Cartoon Analgesia in the Pediatric Plastic Surgery Population

No abstract available

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Topographic Analysis of the Supratrochlear Artery and the Supraorbital Artery: Implication for Improving the Safety of Forehead Augmentation

No abstract available

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Do Bacteria and Biofilm Play a Role in Double-Capsule Formation around Macrotextured Implants?

Background: The double capsule is a complication mostly described in aggressive macrotextured implants. Mechanical shear stress applied onto an immature periprosthetic capsule has been linked to their formation. The authors aim to demonstrate the role of bacterial phenotype and biofilm in the development of the double capsule. Methods: Seven double capsules formed at the interface of macrotextured breast expander implants were studied using scanning electron microscopy. Two samples for each surface of the inner capsule layer (the prosthesis interface and the intercapsular space) were analyzed for bacteria cell size, bacterial density, and biofilm deposition. Results: Although all routine bacterial cultures were negative, the prosthesis interface had both higher bacteria load and biofilm deposition compared with the intercapsular space (Mann-Whitney U test, p = 0.004 and p = 0.008, respectively). Moreover, bacteria cell sizes were significantly smaller at the prosthesis interface in six of seven samples. Comparison of bacteria density and biofilm dispersion showed an increase of biofilm extracellular matrix deposition over 2000 cells/mm2 (linear regression, p = 0.0025). These results indicate a common trend among bacteria species. Conclusions: Bacterial expression between the different surfaces of the double capsule displays significant differences; bacteria at the prosthesis interface are mostly in a biofilm state, whereas they demonstrate a planktonic phenotype at the intercapsular space. When a sufficient amount of bacteria are present at a specific location, quorum sensing may trigger a biofilm phenotypic switch in planktonic bacteria cells. Biofilm formation may alter capsule formation through immune response, thereby weakening capsule strength and facilitating extracellular matrix delamination and double-capsule formation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

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Subfascial Primary Breast Augmentation with Fat Grafting: A Review of 156 Cases: Correction

No abstract available

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Five Steps to Internal Mammary Vessel Preparation in Less than 15 Minutes

Background: Modern breast reconstruction often involves microvascular reconstruction. The most common recipient vessels are the internal mammary artery and vein. Recently, there has been great focus on efficiency, but much of this emphasis has been directed to faster flap harvest or recovery protocols for expeditious discharge. An equally important aspect is internal mammary vessel preparation. Methods: Breast reconstruction was performed in 415 patients (715 breasts) using autologous tissue (850 flaps) from 2012 to 2016. In 97.6 percent of these breast reconstructions, the internal mammary vessels were used. The preparation of these vessels was routinely performed using the five-step technique described here. Results: Internal mammary preparation time ranged from 7 to 45 minutes (median, 15 minutes). The procedure involves five simplified steps, as follows: step 1, the rib is exposed by splitting the pectoralis major muscle; step 2, the perichondrium anterior to the cartilage is incised and dissected away from the cartilage; step 3, the cartilage is removed with a rongeur; step 4, laterally the perichondrium is elevated and incised (under direct vision, this perichondrium is then split directly over the vessels and the cranial and caudal flaps are resected); and step 5, careful dissection is performed on the artery and vein. Conclusions: Safe preparation of recipient vessels in microvascular reconstruction is essential for success. In modern breast reconstruction, the internal mammary artery and vein are typically used. Exposure of these vessels should be predictable and efficient. The authors have found that a systematic approach using the above five steps accomplishes these goals.

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Establishment of an Acquired Lymphedema Model in the Mouse Hindlimb: Technical Refinement and Molecular Characteristics

No abstract available

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Evidence-Based Clinical Practice Guideline: Autologous Breast Reconstruction with DIEP or Pedicled TRAM Abdominal Flaps

Summary: The American Society of Plastic Surgeons commissioned a multistakeholder Work Group to develop recommendations for autologous breast reconstruction with abdominal flaps. A systematic literature review was performed and a stringent appraisal process was used to rate the quality of relevant scientific research. The Work Group assigned to draft this guideline was unable to find evidence of superiority of one technique over the other (deep inferior epigastric perforator versus pedicled transverse rectus abdominis musculocutaneous flap) in autologous tissue reconstruction of the breast after mastectomy. Presently, based on the evidence reported here, the Work Group recommends that surgeons contemplating breast reconstruction on their next patient consider the following: the patient's preferences and risk factors, the setting in which the surgeon works (academic versus community practice), resources available, the evidence shown in this guideline, and, equally important, the surgeon's technical expertise. Although theoretical superiority of one technique may exist, this remains to be reported in the literature, and future methodologically robust studies are needed.

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Discussion: Mixed Reality with HoloLens: Where Virtual Reality Meets Augmented Reality in the Operating Room

No abstract available

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Fat Grafting in Hollow Upper Eyelids and Volumetric Upper Blepharoplasty

Background: Periorbital volume loss creates a shadow frame, and traditional excisional blepharoplasties may aggravate the situation. Divergence in filling treatments establishes a demand for simple and reproducible techniques to achieve consistent results. Here, the author's hollow upper eyelid evaluation and treatment approach are presented. Methods: A retrospective photographic analysis was conducted of 32 women who underwent fat grafting for hollow upper eyelids between 2012 and 2016. Preoperative and postoperative evaluations of upper eyelid ratios at the medial and lateral corneal limbus, together with lateral contour modifications, were used to determine the efficacy of the technique to restore youthful proportions and contours. Results: Preoperative analysis showed 20 eyelids with an inner shadow, or A-pattern; and 44 eyelids with the complete extension of the hollow, or C-pattern. Three patients presented mild blepharoptosis, and eight patients had undergone a previous upper blepharoplasty. Mean grafting volume was 0.4 cc in the deep plane and 2.8 cc in the superficial plane. Fat grafting exclusively was performed in six patients, improving all ratios and correcting the A-pattern deformity. Volumetric upper blepharoplasty combining fat grafting in two levels and orbicularis oculi muscle imbrication was performed in 26 patients, correcting every inverted ratio (p

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Reply: Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction

No abstract available

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Breast Cleavage Remodeling with Fat Grafting: A Safe Way to Optimize Symmetry and to Reduce Intermammary Distance

Background: In their descriptions of the ideal breast, most studies have focused primarily on the dimensions, shape, and proportions. The distance between the breasts has only very rarely been considered. The intermammary distance and the medial symmetry between the breasts are important parts of the outcome of surgery and have a strong bearing on patient satisfaction. However, the control surgeons have over these factors is only relative, and depends heavily on the underlying anatomical characteristics of the patients. Methods: Eighty-six patients undergoing breast augmentation, breast reduction, or mastopexy and breast reconstruction with separated or asymmetric breasts underwent fat grafting in the medial quadrants. Intermammary distances were measured before fat grafting and 12 months later. Complications were also recorded. Results: This technique obtained a statistically significant reduction in the mean intermammary distance (p

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Evidence-Based Medicine: Face Lift

No abstract available

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Impact of Patient Subtype and Surgical Variables on Abdominoplasty Outcomes: A 12-Year Massachusetts General Hospital Experience

Background: The traditional abdominoplasty is one of the most common surgical procedures performed. This study evaluates the impact of different surgical techniques and clinical patient factors on abdominoplasty outcomes. Methods: A retrospective review of consecutive patients undergoing abdominoplasty was performed. Results: Seven hundred seventy-nine patients with a mean age of 43.7 years and a body mass index of 27 kg/m2 underwent abdominoplasty. The majority were women (92.9 percent), and massive weight loss was present in 34.8 percent. Abdominoplasty techniques included traditional (59.4 percent), belt lipectomy (17.9 percent), fleur-de-lis (16.4 percent), umbilical float (9.2 percent), and mini-abdominoplasty (2.8 percent). Half of the study population [n = 384 (49.3 percent)] had concurrent surgical procedures. Total complications (23.0 percent) consisted primarily of wound- and scar-related complications (15.3 percent). Approximately 60 percent of patients received heparin chemoprophylaxis, with overall thromboembolic and hematoma rates less than 1 percent. Univariate analysis revealed that massive weight loss (p = 0.04), fleur-de-lis (p = 0.03) or belt lipectomy (p = 0.05) techniques, and concurrent medial thigh lift (p

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Optimizing Outcomes in Pharyngoesophageal Reconstruction and Neck Resurfacing: 10-Year Experience of 294 Cases

No abstract available

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Injection of Compressed Diced Cartilage in the Correction of Secondary and Primary Rhinoplasty: A New Technique with 12 Years’ Experience

Background: There are instances where small or large pockets are filled with diced cartilage in the nose, without use of wrapping materials. For this purpose, 1-cc commercial syringes were used. The obtained results were partial and incomplete. For better and improved results, the author designed new syringes, with two different sizes, which compress the diced cartilage for injection. Methods: The author presents his experience accrued over the past 12 years with 2366 primary, 749 secondary, 67 cleft lip and nose, and a total of 3182 rhinoplasties, using his new syringe design, which compresses diced cartilage and injects the diced cartilages as a conglutinate mass, simulating carved costal cartilage, but a malleable one. Results: In 3125 patients, the take of cartilage graft was complete (98.2 percent) and a smooth surface was obtained, giving them a natural appearance. In 21 patients (0.65 percent), there was partial resorption of cartilage. Correction was performed with touch-up surgery by reinjection of a small amount of diced cartilage. In 36 patients (1.13 percent), there was overcorrection that, 1 year later, was treated by simple rasping. Conclusions: Compared with diced cartilage wrapped with Surgicel or fascia, the amount of injected cartilage graft is predictable because it consists purely of cartilage. The injected diced cartilage, because it is compressed and becomes a conglutinated mass, resembles a wood chip and simulates carved cartilage. It is superior to carved cartilage in that it is moldable, time saving, and gives a good result with no late show or warping. The injection takes only a few minutes.

