Relationship between chronic rhinosinusitis exacerbation frequency and asthma control

Objectives/Hypothesis

To determine the association between the frequency of acute chronic rhinosinusitis (CRS) exacerbations (AECRS) and the degree of asthma control in asthmatic CRS patients.

Study Design

Cross-sectional study.

Methods

We prospectively recruited 108 asthmatic CRS patients as participants. Asthma control was assessed using the Asthma Control Test (ACT). The frequency of AECRS was assessed using three previously described indirect metrics for AECRS: the frequency of patient-reported sinus infections, CRS-related antibiotics use, and CRS-related oral corticosteroids use in the last 3 months. CRS symptom severity was measured using the 22-item Sinonasal Outcome Test (SNOT-22). Associations between ACT score and metrics for AECRS were performed using linear regression while controlling for clinical and demographic characteristics, including SNOT-22 score.

Results

ACT score was significantly and negatively associated with the frequency of patient-reported sinus infections (adjusted linear regression coefficient [β] = −1.2, 95% confidence interval [CI]: −2.3 to −0.1, P = .033), CRS-related antibiotics courses (adjusted β = −1.4, 95% CI: −2.3 to −0.5, P = .004), and CRS-related oral corticosteroid courses (adjusted β = −1.5, 95% CI: −2.5 to −0.5, P = .004) in the last 3 months, independent of characteristics including SNOT-22 score. Poor asthma control could be detected using one or more sinus infections (70.6% sensitivity, 47.3% specificity), CRS-related antibiotics (50.0% sensitivity, 73.0% specificity), or CRS-related oral corticosteroids (58.8% sensitivity, 71.6% specificity) in the last 3 months.

Conclusions

AECRS are negatively associated with the level of asthma control in asthmatic CRS patients, independent of CRS symptom severity. These results highlight AECRS as a distinct clinical manifestation of CRS that should be routinely assessed in CRS patients.

Level of Evidence

2c. Laryngoscope, 2017

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Patient Adherence to Dysphagia Recommendations: A Systematic Review

Abstract

Patient adherence to treatment recommendations is an important issue for healthcare providers, in a multitude of specialties, and is critical when assessing the efficacy and effectiveness of a particular treatment approach. Patients who have swallowing impairment often require complex and specific interventions requiring altered daily patterns of behavior. Patients with dysphagia who do not follow recommendations or prescribed exercises may not receive maximum benefit of an intervention. Poor adherence also makes it more difficult to evaluate efficacy of a treatment both clinically and in experimental settings. Further, swallow safety can be compromised if certain recommendations are not followed. Our purpose was to systematically review the literature to understand what is known about adherence within the field of dysphagia treatment. We systematically identified 12 studies that tracked and reported patient-specific adherence. In this review, we found that the average adherence rate from these studies ranges between 21.9 and 51.9%. Adherence to prophylactic treatment recommendations for patients with head and neck cancer was the focus in 9/12 studies. The findings of this review identify a large gap in knowledge regarding adherence to dysphagia treatment. Few studies account for adherence within their study designs. When planning dysphagia treatment studies, it is imperative that investigators include information regarding patient adherence to accurately interpret findings. Given the variable adherence rates found in this review, factors influencing patient adherence with dysphagia treatments should be identified to increase adherence in future trials.

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Feasibility of a Mobile Application to Enhance Swallowing Therapy for Patients Undergoing Radiation-Based Treatment for Head and Neck Cancer

Abstract

Dysphagia following treatment for head and neck cancer is one of the most significant morbidities impacting quality of life. Despite the value of prophylactic exercises to mitigate the impact of radiation on long-term swallowing function, adherence to treatment is limited. The purpose of this investigation was to explore the feasibility of a mobile health application to support patient adherence to swallowing therapy during radiation-based treatment. 36 patients undergoing radiation therapy were provided with the Vibrent™ mobile application as an adjunct to standard swallowing therapy. The application included exercise videos, written instructions, reminders, exercise logging, and educational content. 80% of participants used the app during treatment and logged an average of 102 exercise sessions over the course of treatment. 25% of participants logged at least two exercise sessions per day over the 7-week treatment period, and 53% recorded at least one session per day. Exit interviews regarding the patient experience with the Vibrent™ mobile application were largely positive, but also provided actionable strategies to improve future versions of the application. The Vibrent™ mobile application appears to be a tool that can be feasibly integrated into existing patient care practices and may assist patients in adhering to treatment recommendations and facilitate communication between patients and providers between encounters.

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A 5-year prospective study on regenerative periodontal therapy of infrabony defects using minimally invasive surgery and a collagen-enriched bovine-derived xenograft

Abstract

Aim

The primary objective of this study was (1) to evaluate the 5-year clinical outcome of regenerative periodontal therapy (RPT) using minimally invasive surgery and a collagen-enriched bovine-derived xenograft and (2) to identify predictors for clinical attachment level (CAL) gain and vertical radiographic bone (RB) gain.

Materials and methods

Ninety-five non-smoking patients with ≤ 25% full-mouth plaque and bleeding presenting ≥ 6 months after initial periodontal therapy with ≥ 1 isolated interdental infrabony defect were recruited. Minimally invasive surgery (MIST or M-MIST) and a collagen-enriched bovine-derived xenograft were used in all patients. Patients were surgically treated by the same clinician and evaluated up to 5 years of follow-up. Multivariate analyses were used to identify predictors for CAL gain and RB gain.

