Pathophysiology of functional neurological disorder

Despite the prevalence of the disease, neurologists and psychiatrists can be wary of treating patients with functional neurological disorder (FND). Associate Professor David Perez (Massachusetts General Hospital, USA) discusses how FND sits between neurological and psychiatric disciplines, the relationship between poor health status and affective symptoms, and associations with grey matter volumetric profiles. Read more here: http://ift.tt/2kcIIAI

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Cardiovascular effects of Hodgkin’s lymphoma: a review of literature

Abstract

Hodgkin's lymphoma (HL) constitutes 0.6% of all the cancers diagnosed worldwide and 10% of all lymphomas. Ten-year survival rate for HL is estimated to be 80% and cardiovascular death is the prevalent cause for a non-malignant death among these HL survivors. We are reviewing the cardiovascular morbidities associated with Hodgkin's lymphoma from the available literature. We performed a systematic review of all articles published from January 1, 1960 to October 1, 2016 on the MEDLINE database using PubMed search engine. Key factors in the diagnosis and management of these conditions are discussed in individual sections.

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Most impactful factors on the health-related quality of life of a geriatric population with cancer

BACKGROUND

As the population of older adults with cancer continues to grow, the most important factors contributing to their health-related quality of life (HRQOL) remain unclear.

METHODS

A total of 1457 older adults (aged ≥65 years) with cancer participated in a telephone survey. Outcomes were measured using the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the 12-Item Short Form Survey (SF-12) from the Medical Outcomes Study (version 2). Statistical techniques used to identify factors in 4 domains (physical, psychological, social, and spiritual) most strongly associated with HRQOL included linear models, recursive partitioning, and random forests. Models were developed in a training data set (920 respondents) and performance was assessed in a validation data set (537 respondents).

RESULTS

Respondents were a median of 19 months from diagnosis, and 28.1% were receiving active treatment. The most relevant factors found to be associated with PCS were symptom severity, comorbidity scores, leisure-time physical activity, and having physical support needs. The most relevant factors for MCS were having emotional support needs, symptom severity score, and the number of financial hardship events. Results were consistent across modeling techniques. Symptoms found to be strongly associated with PCS included fatigue (adjusted proportion of summary score's variance [R²] = 0.34), pain (adjusted R² = 0.32), disturbed sleep (adjusted R² = 0.16), and drowsiness (adjusted R² = 0.16). Symptoms found to be strongly associated with MCS included fatigue (adjusted R² = 0.23), problems remembering things (adjusted R² = 0.17), disturbed sleep (adjusted R² = 0.16), and lack of appetite (adjusted R² = 0.16).

CONCLUSIONS

The findings of the current study support the importance of addressing persistent symptoms, managing comorbidities, promoting leisure-time physical activity, and addressing financial challenges. A long-term comprehensive approach is needed to ensure the well-being of older adults with cancer. Cancer 2017. © 2017 American Cancer Society.

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Injectable simvastatin gel for minimally invasive periosteal distraction: In vitro and in vivo studies in rat

Abstract

Objectives

To evaluate whether the subperiosteal injection of simvastatin (SIM) with a novel in situ gel-forming system, SrHA/Alg (strontium hydroxyapatite/alginate), can stimulate vertical bone augmentation in a rat calvarial model.

Material and methods

The SrHA/Alg solution was synthesized and combined with different doses of SIM (0.01, 0.02, 0.1, and 0.2 mg) to form the following groups: (1) SrHA/Alg only, (2) SrHA/Alg/0.01, (3) SrHA/Alg/0.02, (4) SrHA/Alg/0.1, and (5) SrHA/Alg/0.2. The SIM release pattern was analyzed, and rat primary periosteum-derived cell (PDC) responses were investigated. Twenty male Wistar rats were enrolled in the calvarial subperiosteal injection experiment with each animal receiving a 200-μl single subperiosteal injection of SrHA/Alg with different amounts of SIM (0, 0.01, 0.02, and 0.1 mg) incorporated (n = 5). The 0.2 mg dose group was not tested in vivo due to the severe toxicity found in vitro. The new bone formation was assessed histologically and radiologically at 8 weeks.