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ASPS/PSF Sponsored Symposia and Workshops

No abstract available

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Managing Alar Flare in Rhinoplasty

Summary: Alar flare is a common feature that contributes to the width of the lower third of the nose. In the right patient, alar flare reduction can improve nasal harmony and facial aesthetic balance; however, it is also difficult to correct if conducted inappropriately or overzealously. The unique anatomy and diverse morphologies of the alar lobule, and the dynamic relationship between flare and changes in tip projection, must be considered. The authors provide guidelines for flare reduction: when it is appropriate and how to tailor the excision pattern to safely and effectively refine nasal width. Alar flare is classified into three types according to alar rim shape on basal view analysis. By designing the excision pattern based on specific flare type, the lower third of the nose is narrowed without creating an operated appearance. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

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Gender Affirmation: Medical & Surgical Perspectives

No abstract available

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The Evolution of Chemical Peeling and Modern-Day Applications

Summary: Despite the growth of technically more sophisticated skin resurfacing modalities, such as those based on light, radiofrequency, and ultrasound, chemical peel procedures have risen 5 to 25 percent over the past year alone. Chemexfoliation carries historical significance and has markedly evolved since its inception in ancient times. As a result of plastic surgery and dermatologic advancements, modern-day chemexfoliation offers plastic surgeons additional safe and effective options for patients with rhytides, dyschromias, and other signs of light- and environment-induced skin damage. This review discusses the historical evolution of chemexfoliation procedures, highlights modern-day practice habits, and touches on the clinically relevant applications of chemical peels.

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Reply: The Anterior Intercostal Artery Flap: Anatomical and Radiologic Study

No abstract available

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Denosumab-induced cutaneous hypersensitivity reaction with distinct clinical and histopathologic findings

Targeted biologic agents are increasingly approved for the treatment of a wide range of medical conditions. Cutaneous drug reactions are seen to varying degrees with these agents, and postmarketing surveillance is critical to identifying adverse and uncommon events. Denosumab is a monoclonal antibody to receptor activator of nuclear factor kappa-B ligand (RANKL) that results in decreased osteoclast activation.

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Examination of the reliability of Gait Assessment and Intervention Tool in patients with a stroke.

The Gait Assessment and Intervention Tool (GAIT) has been recently developed for gait assessment in patients with stroke, and it is considered as a tool that may identify clinically relevant deviations from normal gait and quantifies relevant changes in gait because of an intervention. The objective was to analyze the GAIT psychometric properties in participants with stroke. A convenience sample of 15 adults with stroke was selected (58.15+/-7.8 years; 5.38+/-3.3 years from injury). We used the GAIT for evaluating the gait in patients with stroke. GAIT scoring is based on observations of anterior/posterior and lateral-view video documents. Inter-rater reliability of the GAIT between trained raters was good (intraclass correlation coefficient=0.762; P=0.008; 95% confidence interval=0.251-0.927). The minimal detectable change was 7.68 points (12.39%). Inter-rater reliability for the hip, knee, and ankle items was also good. In conclusion, the current study demonstrated that GAIT has good inter-rater reliability and good internal consistency. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Acoustic Realization and Inventory Size: Kannada and Malayalam Alveolar/Retroflex Laterals and /ɻ/

This study examines formant and spectral moment data for the apical and retroflex lateral sounds /l #x026D;/ of the Dravidian languages Kannada and Malayalam, together with the rhotic /#x027B;/ of Malayalam. Data are presented for 10 male speakers of each language. We find that the first spectral moment is lower for retroflex laterals than for alveolar laterals, and lower for the rhotic /#x027B;/ of Malayalam than for the retroflex lateral in the same language. Differences emerge when the retroflex lateral of Kannada is compared with the same sound in Malayalam. For both languages, F1 is higher and F3 and F4 are lower for the retroflex /#x026D;/ than for the alveolar /l/. However, F2 is higher for the retroflex than for the alveolar sound in Kannada, but lower in Malayalam. This difference is also reflected in differences in the second spectral moment between the languages. It is suggested that since proximity of F2 and F3 is known to be a defining feature of the rhotic /#x027B;/ in Malayalam, principles of phonetic dispersion apply to keep F2 from becoming too close to F3 for the retroflex lateral /#x026D;/ of Malayalam, but not for the same sound in Kannada.
Phonetica 2018;75:85-109

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Association between serious psychological distress and nonparticipation in cancer screening and the modifying effect of socioeconomic status: Analysis of anonymized data from a national cross-sectional survey in Japan

BACKGROUND

It is unclear whether individuals who have serious psychological distress (SPD) are less likely to participate in screening tests for gastric cancer, lung cancer, and other types of cancer. Of the few studies that have examined the association between SPD and participation in cancer screening, none have reported modifying effects of educational, marital, or employment status.

METHODS

The authors analyzed a national representative data set from the 2010 Comprehensive Survey of Living Conditions of Japan., including individuals aged <69 years who met the national program criteria for each type of cancer screening (colorectal, gastric, and lung cancers, n = 29,926; breast cancer, n = 15,423; and cervical cancer, n = 24,735). SPD was defined as a score of 13 or greater on the Kessler 6 scale. Logistic regression analyses were conducted to examine the association between SPD and participation in cancer screening, and multivariate analyses stratified by socioeconomic status also were conducted.

RESULTS

SPD was significantly associated with a lower odds ratio (OR) for participation in screening for colorectal cancer (OR, 0.743; 95% confidence interval [CI], 0.638-0.866), gastric cancer (OR, 0.823; 95% CI, 0.717-0.946), and lung cancer (OR, 0.691; 95% CI, 0.592-0.807). Only educational status significantly modified the effect of SPD on participation in these 3 types of cancer screening (P < .05).

CONCLUSIONS

Individuals with SPD, especially those with lower education levels, were less likely to participate in screening for colorectal, gastric, and lung cancers. Individuals with SPD should be encouraged and supported to participate in cancer screening tests. Cancer 2017. © 2017 American Cancer Society.

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Clinical and radiographic evaluation of pulpectomy in primary teeth: a 18-months clinical randomized controlled trial

To avoid untoward changes when primary teeth are replaced by permanent teeth, resorption of the material used in primary teeth root canal filling should occur at the same rate as root resorption. The Aim of th...

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How Was Your Otology Training? A Survey of Recent Otolaryngology Residents.

Objective: To survey graduating residents or recent graduates of otolaryngology residency programs to evaluate their Otology/Neurotology (ON) experience in residency and discern if they had received adequate training in time to decide whether to pursue a fellowship in Otology or Neurotology. Study Design: Internet-based survey. Methods: A survey was distributed to all US otolaryngology residency programs to distribute to 5th year residents and recent graduates in last 4 years. The survey assessed satisfaction in ON experience, presence of ON fellows, adequacy of experience to decide on ON fellowship, post-graduate year (PGY) year at which residents observed, performed, and proficiently performed five procedures (tympanoplasty, mastoidectomy, ossiculoplasty, stapedectomy, and cochlear implant), and plan for performing these surgeries in practice. Results: 89/106 (84%) of respondents felt they had adequate training in Otology in time to decide whether or not to pursue a fellowship and were found to observe and perform surgeries significantly earlier in training by PGY including: mastoidectomy (observed PGY 1.9 versus PGY 2.3, performed PGY 2.9 versus PGY 3.5), ossiculoplasty (observed 2.1 versus 3.0, performed 3.6 versus 4.3), stapedectomy (observed 2.3 versus 3.0, performed 3.9 versus 4.5), and cochlear implant (observed 2.1 versus 2.8, performed 3.4 versus 4.1) all p

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Bone-conducted Vestibular-evoked Myogenic Potentials Before and After Stapes Surgery.

Objective: To identify whether stapes surgery causes otolith dysfunction using bone-conducted vestibular-evoked myogenic potentials (VEMPs). Study Design: Prospective study. Setting: Hyogo College of Medicine Hospital. Patients: Twenty primary ears (19 otosclerosis, 1 congenital stapes fixation) in 17 patients (2 men, 15 women; mean age 51 yr, range 20-68 yr) who had normal cervical VEMP (cVEMP) and ocular VEMP (oVEMP) results with bone-conducted stimulation were included. Intervention: Stapes surgery. Main Outcome Measure: Both VEMP tests with bone-conducted stimulation were performed before and after stapes surgery. The normalized p13-n23 amplitude of cVEMPs and the nI-pI amplitude of oVEMPs were measured within 3 months after stapes surgery. Then, the asymmetry ratio (AR) was calculated to examine the effect of surgery on otolith function. Results: Seven patients complained of temporary dizziness postoperatively, but their symptoms disappeared within approximately a week. Deterioration of VEMPs of the operated ear was not seen in any ears. Significantly greater amplitude compared with the opposite ear was found for cVEMP in one ear and oVEMP in two ears after the surgery. Their VEMP results recovered to the normal range at 6 months postoperatively. Conclusions: These findings suggest that stapes surgery causes no or undetectably small otolith dysfunction from the perspective of VEMP evaluation. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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The Arthur Prophet Memorial Lecture

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Reflection

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Paediatric dentistry: A multidisciplinary approach

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Stress and burnout research project

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Dental notation: Mental gymnastics

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Fracture resistance of zirconia-based all-ceramic crowns after bur adjustment

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Identifying teeth correctly

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Community dental team screen factory workers for mouth cancer

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Dental education: A gentle touch

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Interview: Say no more... An insight into the Behavioural Insights Team

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Patient benefits: Incorrect advice

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Oral surgery II: Part 3. Cysts of the mouth and jaws and their management

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From the archive: Sydney turns 100

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An estimated carbon footprint of NHS primary dental care within England. How can dentistry be more environmentally sustainable?

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Primary dental care: You're not serious

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Eavesdroppers and nosey neighbours required

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Alternative sugars: Syrup

Elaine Gardner, British Dietetic Association (BDA) Spokesperson, discusses the sugar content in syrup and provides related oral health advice.

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Is it time to digitally enable dentistry with the rest of healthcare?

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Spreading the word about a devastating disease

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BDA AGM

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P275 Refractory hypereosinophilia manifesting as nodular sclerosis classical hodgkin lymphoma—a case presentation

The differential of hypereosinophilia is broad and includes atopy, infection, malignancy, and in rare cases of exclusion, hypereosinophilic syndrome (HES). Thorough evaluation is necessary to elucidate the cause and prevent sequelae of hypereosinophilia.

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P283 Pneumococcal osteomyelitis: a rare diagnosis suggestive of immune deficiency

Despite routine immunization with pneumococcal conjugate vaccines, Streptococcus pneumoniae is still a significant cause of bacteremia, pneumonia and meningitis. Osteoarticular pneumococcal infections are very rare, accounting for less than 5% of all invasive pneumococcal diseases (IPD).

