preoperative findings. Regarding preoperative diagnostic imaging methods, we compared Magnetic Resonance Imaging (MRI), Mammography and Ultrasonography (US).Among the 242 implants which have been explanted, 35 clinical ruptures were confirmed and compared with the related radiological findings. We reported 22 false positives and 15 false negatives. Ultrasonography was the least specific and least accurate method, due to its lowest positive predictive value (PPV) and negative predictive value (NPV). Mammography was the most specific and most accurate method with the highest PPV (96%). Surprisingly, MRI was the most sensitive, but neither the most specific nor the most accurate method despite having the highest NPV (98%).Comparing these three radiological techniques brought us to the conclusion that US associated with MRI can be useful for young patients. Mammography, which was characterized by high specificity and accuracy, could be useful in association with MRI in investigating patients over the age of 40.



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Long-term survival of a randomized phase III trial of head and neck cancer patients receiving concurrent chemoradiation therapy with or without low-level laser therapy (LLLT) to prevent oral mucositis

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Publication date: August 2017
Source:Oral Oncology, Volume 71
Author(s): Héliton S. Antunes, Daniel Herchenhorn, Isabele A. Small, Carlos M.M. Araújo, Celia Maria Pais Viégas, Gabriela de Assis Ramos, Fernando L. Dias, Carlos G. Ferreira
BackgroundThe impact of low-level laser therapy (LLLT) to prevent oral mucositis in patients treated with exclusive chemoradiation therapy remains unknown. This study evaluated the overall, disease-free and progression-free survival of these patients. Methods: Overall, disease-free and progression-free survival of 94 patients diagnosed with oropharynx, nasopharynx, and hypopharynx cancer, who participated on a phase III study, was evaluated from 2007 to 2015. The patients were subjected to conventional radiotherapy plus cisplatin every 3weeks. LLLT was applied with an InGaAlP diode (660nm–100mW–1J–4J/cm2).ResultsWith a median follow-up of 41.3months (range 0.7–101.9), patients receiving LLLT had a statistically significant better complete response to treatment than those in the placebo group (LG=89.1%; PG=67.4%; p=0.013). Patients subjected to LLLT also displayed increase in progression-free survival than those in the placebo group (61.7% vs. 40.4%; p=0.030; HR:1:93; CI 95%: 1.07–3.5) and had a tendency for better overall survival (57.4% vs. 40.4%; p=0.90; HR:1.64; CI 95%: 0.92–2.91).ConclusionThis is the first study to suggest that LLLT may improve survival of head and neck cancer patients treated with chemoradiotherapy. Further studies, with a larger sample, are necessary to confirm our findings.



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Prognostic role of tumor infiltrating lymphocytes in EBV positive and EBV negative nasopharyngeal carcinoma

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Publication date: August 2017
Source:Oral Oncology, Volume 71
Author(s): Marc L. Ooft, Jolique A. van Ipenburg, Weibel W. Braunius, Charlotte I. Zuur, Senada Koljenović, Stefan M. Willems
ObjectivesTumor infiltrating lymphocytes (TILs) correlate with both better and worse prognosis in solid tumors. As therapeutic modalities for nasopharyngeal carcinoma (NPC) are limited, immunotherapy could be a potential alternative. Up till now there is limited prognostic data on the role of TILs in NPC, so we assessed the prognostic role of TILs in Epstein-Barr-virus (EBV) positive and negative NPC.MethodsTissue of 92 NPCs was assessed for CD3, CD4, CD8, PD1 and PDL1 expression in the tumor’s micro-environment. Correlations between clinicopathological characteristics was assessed using the Pearson X2 test, Fisher’s exact test and ANOVA. Survival was analyzed with the Kaplan-Meier method and Cox regression. Differences in CD3, CD4, CD8, PD1, PDL1 counts/(co)expression between EBV positive and negative NPCs were evaluated using the Mann-Whitney U test. Two-tailed P values below 0.05 were considered statistically significant.ResultsEBV positive NPC contains significantly more CD3, CD4 and CD8 TILs than EBV negative NPC. In the whole NPC group, increased CD8 count is associated with better overall survival (OS) (HR 0.219 (95%CI 0.075–0.640)), but also in cases with PDL1 co-expression (HR 0.073 (95%CI 0.010–0.556)). In EBV positive NPC co-expression of CD8 and PDL1 showed better disease free survival (HR 0.407 (95%CI 0.195–0.850)) and OS (HR 0.170 (95%CI 0.037–0.787)).ConclusionsAlthough TILs are significantly different between EBV positive and negative NPCs, it is especially composition of the infiltrate which determines prognosis. Effects of PD1 and CD8 need more study, because these findings show much potential in using immunotherapeutic modalities in NPC treatment.