Results

Before surgery, mean probing depth (PD) was 7.8 mm, CAL was 10.0 mm, and defect depth amounted to 5.2 mm. Seventy-one patients (33 men, 38 women, mean age 52) could be evaluated at 5 years. Mean PD reduction was 3.3 mm (SD 2.2), CAL gain was 3.0 mm (SD 2.1), and RB gain was 57% (SD 38). Forty-five percent showed ≥ 4 mm CAL gain, whereas 24% were considered failures (≤ 1 mm CAL gain). Forty-eight percent showed considerable RB gain (≥ 75%). Regression analyses showed that plaque was a significant predictor for CAL gain (p = 0.001) and RB gain (p = 0.005). Patients' compliance had a significant impact on RB gain (p < 0.001).

Conclusion

Only patients with perfect oral hygiene and excellent compliance should be considered for RPT. Especially, the latter can only be assessed after sufficient follow-up following initial periodontal therapy.

Clinical relevance

RPT failed in 24% of the patients after 5 years. Regression analyses demonstrated a significant impact of plaque and patients' compliance on the long-term outcome. Only patients with perfect oral hygiene and excellent compliance should be considered for RPT. Patients should not be treated too soon following initial therapy, since compliance can only be reliably assessed after sufficient follow-up.

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Epidemiology of REM sleep behavior disorder: both study design and measurement tool count

Publication date: Available online 29 September 2017
Source:Sleep Medicine
Author(s): Jihui Zhang, Shirley Xin Li, Siu Ping Lam, Yun-Kwok Wing




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Overt Skeletal Metastases in a Patient of Occult (Microscopic) Follicular Thyroid Carcinoma: a Rare Case

Abstract

Occult follicular thyroid carcinoma (FTC) presenting as distant metastases is a rare occurrence. However, despite being occult in majority of these cases, primary tumor can be detected on thyroid imaging or during surgery. Here, we present an extremely rare case of an occult FTC with overt skeletal metastases in which primary tumor was discernible only on microscopic examination.

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The 2017 complete overhaul of adjuvant therapies for high-risk melanoma and its consequences for staging and management of melanoma patients

Publication date: November 2017
Source:European Journal of Cancer, Volume 86
Author(s): Alexander M.M. Eggermont, Reinhard Dummer
The spectacular outcomes of the phase III trials regarding nivolumab versus ipilimumab in fully resected stage IIIB/C–IV and of the combination of dabrafenib (D) plus trametinib (T) in BRAF-mutant stage III patients demonstrate that effective treatments in advanced melanoma are also highly effective in the adjuvant setting. In 2016, an overall survival benefit with adjuvant high-dose ipilimumab was demonstrated, and the European Organisation for Research and Treatment of Cancer trial 1325 comparing pembrolizumab versus placebo will complete the picture in the early 2018. Toxicity profiles are in line with the experience in advanced melanoma, i.e. favourable for the anti-PD1 agents and for D + T and problematic for ipilimumab. The 2017 outcomes are practice changing and put an end to the use of interferon (IFN) and ipilimumab. In countries with only access to IFN, its use can be restricted to patients with ulcerated melanoma, based on the individual patient data meta-analysis recently published. Because of the results of the Melanoma Sentinel Lymph node Trial-2 (MSLT-2) trial, completion lymph node dissection (CLND) will decrease sharply, leading to a lack of optimal prognostic information. Prognosis in sentinel node–positive stage IIIA/B patients is extremely heterogeneous with 5-year survival rates varying from 90% to 40% and depends mostly on the number of positive nodes identified by CLND. This information is crucial for clinical decision-making. How to guarantee optimal staging information needs to be discussed urgently. Further improvements of adjuvant therapies will have to address all these questions as well as the exploration of neoadjuvant use of active drugs and combination approaches. Important paradigm shifts in the management of high-risk melanoma patients are upon us.



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Multidisciplinary quality assurance and control in oncological trials: Perspectives from European Organisation for Research and Treatment of Cancer (EORTC)

Publication date: November 2017
Source:European Journal of Cancer, Volume 86
Author(s): Members of EORTC QACDenisLacombeCorneelCoensChristinede BalincourtLisaLicitraMarcelden DulkJean-PascalMachielsDamienWeberMartinSpahnRobertoSalgadoBerndKasperPeterHau.Working Groups of Scientific ExpertsFayBetsouKozoKataokaCarmelaCaballeroYanLiuCoenHurkmansSergeEvrard
Quality assurance (QA) programmes are one of the mainstays of clinical research and constitute the pillars on which European Organisation for Research Treatment of Cancer (EORTC) delivers multidisciplinary therapeutic progress. Changing practice treatments require solid evidence-based data, which can only be achieved if integral QA is part of the infrastructure sustaining research projects. Cancer treatment is a multimodality approach, which is often applied either in sequence and/or in combination. Each modality plays a key role in cancer control. The modalities by which QA is applied varies substantially within and across the disciplines. In addition, translational and diagnostic disciplines take an increasing role in the era of precision medicine. Building on the structuring effect of clinical research with fully integrated multidisciplinary QA programmes associated with the solutions addressing the chain of custody for biological material and data integrity as well as compliance ensure at the same time validity of clinical research output but also have a training effect on health care providers, who are more likely to apply such principles as routine. The principles of QA are therefore critical to be embedded in multidisciplinary infrastructure to guarantee therapeutic progress. These principles also provide the basis for the functioning of multidisciplinary tumour board. However, technical, operational and economic challenges which go with the implementation of such programmes require optimal know-how and the coordination of the multiple expertise and such efforts are best achieved through centralised infrastructure.