Results

The slow release of SIM was confirmed, and PDC viability decreased in the SrHA/Alg/0.2 group. Alkaline phosphatase positive areas and mineralization areas were significantly greater in the SrHA/Alg/0.01 and SrHA/Alg/0.02 groups (p < .05). The mRNA expression level of Runx2 significantly increased in the SrHA/Alg/SIM-0.02 group by day 7 (p < .05) and significantly higher levels of VEGF were found in the SrHA/Alg/0.01 and SrHA/Alg/0.02 groups at different time points (p < .05). In vivo, no prominent clinical sign of inflammation was observed, and the most significant bone gain was shown in the SrHA/Alg/0.02 group (p < .05). The osteoclast formation within the newly formed bone area was reduced in the SrHA/Alg/0.1 group (p < .05).

Conclusions

When combined with SrHA/Alg system, the 0.02 mg SIM seemed to be the optimal dose to stimulate subperiosteal bone formation without inducing inflammation. This combination may hold potential therapeutic benefits for clinical bone augmentation in a minimally invasive manner.

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Chronic Exposure to Water of Lake Qaroun Induced Metal-Related Testicular Damage and Endocrine Disruption in Male Fish

Abstract

The uncontrolled releasing of hazardous wastes into Lake Qaroun was adversely impacting the aquatic environment and its biota. Therefore, this approach was designed to investigate the impact of these discharges on the reproductive and testicular function of Oreochromis niloticus. Several biomarkers were applied on the testicular tissues as metal bioaccumulation levels, histological examination with recording the ovotestis appearance and antioxidant status after 45 days of exposure to 0, 10, 20, & 30% of Lake Qaroun water (LQW). The bioaccumulated Cu, Mn, Fe, Pb, and Cd were unequally distributed in the testes but all these metals showed a significant concentration-dependent elevation among the studied groups. The exposure to LQW significantly increased the histological alterations in the testicular tissues as vacuolar degeneration, loss of tubular organization, and degeneration of Leydig cell. Based on the frequent appearance of histopathological abnormalities and ovotestis recording, the most deformed testicular tissues were observed in the 30% LQW-exposed groups. The ovotestis severity index (OSI) was significantly raised in LQW-exposed groups compared to the control group. The activities of superoxide dismutase, catalase as well as glutathione-reduced levels were significantly (p < 0.05) decreased in testes after chronic exposure to LQW. On the other pole, the activities of glutathione peroxidase enzyme and malondialdehyde formation were sharply increased. In view of the above, the exposure to LQW induced metal-related oxidative damage to the testicular tissues and impaired the male reproductive health. This study showed strong correlations between the anthropogenic activities around Lake Qaroun and the reproductive dysfunction in fish.

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Adjunctive perampanel in partial-onset seizures: Asia-Pacific, randomized phase III study

Objectives

To evaluate the efficacy, safety, and tolerability of perampanel, a selective, non-competitive, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist, as an adjunctive treatment for patients with refractory partial-onset seizures (POS) from Asia-Pacific.

Materials & methods

This multicenter, randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov identifier: NCT01618695) involved patients aged ≥12 years with refractory POS (receiving 1-3 antiepileptic drugs). Patients were randomized (1:1:1:1) to receive once-daily placebo or perampanel 4, 8, or 12 mg over a 6-week titration and 13-week maintenance double-blind period. Enzyme-inducing antiepileptic drugs were equally stratified between groups. The primary efficacy endpoint was percent change in POS frequency per 28 days (double-blind phase vs baseline). Other efficacy endpoints included ≥50% responder rate and seizure freedom. Treatment-emergent adverse events (TEAEs) were also monitored.

Results

Of 710 randomized patients, seizure frequency data were available for 704 patients. Median percent changes in POS frequency per 28 days indicated dose-proportional reductions in seizure frequency: −10.8% with placebo and −17.3% (P = .2330), −29.0% (P = .0003), and −38.0% (P < .0001) with perampanel 4, 8, and 12 mg, respectively. In total, 108 (15.3%) patients discontinued treatment; 44 (6.2%) due to TEAEs. TEAEs occurring in ≥5% of patients, and reported at least twice as frequently with perampanel vs placebo, included dizziness and irritability.