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A network meta-analysis of the sequencing and types of systemic therapies with definitive radiotherapy in locally advanced squamous cell carcinoma of the head and neck (LASCCHN)☆

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Publication date: August 2017
Source:Oral Oncology, Volume 71
Author(s): Katarzyna J. Jerzak, Keemo Delos Santos, Ronak Saluja, Kelly Lien, Justin Lee, Kelvin K.W. Chan
ObjectivesThe current standard therapy for locally advanced squamous cell carcinoma of the head and neck (LASCCHN) is platinum-based chemotherapy plus concurrent radiotherapy (CRT), but several systemic therapies have been evaluated. We performed a Bayesian network meta-analysis (NMA) with random effects to enable direct and indirect comparisons of all existing treatment modalities for LASCCHN simultaneously.Material and methodsA systematic review was conducted using MEDLINE, EMBASE, ASCO abstracts, ASTRO abstracts and the Cochrane Central of Registered Trials using Cochrane methodology to identify randomized controlled trials (RCTs) up to June 2016. Only abstracts that involved the same definitive radiotherapy in the arms for the RCT were included.ResultsSixty-five RCTs involving 13,574 patients and 16 different treatment strategies were identified. Chemotherapy plus concurrent radiation (CRT) was superior to RT with a HR of 0.74 (95%CR 0.69–0.79) for OS in the NMA. Only 3 trials compared RT alone to concurrent therapy with an EGFR antibody (ERT), demonstrating a superior OS (HR 0.75, 95% CR 0.60–0.94), but this difference was not statistically significant when interpreted in a NMA (HR 0.84, 95%CR 0.65–1.08). ERT was not superior to CRT (HR 1.19, 95%CR 0.93–1.54), and the addition of neo-adjuvant taxane-based chemotherapy to CRT was not beneficial (HR 0.86, 95% CR 0.70–1.07).ConclusionThe addition of either adjuvant or neoadjuvant chemotherapy to the CRT backbone does not confer an OS benefit in the treatment of LASCCHN. Similarly, ERT does not confer an OS benefit for patients who are eligible for CRT.



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Comment on relative brain size in early primates and the use of encephalization quotients in primate evolution

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Publication date: Available online 3 June 2017
Source:Journal of Human Evolution
Author(s): Christopher C. Gilbert, William L. Jungers




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Basic Guide to Oral and Maxillofacial Surgery

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Cinzia Pickett Description An illustrated guide to oral and maxillofacial surgery, written by dental nurses for dental nurses Basic Guide to Oral and Maxillofacial Surgery will help you understand the... Read more »

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Supra-Gingival Minimally Invasive Dentistry : A Healthier Approach to Esthetic Restorations

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Jose Luis Ruiz Description Supra-Gingival Minimally Invasive Dentistry: A Healthier Approach to Esthetic Restorations provides a real-world approach to healthier supra-gingival minimally invasive restorations, as an alternative to more invasive... Read more »

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The impact of glucocorticosteroids administered for systemic diseases on the osseointegration and survival of dental implants placed without bone grafting—a retrospective study in 31 patients

Publication date: Available online 4 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Vassileios Petsinis, Georgios Kamperos, Foteini Alexandridi, Konstantinos Alexandridis
PurposeTo evaluate the impact of glucocorticosteroids, administered for the treatment of systemic diseases, on the osseointegration and survival of dental implants placed without bone grafting.Materials and MethodsA retrospective study was conducted in search of patients treated with dental implants while receiving glucocorticosteroid therapy for various systemic diseases. In these cases, a conventional two-stage surgical protocol was used, without bone regeneration procedures. The osseointegration was clinically and radiographically tested at the uncovering of the implants. The follow-up after loading was set at a minimum of 3 years.ResultsA total of 31 patients were included in the study. Of the 105 dental implants placed, 104 were osseointegrated (99%). No bone absorption was radiographically noted at the uncovering of the osseointegrated implants. All of the osseointegrated implants were successfully loaded for the prosthetic restoration. The mean follow-up period after loading was 71 months, with an implant survival rate of 99%.ConclusionsGlucocorticosteroid intake for systemic diseases does not have a significant impact on the osseointegration and the 3-year survival of dental implants placed with a conventional two-stage surgical protocol and without bone grafting. Therefore, it should not be considered a contraindication for dental implant placement.