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P282 Recurrent candidal esophagitis in an otherwise healthy host

Candida Albicans is a yeast that naturally colonizes the skin and mucosa. Chronic Mucocutaneous Candidiasis Syndrome (CMCS) presents with recurrent superficial candida infection, and is associated with other clinical manifestations such as autoimmunity or bacterial infections. Chronic Mucocutaneous Candidaisis Disease (CMCD) is a new entity in which patients present solely with superficial candidiasis. Here we present an interesting case of CMCD.

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P337 Remission of cow’s milk allergy during rituximab therapy: a case report

Food allergy has no known treatment. However, novel therapies are being studied in the hope of promoting tolerance. This case report describes the remission of food allergy during rituximab therapy.

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P222 Effects of immunoglobulin e concentration, eosinophil concentration, and atopy status on benralizumab efficacy in asthma

We investigated the efficacy of the anti-eosinophilic monoclonal antibody benralizumab for patients with severe, uncontrolled asthma by high versus low serum IgE concentrations and atopy status.

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OR001 Drug rash eosinophilia and systemic symptoms (DRESS) syndrome identified in electronic health record allergy module

Drug rash eosinophilia and systemic symptoms (DRESS) syndrome is a rare and severe hypersensitivity reaction. Due to challenges in case identification, DRESS epidemiology remains poorly characterized in the US. We used the electronic health record (EHR) allergy module to identify and describe DRESS syndrome cases in an integrated US healthcare system.

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P280 Severe combined immunodeficiency in cartilage hair hypoplasia

Cartilage Hair Hypoplasia (CHH) is associated with immune deficiency, which is a leading cause of mortality in these patients. Newborn screening (NBS) utilizing T-cell receptor excision circles (TRECs) is critical for early diagnosis of severe combined immunodeficiency (SCID), enabling prompt treatment and decreased morbidity/mortality.

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OR002 Testing strategies for immediate and delayed reactions to cephalosporins

Similar to penicillin allergy up to 8% of the general population are labeled as cephalosporin allergic; however, specific and validated testing strategies to manage immediate and delayed cephalosporin hypersensitivities are not well defined.

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P206 Effect of inhaled corticosteroid use on weight (BMI) in moderate to severe asthmatic pediatric patients

The effect of inhaled corticosteroids (ICS) on weight (BMI) in moderate to severe asthmatic pediatric patients has not been established. Obesity has been shown to decrease response to ICS as well as increase the risk of worse asthma symptoms.

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OR003 Common misconceptions in the recognition and treatment of anaphylaxis in community hospital based medical professionals

Intramuscular epinephrine is the primary treatment for anaphylaxis. Delays in administration of epinephrine have been associated with increased mortality in anaphylaxis. Despite numerous publications regarding this topic, interdisciplinary recognition, primary treatment and epinephrine administration route choices remain inconsistent. We hypothesize that a multidisciplinary quality improvement project is required to address common misconceptions in order to facilitate the preparedness to recognize and treat anaphylaxis appropriately.

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P296 Hypogammaglobulinemia in a patient with Turner’s Syndrome (TS) and celiac disease

Turner's syndrome (TS), a rare chromosomal disorder that affects females, is characterized by loss of one of the X chromosomes. This case report demonstrates a patient with TS who has hypogammaglobulinemia and celiac disease.

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OR004 Safe and effective implementation of chemotherapy outpatient desensitizations

Hypersensitivity reactions (HSRs) to platinum-based chemotherapies are increasing as cancer rates are rising. Desensitization protocols allow patients to receive first-line therapy despite HSRs, but are often performed in the inpatient setting for close monitoring by trained personnel and to mitigate risk. We aimed to evaluate a safe and effective strategy for performing desensitizations in the outpatient setting, with a focus on decreasing delays in medication administration, patient inconvenience, and overall treatment time.

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P230 Long-term assessment of the burden of atopic sensitization in patients with severe/difficult-to-treat asthma

Analyses of data from TENOR II demonstrated that approximately 50% of patients had uncontrolled asthma based on NHLBI impairment category. Here we report the long-term burden of disease in patients relative to aeroallergen sensitization from the TENOR II cohort.

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OR005 A penicillin skin testing initiative in an outpatient allergy practice

The penicillin allergy label has significant clinical implications and there is renewed interest in penicillin allergy de-labeling. We identified the clinical characteristics of all penicillin-allergic patients presenting to an outpatient allergy practice, and offered all qualifying patients penicillin skin testing (PST).

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P214 Mepolizumab induction therapy for eosinophilic granulomatosis with polyangiitis (EGPA)

Mepolizumab has been used as an adjuvant therapy for refractory EGPA. We report biopsy confirmed EGPA using conventional doses of Mepolizumab for induction treatment.

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OR006 Usability and comprehension of an illustrated Canadian Anaphylaxis Action Plan for Kids (Kids’ CAP study)

We designed a written plan called Canadian Anaphylaxis Action Plan for Kids (Kids' CAP) which incorporate validated pictograms with written instructions. Using a patient-centered approach, we aimed to assess the impact of the Kids' CAP on anaphylaxis recognition and treatment and to determine its perceived usefulness.

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P345 New onset concurrent eosinophilic gastritis in patients with eosinophilic esophagitis: a case series

Eosinophilic Esophagitis (EoE) is thought to be a disease limited to the esophagus.

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OR101 Outcomes of patients with aspirin-exacerbated respiratory disease on omalizumab

The current treatment for patients with aspirin-exacerbated respiratory disease (AERD) who have uncontrolled asthma or chronic rhinosinusitis is aspirin desensitization. However, some patients are unable to undergo or fail desensitization, and treatment with omalizumab is an option although efficacy data is scarce.

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P329 Utility and safety of the intermittent oral immunotherapy, step-up method, for severe food allergy patients

Although Oral Immunotherapy (OIT) is a hopeful treatment for severe food allergy patients, its usefulness and safeness is still unclear. We evaluated the utility and safety of our intermittent OIT protocol, Step-up method.

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OR011 Safety of multi-dose immunotherapy vials after routine use

Recent proposed changes to US Pharmaceutical General Chapter <797> (USP <797>) have prompted discussion regarding the safety of multi-dose immunotherapy extract vials after routine use. We present evidence to support the argument that currently accepted aseptic protocols for handling and administration of multi-dose immunotherapy extract maintenance vials during routine patient care does not result in risk of microbial growth and that changes as suggested by the proposed USP <797> guidelines are not needed.

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A Lumbosacral Plexopathy Compressed by Huge Uterine Myoma.

No abstract available

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A matched-filter algorithm to detect amperometric spikes resulting from quantal secretion

Publication date: 1 January 2018
Source:Journal of Neuroscience Methods, Volume 293
Author(s): Supriya Balaji Ramachandran, Kevin D. Gillis
BackgroundElectrochemical microelectrodes located immediately adjacent to the cell surface can detect spikes of amperometric current during exocytosis as the transmitter released from a single vesicle is oxidized on the electrode surface. Automated techniques to detect spikes are needed in order to quantify the spike rate as a measure of the rate of exocytosis.New methodWe have developed a Matched Filter (MF) detection algorithm that scans the data set with a library of prototype spike templates while performing a least-squares fit to determine the amplitude and standard error. The ratio of the fit amplitude to the standard error constitutes a criterion score that is assigned for each time point and for each template. A spike is detected when the criterion score exceeds a threshold and the highest-scoring template and the time of peak score is identified. The search for the next spike commences only after the score falls below a second, lower threshold to reduce false positives. The approach was extended to detect spikes with double-exponential decays with the sum of two templates.ResultsReceiver Operating Characteristic plots (ROCs) demonstrate that the algorithm detects >95% of manually identified spikes with a false-positive rate of ∼2%.Comparison with existing methodsROCs demonstrate that the MF algorithm performs better than algorithms that detect spikes based on a derivative-threshold approach.ConclusionsThe MF approach performs well and leads into approaches to identify spike parameters.



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Widespread optogenetic expression in macaque cortex obtained with MR-guided, convection enhanced delivery (CED) of AAV vector to the thalamus

Publication date: 1 January 2018
Source:Journal of Neuroscience Methods, Volume 293
Author(s): Azadeh Yazdan-Shahmorad, Nan Tian, Viktor Kharazia, Lluis Samaranch, Adrian Kells, John Bringas, Jiwei He, Krystof Bankiewicz, Philip N. Sabes
BackgroundIn non-human primate (NHP) optogenetics, infecting large cortical areas with viral vectors is often a difficult and time-consuming task. Previous work has shown that parenchymal delivery of adeno-associated virus (AAV) in the thalamus by convection-enhanced delivery (CED) can lead to large-scale transduction via axonal transport in distal areas including cortex. We used this approach to obtain widespread cortical expression of light-sensitive ion channels.New methodAAV vectors co-expressing channelrhodopsin-2 (ChR2) and yellow fluorescent protein (YFP) genes were infused into thalamus of three rhesus macaques under MR-guided CED. After six to twelve weeks recovery, in vivo optical stimulation and single cell recording in the cortex was carried out using an optrode in anesthetized animals. Post-mortem immunostaining against YFP was used to estimate the distribution and level of expression of ChR2 in thalamus and cortex.ResultsHistological analysis revealed high levels of transduction in cortical layers. The patterns of expression were consistent with known thalamo-cortico-thalamic circuits. Dense expression was seen in thalamocortiocal axonal fibers in layers III, IV and VI and in pyramidal neurons in layers V and VI, presumably corticothalamic neurons. In addition we obtained reliable in vivo light-evoked responses in cortical areas with high levels of expression.Comparison with existing methodsThalamic CED is very efficient in achieving large expressing areas in comparison to convectional techniques both in minimizing infusion time and in minimizing damage to the brain.ConclusionMR-guided CED infusion into thalamus provides a simplified approach to transduce large cortical areas by thalamo-cortico-thalamic projections in primate brain.



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Link: Fixed Dose PCC

this is how PCC should be given...

EMCrit by Scott Weingart.

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The utility of 68Ga-DOTATATE positron-emission tomography/computed tomography in the diagnosis, management, follow-up and prognosis of neuroendocrine tumors

Future Oncology, Ahead of Print.


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The utility of 68Ga-DOTATATE positron-emission tomography/computed tomography in the diagnosis, management, follow-up and prognosis of neuroendocrine tumors

Future Oncology, Ahead of Print.