Conclusions

Adjunctive perampanel (8 and 12 mg/d) significantly improved seizure control in patients with refractory POS. Safety and tolerability were acceptable at daily doses of perampanel 4-12 mg.

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Lefaivre, C.: Traumatic Brain Injury Rehabilitation: The Lefaivre Rainbow Effect

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An Update of a Prospective Study of SBRT for Post-chemoradiation Residual Disease in Stage II/III Non-small Cell Lung Cancer. In Reply to Dr. P. Hurmuz

Publication date: Available online 16 December 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Sameera S. Kumar, Ronald C. McGarry




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Rapid and comprehensive discovery of unreported shellfish allergens using large-scale transcriptomic and proteomic resources

Publication date: Available online 16 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Roni Nugraha, Sandip D. Kamath, Elecia Johnston, Kyall R. Zenger, Jennifer M. Rolland, Robyn E. O'Hehir, Andreas L. Lopata




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Balloon Angioplasty Versus Stenting for the Treatment of Failing Arteriovenous Grafts: A Meta-Analysis

Publication date: Available online 16 December 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): George N. Kouvelos, Konstantinos Spanos, George A. Antoniou, Ioannis Vassilopoulos, Christos Karathanos, Miltiadis I. Matsagkas, Athanasios D. Giannoukas
PurposeTo assess the outcomes of plain balloon angioplasty versus stenting for the treatment of failed or malfunctioning chronic haemodialysis arteriovenous grafts (AVGs).MethodsA systematic search of the literature was undertaken using the PUBMED, EMBASE, and Cochrane databases from January 2000 to September 2016 for articles comparing balloon angioplasty versus stenting in the management of failed or malfunctioning chronic haemodialysis AVGs. Results are reported as OR and 95% CI.ResultsThe search identified eight studies (1051 patients). Balloon angioplasty alone was used in 521 patients (49.6%) and stenting in 530 patients (50.4%). At the time of the endovascular re-intervention, the mean life of AVGs was 807.7±115.4 days for the balloon angioplasty and 714.2±96.3 days for the stenting group (p=.92). All AVGs were located in the arm. Most procedures (98.1%) were performed across the venous anastomosis, while 88% of the patients in the stenting group received a stent graft. The technical success rate was significantly higher in the stenting group (OR 0.16, 95% CI 0.08–0.31, p<.001). At 12 months, loss of primary and secondary patency was significantly higher in patients undergoing plain balloon angioplasty compared with stenting (OR 3.54, 95% CI 2.18–5.74, p<.001, and OR 1.82, 95% 1.17–2.82, p=.008, respectively).ConclusionStenting is associated with better technical success and patency rates compared with plain angioplasty in treating failed or malfunctioning chronic haemodialysis AVGs, and thus it should be considered as the first line therapeutic option.



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Re: Dental Care for the Working Poor—We Need Answers

Publication date: Available online 16 December 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Lou Belinfante




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Drosophila active zones: from molecules to behaviour

Publication date: Available online 16 December 2017
Source:Neuroscience Research
Author(s): Nadine Ehmann, David Owald, Robert J. Kittel
In a constantly changing environment, neuronal circuits need to be updated and adjusted to elicit directed actions. Synaptic plasticity plays an important role in modulating such globally and locally acting networks. The active zone (AZ) is a protein-rich compartment of chemical synapses, where precisely orchestrated molecular interactions control synaptic vesicle (SV) fusion with the presynaptic membrane. The subsequent release of neurotransmitter substances onto postsynaptic receptor fields forms the basis of neuronal communication. Structural, functional and molecular features of AZs can differ significantly between systems, within one and the same neuron and at an individual site over time. Moreover, the properties of an AZ can be altered by changes in cellular activity. While it is recognized that such AZ plasticity modulates synaptic communication, our mechanistic understanding of its impact on neural network function and animal behaviour is far from complete. Research on Drosophila melanogaster has created an advantageous situation for investigating molecular mechanisms of AZ physiology in a behavioural context. The sophisticated genetic tools and excellent experimental accessibility of the fruit fly can now be combined with detailed anatomical information on the nervous system and quantifiable readouts of various behaviours at high resolution. Here, we review molecular studies of AZ structure and function at the neuromuscular junction (NMJ) and consider how mechanisms identified in the periphery may relate to the operation of central AZs. Our discussion emphasizes that the location of AZs in central networks defines sites of plasticity which shape animal behaviour.