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Programmable cells of monocytic origin as a source of osteochondroprogenitors: Effect of growth factors on osteogenic differentiation

Publication date: Available online 4 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Yahya Açil, Björn Möller, Jörg Wiltfang, Fred Fändrich, Hendrik Ungefroren
We have demonstrated previously that peripheral blood monocytes can be converted in vitro to a multipotent stem cell−like cell termed programmable cell of monocytic origin (PCMO) and subsequently into cells with chondrocyte-like phenotype. Here, we investigated whether PCMO could also be differentiated into osteoblast-like cells using growth factors with known osteoinductive potency. Following stimulation with BMP-2, BMP-7, IGF-1 or TGF-β1 for 7 and 14 days, PCMOs were analysed for mRNA expression of collagen types I and V, alkaline phosphatase, osteocalcin, runt-related transcription factor-2 (Runx2) and Osterix (Osx) by quantitative RT-PCR (qPCR) and the levels of collagen I in culture supernatants by ELISA. The expression of osteoblastic markers was evident, albeit at a different extent in cultures of PCMOs after treatment with the above-mentioned growth factors. Culture supernatants from PCMOs stimulated for 6-10 days with BMP-2, BMP-7, IGF-1 or TGF-β1 contained high levels of collagen type I, together with earlier data indicating synthesis and proper secretion. The findings suggest that PCMOs can transform into cells that are phenotypically similar to osteoblasts and identify these cells as osteochondroprogenitors. The possibility of differentiating PCMOs from peripheral blood in sizable quantities could be a novel way to obtain autologous bone-like substitutes without donor-site morbidity.



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Fluorescence based characterization of early oral squamous cell carcinoma using the Visually Enhanced Light Scope technique

Publication date: Available online 3 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Egon Burian, Caterina Schulz, Florian Probst, Benjamin Palla, Matthias Tröltzsch, Fabio Maglitto, Luigi Califano, Michael Ehrenfeld, Sven Otto
ObjectivesSeveral diagnostic tools have been developed to assess benign and potentially malignant disorders of soft tissues. In this study, we aimed to assess the value of the VELscope® (Visually Enhanced Light Scope) imaging device as a technical tool to investigate malignant lesions of the oral cavity.Material and methodsIn this retrospective study we analyzed the photographs of 90 patients who suffered from malignant oral soft tissue lesions or carcinoma in situ (CIS) from 2008 to 2014 in the Clinic of Oral and Maxillofacial Surgery of LMU in Munich.ResultsIn 85.6% of the cases fluorescence quenching/loss could be detected. The average value for the colour red shows a significant difference in pathologic and physiologic tissues (p=0.007) with a higher median for pathologic tissues. For the colours green and blue our measurements show significantly higher values in the healthy tissue (p< 0.001.). The shade of red showed significantly higher values for pathologic tissues when compared to all three colours (p< 0.001). Furthermore, the shades of green and blue showed significantly lower values in the pathologic tissue (p< 0.001).ConclusionIn the near future, VELscope® could help to a greater extent than visual observation alone in identifying the margins of tumor resections. VELscope® still lacks the ability to identify the overall risk level of oral lesions.



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The influence of different abutment materials on tissue regeneration after surgical treatment of peri-implantitis - a randomized controlled preclinical study

Publication date: Available online 3 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Tobias Moest, Jan Wrede, Christian Martin Schmitt, Melanie Stamp, Friedrich Wilhelm Neukam, Karl Aandreas Schlegel
ObjectivesThis study aimed to assess the impact of different abutment materials on peri-implant tissue regeneration after surgical treatment of peri-implantitis in a large animal model.Material and MethodsTitanium implants (n = 51) were inserted in the upper and lower jaw of eight beagle dogs and a peri-implant infection was induced. After two months the peri-implant infection was surgically treated and abutments with different surfaces (Ti-2: n = 14; CoCrMb: n = 13; Ag-modified Ti-4: n =14; Ti-4 control: n = 10) were applied. Clinical attachment level (CAL), modified sulcus bleeding index (mBI), bleeding on probing (BoP), and the sulcus fluid flow rate (SFFR) were determined 4, 8, and 12 weeks after surgical treatment to document the peri-implant tissue reaction.ResultsSuperior levels for CAL and mBI were found with the Ti-4 control and the Ag-modified abutments, with the Ag-modified abutments showing the best values after 12 weeks. Lowest SFFR values compared with the other treatment groups underlined the superior soft tissue reaction adjacent to Ag-modified abutments. After 12 weeks inferior CAL, SFFR, BOP and mBI values were documented for the Ti-2 surface.ConclusionWithin limitations of the study, Ag-modified abutments lead to superior tissue reactions. Further studies are needed to investigate the properties of abutment materials.