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Radiomics to predict immunotherapy-induced pneumonitis: proof of concept

Summary

We present the first reported work that explores the potential of radiomics to predict patients who are at risk for developing immunotherapy-induced pneumonitis. Despite promising results with immunotherapies, immune-related adverse events (irAEs) are challenging. Although less common, pneumonitis is a potentially fatal irAE. Thus, early detection is critical for improving treatment outcomes; an urgent need to identify biomarkers that predict patients at risk for pneumonitis exists. Radiomics, an emerging field, is the automated extraction of high fidelity, high-dimensional imaging features from standard medical images and allows for comprehensive visualization and characterization of the tissue of interest and corresponding microenvironment. In this pilot study, we sought to determine whether radiomics has the potential to predict development of pneumonitis. We performed radiomic analyses using baseline chest computed tomography images of patients who did (N = 2) and did not (N = 30) develop immunotherapy-induced pneumonitis. We extracted 1860 radiomic features in each patient. Maximum relevance and minimum redundancy feature selection method, anomaly detection algorithm, and leave-one-out cross-validation identified radiomic features that were significantly different and predicted subsequent immunotherapy-induced pneumonitis (accuracy, 100% [p = 0.0033]). This study suggests that radiomic features can classify and predict those patients at baseline who will subsequently develop immunotherapy-induced pneumonitis, further enabling risk-stratification that will ultimately lead to better treatment outcomes.

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Allogeneic human double negative T cells as a novel immunotherapy for acute myeloid leukemia and its underlying mechanisms.

Purpose: To explore the potential of ex vivo expanded healthy donor derived allogeneic CD4 and CD8 double negative cells (DNTs) as a novel cellular immunotherapy for leukemia patients. Experimental Design: Clinical grade DNTs from peripheral blood of healthy donors were expanded and their anti-leukemic activity and safety were examined using flow-cytometry based in vitro killing assays and xenograft models against AML patient blasts and healthy donor-derived hematopoietic cells. Mechanism of action was investigated using antibody-mediated blocking assays and recombinant protein treatment assays. Results:  Expanded DNTs from healthy donors target a majority(36/46) of primary AML cells including 9 chemotherapy-resistant patient samples in vitro and significantly reduce the leukemia load in patient-derived xenograft models in a DNT-donor unrestricted manner. Importantly, allogeneic DNTs do not attack normal hematopoietic cells or affect hematopoietic stem/progenitor cell engraftment and differentiation, nor cause xenogeneic graft-versus-host disease in recipients. Mechanistically, DNTs express high levels of NKG2D and DNAM-1 that bind to cognate ligands preferentially expressed on AML cells. Upon recognition of AML cells, DNTs rapidly release IFN which further increases NKG2D and DNAM-1 ligands expression on AML cells. IFN pretreatment enhances the susceptibility of AML cells to DNT-mediated cytotoxicity, including primary AML samples that are otherwise resistant to DNTs, and the effect of IFN treatment is abrogated by NKG2D and DNAM-1 blocking antibodies. Conclusion: This study supports healthy donor-derived allogeneic DNTs as a therapy to treat patients with chemotherapy-resistant AML and also reveals interrelated roles of NKG2D, DNAM-1, and IFN in selective targeting of AML by DNTs.

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Low PD-1 expression in Cytotoxic CD8+ Tumor infiltrating Lymphocytes Confers an Immune Privileged Tissue Microenvironment in NSCLC with a Prognostic and Predictive Value

The success of immune checkpoint inhibitors strengthens the notion that tumor growth and regression are immune regulated. To determine whether distinct tissue immune microenvironments differentially impact on clinical outcome in Non Small Cell Lung Cancer (NSCLC), an extended analysis of PD-L1 and Tumor Infiltrating Lymphocytes (TILs) was performed. Experimental Design Samples from resected adenocarcinoma (ADC 42) and squamous cell carcinoma (SCC 58) and from 26 advanced diseases (13 ADC, 13 SCC) treated with nivolumab were analyzed. PD-L1 expression and the incidence of CD3, CD8, CD4, PD-1, CD57, FOXP3, CD25 and Granzyme B TILs was immunohistochemically assessed. Results PD-L1 levels inversely correlated with N involvement although did not show a statistical significant prognostic value in resected patients. The incidence and phenotype of TILs differed in SCC vs ADC in which EGFR and KRAS mutations conditioned a different frequency and tissue localization of lymphocytes. NSCLC resected patients with high CD8 pos lymphocytes lacking PD-1 inhibitory receptor had a longer Overall Survival (OS:HR=2.268, 95%CI 1.056-4.871,p=0.03). PD-1-to-CD8 ratio resulted a prognostic factor both on univariate (HR=1.952, 95%CI 1.34-3.12,p=0.001) and multivariate (HR=1.943, 95%CI 1.38-2.86,p=0.009) analysis. Moreover, low PD-1 incidence among CD8^pos cells was a distinctive feature of nivolumab treated patients showing clinical benefit with a prolonged Progression-Free Survival (PFS:HR=4.51, 95%CI 1.45-13.94,p=0.004). Conclusions In the presence of intrinsic variability in PD-L1 expression, the reservoir of PD-1 negative effector T-lymphocytes provides an immune-privileged microenvironment with a positive impact on survival of patients with resected disease and response to immunotherapy in advanced NSCLC.

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Concurrent inhibition of Pim and FLT3 kinases enhances apoptosis of FLT3-ITD acute myeloid leukemia cells through increased Mcl-1 proteasomal degradation

Purpose:fms-like tyrosine kinase 3 internal tandem duplication (FLT3-ITD) is present in 30% of acute myeloid leukemia (AML), and these patients have short disease-free survival. FLT3 inhibitors have limited and transient clinical activity, and concurrent treatment with inhibitors of parallel or downstream signaling may improve responses. The oncogenic serine/threonine kinase Pim-1 is upregulated downstream of FLT3-ITD and also promotes its signaling in a positive feedback loop, suggesting benefit of combined Pim and FLT3 inhibition. Experimental Design: Combinations of clinically active Pim and FLT3 inhibitors were studied in vitro and in vivo. Results: Concurrent treatment with the pan-Pim inhibitor AZD1208 and FLT3 inhibitors at clinically applicable concentrations abrogated in vitro growth of FLT3-ITD, but not wild-type FLT3 (FLT3-WT), cell lines. AZD1208 co-treatment increased FLT3 inhibitor-induced apoptosis of FLT3-ITD, but not FLT3-WT, cells measured by sub-G1 fraction, annexin V labeling, mitochondrial membrane potential and PARP and caspase-3 cleavage. Concurrent treatment with AZD1208 and the FLT3 inhibitor quizartinib decreased growth of MV4-11 cells, with FLT3-ITD, in mouse xenografts and prolonged survival, enhanced apoptosis of FLT3-ITD primary AML blasts, but not FLT3-WT blasts or remission marrow cells, and decreased FLT3-ITD AML blast colony formation. Mechanistically, AZD1208 and quizartinib co-treatment decreased expression of the anti-apoptotic protein Mcl-1. Decrease in Mcl-1 protein expression was abrogated by treatment with the proteasome inhibitor MG132, and was preceded by downregulation of the Mcl-1 deubiquitinase USP9X, a novel mechanism of Mcl-1 regulation in AML. Conclusion: The data support clinical testing of Pim and FLT3 inhibitor combination therapy for FLT3-ITD AML.

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Prospective feasibility trial for genomics-informed treatment in recurrent and progressive glioblastoma

Purpose: Glioblastoma is an aggressive and molecularly heterogeneous cancer with few effective treatment options. We hypothesized that next-generation sequencing can be used to guide treatment recommendations within a clinically acceptable time frame following surgery for patients with recurrent glioblastoma. Methods: We conducted a prospective genomics-informed feasibility trial in adults with recurrent and progressive glioblastoma. Following surgical resection, genome-wide tumor/normal exome-sequencing and tumor RNA-sequencing was performed to identify molecular targets for potential matched therapy. A multi-disciplinary molecular tumor board issued treatment recommendations based on the genomic results, blood brain barrier penetration of the indicated therapies, drug-drug interactions, and drug safety profiles. Feasibility of generating genomics-informed treatment recommendations within 35 days of surgery was assessed. Results: Of the 20 patients enrolled in the study, 16 patients had sufficient tumor tissue for analysis. Exome-sequencing was completed for all patients and RNA-sequencing was completed for 14 patients. Treatment recommendations were provided within the study's feasibility time frame for 15 of 16 (94%) patients. Seven patients received treatment based on the tumor board recommendations. Two patients reached 12-month progression-free survival, both adhering to treatments based on the molecular profiling results. One patient remained on treatment and progression-free 21 months after surgery, three-times longer than the patient's previous time to progression. Analysis of matched non-enhancing tissue from 12 patients revealed overlapping as well as novel putatively actionable genomic alterations. Conclusion: Use of genome-wide molecular profiling is feasible and can be informative for guiding real-time, central nervous system (CNS)-penetrant, genomics-informed treatment recommendations for patients with recurrent glioblastoma.

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Hepatitis C virus-induced prion protein expression facilitates hepatitis C virus replication

Abstract

Hepatitis C virus (HCV) infects approximately 180 million people worldwide. Significant progress has been made since the establishment of in vitro HCV infection models in cells. However, the replication of HCV is complex and not completely understood. Here, we found that the expression of host prion protein (PrP) was induced in an HCV replication cell model. We then showed that increased PrP expression facilitated HCV genomic replication. Finally, we demonstrated that the KKRPK motif on the N-terminus of PrP bound nucleic acids and facilitated HCV genomic replication. Our results provided important insights into how viruses may harness cellular protein to achieve propagation.

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Pseudomyxoma pleuri as a Surgical Emergency: a Rare Case Report

Abstract

Pseudomyxoma pleuri is a rare condition and it mostly results from secondary involvement of an abdominal pathology. Massive pleural disease impedes cardiopulmonary functions and threatens life. We are reporting our experience about managing a middle-age lady with a known case of Pseudomyxoma peritonei, who presented to causality with progressive breathing difficulty in acute exacerbation and cardiopulmonary compromise.

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Assessing the role of immune system in cancer progression from minimal residual disease

The immune system plays a major role in resisting the development and progression of cancer. Analysis of the molecular mechanisms of immune resistance to cancer has led to the formulation of several immunotherapeutic strategies. Although the immune system is portrayed in the literature as an effective tool for primary cancer control, its role in the development of recurrent tumors was relatively unexplored. It is well established that most cancers contain a subpopulation of cancer cells, that possess an inherent survival instinct which aids them to adopt a dormant state when subjected to stress [1–4].