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Recovery of 3-Iodothyronamine and Derivatives in Biological Matrixes: Problems and Pitfalls

Thyroid Oct 2017, Vol. 27, No. 10: 1323-1331.


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Do Lower-Risk Thyroid Cancer Patients Who Live in Regions with More Aggressive Treatments Have Better Outcomes?

Thyroid Oct 2017, Vol. 27, No. 10: 1246-1257.


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Future Meetings

Thyroid Oct 2017, Vol. 27, No. 10: 1339-1339.


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87th Annual Meeting of the American Thyroid Association October 18–22, 2017, Victoria, British Columbia, Canada

Thyroid Oct 2017, Vol. 27, No. 10: 1213-1214.


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Thyroid Hormone Receptor Alpha is Essential to Maintain the Satellite Cell Niche During Skeletal Muscle Injury and Sarcopenia of Aging

Thyroid Oct 2017, Vol. 27, No. 10: 1316-1322.


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Referral Trends for Surgical Management of Graves' Disease

Thyroid Oct 2017, Vol. 27, No. 10: 1337-1338.


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Editorial Board/Reviewing Committee

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Closing gaps in brain disease—from overlapping genetic architecture to common motifs of synapse dysfunction

Publication date: February 2018
Source:Current Opinion in Neurobiology, Volume 48
Author(s): Jochen Roeper
Recent progress in the synaptic pathophysiology of brain diseases is reviewed. To emphasize the emergence of common motifs in synapse dysfunctions across neurodevelopmental, psychiatric and neurological disorders, conventional clinical boundaries are disregarded and a decidedly trans-diagnostic, potentially unifying view of altered synapse function is promoted. Based on the overlapping genetic architecture of brain disorders, which often converges on genes related to synaptic functions, disease-related changes in basic pre-synaptic and post-synaptic communication, neuromodulation-gated changes in Hebbian plasticity, dynamic interactions between Hebbian and homeostatic plasticity, and changes in synaptic maintenance by autophagy and glial-mediated phagocytosis are highlighted.



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Editorial overview: Computational neuroscience

Publication date: Available online 29 September 2017
Source:Current Opinion in Neurobiology
Author(s): Christian Machens, Adrienne Fairhall




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Can We Predict Who Will Develop Hypertension After Carotid Endarterectomy?

Publication date: Available online 29 September 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): José M. Ferro




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Save the Date! Lone Star Rhinology and Rhinoplasty Course Scheduled for November

The Department of Otorhinolaryngology-Head & Neck Surgery at UTHealth's McGovern Medical School is proud to sponsor 2017 Lone Star Rhinology... Read the full article...

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Dr. Amber Luong Receives 2017 Helen F. Krause, MD Memorial Trailblazer Award

Amber Luong, MD, PhD, associate professor of otorhinolaryngology, has been recognized with the 2017 Helen F. Krause, MD Memorial Trailblazer... Read the full article...

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ORL Frontiers 2017 Recap

More than 70 physicians and other healthcare professionals attended ORL Frontiers 2017, held last June at the Brown Foundation Institute... Read the full article...

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Factors influencing age of onset of wheezing among children with recurrent wheezing and the association of Vitamin D status with atopic manifestations

Bijay Kumar Meher, Deepti Damayanty Pradhan, S Pradeep, Leena Das, Siba Shankar Beriha, Sumanta Panigrahi

Indian Journal of Allergy, Asthma and Immunology 2017 31(2):76-82

Background: Onset of wheezing before 3 years of age is concerning due to its potential for the development of asthma. Different risk factors, atopic manifestations, and Vitamin D deficiency are attributed to it. Aims: The aim of this study is to assess the factors influencing the age of wheezing onset among children with early-onset recurrent wheezing and the association of Vitamin D status with different atopic manifestations. Subjects And Methods: This cross-sectional observational study included 141 children aged from 1 month to 14 years with recurrent wheezing. Onset of wheezing after 36 months was excluded from the study. Different risk factors and atopic manifestations were recorded, and Vitamin D levels were measured. Descriptive analysis, independent t-test, analysis of variance, and regression analysis were done using SPSS version 24.0. Results: Of 141 children, 65 (46.0%) had onset of wheezing at <1 year of age. Children with onset of wheezing <1 year had early age of presentation (29.38 ± 29.35 vs. 46.25 ± 27.77 months) were predominately male (52.1% vs. 47.9%) and had a low birth weight (2688.46 ± 608.84 vs. 2904.61 ± 510.96 g) and high Vitamin D level (22.01 ± 12.63 vs. 16.65 ± 9.05 ng/mL; P < 0.05). In the regression analysis, birth weight, family with >1 sibling, and atopic dermatitis had regression coefficients of 0.393 (P < 0.01), 4.525 (P < 0.01), and −2.970, respectively (P > 0.05). Conclusions: Children with onset of wheezing before 1 year were predominantly male and had a lower birth weight. Vitamin D deficiency does not hasten the onset of wheezing; however, a low birth weight and associated atopic dermatitis hasten the onset of wheezing, and being part of a family with >1 sibling delays onset.