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Synchrotron radiation μCT and histology evaluation of bone-to-implant contact

Publication date: Available online 3 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Camilla Albeck Neldam, Jon Sporring, Alexander Rack, Torsten Lauridsen, Ellen-Margrethe Hauge, Henrik L. Jørgensen, Niklas Rye Jørgensen, Robert Feidenhansl, Else Marie Pinholt




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The impact of surgical intervention and antibiotics on MRONJ stage II and III – retrospective study

Publication date: Available online 4 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Matthias Zirk, Matthias Kreppel, Johannes Buller, Julij Pristup, Franziska Peters, Timo Dreiseidler, Max Zinser, Joachim E. Zöller
ObjectivesMetastatic bone disease and osteoporosis are the main indications for bisphosphonates and anti-resorptive agent therapy. Inhibition of bone turnover and angiogenesis are mainly responsible for the development of Medication Related Osteonecrosis of Jaws (MRONJ) as therapeutic side-effect. Yet, the role of infection for the development and recurrence of MRONJ is not fully elucidated. The aim of this retrospective study is to explore if a difference in antibiotic regimes has an impact on the surgical intervention needed to achieve a painless stable stage of the disease. Furthermore, we investigated concomitant submucosal infections in local relation to the MRONJ site.MethodsA retrospective study (2006-2015) of 143 patients treated with MRONJ stage II and stage III in a single institutional university hospital was performed. All patients experienced at least one surgical intervention and received antibiotics. Their medical records, pathological and microbial findings were reviewed. Data was controlled for the achievement of an event free time period of at least 12 months.ResultsWe investigated the number and kind of treatments that were performed on patients with MRONJ stage II and III to achieve a painless stable stage of the disease. The first and second healing approach differed significantly from each other (p<0.05). In 7 (4.9%) cases up to four surgical interventions were needed to achieve oral rehabilitation. In 135 (95.1 %) of all cases a segmental resection could be prevented, with extended decortication being the most applied method. Patients under perioperative ampicillin/sulbactam showed a significant reduction for a second or fourth intervention compared to the clindamycin group (p<0.05). Results for a third intervention presented a similar difference between both groups, but were not significant (p= 0.06). Intraoperatively in 76 out of 241 (31.5%) cases presented putrid submucosal infections. The isolated bacteria were gram-negative facultative anaerobes (39.1%) and strictly anaerobic bacteria (gram-positive/38.2%, gram-negative/19.1%). Susceptibly of the cultured bacteria were significantly (p<0.05) in favor to ampicillin/sulbactam (79.1%) compared to clindamycin (49.5%).ConclusionThe perioperative antibiotic regime for patients with MRONJ stage II and III undergoing surgically treatment does have an influence on the recurrence of the disease. Further investigation is needed to elucidate the role of infection in the treatment of MRONJ.



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What is the effect of Anti-resorptive drugs (ARDs) on the development of Medication-Related Osteonecrosis of the jaw (MRONJ) in Osteoporosis Patients: A Systematic Review

Publication date: Available online 3 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Suad Aljohani, Riham Fliefel, Jacob Ihbe, Jan Kühnisch, Michael Ehrenfeld, Sven Otto
PurposeTo conduct a systematic review of the literature to detect the effect of anti-resorptive drugs (ARDs) and their administration characteristics in the development of medication-related osteonecrosis of the jaw (MRONJ) in osteoporosis patients.MethodsSystematic search in PubMed, Web of Sciences and Cochrane Library was performed for relevant studies to July 2016. Population variables (age, gender, comorbidities, medications, preceding events, number of patients with MRONJ), ARDs and clinical variables were abstracted independently from these articles.ResultsThe 44 eligible studies described 680 MRONJ cases in osteoporotic patients. The mean age of MRONJ patients was 69.7±5.2 years. It was more common in females. Mandible was the most common site. Alendronate was the most frequently administered ARD. Oral route of administration was noted in 86.7% of the patients. The mean duration of BPs intake was 50.4±19 months. Extraction was the most frequently preceding event followed by dentoalveolar surgery. Corticosteroids or immunosuppressants were the most common concomitant medications in MRONJ.ConclusionA long duration of ARDs administration seems to be an important risk factor in MRONJ development. Patients under treatment with corticosteroids or immunosuppressants might be at a higher risk even if the BPs duration is less than 4 years.