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Loss of inhibition in ipsilateral somatosensory areas following altered afferent nerve signaling from the hand

Publication date: Available online 16 December 2017
Source:Neuroscience Research
Author(s): Anders Björkman, Andreas Weibull
Cutaneous stimulation of the hand results in increased neural activity in the contralateral primary somatosensory cortex (S1) in humans, whereas an inhibition of neurons is seen in the ipsilateral S1.The aim of this study was to assess changes in neural activity in the S1 bilaterally, with a focus on the ipsilateral hemisphere, following altered afferent nerve signaling from the hand. Three cohorts, all with altered afferent nerve signaling from the hand, participated in the study. There were: 18 patients with traumatic median nerve injury, 10 patients with vibration induced neuropathy and 11 healthy subjects who had their dominant hand and wrist immobilized for 72 hours. In addition, 36 healthy subjects were included as controls. Each subject was examined using functional magnetic resonance imaging at 3 Tesla. All three study cohorts showed enlarged activation in the contralateral S1 during tactile stimulation compared to healthy controls. Moreover, inhibition of the ipsilateral S1 was significantly decreased or completely lost. Thus, somatosensory areas of both hemispheres respond to changed afferent nerve signaling from the hand. The loss of inhibition of neurons in the ipsilateral S1 suggests an important role of the ipsilateral hemisphere in the cerebral adaptation following a change in afferent nerve signaling.



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In reference to “Central nervous system anomalies in craniofacial microsomia: a systematic review”

Publication date: Available online 2 December 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): D. Brotto, A. Martini, R. Manara




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Unilateral sagittal split ramus osteotomy: an alternative for some cases of asymmetric mandibular prognathism

Publication date: Available online 6 December 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): R. Fariña, C. Mebus, C. Mayer, R. Torrealba, E. Moreno
The objective of this study was to propose a treatment protocol for patients with lateral prognathism based on the unilateral sagittal split ramus osteotomy (USSRO). This was a prospective study involving 31 patients with lateral prognathism, who required a bilateral sagittal split ramus osteotomy (BSSRO). Two groups were formed using the proposed protocol, with specific inclusion criteria for each group: BSSRO (n=17) and USSRO (n=14). Occlusal parameters (dental midline deviation, overbite, and overjet) were measured preoperatively (T0), at model surgery (T1), 1 month postoperative (T2), and 1year after surgery (T3) and compared. P-values of <0.05 were considered significant. No significant difference was found between the USSRO and BSSRO groups for all occlusal parameters (T0, T1, T2, and T3). In both groups, there was a significant difference between T0 and T1 and no significant difference between T1 and T2 or T1 and T3 in all of the occlusal parameters; the exception was overbite between T1 and T2 in the BSSRO group, which showed a significant difference. No patient in either group showed signs or symptoms of temporomandibular joint dysfunction at T0 or T3. USSRO was found to be a stable alternative in patients with asymmetric mandibular prognathism. At the same time, it reduced the operating time and morbidity when compared to BSSRO.



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Editorial Board/Reviewing Committee

Publication date: January 2018
Source:International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 1





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Hyalinizing clear cell carcinoma of salivary gland origin in the head and neck: clinical and histopathological analysis