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In silico identification and characterization of putative kuruma prawn (Marsupenaeus japonicus) allergens

Kar Ee Hoh, Venkataramanan Swaminathan

Indian Journal of Allergy, Asthma and Immunology 2017 31(2):87-93

Background: Prawn is one of the major sources of shellfish allergens, which will induce mild to severe allergic reactions. Aim: The objective of this study was to predict putative allergens and its characteristics present in Marsupenaeus japonicus through an in silico approach. Materials And Methods: In this present study, in silico tools, RaptorX, Bepipred Linear Epitope and Parker Hydrophilicity Prediction method, and MHC2Pred were used to predict the putative and cross-reactive allergens, tertiary and secondary structures, B-cell linear epitopes, and T-cell epitopes, respectively. Results: As a result, eight putative and cross-reactive allergens including tropomyosin fast isoform, arginine kinase, sarcoplasmic calcium binding protein, myosin light chain, chymotrypsin like proteinase, superoxide dismutase, cathepsin B, and trypsin were predicted by analyzing the protein sequences of M. japonicus. Furthermore, five amino acids (Ala, Ser, Asn, Gly, and Lys) play a vital role in immunoglobulin E binding allergenic epitope. At least one of them was found in the predicted B-cell epitope for each of the predicted putative allergens. Moreover, the predicted T-cell epitopes were highly associated with human leukocyte antigen (HLA) DRB1*0101 and HLA-DRB1*0901 alleles while mediating T-cell immune responses. Conclusion: These results can be utilized to contribute in peptide immunotherapy and reduce the allergic diseases related to shellfish.

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Prevalence of aeroallergens in patients of bronchial asthma and/or allergic rhinitis in India based on skin prick test reactivity

Raj Kumar, Manoj Kumar, Indu Bisht, Kamal Singh

Indian Journal of Allergy, Asthma and Immunology 2017 31(2):45-55

Background: Exposures to various aeroallergens play a crucial role in the pathogenesis of bronchial asthma (BA) and allergic rhinitis (AR). On the basis of climate change, the prevalence of aeroallergens may vary in different regions. AIMS: The aim of the study was to determine the prevalence of the sensitivity to aeroallergens among patients with BA and/or AR based on skin prick test (SPT) reactivity in India. Settings And Design: This study was conducted at National Centre of Respiratory Allergy, Asthma and Immunology and Department of Respiratory Allergy and Applied Immunology, (Department of Respiratory Medicine), Vallabhbhai Patel Chest Institute, University of Delhi, Delhi-110007 (India). Subjects And Methods: A total of 4835 patients were screened from the Outpatient Department of institute during the period of August 2008 to July 2016. Out of 4835 patients, 4263 patients were performed SPT consisting of 2361 (55.38%) males and 1902 (44.62%) females, with a mean age of 30.06 years were included in the study. Diagnosis of BA and AR was made according to the GINA and ARIA guidelines, respectively. SPT was done with 58 different types of aeroallergens, which included grass pollens, weed pollens, tree pollens, dust, fungi, insects, kapok cotton, wool, and silk antigens. Statistical Analysis Used: Data analysis was done using Excel 2007. Results: Significant skin positive reaction (2 + and above) against aeroallergens were found in 1993 (46.77%) participants including 422 (9.9%) BA patients, 570 (13.37%) AR patients, and 1001 (23.48%) of both BA/AR. The younger adults aged 20–29 years were the foremost commonly affected group with 626 (14.68%) significant skin-positive patients. Among individual allergens, most common aeroallergen was mosquito (30.89%) and least common was Ehretia (0.37%). Conclusions: In different states of India, the mosquito was found the most common sensitizing allergen in BA and/or AR patients. Sensitization was the most common in the younger age group (20–29 years) patients.

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Epidemiology of bronchial asthma among children in Jazan Region, Saudi Arabia

Alhussen F Khawaji, Abdulhameed Basudan, Abdulrahman Moafa, Mohammed Faqihi, Mohammed Alhazmi, Taher A Mahnashi, Yaseen Haddadi, Abuobaida K Yassin

Indian Journal of Allergy, Asthma and Immunology 2017 31(2):69-75

Context: Asthma is a global problem, its prevalence varies among different countries and cities and age groups. In children, asthma is one of the most common chronic diseases and one of the leading causes of morbidity and mortality. Aims: This study was conducted to estimate the prevalence of asthma among children in Jazan Region (JR), Saudi Arabia. Settings And Design: This is study conducted in Jazan region, saudi arabia among school age children. It is a cross-sectional study used a modified international study os asthma and allergy in children questionnaire. Subjects And Methods: The target study population were school age, witth sample size of 1200 distributed to all geographical areas. Statistical Analysis Used: The data had been entered and analyzed using Statistical Package for Social Sciences software version 22.0. Descriptive statistics (e.g., number, percentage) and analytic statistics using Chi-square tests (χ2) to test for the association and/or the difference between two categorical variables will be applied. A P < 0.05 was considered statistically significant. Results: The total study population was 1400, most of them were Saudi (1273, 90.9%). Male students were 840 (60.0%), and female students were 560 (40.0%). According to the residency, 811 (57.9%) students were lived in rural, 64.7% of them were male, and 589 (42.1%) of participants lived in urban area. Most of the students lived in plain area (840, 60.0%), and only 16.4% of them lived in mountain area in which 63.5% of them were male. Elementary school students account 54.1% of total students; about 63% of them were male. The prevalence of life-long wheezes was 17.7%. The prevalence of exercise-induced wheeze and wheeze during the last 12 months was 206 (14.7%) and 159 (11.4%), respectively. Students with the past medical history of bronchial asthma were 212 (15.1%), with no clear statistical significant difference in frequency between male and female (P = 0.161). Asthma was confirmed by doctor in 10% of participants. Conclusions: The prevalence of asthma among children in JR is slightly higher than those reported from local and regional reports.