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Analyzing the teeth next to the alveolar cleft: Examination and treatment proposal prior to bone grafting based on three-dimensional versus two-dimensional diagnosis—a diagnostic study

Publication date: Available online 3 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Susanne Wriedt, Bilal Al-Nawas, Irene Schmidtmann, Sami Eletr, Heinrich Wehrbein, Maximilian Moergel, Collin Jacobs
PurposeThe objective was to evaluate the diagnostic and prognostic value of three-dimensional (3D) cone beam computed tomography (CBCT) on information about the cleft and alignment of cleft neighboring teeth.Materials and MethodsPanoramic X-rays, small-volume CBCTs, and study casts of 20 patients with a total of 22 alveolar clefts were analyzed prior to secondary bone grafting. Six maxillofacial surgeons and 6 orthodontists rated the following parameters: visibility of alveolar cleft expansion, position and probability of alignment of cleft neighbored teeth. Two-dimensional (2D) X-rays and casts were rated first; CBCT and casts followed at least 4 weeks later. Radiologic bone height in the region of the former alveolar cleft, as well as alignment and reasons for nonalignment of cleft neighbored teeth, were recorded 4 years later.ResultsThe rate of proper proposals regarding the real treatment outcome using 2D- or 3D-material did not differ statistically. Although 5%-45% of the proposals were changed when using 3D instead of 2D records, Fleiss multirater kappas showed no essential differences. Raters’ profession and experience had no influence on the rate of correct proposals.ConclusionIn orthodontics, small-volume CBCT may be justified only as supplement to a routine panoramic X-ray, and only in selected cases or for surgical preparation.



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Expression of Notch signaling pathway during osteoarthritis in the temporomandibular joint

Publication date: Available online 3 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Lingli Lan, Yangmei Jiang, Weina Zhang, Ting Li, Binbin Ying, Songsong Zhu
PurposeOur study aim was to characterize the expression of Notch molecules during temporomandibular joint osteoarthritis (TMJOA), thus exploring the mechanism and roles that Notch signaling possibly plays in the initiation and progression of TMJOA.Materials and MethodsA total of 126 mice were divided randomly into experimental groups, a sham-surgery group and a normal control group. In the experimental group, total discectomy was performed in the right temporomandibular joint (TMJ) to induce TMJOA; the sham-operation group underwent the same procedure without disc removal, and the normal control group was left undisturbed. Fourteen mice in each group were sacrificed in batches respectively at 1, 2, and 4 weeks postoperatively. Histology was performed to examine TMJOA in eight condyles each group, and a modified Mankin scoring system was used for evaluation. Immunohistochemistry was carried out to characterize the expression of the Notch markers Notch1, Jagged1, Hes1, and Hes5. Real-time polymerase chain reaction (RT-PCR) was performed for further detection and analysis of Notch markers in six condyles in each group.ResultsNotch1, Jagged1, and Hes5 were activated in the experimental group, with expression levels that increased dramatically over time, whereas the control group showed no fluctuation. Hes1 expression was suppressed at the beginning but was up-regulated afterward.ConclusionsOur data suggest that Notch signaling is activated in TMJOA with a much more abundant expression in osteoarthritis cartilage.