Publication date: Available online 6 December 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): X.-H. Yang, L. Liu, Y.-Y. Shi, Y.-J. Hu, Q.-G. Hu, P. Zhang
Hyalinizing clear cell carcinoma (HCCC) is an extremely rare neoplasm of salivary gland origin with a low-grade indolent nature. It is difficult to distinguish from other malignant salivary gland tumours. Clinical outcomes following surgery are generally reported as good. The aim of this study was to further determine the features of HCCC. This study was approved by Medical ethics review of affiliated hospital of jiangsu university. Fourteen new cases of HCCC are reported. The clinical and histopathological data of these 14 cases were analysed alongside those of 141 cases identified in a systematic review of the literature (up to 2016). Demographic data, histopathological findings, clinical presentation, primary treatment, and outcomes were extracted. Histologically, HCCC tumour cells had a clear cell morphology with hyalinized stroma. Immunohistochemical results were positive for cytokeratins and EMA, but negative for SMA, S100, vimentin, and calponin. Twelve of the 14 patients showed EWSR1 translocation. Local nodal metastasis on presentation was present in 17.3% and the overall recurrence rate was 17.7% in the total population (N=155), compared with 35.7% and 21.4%, respectively, in the new cases alone. Focal necrosis and local metastasis were identified as possibly associated with recurrence. The overall prognosis was good: only 3.8% of patients died of the disease. HCCC is less indolent than was previously thought, but overall the prognosis is good. Risk factors for recurrence may include focal necrosis and local metastasis at presentation. The best treatment for patients with HCCC is wide local excision combined with regional lymph node dissection.



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Soft palate functional reconstruction with buccinator myomucosal island flaps

Publication date: Available online 8 December 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): O. Massarelli, L.A. Vaira, R. Gobbi, A. Biglio, G. Dell'aversana Orabona, G. De Riu
Oropharyngeal reconstruction after ablative surgery is a challenge. The results of a retrospective study of 17 patients who underwent total or sub-total soft palate reconstruction with a buccinator myomucosal island flap, between 2008 and 2016, are reported herein. An analysis of flap type and size, harvesting time, and postoperative complications was performed. Patients underwent standardized tests to assess the recovery of sensitivity, deglutition, quality of life (QoL), and donor site morbidity, at >6 months after surgery or the end of adjuvant therapy, if performed. All flaps were transposed successfully. Only minor donor and recipient site complications occurred. The sensitivity assessment showed that touch, two-point discrimination, and pain sensations were recovered in all patients. Significant differences between the flap and native mucosa were reported for tactile (P=0.004), pain (P=0.001), and two-point discrimination (P=0.001) thresholds. The average deglutition score reported was 6.1/7, with only minimal complaints regarding deglutition. The QoL assessment showed high physical (24.6/28), social (25/28), emotional (19.1/24), and functional (24.6/28) scores. No major donor site complications were noted in any patient; the average donor site morbidity score was 8.1/9. Buccinator myomucosal island flaps represent a valuable functional oropharyngeal option for reconstruction, requiring a short operating time and presenting a low donor site morbidity rate.



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Botulinum toxin A for patients with orofacial dystonia: prospective, observational, single-centre study

Publication date: Available online 6 December 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): G. Ruiz-de-León-Hernández, R.-M. Díaz-Sánchez, D. Torres-Lagares, E. Hernández-Pacheco, M. González-Martín, M.-A. Serrera-Figallo
The objective of this study was to demonstrate the efficacy of intramuscular botulinum toxin type A (BTX-A) as a method of controlling the symptoms of focal facial dystonia. A prospective, longitudinal, observational, pre–post (case-series) single-centre study was conducted over a period of 3 months, involving 30 patients with focal dystonia. The patients were enrolled on a first-come, first-served basis. For all patients, the abnormal movements were evaluated using the Abnormal Involuntary Movement Scale (AIMS). The AIMS results were recorded immediately before BTX-A injection (primary predictor variable) and after 3 months (the toxin reaches its maximum effect 2 weeks after injection, and the effect is maintained for 3 months). An improvement in AIMS score was the primary outcome variable. Treatment efficacy was evaluated using the Pearson correlation index with a level of significance of P<0.05. The average age of the study subjects was 70.9±12.7years (20 female, 10 male). The mean dose of BTX-A used was 27.4±20.5U. The mean improvement in AIMS score after treatment was 5.2±4.2. A significant correlation was found between the dose applied and the reduction in AIMS score (P<0.05). BTX-A can be used in the treatment of focal dystonia and provides reproducible results.