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Study of prevalence of bronchial asthma in school children of 6–12 years of age in rural schools of Tumakuru district

Priyadarshini Bai Govinda Naik, Puttaswamy Ravikumar

Indian Journal of Allergy, Asthma and Immunology 2017 31(2):56-60

Context: Pediatric asthma is a serious global health problem. The recent rise in the prevalence of asthma was associated with environmental pollution, urbanization, and the change in demography. Aims: The present study was undertaken to determine the prevalence of asthma in school children of rural parts of Tumakuru district and to study its association with different epidemiological factors. Settings And Design: This study is a questionnaire-based study (International Study of Asthma and Allergies in Childhood-Questionnaire) carried out in four randomly selected rural schools of Tumakuru district. Subjects And Methods: The questionnaire was distributed to all the children (n = 1750) and asked to fill the questionnaire with the help of their parents. These questionnaires were given standard scores to diagnose asthma. Other epidemiological factors were also recorded in the questionnaire and studied. Statistical Analysis Used: The statistical analysis was done using MSTAT software. Chi-square test was used to get the P value. P < 0.05 was considered statistically significant. Results: The prevalence of asthma in our study was 3.12% (n = 51). Boys had a slightly higher prevalence 3.36% (n = 32) than girls 2.8% (n = 19). We found 58.8% (n = 30) of these asthmatics had allergic rhinitis and 19.6% (n = 10) had a history of atopy. Overall prevalence of allergic rhinitis was 8.3% (n = 137) and atopy was 1.13% (n = 23). Conclusions: The study showed 3.12% of children are affected with asthma, and its prevalence is significantly associated with epidemiological factors such as family history of allergy, high socioeconomic status, and use of fire wood for cooking.

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Pediatric peak expiratory flow rate nomograms for Ernakulam district

Jomon Mathew John

Indian Journal of Allergy, Asthma and Immunology 2017 31(2):83-86

Objective: To obtain the normal reference values of peak expiratory flow rates (PEFRs) among healthy school-going children between 8 and 12 years and thereby construct a nomogram. Materials And Methods: A cross-sectional study was conducted among healthy children attending schools in Ernakulam district over a period of 1 year. PEFR values were recorded using a Mini-Wright peak flow meter, and the best of three readings was documented. Results: Nine hundred and fifty-four students were studied. PEFR increases as the age increases. A similar trend was observed across various heights. Nomograms based on age and height were constructed separately for boys and girls. Conclusion: Established baseline values of PEFR in this study can be useful in diagnosing and following asthmatic children in Ernakulam district.

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Endobronchial aspergilloma mimicking bronchogenic carcinoma removed through flexible fiber-optic bronchoscopy

P Hari Lakshmanan, Muhammed Jasim Abdul Jalal, Dhanya Jacob, Ami Maria Emmanuel

Indian Journal of Allergy, Asthma and Immunology 2017 31(2):94-96

Endobronchial aspergilloma is a rare, noninvasive aspergillosis. It may be associated with a parenchymal lesion and/or cavity. We describe a case of endobronchial aspergillosis mimicking bronchogenic carcinoma subsequently removed completely through fiber-optic bronchoscope itself. This case report, while highlighting the existence of this unique clinical entity, also throws light on potential treatment option which can be curative.

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Suitability of Test Chambers for Analyzing Air Pollutant Removal by Plants and Assessing Potential Indoor Air Purification

Abstract

A unique test chamber system, which enables experiments with plants under highly controlled environmental conditions, was used to examine the pollutant removal efficiency of plants. For this purpose, the removal of two different volatile organic compounds (VOC) (toluene, 2-ethylhexanol) from the air by aerial plant parts of two common indoor plant species (Dieffenbachia maculata and Spathiphyllum wallisii) was monitored. While the control over environmental conditions (temperature, relative humidity, CO₂ content, and light condition) worked very well in all experiments, control experiments with the empty chamber revealed high losses of VOC, especially 2-ethylhexanol, over the test duration of 48 h. Nonetheless, compared to the empty chamber, a significantly stronger and more rapid decline in the toluene as well as in the 2-ethylhexanol concentrations was observed when plants were present in the chamber. Interestingly, almost the same VOC removal as by aerial plant parts could be achieved by potting soil without plants. A comparative literature survey revealed substantial heterogeneity in previous results concerning the VOC removal efficiency of plants. This can be mainly attributed to a high diversity in experimental setup. The experimental setup used in the current study offers an excellent opportunity to examine also plant physiological responses to pollutant exposure (or other stressors) under highly controlled conditions. For the analysis of VOC removal under typical indoor conditions, to obtain data for the assessment of realistic VOC removal efficiencies by plants in rooms and offices, a guideline would be helpful to achieve more coherent findings in this field of research.