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Device to stablise nasoendotracheal tube during intraoral or orthognathic surgery

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Publication date: Available online 3 June 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): S.-H. Kang, S.-H. Lee




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The impact of glucocorticosteroids administered for systemic diseases on the osseointegration and survival of dental implants placed without bone grafting—a retrospective study in 31 patients

Publication date: Available online 4 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Vassileios Petsinis, Georgios Kamperos, Foteini Alexandridi, Konstantinos Alexandridis
PurposeTo evaluate the impact of glucocorticosteroids, administered for the treatment of systemic diseases, on the osseointegration and survival of dental implants placed without bone grafting.Materials and MethodsA retrospective study was conducted in search of patients treated with dental implants while receiving glucocorticosteroid therapy for various systemic diseases. In these cases, a conventional two-stage surgical protocol was used, without bone regeneration procedures. The osseointegration was clinically and radiographically tested at the uncovering of the implants. The follow-up after loading was set at a minimum of 3 years.ResultsA total of 31 patients were included in the study. Of the 105 dental implants placed, 104 were osseointegrated (99%). No bone absorption was radiographically noted at the uncovering of the osseointegrated implants. All of the osseointegrated implants were successfully loaded for the prosthetic restoration. The mean follow-up period after loading was 71 months, with an implant survival rate of 99%.ConclusionsGlucocorticosteroid intake for systemic diseases does not have a significant impact on the osseointegration and the 3-year survival of dental implants placed with a conventional two-stage surgical protocol and without bone grafting. Therefore, it should not be considered a contraindication for dental implant placement.



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Programmable cells of monocytic origin as a source of osteochondroprogenitors: Effect of growth factors on osteogenic differentiation

Publication date: Available online 4 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Yahya Açil, Björn Möller, Jörg Wiltfang, Fred Fändrich, Hendrik Ungefroren
We have demonstrated previously that peripheral blood monocytes can be converted in vitro to a multipotent stem cell−like cell termed programmable cell of monocytic origin (PCMO) and subsequently into cells with chondrocyte-like phenotype. Here, we investigated whether PCMO could also be differentiated into osteoblast-like cells using growth factors with known osteoinductive potency. Following stimulation with BMP-2, BMP-7, IGF-1 or TGF-β1 for 7 and 14 days, PCMOs were analysed for mRNA expression of collagen types I and V, alkaline phosphatase, osteocalcin, runt-related transcription factor-2 (Runx2) and Osterix (Osx) by quantitative RT-PCR (qPCR) and the levels of collagen I in culture supernatants by ELISA. The expression of osteoblastic markers was evident, albeit at a different extent in cultures of PCMOs after treatment with the above-mentioned growth factors. Culture supernatants from PCMOs stimulated for 6-10 days with BMP-2, BMP-7, IGF-1 or TGF-β1 contained high levels of collagen type I, together with earlier data indicating synthesis and proper secretion. The findings suggest that PCMOs can transform into cells that are phenotypically similar to osteoblasts and identify these cells as osteochondroprogenitors. The possibility of differentiating PCMOs from peripheral blood in sizable quantities could be a novel way to obtain autologous bone-like substitutes without donor-site morbidity.



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Fluorescence based characterization of early oral squamous cell carcinoma using the Visually Enhanced Light Scope technique

Publication date: Available online 3 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Egon Burian, Caterina Schulz, Florian Probst, Benjamin Palla, Matthias Tröltzsch, Fabio Maglitto, Luigi Califano, Michael Ehrenfeld, Sven Otto
ObjectivesSeveral diagnostic tools have been developed to assess benign and potentially malignant disorders of soft tissues. In this study, we aimed to assess the value of the VELscope® (Visually Enhanced Light Scope) imaging device as a technical tool to investigate malignant lesions of the oral cavity.Material and methodsIn this retrospective study we analyzed the photographs of 90 patients who suffered from malignant oral soft tissue lesions or carcinoma in situ (CIS) from 2008 to 2014 in the Clinic of Oral and Maxillofacial Surgery of LMU in Munich.ResultsIn 85.6% of the cases fluorescence quenching/loss could be detected. The average value for the colour red shows a significant difference in pathologic and physiologic tissues (p=0.007) with a higher median for pathologic tissues. For the colours green and blue our measurements show significantly higher values in the healthy tissue (p< 0.001.). The shade of red showed significantly higher values for pathologic tissues when compared to all three colours (p< 0.001). Furthermore, the shades of green and blue showed significantly lower values in the pathologic tissue (p< 0.001).ConclusionIn the near future, VELscope® could help to a greater extent than visual observation alone in identifying the margins of tumor resections. VELscope® still lacks the ability to identify the overall risk level of oral lesions.