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Anaesthetic efficacy of 4% articaine compared with 2% mepivacaine: a randomized, double-blind, crossover clinical trial

Publication date: Available online 2 December 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M.C. Bortoluzzi, P. de Camargo Smolarek, R. Cecato, M.T. Pochapski, A.C.R. Chibinski
The aim of this study was to evaluate the clinical efficacy of 4% articaine (Ar4) compared to 2% mepivacaine (Me2), both in combination with 1:100,000 epinephrine, in a unique soft tissue model. This was a randomized, double-blind, crossover clinical trial. The anaesthetic was applied to the lower lip using a computerized local delivery system. The following were evaluated: blood flow, thermal sensation, pressure and proprioception, extent of anaesthesia, gradual elimination, and the final duration of the effect of the anaesthesia. Seventy-two volunteers completed all parts of the study. Significant differences, which indicated better effectiveness of Me2 compared to Ar4, were observed in the following tests: reduction in blood flow (larger in the Me2 group); anaesthetized area at 30min (larger in the Me2 group); pressure tests; temperature tests after 20min; fine and discriminatory proprioception tests after 20min. The volunteers' perception of anaesthesia at 30, 40, 50, and 60min was superior for Me2 at all recorded time points. The duration of anaesthesia was also superior for Me2. The overall performance of Me2 was superior to Ar4, implying that Me2 provides a more effective anaesthesia in terms of depth, extent, and duration.



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Editorial Board/Reviewing Committee

Publication date: December 2017
Source:International Journal of Oral and Maxillofacial Surgery, Volume 46, Issue 12





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Comprehensive analysis of soft tissue changes in response to orthognathic surgery: mandibular versus bimaxillary advancement

Publication date: Available online 15 December 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): A. Almukhtar, B. Khambay, X. Ju, A. Ayoub
This study was performed to compare soft tissue changes in response to mandibular and bimaxillary advancement osteotomy. Preoperative and postoperative cone beam computed tomography scans of 24 cases were analysed: 12 underwent bimaxillary advancement and 12 underwent mandibular advancement. The skeletal surgical movements were measured and soft tissue changes were displayed on a three-dimensional colour map. The intensity and shade of the colour indicated the magnitude and direction of the changes. In the bimaxillary advancement group, maxillary advancement was 5.5±2.7mm with anterior vertical impaction of 2.7±2.5mm; mandibular advancement was 4.6±3.2mm. Most of the mediolateral soft tissue changes were limited to the anatomical boundaries of the paranasal region – the columella together with the alar bases of the nose; these showed clear forward movement, which extended to involve most of the cheeks. In the mandibular surgery group, the mean advancement was 3.5±2.6mm. The chin region, lower lip, and inferior parts of the cheek showed forward shift with minimal changes at the vermilion border, which was only displaced in an upward direction. In conclusion, dense anatomical correspondence is a clinically meaningful method of producing a visual comprehensive analysis of the changes in response to orthognathic surgery.



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Comparative study of volumetric changes and trabecular microarchitecture in human maxillary sinus bone augmentation with bioactive glass and autogenous bone graft: a prospective and randomized assessment

Publication date: Available online 13 December 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): R.S. Pereira, J.D. Menezes, J.P. Bonardi, G.L. Griza, R. Okamoto, E. Hochuli-Vieira
The aim of this study was to compare the volumetric changes and the new bone microarchitecture in human maxillary sinuses augmented with bioactive glass (Biogran) alone, bioactive glass combined with autogenous bone graft (1:1), or autogenous bone graft alone. Twelve maxillary sinuses were grafted with bioactive glass (group 1), nine with bioactive glass mixed with autogenous bone graft 1:1 (group 2), and 12 with autogenous bone graft (group 3). Patients underwent cone beam computed tomography 15days after the procedure to determine the initial volume of the graft (T1) and again 6 months later (T2). Biopsies were obtained at the time of dental implant placement and were subjected to micro-computed tomography. The volumetric change was 44.2% in group 1, 37.9% in group 2, and 45.7% in group 3 (P>0.05). The trabecular microarchitecture results showed that the materials used in groups 1 and 2 were good bone substitutes. However, the addition of 50% bioactive glass to autogenous bone graft improved the microarchitecture of the graft. Furthermore, the results for volumetric changes indicated that bioactive glass, its association with autogenous bone graft in a 1:1 ratio, and autogenous bone graft alone have similar resorption.