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Tumor PD-L1 expression is associated with improved survival and lower recurrence risk in young women with oral cavity squamous cell carcinoma

Young patients with oral cavity squamous cell carcinoma (OCSCC) are often recognized as a distinct epidemiological cohort. In this study, genomic and immune-based metrics were correlated with long-term outcomes for a young patient population treated at a single institution. A fully clinically annotated, retrospective cohort of 81 patients aged ≤45 years with OCSCC is described, and the impact of clinicopathological features on long-term survival outcomes is reported. Genomic and immune parameters were integrated utilizing a whole-exome sequencing and immunohistochemical approach among females in the cohort.

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Prognostic factors in head and neck mucoepidermoid carcinoma: experience at a single institution based on 64 consecutive patients over a 28-year period

Mucoepidermoid carcinoma (MEC) is the most common malignancy of the salivary glands. The clinical behaviour of MEC is largely unpredictable, ranging from indolent tumour growth to highly aggressive metastatic spread. The objective of this study was to determine the clinicopathological predictors of recurrence and survival in patients with head and neck MEC. The medical records of 64 patients who underwent surgical treatment for head and neck MEC between 1982 and 2010 were reviewed. The main outcome measures were disease-free survival (DFS) and overall survival (OS).

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Intraoperative 5-aminolevulinic acid-induced photodynamic diagnosis of metastatic brain tumors with histopathological analysis

Abstract

Background

Fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA) is a promising real-time navigation method in the surgical resection of malignant gliomas. In order to determine whether this method is applicable to metastatic brain tumors, we evaluated the usefulness of intraoperative fluorescence patterns and histopathological features in patients with metastatic brain tumors.

Methods

We retrospectively reviewed the cases of 16 patients with metastatic brain tumors who underwent intraoperative 5-ALA fluorescence-guided resection. Patients were given 20 mg/kg of 5-ALA orally 2 h prior to the surgery. High-powered excitation illumination and a low-pass filter (420, 450, or 500 nm) were used to visualize the fluorescence of protoporphyrin IX (PpIX), the 5-ALA metabolite. We evaluated the relationships between the fluorescence and histopathological findings in both tumoral and peritumoral brain tissue.

Results

Tumoral PpIX fluorescence was seen in only 5 patients (31%); in the remaining 11 patients (69%), there was no fluorescence in the tumor bulk itself. In 14 patients (86%), vague fluorescence was seen in peritumoral brain tissue, at a thickness of 2–6 mm. The histopathological examination found cancer cell invasion of adjacent brain tissue in 75% of patients (12/16), at a mean ± SD depth of 1.4 ± 1.0 mm (range 0.2–3.4 mm) from the microscopic border of the tumor. There was a moderate correlation between vague fluorescence in adjacent brain tissue and the depth of cancer cell invasion (P = 0.004).

Conclusion

Peritumoral fluorescence may be a good intraoperative indicator of tumor extent, preceding more complete microscopic gross total resection.

Trial registration

Institutional Review Board of Osaka Medical College No. 42, registered February 17, 1998, and No. 300, registered April 1, 2008. They were retrospectively registered.

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Epidemiology of REM sleep behavior disorder: both study design and measurement tool count

REM sleep behavior disorder (RBD) is characterized by both dream enactment behaviors (DEB) and loss of muscle atonia during REM sleep (RSWA).1 To confirm the diagnosis of RBD, a history of DEB reported by patients/caregivers or recorded by video-polysomnography and the demonstration of RSWA during polysomnographic recording are needed.2 However, video-polysomnographic (vPSG) analysis is costly and time-consuming, which significantly limits the feasibility of conducting vPSG study for all subjects in a large-scale epidemiologic study.

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Subcutaneous mastectomy in female-to-male transsexuals – optimizing perioperative and operative management in 8 years clinical experience

The incidence of complications, especially acute hematoma requiring surgical revision in female-to-male transsexuals (FTMTS), is consistently highly documented in literature with up to 33 %. Since 2008 we perform subcutaneous mastectomies in FTMTS with an annually increasing number of cases. Due to an initially high hematoma revision rate in the previously published cohort (2008-2013), we implemented peri- and postoperative preventive measures and compared the results with recent patient cohort (2014-2016).

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Hypersensitivity Pneumonitis: Lessons from the Great Imitator in Interstitial Lung Disease

Annals of the American Thoracic Society, Volume 14, Issue 10, Page 1506-1507, October 2017.


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Derivation and Validation of a Prognostic Model to Predict 6-Month Mortality in an Intensive Care Unit Population

Annals of the American Thoracic Society, Volume 14, Issue 10, Page 1556-1561, October 2017.


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Prognostication during Critical Illness: Moving the Field Forward

Annals of the American Thoracic Society, Volume 14, Issue 10, Page 1510-1511, October 2017.


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Rationale and Design of the Lung Cancer Screening Implementation. Evaluation of Patient-Centered Care Study

Annals of the American Thoracic Society, Volume 14, Issue 10, Page 1581-1590, October 2017.


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Presence of Air Trapping and Mosaic Attenuation on Chest Computed Tomography Predicts Survival in Chronic Hypersensitivity Pneumonitis

Annals of the American Thoracic Society, Volume 14, Issue 10, Page 1533-1538, October 2017.


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Decisions around Long-term Ventilation for Children. Perspectives of Directors of Pediatric Home Ventilation Programs

Annals of the American Thoracic Society, Volume 14, Issue 10, Page 1539-1547, October 2017.


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Skeletal Muscle Ultrasound in Critical Care: A Tool in Need of Translation

Annals of the American Thoracic Society, Volume 14, Issue 10, Page 1495-1503, October 2017.