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The influence of different abutment materials on tissue regeneration after surgical treatment of peri-implantitis - a randomized controlled preclinical study

Publication date: Available online 3 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Tobias Moest, Jan Wrede, Christian Martin Schmitt, Melanie Stamp, Friedrich Wilhelm Neukam, Karl Aandreas Schlegel
ObjectivesThis study aimed to assess the impact of different abutment materials on peri-implant tissue regeneration after surgical treatment of peri-implantitis in a large animal model.Material and MethodsTitanium implants (n = 51) were inserted in the upper and lower jaw of eight beagle dogs and a peri-implant infection was induced. After two months the peri-implant infection was surgically treated and abutments with different surfaces (Ti-2: n = 14; CoCrMb: n = 13; Ag-modified Ti-4: n =14; Ti-4 control: n = 10) were applied. Clinical attachment level (CAL), modified sulcus bleeding index (mBI), bleeding on probing (BoP), and the sulcus fluid flow rate (SFFR) were determined 4, 8, and 12 weeks after surgical treatment to document the peri-implant tissue reaction.ResultsSuperior levels for CAL and mBI were found with the Ti-4 control and the Ag-modified abutments, with the Ag-modified abutments showing the best values after 12 weeks. Lowest SFFR values compared with the other treatment groups underlined the superior soft tissue reaction adjacent to Ag-modified abutments. After 12 weeks inferior CAL, SFFR, BOP and mBI values were documented for the Ti-2 surface.ConclusionWithin limitations of the study, Ag-modified abutments lead to superior tissue reactions. Further studies are needed to investigate the properties of abutment materials.



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Synchrotron radiation μCT and histology evaluation of bone-to-implant contact

Publication date: Available online 3 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Camilla Albeck Neldam, Jon Sporring, Alexander Rack, Torsten Lauridsen, Ellen-Margrethe Hauge, Henrik L. Jørgensen, Niklas Rye Jørgensen, Robert Feidenhansl, Else Marie Pinholt




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The impact of surgical intervention and antibiotics on MRONJ stage II and III – retrospective study

Publication date: Available online 4 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Matthias Zirk, Matthias Kreppel, Johannes Buller, Julij Pristup, Franziska Peters, Timo Dreiseidler, Max Zinser, Joachim E. Zöller
ObjectivesMetastatic bone disease and osteoporosis are the main indications for bisphosphonates and anti-resorptive agent therapy. Inhibition of bone turnover and angiogenesis are mainly responsible for the development of Medication Related Osteonecrosis of Jaws (MRONJ) as therapeutic side-effect. Yet, the role of infection for the development and recurrence of MRONJ is not fully elucidated. The aim of this retrospective study is to explore if a difference in antibiotic regimes has an impact on the surgical intervention needed to achieve a painless stable stage of the disease. Furthermore, we investigated concomitant submucosal infections in local relation to the MRONJ site.MethodsA retrospective study (2006-2015) of 143 patients treated with MRONJ stage II and stage III in a single institutional university hospital was performed. All patients experienced at least one surgical intervention and received antibiotics. Their medical records, pathological and microbial findings were reviewed. Data was controlled for the achievement of an event free time period of at least 12 months.ResultsWe investigated the number and kind of treatments that were performed on patients with MRONJ stage II and III to achieve a painless stable stage of the disease. The first and second healing approach differed significantly from each other (p<0.05). In 7 (4.9%) cases up to four surgical interventions were needed to achieve oral rehabilitation. In 135 (95.1 %) of all cases a segmental resection could be prevented, with extended decortication being the most applied method. Patients under perioperative ampicillin/sulbactam showed a significant reduction for a second or fourth intervention compared to the clindamycin group (p<0.05). Results for a third intervention presented a similar difference between both groups, but were not significant (p= 0.06). Intraoperatively in 76 out of 241 (31.5%) cases presented putrid submucosal infections. The isolated bacteria were gram-negative facultative anaerobes (39.1%) and strictly anaerobic bacteria (gram-positive/38.2%, gram-negative/19.1%). Susceptibly of the cultured bacteria were significantly (p<0.05) in favor to ampicillin/sulbactam (79.1%) compared to clindamycin (49.5%).ConclusionThe perioperative antibiotic regime for patients with MRONJ stage II and III undergoing surgically treatment does have an influence on the recurrence of the disease. Further investigation is needed to elucidate the role of infection in the treatment of MRONJ.