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TGF-{beta} promotes genomic instability after loss of RUNX3

Studies of genomic instability have historically focused on intrinsic mechanisms rather than extrinsic mechanisms based on the tumor microenvironment (TME). TGF-β is the most abundantly secreted cytokine in the TME where it imparts various aggressive characteristics including invasive migration, drug resistance and epithelial-to-mesenchymal transition (EMT). Here we show that TGF-β also promotes genomic instability in the form of DNA double strand breaks (DSB) in cancer cells which lack the tumor suppressor gene RUNX3. Loss of RUNX3 resulted in transcriptional downregulation of the redox regulator heme oxygenase-1 (HO-1 or HMOX1). Consequently, elevated oxidative DNA damage disrupted genomic integrity and triggered cellular senescence, which was accompanied by tumor-promoting inflammatory cytokine expression and acquisition of the senescence-associated secretory phenotype (SASP). Recapitulating the above findings, tumors harbouring a TGF-β gene expression signature and RUNX3 loss exhibited higher levels of genomic instability. In summary, RUNX3 creates an effective barrier against further TGF-β-dependent tumor progression by preventing genomic instability. These data suggest a novel cooperation between cancer cell-extrinsic TGF-β signaling and cancer cell-intrinsic RUNX3 inactivation as aggravating factors for genomic instability.

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NF-kB promotes ovarian tumorigenesis via classical pathways supporting proliferative cancer cells and alternative pathways supporting ALDH+ cancer stem-like cells

Understanding the mechanisms supporting tumor-initiating cells (TIC) is vital to combat advanced stage recurrent cancers. Here we show that in advanced ovarian cancers NF-kB signaling via the RelB transcription factor supports TIC populations by directly regulating the cancer stem-like associated enzyme aldehyde dehydrogenase (ALDH). Loss of RelB significantly inhibited spheroid formation, ALDH expression and activity, chemoresistance, and tumorigenesis in subcutaneous and intrabursal mouse xenograft models of human ovarian cancer. RelB also affected expression of the ALDH gene ALDH1A2. Interestingly, classical NF-kB signaling through the RelA transcription factor was equally important for tumorigenesis in the intrabursal model, but had no effect on ALDH. In this case, classical signaling via RelA was essential for proliferating cells, whereas the alternative signaling pathway was not. Our results show how NF-kB sustains diverse cancer phenotypes via distinct classical and alternative signaling pathways, with implications for improved understanding of disease recurrence and therapeutic response.

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Global metabolomic profiling of uterine leiomyomas

Global metabolomic profiling of uterine leiomyomas

British Journal of Cancer, Published online: 26 October 2017; doi:10.1038/bjc.2017.361

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Intratumoural PD-L1 expression is associated with worse survival of patients with Epstein–Barr virus-associated gastric cancer

Intratumoural PD-L1 expression is associated with worse survival of patients with Epstein–Barr virus-associated gastric cancer

British Journal of Cancer, Published online: 26 October 2017; doi:10.1038/bjc.2017.369

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Tetracycline use and risk of incident skin cancer: a prospective study

Tetracycline use and risk of incident skin cancer: a prospective study

British Journal of Cancer, Published online: 26 October 2017; doi:10.1038/bjc.2017.378

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Forced expiratory values in 1 second corresponding to Pediatric Respiratory Assessment Measure and Acute Asthma Intensity Research Score values during pediatric acute asthma exacerbations

Acute asthma exacerbations are one of the most frequent reasons for emergency department (ED) visits and hospitalizations. Expert panel guidelines recommend measurement of percent-predicted forced expiratory volume in 1 second (FEV1) or peak expiratory flow for exacerbation severity assessment and treatment decision making.1 These guidelines categorize exacerbation severity according to percent-predicted FEV1 as mild to moderate (FEV1 ≥40%) and severe (FEV1 <40%), but acute care facilities that treat pediatric exacerbations generally do not have the equipment or personnel for such measures of lung function.

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Paternal gonadal mosaicism as cause of a puzzling inheritance pattern of activated PI3-kinase delta syndrome

Birth defects caused by de novo chromosomal abnormalities resulting in single-gene defects occur in approximately 5% of all live births.1 Affected offspring have a broad range of illnesses, including primary immunodeficiency diseases, a genetically heterogeneous group of disorders presenting with a clinical spectrum of mild to severe infections, often complicated by autoimmunity and malignancies.2 Most primary immunodeficiency diseases are monogenic diseases with a Mendelian inheritance pattern.

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Bee moth (Galleria mellonella) allergy

We present a case of bee moth (Galleria mellonella) allergy with new clinical and immunologic features. While taking part in trout fishing games during the past year, a 34-year-old amateur fisherman with no personal history of allergic diseases experienced several attacks of rhinoconjunctivitis and late asthmatic reactions. Symptoms of rhinoconjunctivitis began when starting to fish and persisted during the day. This was followed by mild wheezing and dyspnea during the following night. Symptoms worsened during the most recent fishing excursion, and mild breathing difficulty tends to last until the night of the next day.

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Association of consistently suboptimal quality of life with consistently poor asthma control in children with asthma

Asthma is one of the most prevalent chronic conditions in children, affecting 8.4% of American children and adolescents (approximately 6.2 million) in 2015.1 Although previous studies have found that poor asthma control is associated with impaired physical, psychological, and social aspects of health-related quality of life (HRQoL),2 some studies have suggested that impaired psychological aspects of HRQoL (ie, anxiety and depressive symptoms) cause poor asthma control.3 The effects of impaired HRQoL domains (eg, fatigue, pain, mobility, and peer relationships) in addition to anxiety and depressive symptoms on subsequent asthma outcomes in pediatric populations have been inadequately studied.

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Treating laryngopharyngeal reflux: Evaluation of an anti-reflux program with comparison to medications

To determine if an anti-reflux induction program relieves laryngopharyngeal reflux (LPR) symptoms more effectively than medication and behavioral changes alone.

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Pediatric airway study: Endoscopic grading system for quantifying tonsillar size in comparison to standard adenotonsillar grading systems

Current grading systems may not allow clinicians to reliably document and communicate adenotonsillar size in the clinical setting. A validated endoscopic grading system may be useful for reporting tonsillar size in future clinical outcome studies. This is especially important as tonsillar enlargement is the cause of a substantial health care burden on children.

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Lower Plasma Choline Levels are Associated with Sleepiness Symptoms

Sleepiness and cardiovascular disease share common molecular pathways; thus, metabolic risk factors for sleepiness may also predict cardiovascular disease risk. Daytime sleepiness predicts mortality and cardiovascular disease, although the mechanism is unidentified. This study explored the associations between subjective sleepiness and metabolite concentrations in human blood plasma within the oxidative and inflammatory pathways, in order to identify mechanisms that may contribute to sleepiness and cardiovascular disease risk.

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Autologous dermis - fat grafts as primary and secondary orbital transplants before rehabilitation with artificial eyes

The aim of this study was to examine the role of autologous dermis-fat grafts in the reconstruction of orbital soft-tissue defects.

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Antitumor activity of Lepidium latifolium and identification of the epithionitrile 1-cyano-2,3-epithiopropane as its major active component

Abstract

Consumption of Brassica (Cruciferae) vegetables is associated with a reduced risk of cancer, but identification of the active components and insights into the underlying molecular events are scarce. Here we found that an extract of Lepidium latifolium, a cruciferous plant native to southern Europe, Mediterranean countries and Asia, showed in vitro cytotoxic activity, inducing caspase-dependent apoptosis, in a variety of human tumor cells, and the plant juice showed in vivo antitumor activity in a HT-29 human colon cancer xenograft mouse model. The epithionitrile 1-cyano-2,3-epithiopropane (CETP) was identified as the major active cancer cell-killing principle of L. latifolium. Synthetic and plant-derived CETP displayed similar proapoptotic activities as assessed by biochemical and morphological analyses. Analysis of the antiproliferative capacity of CETP on a wide number of cancer cell lines from the NCI-60 cell line panel followed by COMPARE analysis, revealed an activity profile different from known anticancer agents. Flow cytometry and biochemical analyses revealed that CETP-induced apoptosis involved mitochondria, as assessed by loss of mitochondrial transmembrane potential and generation of reactive oxygen species, while overexpression of Bcl-X_L and Bcl-2 prevented CETP-induced apoptosis. Inhibition of reactive oxygen species by glutathione and N-acetyl cysteine reduced the apoptotic response induced by CETP. FADD dominant negative form, blocking Fas/CD95 signaling, and a specific caspase-8 inhibitor also inhibited CETP-induced killing. Taken together, our data suggest that the cancer cell-killing action of CETP, involving both intrinsic and extrinsic apoptotic signaling pathways, underlies the antitumor activity of L. latifolium plant, which could be of potential interest in cancer treatment. This article is protected by copyright. All rights reserved

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Inhibition of Autophagy Initiation Potentiates Chemosensitivity in Mesothelioma

Abstract

The benefits of inhibiting autophagy in cancer are still controversial, with differences in outcome based on the type of tumor, the context and the particular stage of inhibition. Here, we investigated the impact of inhibiting autophagy at different stages on chemosensitivity using 3-dimensional (3D) models of mesothelioma, including ex vivo human tumor fragment spheroids. As shown by LC3B accumulation, we successfully inhibited autophagy using either an early stage ULK1/2 inhibitor (MRT 68921) or a late stage inhibitor (hydroxychloroquine). We found that inhibition of autophagy at the early stage, but not at late stage, potentiated chemosensitivity. This effect was seen only in those spheroids with high autophagy and active initiation at steady state. Inhibition of autophagy alone, at either early or late stage, did not cause cell death, showing that the inhibitors were non-toxic and that mesothelioma did not depend on autophagy at baseline, at least over 24 h. Using ATG13 puncta analysis, we found that autophagy initiation identified tumors that are more chemosensitive at baseline and after autophagy inhibition. Our results highlight a potential role of autophagy initiation in supporting mesothelioma cells during chemotherapy. Our work also highlights the importance of testing the inhibition of different stages in order to uncover the role of autophagy and the potential of its modulation in the treatment of cancer. This article is protected by copyright. All rights reserved

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Eugenol potentiates cisplatin anti-cancer activity through inhibition of ALDH-positive breast cancer stem cells and the NF-κB signaling pathway