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Pulmonary Hypertension and Primary Graft Dysfunction in Lung Transplant Recipients: We Still Have a Long Way to Go

Annals of the American Thoracic Society, Volume 14, Issue 10, Page 1504-1505, October 2017.


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A Challenging Diagnosis of Endobronchial Aortic Pseudoaneurysm

Annals of the American Thoracic Society, Volume 14, Issue 10, Page 1595-1597, October 2017.


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Dry Powder Inhalers and Humidity: Another Factor to Consider to Ensure Adequate Lung Delivery

Annals of the American Thoracic Society, Volume 14, Issue 10, Page 1602-1602, October 2017.


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Clinical Risk Factors and Prognostic Model for Primary Graft Dysfunction after Lung Transplantation in Patients with Pulmonary Hypertension

Annals of the American Thoracic Society, Volume 14, Issue 10, Page 1514-1522, October 2017.


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Risk-Reducing Mastectomy and Breast Reconstruction

Publication date: Available online 29 September 2017
Source:Clinics in Plastic Surgery
Author(s): Bradley S. Eisemann, Aldona J. Spiegel

Teaser

Breast cancer affects nearly every woman either personally or through a family member or friend. Awareness of associated familial and genetic risks has been steadily increasing over the last decade. Bilateral risk-reduction mastectomy seeks to decrease the incidence and mortality of breast cancer in women without abnormality but with elevated risk of developing cancer. Contralateral risk-reduction mastectomy aims to decrease the incidence of contralateral breast cancer in women diagnosed with unilateral breast cancer. As understanding improves and techniques progress, the relative merits of surgical risk reduction will change as well.


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Modulation of hyperpolarization-activated cation current Ih by volatile anesthetic sevoflurane in the mouse striatum during postnatal development

Publication date: Available online 29 September 2017
Source:Neuroscience Research
Author(s): Yusuke Sugasawa, Masataka Fukuda, Nozomi Ando, Ritsuko Inoue, Sakura Nakauchi, Masami Miura, Kinya Nishimura
Volatile anesthetics have been reported to inhibit hyperpolarization-activated cyclic-nucleotide gated channels underlying the hyperpolarization-activated cation current (Ih) that contributes to generation of synchronized oscillatory neural rhythms. Meanwhile, the developmental change of Ih has been speculated to play a pivotal role during maturation. In this study, we examined the effect of the volatile anesthetic sevoflurane, which is widely used in pediatric surgery, on Ih and on functional Ih activation kinetics of cholinergic interneurons in developing striatum. Our analyses showed that the changes in Ih of cholinergic interneurons occurred in conjunction with maturation. Sevoflurane application (1–4%) caused significant inhibition of Ih in a dose-dependent manner, and apparently slowed Ih activation. In current-clamp recordings, sevoflurane significantly decreased spike firing during the rebound activation, which is essential for responses to the sensory inputs from the cortex and thalamus. The sevoflurane-induced inhibition of Ih in striatal cholinergic interneurons may lead to alterations of the acetylcholine-dopamine balance in the neural circuits during the early postnatal period.



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Kids First Pediatric Research Program Moves Forward

Progress continues to be made with the Gabriella Miller Kids First Research Program, which is creating opportunities for investigators from different research communities to share resources and collaborate on research into childhood cancers and certain birth defects.

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Second primary cancer after major salivary gland carcinoma

Abstract

Background

We investigated the risk of second primary cancers after major salivary gland carcinoma in Finland, with a population of 5.5 million.

Methods

Nationwide cancer registry data were used to identify patients with major salivary gland carcinoma diagnosed between 1953 and 2014. Standardized incidence ratios (SIRs) were estimated to compare their second primary cancer risk with the respective site-specific cancer risk in the general population.

Results

There were 1727 patients with major salivary gland carcinomas and 222 second primary cancers had been diagnosed in these patients (SIR 1.43). The risk was increased for cancers of the thyroid (SIR 5.12), breast (SIR 1.63), respiratory organs (SIR 1.63), male genital organs (SIR 1.48), melanoma of the skin (SIR 3.35), and nonmelanoma skin cancer (SIR 2.50). The risk was high during the first 5 years and after 20 years of diagnosis.

Conclusion

Second primary cancers can occur among patients with major salivary gland carcinoma even after a long time period. This needs to be recognized in the follow-up of these patients.

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NLRC and NLRX gene family mRNA expression and prognostic value in hepatocellular carcinoma

Abstract

Nucleotide-binding oligomerization domain (NOD)-like receptor (NLR)C and NLRX family proteins play a key role in the innate immune response. The relationship between these proteins and hepatocellular carcinoma (HCC) remains unclear. This study investigated the prognostic significance of NLRC and NLRX family protein levels in HCC patients. Data from 360 HCC patients in The Cancer Genome Atlas database and 231 patients in the Gene Expression Omnibus database were analyzed. Kaplan–Meier analysis and a Cox regression model were used to determine median survival time (MST) and overall and recurrence-free survival by calculating the hazard ratio (HR) and 95% confidence interval (CI). High NOD2 and low NLRX1 expression in tumor tissue was associated with short MST (P = 0.012 and 0.014, respectively). A joint-effects analysis of NOD2 and NLRX1 combined revealed that groups III and IV had reduced risk of death from HCC as compared to group I (adjusted P = 0.001, adjusted HR = 0.31, 95% CI = 0.16–0.61 and adjusted P = 0.043, adjusted HR = 0.63, 95%CI = 0.41–0.99, respectively). NOD2 and NLRX1 expression levels are potential prognostic markers in HCC following hepatectomy.