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Sequencing of bimaxillary surgery in the correction of vertical maxillary excess: retrospective study

Publication date: Available online 12 December 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): F.S. Salmen, T.F.M. de Oliveira, M.A.C. Gabrielli, V.A. Pereira Filho, M.F. Real Gabrielli
The aim of this study was to evaluate the precision of bimaxillary surgery performed to correct vertical maxillary excess, when the procedure is sequenced with mandibular surgery first or maxillary surgery first. Thirty-two patients, divided into two groups, were included in this retrospective study. Group 1 comprised patients who received bimaxillary surgery following the classical sequence with repositioning of the maxilla first. Patients in group 2 received bimaxillary surgery, but the mandible was operated on first. The precision of the maxillomandibular repositioning was determined by comparison of the digital prediction and postoperative tracings superimposed on the cranial base. The data were tabulated and analyzed statistically. In this sample, both surgical sequences provided adequate clinical accuracy. The classical sequence, repositioning the maxilla first, resulted in greater accuracy for A-point and the upper incisor edge vertical position. Repositioning the mandible first allowed greater precision in the vertical position of pogonion. In conclusion, although both surgical sequences may be used, repositioning the mandible first will result in greater imprecision in relation to the predictive tracing than repositioning the maxilla first. The classical sequence resulted in greater accuracy in the vertical position of the maxilla, which is key for aesthetics.



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Influence of involuntary cigarette smoke inhalation on osseointegration: a systematic review and meta-analysis of preclinical studies

Publication date: Available online 9 December 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): F. Javed, S.V. Kellesarian, T. Abduljabbar, A.T. Abduljabbar, Z. Akram, F. Vohra, I. Rahman, G.E. Romanos
There are no studies that have systematically reviewed the influence of involuntary cigarette smoke inhalation (ICSI) on the stability of implants. The aim of the present study was to perform a systematic review and meta-analysis of preclinical studies that assessed the influence of involuntary cigarette smoke inhalation ICSI on osseointegration. Indexed databases (PubMed, Google-Scholar, Scopus, EMBASE, and Web of Knowledge) were searched till September 2017. Titles and abstracts of studies identified using the above-described protocol were independently screened by 2 authors. Full-texts of studies judged by title and abstract to be relevant were independently evaluated for the stated eligibility criteria. Nine studies were included. Six studies showed that ICSI compromised bone area contact around implants. In 4 studies, peri-implant bone mineral density was significantly higher in the control group than among subjects exposed to ICSI. For the effects of ICSI on the osseointegration of dental implants, significant differences could be observed for bone-to-implant contact for test subjects in cancellous (Z=−4.08, p<0.001) and cortical bone (Z=−4.31, p<0.001) respectively. ICSI may negatively influence osseointegration of dental implants. It is imperative to educate patients about the negative effects of passive smoking on dental and systemic health.



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Reasons for Distress Among Burn Survivors at 6, 12 and 24 Months Post-Discharge: A Burn Injury Model System Investigation

Publication date: Available online 16 December 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): S.A. Wiechman, K. McMullen, G.J. Carrougher, J.A. Fauerbach, C. Ryan, D.N. Herndon, R. Holavanahalli, N.S. Gibran, K. Roaten
ObjectiveTo identify important sources of distress among burn survivors at discharge and at 6, 12 and 24 months post injury, and to examine if the distress related to these sources changed over time. Design: Exploratory. Setting: Outpatient burn clinics in 4 sites across the country. Participants: A total of 1009 participants who met pre-stablished criteria for having a major burn injury were enrolled in this multisite study. Interventions: Participants were given a previously developed list of 12 sources of distress among burn survivors, and asked to rate on a 10-point, Likert-type scale (0 = no distress to 10 = high distress) how much distress each of the 12 issues was causing them at the time of each follow-up. Main Outcomes: The SF-12® Health Survey was administered at each time point as a measure of health-related quality of life. The Satisfaction With Appearance Scale (SWAP) was used to understand the relationship between sources of distress and body image. Finally, whether a person returned to work was used to determine the impact of sources of distress on returning to employment. Results: It was encouraging that no symptoms were worsening at 2 years. However, financial concerns and long recovery time are two of the highest means at all time points. Pain and sleep disturbance had the biggest impact on ability to return to work. Conclusions: . These findings can be used to inform burn-specific interventions and to give survivors an understanding of the temporal trajectory for various causes of distress. In particular, it appears that interventions targeted at sleep disturbance and high pain levels can potentially impact distress over financial concerns by allowing a person to return to work more quickly.