Abstract

Triple-negative breast tumors are very aggressive and contain relatively high proportion of cancer stem cells, and resistant to chemotherapeutic drugs including cisplatin. To overcome these limitations, we combined eugenol, a natural polyphenolic molecule with cisplatin to normalize cisplatin mediated toxicity and potential drug resistance. Interestingly, the combination treatment provided significantly greater cytotoxic and pro-apoptotic effects as compared to treatment with eugenol or cisplatin alone on several triple-negative breast cancer cells both in vitro and in vivo. Furthermore, adding eugenol to cisplatin potentiated the inhibition of breast cancer stem cells by inhibiting ALDH enzyme activity and ALDH-positive tumor initiating cells. We provide also clear evidence that eugenol potentiates cisplatin inhibition of the NF-κB signaling pathway. Indeed, the binding of NF-κB to its cognate binding sites present in the promoters of IL-6 and IL-8 was dramatically reduced, which led to potent down-regulation of the IL-6 and IL-8 cytokines upon combination treatment relative to the single agents. Similar effects were observed on proliferation, inhibition of epithelial-to-mesenchymal transition and stemness markers in tumor xenografts. These results provide strong preclinical justification for combining cisplatin with eugenol as therapeutic approach for triple-negative breast cancers through targeting the resistant ALDH-positive cells and inhibiting the NF-κB pathway. This article is protected by copyright. All rights reserved

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Mouse double minute 4 variants modify susceptibility to risk of recurrence in patients with squamous cell carcinoma of the oropharynx

Abstract

Given the crucial role of Mouse double minute 4 (MDM4) oncoprotein in p53 pathway, single nucleotide polymorphisms (SNPs) could serve as such biomarkers for prediction of SCCOP recurrence. Thus, we investigated associations between three tagging putatively functional variants of MDM4, two in the 3' untranslated region of 3' UTR [rs11801299 (NC_000001.10:g.204529084G>A) and rs10900598(NC_000001.10:g.204525568G>T)] and one in intron 1 [rs1380576(NC_000001.10:g.204488278G>C)], and recurrence risk of SCCOP in 1,008 incident patients. A log-rank test and multivariable Cox models were used to assess associations. Patients with MDM4-rs10900598 GT/TT had a worse disease-free survival (DFS) compared with corresponding GG genotype, while those with rs11801299 AG/AA genotypes had a lower recurrence risk than the cases with rs11801299 GG genotype (both log-rank, P<0.001). Multivariable analysis showed that significantly different recurrence risk were found among patients with MDM4-rs10900598 GT/TT and rs11801299 AG/AA variant genotypes (HR, 2.0, 95% CI, 1.4–2.9 and HR, 0.4, 95% CI, 0.3–0.6, respectively) compared with their corresponding common homozygous genotypes. Furthermore, after combining the risk genotypes of the three SNPs, patients among low-risk group had a significantly lower risk of SCCOP recurrence than those in high-risk group (HR, 0.2, 95% CI, 0.1–0.3). The risk for both individual SNPs or combined risk genotypes was restricted to HPV-positive SCCOP patients. Our findings suggest that the MDM4 polymorphisms may, individually or in combination, confer an independent risk of SCCOP recurrence, particularly in HPV-positive SCCOP patients. However, larger studies are needed to validate our findings. This article is protected by copyright. All rights reserved

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Acoustics of Clear and Noise-Adapted Speech in Children, Young, and Older Adults

Purpose

This study investigated acoustic–phonetic modifications produced in noise-adapted speech (NAS) and clear speech (CS) by children, young adults, and older adults.

Method

Ten children (11–13 years of age), 10 young adults (18–29 years of age), and 10 older adults (60–84 years of age) read sentences in conversational and clear speaking style in quiet and in noise. A number of acoustic measurements were obtained.

Results

NAS and CS were characterized by a decrease in speaking rate and an increase in 1–3 kHz energy, sound pressure level (SPL), vowel space area (VSA), and harmonics-to-noise ratio. NAS increased fundamental frequency (F0) mean and decreased jitter and shimmer. CS increased frequency and duration of pauses. Older adults produced the slowest speaking rate, longest pauses, and smallest increase in F0 mean, 1–3 kHz energy, and SPL when speaking clearly. They produced the smallest increases in VSA in NAS and CS. Children slowed down less, increased the VSA least, increased harmonics-to-noise ratio, and decreased jitter and shimmer most in CS. Children increased mean F0 and F1 most in noise.

Conclusions

Findings have implications for a model of speech production in healthy speakers as well as the potential to aid in clinical decision making for individuals with speech disorders, particularly dysarthria.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/doi/10.1044/2017_JSLHR-S-16-0130/2660931/Acoustics-of-Clear-and-NoiseAdapted-Speech-in

Generalized Adaptation to Dysarthric Speech

Purpose

Generalization of perceptual learning has received limited attention in listener adaptation studies with dysarthric speech. This study investigated whether adaptation to a talker with dysarthria could be predicted by the nature of the listener's prior familiarization experience, specifically similarity of perceptual features, and level of intelligibility.

Method

Following an intelligibility pretest involving a talker with ataxic dysarthria, 160 listeners were familiarized with 1 of 7 talkers with dysarthria—who differed from the test talker in terms of perceptual similarity (same, similar, dissimilar) and level of intelligibility (low, mid, high)—or a talker with no neurological impairment (control). Listeners then completed an intelligibility posttest on the test talker.

Results

All listeners benefited from familiarization with a talker with dysarthria; however, adaptation to the test talker was superior when the familiarization talker had similar perceptual features and reduced when the familiarization talker had low intelligibility.

Conclusion

Evidence for both generalization and specificity of learning highlights the differential value of listeners' prior experiences for adaptation to, and improved understanding of, a talker with dysarthria. These findings broaden our theoretical knowledge of adaptation to degraded speech, as well as the clinical application of training paradigms that exploit perceptual processes for therapeutic gain.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/doi/10.1044/2017_JSLHR-S-17-0127/2660935/Generalized-Adaptation-to-Dysarthric-Speech

Intelligibility of Noise-Adapted and Clear Speech in Child, Young Adult, and Older Adult Talkers

Purpose

This study examined intelligibility of conversational and clear speech sentences produced in quiet and in noise by children, young adults, and older adults. Relative talker intelligibility was assessed across speaking styles.

Method

Sixty-one young adult participants listened to sentences mixed with speech-shaped noise at −5 dB signal-to-noise ratio. The analyses examined percent correct scores across conversational, clear, and noise-adapted conditions and the three talker groups. Correlation analyses examined whether talker intelligibility is consistent across speaking style adaptations.

Results

Noise-adapted and clear speech significantly enhanced intelligibility for young adult listeners. The intelligibility improvement varied across the three talker groups. Notably, intelligibility benefit was smallest for children's speaking style modifications. Listeners also perceived speech produced in noise by older adults to be less intelligible compared to the younger talkers. Talker intelligibility was correlated strongly between conversational and clear speech in quiet, but not for conversational speech produced in quiet and in noise.

Conclusions

Results provide evidence that intelligibility variation related to age and communicative barrier has the potential to aid clinical decision making for individuals with speech disorders, particularly dysarthria.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/doi/10.1044/2017_JSLHR-S-16-0165/2660932/Intelligibility-of-NoiseAdapted-and-Clear-Speech

Influence of Altered Auditory Feedback on Oral–Nasal Balance in Speech

Purpose

This study explored the role of auditory feedback in the regulation of oral–nasal balance in speech.

Method

Twenty typical female speakers wore a Nasometer 6450 (KayPentax) headset and headphones while continuously repeating a sentence with oral and nasal sounds. Oral–nasal balance was quantified with nasalance scores. The signals from 2 additional oral and nasal microphones were played back to the participants through the headphones. The relative loudness of the nasal channel in the mix was gradually changed so that the speakers heard themselves as more or less nasal. An additional amplitude control group of 9 female speakers completed the same task while hearing themselves louder or softer in the headphones.

Results

A repeated-measures analysis of variance of the mean nasalance scores of the stimulus sentence at baseline, minimum, and maximum nasal feedback conditions demonstrated a significant effect of the nasal feedback condition. Post hoc analyses found that the mean nasalance scores were lowest for the maximum nasal feedback condition. The scores of the minimum nasal feedback condition were significantly higher than 2 of the 3 baseline feedback conditions. The amplitude control group did not show any effects of volume changes on nasalance scores.

Conclusions

Increased nasal feedback led to a compensatory adjustment in the opposite direction, confirming that oral–nasal balance is regulated by auditory feedback. However, a lack of nasal feedback did not lead to a consistent compensatory response of similar magnitude.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://article/doi/10.1044/2017_JSLHR-S-16-0390/2660934/Influence-of-Altered-Auditory-Feedback-on

Common and Uncommon Benign Pancreatic Lesions Mimicking Malignancy: Imaging Update and Review

There is a broad range of inflammatory, pseudotumoral and benign lesions that may masquerade as pancreatic malignancies, often representing a challenge to the radiologist. Unawareness of these entities can lead to inadequate differential diagnoses or misdiagnosis, with important prognostic and therapeutic consequences. The purpose of this article is to revisit a spectrum of lesions, varying from common to exceedingly rare non-malignant, that may mimic malignant pancreatic neoplasms on imaging, identifying relevant features that may contribute to reaching the correct diagnosis.

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Validation of a Paediatric Speech and Language Screening (RALF)

Background/Aims: This study aims to analyse psychometric characteristics of the Portuguese Paediatric Speech and Language Screening (RALF) test. Methods: 202 Portuguese children aged 3; 0–5; 11 were recruited from 4 kindergartens participating in this study. Reliability and validity (sensitivity and specificity) data were obtained and analysed. Results: Content validity, analysed by an expert panel (general practitioner, kindergarten, teacher, nurse, and speech and language pathologist) revealed that the items were representative and relevant for the content the instrument intends to measure. Sensitivity values were 95, 96, and 83% and specificity values were 85, 84, and 71% for the age groups 3; 0–3; 11, 4; 0–4; 11, and 5; 0–5; 11, respectively. Internal consistency, calculated through Cronbach's alpha, was 0.7, 0.8, and 0.7, respectively. The inter-judge reliability (interclass correlation coefficient) was 0.951. The results ensure the content validity of RALF. Sensitivity and specificity values revealed that RALF could discriminate typical from disordered speech-language developing children. RALF also presented good internal consistency and excellent reliability. Conclusion: RALF is a reliable and valid screening instrument that health and educational professionals can use in Portuguese children to identify children who may need a speech-language diagnosis for consideration or referral to speech therapy services.
Folia Phoniatr Logop 2017;68:247–251

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WEBINAR: Receive Hundreds of Sleep Patients From Hospitals Thanks to Project Rose

OBJECTIVE

The American Sleep and Breathing Academy (ASBA) recently partnered with NFL greats Earl Campbell and Gary Baxter in Tyler, Texas to ensure the highest quality sleep program for the community. ASBA Executive Directors David Gergen and Alan Hickey were among the special guests invited to the grand opening of their first facility. We are looking for qualified sleep dentists to join the ASBA/Project Rose team and work in their new hospitals and clinics that are open across the country. Don't miss out on your opportunity to be a part of this! Register for the webinar and find out more.