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What is the effect of Anti-resorptive drugs (ARDs) on the development of Medication-Related Osteonecrosis of the jaw (MRONJ) in Osteoporosis Patients: A Systematic Review

Publication date: Available online 3 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Suad Aljohani, Riham Fliefel, Jacob Ihbe, Jan Kühnisch, Michael Ehrenfeld, Sven Otto
PurposeTo conduct a systematic review of the literature to detect the effect of anti-resorptive drugs (ARDs) and their administration characteristics in the development of medication-related osteonecrosis of the jaw (MRONJ) in osteoporosis patients.MethodsSystematic search in PubMed, Web of Sciences and Cochrane Library was performed for relevant studies to July 2016. Population variables (age, gender, comorbidities, medications, preceding events, number of patients with MRONJ), ARDs and clinical variables were abstracted independently from these articles.ResultsThe 44 eligible studies described 680 MRONJ cases in osteoporotic patients. The mean age of MRONJ patients was 69.7±5.2 years. It was more common in females. Mandible was the most common site. Alendronate was the most frequently administered ARD. Oral route of administration was noted in 86.7% of the patients. The mean duration of BPs intake was 50.4±19 months. Extraction was the most frequently preceding event followed by dentoalveolar surgery. Corticosteroids or immunosuppressants were the most common concomitant medications in MRONJ.ConclusionA long duration of ARDs administration seems to be an important risk factor in MRONJ development. Patients under treatment with corticosteroids or immunosuppressants might be at a higher risk even if the BPs duration is less than 4 years.



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Analyzing the teeth next to the alveolar cleft: Examination and treatment proposal prior to bone grafting based on three-dimensional versus two-dimensional diagnosis—a diagnostic study

Publication date: Available online 3 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Susanne Wriedt, Bilal Al-Nawas, Irene Schmidtmann, Sami Eletr, Heinrich Wehrbein, Maximilian Moergel, Collin Jacobs
PurposeThe objective was to evaluate the diagnostic and prognostic value of three-dimensional (3D) cone beam computed tomography (CBCT) on information about the cleft and alignment of cleft neighboring teeth.Materials and MethodsPanoramic X-rays, small-volume CBCTs, and study casts of 20 patients with a total of 22 alveolar clefts were analyzed prior to secondary bone grafting. Six maxillofacial surgeons and 6 orthodontists rated the following parameters: visibility of alveolar cleft expansion, position and probability of alignment of cleft neighbored teeth. Two-dimensional (2D) X-rays and casts were rated first; CBCT and casts followed at least 4 weeks later. Radiologic bone height in the region of the former alveolar cleft, as well as alignment and reasons for nonalignment of cleft neighbored teeth, were recorded 4 years later.ResultsThe rate of proper proposals regarding the real treatment outcome using 2D- or 3D-material did not differ statistically. Although 5%-45% of the proposals were changed when using 3D instead of 2D records, Fleiss multirater kappas showed no essential differences. Raters’ profession and experience had no influence on the rate of correct proposals.ConclusionIn orthodontics, small-volume CBCT may be justified only as supplement to a routine panoramic X-ray, and only in selected cases or for surgical preparation.



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Expression of Notch signaling pathway during osteoarthritis in the temporomandibular joint

Publication date: Available online 3 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Lingli Lan, Yangmei Jiang, Weina Zhang, Ting Li, Binbin Ying, Songsong Zhu
PurposeOur study aim was to characterize the expression of Notch molecules during temporomandibular joint osteoarthritis (TMJOA), thus exploring the mechanism and roles that Notch signaling possibly plays in the initiation and progression of TMJOA.Materials and MethodsA total of 126 mice were divided randomly into experimental groups, a sham-surgery group and a normal control group. In the experimental group, total discectomy was performed in the right temporomandibular joint (TMJ) to induce TMJOA; the sham-operation group underwent the same procedure without disc removal, and the normal control group was left undisturbed. Fourteen mice in each group were sacrificed in batches respectively at 1, 2, and 4 weeks postoperatively. Histology was performed to examine TMJOA in eight condyles each group, and a modified Mankin scoring system was used for evaluation. Immunohistochemistry was carried out to characterize the expression of the Notch markers Notch1, Jagged1, Hes1, and Hes5. Real-time polymerase chain reaction (RT-PCR) was performed for further detection and analysis of Notch markers in six condyles in each group.ResultsNotch1, Jagged1, and Hes5 were activated in the experimental group, with expression levels that increased dramatically over time, whereas the control group showed no fluctuation. Hes1 expression was suppressed at the beginning but was up-regulated afterward.ConclusionsOur data suggest that Notch signaling is activated in TMJOA with a much more abundant expression in osteoarthritis cartilage.



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