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Residual stress of porcelain-fused to zirconia 3-unit fixed dental prostheses measured by nanoindentation

Publication date: Available online 16 December 2017
Source:Dental Materials
Author(s): Vinicius P. Fardin, Estevam A. Bonfante, Paulo G. Coelho, Malvin N. Janal, Nick Tovar, Lukasz Witek, Dimorvan Bordin, Gerson Bonfante
ObjectiveTo evaluate the residual stress (nanoindentation based on hardness) of fatigued porcelain-fused to zirconia 3-unit fixed dental prostheses (FDP) with different framework designs.MethodsTwenty maxillary 3-unit FDP replacing second-premolar (pontic) were fabricated with conventional framework-design (even-thickness of 0.5mm and 9mm² connector area) and modified framework-design (thickness of 0.5mm presenting lingual collar connected to proximal struts and 12mm² connector area). Connector marginal ridges were loaded and the fractured and suspended FDPs were divided (n=3/each) into: (1) Fractured zirconia even-thickness (ZrEvenF); (2) Suspended zirconia even-thickness (ZrEvenS); (3) Fractured zirconia with modified framework (ZrModF); (4) Suspended zirconia with modified framework (ZrModS); (5) Non-fatigued FDP with conventional framework design (Control). The FDPs were nanoindented at 0.03mm (Region of Interest (ROI) 1), 0.35mm (ROI 2) and 1.05mm (ROI 3) distances from porcelain veneer outer surface with peak load 4000μN. The Linear Mixed Analysis of Variance (ANOVA) Model on ranks and Least Significant Difference Test on ranks (95%) were used.ResultsHighest rank hardness values were found for Control group and ZrModS, whereas the lowest values were found in ZrModF. Statistical differences (p=0.000) were found among all groups except for comparison between ZrModS and Control group (p=0.371). Hardness between ROIs were statistically significant different (p<0.001) where ROI 1 presented the lowest values.SignificanceFramework-design modification did not influence the residual stress of porcelain-fused to zirconia fatigued 3-unit FDP. Whereas fractured FDPs showed the highest residual stress compared to suspended and control FDPs. Residual stress increased as nanoindented away from framework.



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Liposomal Bupivacaine in Implant-Based Breast Reconstruction

Purpose: This study evaluates the role of liposomal bupivacaine in implant-based breast reconstruction. Methods: A prospective, randomized, single-blind trial of liposomal bupivacaine in implant-based breast reconstruction was performed. Patients in the control arm were treated with 20 mL 0.25% bupivacaine with epinephrine 1:200,000 to each breast pocket. Patients in the experimental arm were treated with 10 mL 1.3% liposomal bupivacaine delivered to each breast pocket. Pain scores were recorded over the course of patients' hospital stay. Consumption of pain medications, benzodiazepines, and anti-emetics was monitored. Length of stay and other direct cost data were collected. Results: Twenty-four patients were enrolled, with 12 women randomized to each arm. Average postoperative pain scores were 3.66 for patients in the control arm and 3.68 for patients in the experimental arm. Opioid consumption was 1.43 morphine equivalent dosing/h for patients in the control arm and 0.76 morphine equivalent dosing/h for patients in the experimental arm (P = 0.017). Diazepam consumption was 0.348 mg/h for patients in the control arm and 0.176 mg/h for patients in the experimental arm (P = 0.011). Average length of hospital stay was 46.7 hours for patients in the control arm and 29.8 hours for patients in the experimental arm (P = 0.035). Average hospital charges were $18,632 for patients in the control arm and $10,828 for patients in the experimental arm (P = 0.039). Conclusions: Liposomal bupivacaine reduces opioid and benzodiazepine consumption, length of stay, and hospital charges. These data support a role for liposomal bupivacaine in implant-based breast reconstruction.

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