 

SCHEDULE

Review Benefits of Joining Project Rose
Hundreds of patients in your chair without having to pay for marketing
Higher reimbursements because the hospital will bill for you
Work with the best equipment in the industry
Be a part of the winning team

Review Special Staff Training – Sleep Coordinator Specialist 

"Certification"Improve office productivity with expert staff training and special certification

 

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Adult hippocampal neurogenesis in neuropathic pain and alkyl glycerol ethers treatment

Publication date: Available online 26 October 2017
Source:Acta Histochemica
Author(s): Anna A. Tyrtyshnaia, Igor V. Manzhulo, Ruslan M. Sultanov, Ekaterina V. Ermolenko
Neuropathic pain manifested by a number of sensory symptoms is often accompanied by disorders of higher nervous activity, such as memory impairment, depression, anxiety, anhedonia, etc. This emphasizes the involvement of supraspinal structures including the hippocampus in neuropathic pain pathogenesis. In the present study, we focused on the impact of chronic neuropathic pain on hippocampal neurogenesis and microglial state. In addition, we test the effect of alkyl glycerol ethers on hippocampal neuronal and microglial plasticity as well as behavioral parameters. Neuropathic pain was induced using the model of sciatic nerve chronic constriction injury. We found an impairment of working memory and locomotor activity in animals with neuropathic pain, which was prevented by alkyl glycerol ethers treatment. Sciatic nerve ligation in mice contributed to the decrease in hippocampal neurogenesis intensity. Alkyl glycerol ethers administration significantly reduced this effect. Neuropathic pain-associated neurogenesis reduction was accompanied by an increased percentage of Iba1-labeled area in the CA1 hippocampal region on the 14th and 28th days after surgery. In addition, we observed a decrease in hippocampal pro-inflammatory microglia marker CD86 immunostaining on day 28 after surgery in alkyl glycerol ethers-treated mice with sciatic nerve ligation. These results are consistent with data on pro- and anti-inflammatory cytokines expression in the hippocampus. Alkyl glycerol ethers administration increased IL-10 and decreased IL-1β hippocampal expression in animals with neuropathic pain. Taken together, these data suggest that neuropathic pain-behavior in rodents is accompanied by changes in microglia polarization, thereby contributing to neurogenesis impairment and cognitive disturbances. Alkyl glycerol ethers prevented M1 microglial activation, contributing to the maintenance of normal neurogenesis levels within the hippocampus and normalizing working memory.

Graphical abstract

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Clinical and radiographic evaluation of pulpectomy in primary teeth: a 18-months clinical randomized controlled trial

Abstract

Background

To avoid untoward changes when primary teeth are replaced by permanent teeth, resorption of the material used in primary teeth root canal filling should occur at the same rate as root resorption. The Aim of this study was to compare the success rates of a mixed primary root canal filling (MPRCF, ingredients: zinc oxide–eugenol [ZOE], iodoform, calcium hydroxide) to those of ZOE and Vitapex in pulpectomised primary molars.

Methods

One hundred and sixty primary molars from 155 children (average age 5.88 ± 1.27 years) underwent two-visit pulpectomy using one of the three materials. The clinical and radiographic findings at 6, 12 and 18 months were assessed.

Results

At 6 and 12 months, the MPRCF and ZOE success rates were 100%. The Vitapex group showed clinical success rate and radiographic success rate of 100 and 94.5% at 6 months, and 80.4 and 60.7% at 12 months. The 18-month clinical success rates of the MPRCF, ZOE and Vitapex were 96.2, 92.2 and 71.4% and radiographic success rates were 92.5, 88.2 and 53.6%, respectively. There was a statistically significant difference in the success rates between MPRCF and Vitapex and no significant differences between MPRCF and ZOE. More MPRCF were resorbed at same rate with roots than ZOE and Vitapex. Early resorption of root filling resulted in more failure.

Conclusions

The mixture of ZOE, iodoform and calcium hydroxide can be considered an effective root canal filling material in pulp involved primary teeth and had no adverse effect on tooth replacement.

Trial registration

ChiCTR-TRC-14004938. Registered 13 July 2014.

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Tetracycline use and risk of incident skin cancer: a prospective study

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Global metabolomic profiling of uterine leiomyomas

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Intratumoural PD-L1 expression is associated with worse survival of patients with Epstein–Barr virus-associated gastric cancer

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Minimally invasive surgery as a treatment option for gastric cancer with liver metastasis: a comparison with open surgery

Abstract

Background

As minimally invasive techniques advances, minimally invasive surgery (MIS) has emerged as an alternative modality for advanced gastric cancer. In this study, we compared the short- and long-term surgical outcomes of MIS and conventional open surgery for gastric cancer liver metastasis (GCLM) in terms of safety, feasibility, and efficacy.

Methods

This retrospective study used data from a prospective database at the Chinese People's Liberation Army General Hospital. From January 2006 to June 2016, 53 gastric cancer patients with synchronous liver metastasis accepted radical gastrectomy combined with either or both hepatectomy and radiofrequency ablation for liver metastases. The 53 patients enrolled in the study were divided into two groups: a conventional open surgery group (n = 42) and an MIS group (n = 11). Propensity score matching (PSM) analysis was performed to overcome possible bias.

Results

With PSM performed at a 1:3 ratio, 11 patients who received MIS were compared with 33 open surgery cases. Mean operation time was significantly longer for the MIS group compared with the open surgery group (301 vs. 236 min, P = 0.032), while the open surgery group had a larger estimated blood loss than the MIS group (421 vs. 196 ml, P = 0.019). Time to first flatus and postoperative complications, including Clavien–Dindo classification, were similar in the two groups. However, patients undergoing MIS had a significantly shorter time to first sips of water (P = 0.020) and soft diet (P = 0.020) compared with open surgery counterparts. Long-term outcomes were comparable between groups (P = 0.090) after adjustment by PSM analysis.

Conclusions

MIS achieved superior short-term outcomes and comparable long-term outcomes compared with open surgery in GCLM patients. For experienced surgeons, both laparoscopic and robotic methods of MIS are reasonable approaches for the management of highly selected GCLM patients.

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Editorial Board Page

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11





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Table of Contents

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11





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AAOMS Author Disclosure forms

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11





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Is It Time to Reexamine Reexamination?

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11
Author(s): James R. Hupp




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Effectiveness, Safety, and Predictors of Response to Botulinum Toxin Type A in Refractory Masticatory Myalgia: A Retrospective Study

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11
Author(s): Shehryar N. Khawaja, Steven J. Scrivani, Nicole Holland, David A. Keith
PurposeMasticatory muscle pain disorders respond well to conservative therapy; however, in some patients the pain becomes refractory. Botulinum toxin type A (BoT-A) therapy has been shown to be an effective modality in the management of refractory headache disorders. Conversely, there are conflicting reports in the literature regarding the efficacy, safety, and predictors of therapeutic response to BoT-A therapy for management of refractory masticatory muscle pain.Materials and MethodsWe performed a retrospective chart review of patients who underwent at least 2 injection cycles of 100 U of BoT-A for refractory masticatory myalgia in the Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, between May 2012 and June 2016. Information regarding demographic, diagnostic, and therapeutic characteristics was extracted and analyzed. The χ² test was used for analysis between independent and dependent variables. Forward step-wise–type logistic regression analysis was conducted to determine the predictors of outcome.ResultsAmong 116 participants, 30.6% reported significant relief in pain for a mean period of 10.1 weeks. A total of 16.4% of participants reported at least 1 adverse effect. The effectiveness of the BoT-A therapy was found to be statistically associated with the presence of muscle hypertrophy (P = .004), range of motion (P = .02), concurrent use of opioid analgesics (P = .003), and local anesthetic trigger-point injections (P = .003). Logistic regression analyses suggested that the presence of muscle hypertrophy and occurrence of adverse effects were predictors of positive outcome. On the contrary, concurrent use of opioid analgesics was found to be a predictor for no or minimal relief.ConclusionsBoT-A therapy provides significant relief for approximately one third of patients with refractory masticatory muscle pain. Therapy is associated with a mild risk of adverse effects. The presence of muscle hypertrophy, occurrence of an adverse effect, and concurrent use of opioid analgesics were found to be predictors of outcome response.



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Pathogenesis of cleft palate in Robin sequence: Observations from prenatal MRI

Publication date: Available online 16 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Cory M. Resnick, Judy A. Estroff, Tessa D. Kooiman, Carly E. Calabrese, Maarten J. Koudstaal, Bonnie L. Padwa
PurposeThe etiology of the palatal cleft in Robin sequence (RS) is unknown. The purpose of this study was to assess position of the fetal tongue on prenatal magnetic resonance imaging (MRI) and to suggest a potential relationship between tongue position and development of the cleft palate seen in the majority patients with RS.MethodsThis is a retrospective case-control study including fetuses with prenatal MRIs performed in our center from 2002-2017. Inclusion criteria were: (1) prenatal MRI of adequate quality, (2) live-born infant, and (3) postnatal diagnosis of Robin sequence ("Robin" group) or cleft lip and palate ("CLP" group). Subjects with postnatal RS without a palatal cleft were excluded. A control group with normal facial morphology was gestational-age matched. The outcome variable was tongue position on fetal MRI described as: within the cleft, along the floor-of-mouth, other, or indeterminate.Results122 subjects with mean gestational age at MRI of 25.8±4.9 weeks were included: Robin, n=21 (17%), CLP, n=47 (39%), control, n=54 (44%). The tongue was visualized within the palatal cleft in 76.2% of the Robin group and 4.3% of the CLP group. The tongue was found along the floor-of-mouth (normal position) in the remainder of the Robin and CLP groups, and in 100% of the control group.ConclusionThese findings suggest a relationship between in-utero tongue position and the development of a cleft palate in RS.



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Velopharyngeal Insufficiency and Hypernasal Voice: 15 Years' Experience With Furlow Palatoplasty

Publication date: Available online 16 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): M.I. Rizzo, P. Cecchi, O. Rajabtork Zadeh, M. Zama




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Juvenile Idiopathic Arthritis Practice Patterns Among Oral and Maxillofacial Surgeons

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11
Author(s): Brian E. Kinard, Shelly Abramowicz
PurposeThe purpose of this investigation is to assess the current clinical practices by oral and maxillofacial surgeons (OMSs) in the United States regarding diagnosis and treatment of temporomandibular joint (TMJ) involvement in children with juvenile idiopathic arthritis (JIA).Materials and MethodsWe implemented a cross-sectional survey of academic OMSs in the United States via an electronic survey. The survey included respondent demographic data, patient volumes, diagnostic methods, and management practices for children with JIA and TMJ involvement. The results of the survey were analyzed using descriptive statistics.ResultsThe study respondents were composed of 52 surgeons. Most respondents were men (n = 43, 87.8%), were aged 51 to 60 years (n = 20, 39.2%), were in full-time academics (n = 42, 84%), had more than 20 years of experience (n = 26, 50%), and were seeing 1 to 5 patients with JIA per month (n = 21, 46.7%). Most patients were aged 11 to 15 years (n = 22, 61.1%) and were managed with 1 to 2 systemic medications (n = 30, 81.1%). All OMSs reported evaluating TMJ involvement by reviewing patient history, clinical examination, and imaging. The most commonly used imaging modality was panoramic radiographs (n = 24, 63.2%) and magnetic resonance imaging (n = 22, 57.9%). OMSs decided to inject intra-articular medication based on history and symptoms (n = 36, 94.7%). Once in remission, patients were followed up at yearly (n = 12, 36.4%) or 6-month (n = 10, 30.3%) intervals.ConclusionsOur study shows that, in general, there is consensus among US OMSs regarding diagnosis of TMJ involvement in children with JIA. There is less concordance among the respondents regarding treatment. Currently, management of TMJ involvement in children with JIA is mostly based on expert opinions and retrospective studies. This study further highlights the need for randomized clinical trials and multi-institution collaboration to allow for evidence-based diagnosis and treatment.



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Accuracy of 3-Dimensional Virtual Surgical Simulation Combined With Digital Teeth Alignment: A Pilot Study

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11
Author(s): Jung-Hoon Kim, Young-Chel Park, Hyung-Seog Yu, Moon-Key Kim, Sang-Hoon Kang, Yoon Jeong Choi
PurposeTo evaluate the accuracy of virtual surgical simulation combined with digital teeth alignment and the applicability of this technique to the diagnosis and establishment of a 3-dimensional (3D) visualized treatment objective for orthognathic surgery by comparing virtual simulation images with actual post-treatment images.Materials and MethodsThis retrospective study included patients who underwent computed tomography (CT) before and after treatment. The 3D digital images were constructed from the initial CT images and dental cast scan data, and virtual surgical simulation combined with digital teeth alignment was performed. Accuracy of the virtual simulation was analyzed by comparing the distances of skeletal and dental landmarks in the horizontal, sagittal, and coronal reference planes with those on post-treatment images using the Wilcoxon signed rank test. Intraclass correlation coefficients were calculated to evaluate the degree of concordance between the 2 images.ResultsThe study sample included 11 patients (mean age, 18.8 yr). Most landmarks had differences smaller than 2 mm in the 3 reference planes between virtual simulation and post-treatment images; these differences were not statistically significant (P > .05). Most skeletal landmarks, except the A point, B point, and gonion, showed normal to high concordance between the virtual simulation and post-treatment images in the 3 reference planes (P < .05); dental landmarks exhibited a broad range of concordance.ConclusionThe 3D virtual surgical simulation combined with digital teeth alignment using pretreatment CT images yielded results sufficiently accurate to be used for the diagnosis and establishment of visualized treatment objectives for orthognathic surgery.



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One-Stage Supramaximal Full-Thickness Wedge Resection of Vascular Lip Anomalies

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11
Author(s): Dawn K. De Castro, Zhi Yang Ng, Paul W. Holzer, Milton Waner, Curtis L. Cetrulo, Aaron Fay
PurposeVascular lip anomalies include infantile hemangiomas, venous malformations, and arteriovenous malformations. Surgical management can be complicated by alterations in horizontal length, vertical height, and lip thickness from the underlying pathology. Additional reconstructive challenges include preservation of oral continence, vermillion definition, and the sublabial sulcus. This report describes a technique of supramaximal single-stage full-thickness wedge resection of these lesions.Materials and MethodsA retrospective study approved by the institutional review board of patients who underwent full-thickness resection of vascular lip anomalies from December 2007 through February 2013 was performed. Patient demographics, final diagnosis, preoperative treatment, examination findings (pre- and postoperative), intraoperative management, and follow-up findings were reviewed.ResultsEighteen patients (9 female) with a mean age of 25 ± 19.8 years (range, 3 to 70 yr) were identified. Underlying pathologies were arteriovenous malformation (6), port wine stain with secondary soft tissue hypertrophy (6), capillary malformation (1), venous malformation (3), and infantile hemangioma (2). Prior treatments included embolization, lasers, surgical excision, steroids, and propranolol; 8 patients were treatment naive. All patients underwent a single or double pentagonal-shaped wedge resection of the involved upper or lower lip. An average of 3.75 cm (41.7%; range, 20 to 70%) of horizontal lip length was excised. Four patients required additional concomitant debulking of the vermillion. No intraoperative complications were noted. Postoperatively, 1 patient developed wound dehiscence at 12 days and another had a midline depression with mild oral incontinence. Follow-up averaged 1,074 days (range, 371 to 1,777 days) and patients and their parents reported a high degree of satisfaction with the improvement in lip appearance and symmetry except for 1 patient who required further debulking. The sublabial sulcus and vermillion and cutaneous definition were preserved in all cases.ConclusionDespite the traditional recommendation that no more than 30% of lip length be surgically removed, vascular lip anomalies result in tissue hypertrophy, horizontal elongation, ectropion labii, and tissue expansion that allow up to 70% of the lip to be excised.



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News and Announcements

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11





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Unicystic Ameloblastoma Revisited: Comparison of Massachusetts General Hospital Outcomes With Original Robinson and Martinez Report

Publication date: November 2017
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 11
Author(s): Anne-Frédérique Chouinard, Zachary S. Peacock, William C. Faquin, Leonard B. Kaban
PurposeRobinson and Martinez established unicystic ameloblastoma (UA) as a distinct pathologic entity in 1977. Using their original description, the aims of this study were to compare the clinical presentation and outcomes of UA treated at Massachusetts General Hospital (MGH) with outcomes reported in the original article.Patients and MethodsThis was a retrospective cohort study of MGH patients treated for UA during a 15-year period. Patients were included if they had a confirmed clinical and histologic diagnosis of UA. The primary predictor variable was the source of the study sample (MGH vs Robinson and Martinez). Secondary variables included age, gender, radiographic appearance, treatment, and histologic subtype. The primary outcome variable was the number of recurrences over time comparing the 2 groups.ResultsThere were 19 patients (10 female and 9 male patients) in the MGH group and 20 patients (10 female and 10 male patients) in the Robinson and Martinez study. The lesions were predominantly unilocular (13 in MGH group and 19 in Robinson and Martinez group), located in the mandible (18 in MGH group and 20 in Robinson and Martinez group), and tooth associated (12 in MGH group and 14 in Robinson and Martinez group). No statistically significant demographic differences were noted between the 2 groups. In the MGH group, 13 cases (68%) exhibited mural or intramural ameloblastic epithelium, 4 (21%) were luminal or intraluminal, and 2 were unknown. However, histologic configuration was not reported in the Robinson and Martinez group. MGH patients were treated by enucleation (n = 7, 37%) or resection (n = 12, 63%) compared with enucleation in 100% cases in the Robinson and Martinez group. Overall, the disease-free survival rate was higher in the Robinson and Martinez group, but the difference was not statistically significant (P = .089). Within the MGH group, 100% of recurrences occurred in patients with mural invasion treated by enucleation.ConclusionsThe results of this study support UA as a distinct entity based on demographic, clinical, and radiographic criteria. Outcomes in the MGH group were influenced by the degree of ameloblastic epithelial invasion and suggest that this variable should be considered when planning treatment.



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Characteristics of Supernumerary Teeth in Non-Syndromic Population in an Urban Dental School Setting

Publication date: Available online 16 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Mackensie McBeain, Michael Miloro
PurposeThe purpose of this study is to analyze the clinical records of all patients evaluated for supernumerary teeth at the University of Illinois, Department of Oral and Maxillofacial Surgery postgraduate clinic from January 1, 2010 to October 31, 2015 in order to determine the demographics of impacted supernumerary teeth among different ethnicities within the city of Chicago, Illinois.Patients and MethodsA retrospective case series was completed on subjects eligible for inclusion in the study who had a diagnosis of at least one full bony impacted supernumerary tooth (D7240). Other variables evaluated included date of surgical intervention, age at time of treatment, gender, ethnicity, location and number of supernumerary teeth present, and family history of supernumerary teeth.ResultsThere were 459 male and 308 female patients, with a 1.5:1 male:female ratio. Patient ages ranged from 4 to 51 years (avg. 13.1) at the time of surgery. 74.7% (573) of the patients were of Hispanic descent. Supernumerary teeth were found most frequently in the maxilla (69.9%), specifically in the central incisor region (526 teeth, 51.2%). In the responding patient sample (258 patients), 53 patients (20.5%) reported a family history of supernumerary dentition. Of these 53 patients that reported a family history of supernumerary dentition, 37 (69.8%) were of Hispanic descent. The majority of these Hispanic patients (83.8%) originated from Mexico.ConclusionsThe incidence of supernumerary teeth is higher among male patients (M:F ratio of 1.5:1), and these teeth are most frequently found in the maxilla (69.9%), specifically the central incisor region (51.2%). A large percentage of patients (20.5%) also have first-degree relatives with a supernumerary dentition, and this fact may warrant further investigation into the possible genetics responsible for the formation of supernumerary teeth.



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