Nucleotide-binding oligomerization domain (NOD)-like receptor (NLR)C and NLRX family proteins play a key role in the innate immune response. The relationship between these proteins and hepatocellular carcinoma (HCC) remains unclear. This study investigated the prognostic significance of NLRC and NLRX family protein levels in HCC patients.

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Stratified analyses are necessary to verify the influence of salt intake in MS

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Response to Cappuccio et al.

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Reply to “Stratified analyses are necessary to verify the influence of salt intake in MS”

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Implications of Antiangiogenic Therapy on Radiographic Assessment of Brain Tumors

Publication date: December 2017
Source:World Neurosurgery, Volume 108
Author(s): Harsha Narayanamurthy, Michael Zhang, Mario Teo




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Quantitative Comparison of Three Endoscopic Approaches to the Parasellar Region: Laboratory Investigation

Publication date: December 2017
Source:World Neurosurgery, Volume 108
Author(s): Evgenii Belykh, Kaan Yağmurlu, Yuan Hong, Michael A. Mooney, Baran Bozkurt, Vadim A. Byvaltsev, Peter Nakaji, Mark C. Preul
BackgroundEndoscopic endonasal transsphenoidal and contralateral sublabial transmaxillary approaches are used for approaching parasellar lesions. The aim of this anatomical study was to compare endoscopic endonasal uninostril and binostril (contralateral) and contralateral sublabial transmaxillary approaches via a quantitative analysis of exposure limits and instrument working avenues.MethodsSix formalin-fixed silicone-injected adult cadaveric heads (12 sides) were studied. The surgical working area, depth of the surgical corridor, angle of attack, and surgical freedom were measured and compared for the 3 approaches.ResultsThe endoscopic binostril endonasal approach to the parasellar area provided greater surgical freedom in the opticocarotid recess (OCR) and superior orbital fissure (SOF) compared with that of the uninostril endonasal approach (OCR, P < 0.01; SOF, P = 0.01) and the contralateral sublabial transmaxillary approach (OCR, P = 0.01; SOF, P = 0.03). The horizontal and vertical angles of attack with the binostril endonasal approach also were greater than those of the uninostril approach (OCR, P ≤ 0.05; SOF, P ≤ 0.01) and the contralateral transmaxillary approach (OCR, P ≤ 0.01; SOF, P ≤ 0.01). However, the contralateral sublabial transmaxillary approach provided more lateral exposure than the uninostril or binostril endonasal approach to the parasellar area, and it enabled a shorter surgical trajectory to the contralateral parasellar area (P < 0.01).ConclusionsAn anatomical comparison of the 3 endoscopic approaches to the parasellar area showed that the binostril approach provides greater exposure and freedom for instrument manipulation. The contralateral transmaxillary route provided a more lateral view, increasing exposure on average by 48%, with shorter surgical depth; however, surgical freedom was inferior to that of the binostril approach.



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Predicting Short-Term Outcome After Surgery for Primary Spinal Tumors Based on Patient Frailty

Publication date: December 2017
Source:World Neurosurgery, Volume 108
Author(s): A. Karim Ahmed, C. Rory Goodwin, Rafael De la Garza-Ramos, Rachel C. Kim, Nancy Abu-Bonsrah, Risheng Xu, Daniel M. Sciubba
ObjectiveFrailty, decreased physiologic reserve and increased vulnerability to stressors beyond what is expected for normal aging, is associated with increased risk of morbidity and mortality. The objective of this study was to develop a preoperative frailty index for patients undergoing surgery for primary spinal column tumors that predicts morbidity, mortality, and length of stay.MethodsThe Nationwide Inpatient Sample database from 2002 to 2011 was used to identify patients who underwent surgery for a primary spinal tumor. The spinal tumor frailty index, consisting of 9 items, was applied to each patient. Patients were characterized as "not frail" (0), "mildly frail" (1), "moderately frail" (2), and "severely frail" (≥3).ResultsInclusion criteria were met by 1589 patients. Overall major complication rate was 10.6%. Compared with patients without frailty, patients with mild (odds ratio 3.83; 95% confidence interval, 2.63–5.58), moderate (odds ratio 6.80; 95% confidence interval, 4.10–11.3), and severe frailty (odds ratio 13.05; 95% confidence interval, 6.34–26.87) had significantly increased odds of developing complications (all P < 0.001). Mean length of stay was 6.4 days ± 0.2, 9.8 days ± 0.6, 14.4 days ± 1.7, and 18.3 days ± 2.6 for patients without frailty, with mild frailty, with moderate frailty, and with severe frailty (P < 0.05 between all groups).ConclusionsCompared with patients without frailty, patients with mild, moderate, and severe frailty had significantly increased odds of developing postoperative complications. Systematic evaluation of preoperative frailty should play a key role in decision making for patients undergoing surgery for primary spinal tumors.



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Consensus guidelines for the identification and treatment of biofilms in chronic non-healing wounds

Abstract

Background: Despite a growing consensus that biofilms contribute to a delay in the healing of chronic wounds, conflicting evidence pertaining to their identification and management can lead to uncertainty regarding treatment. This, in part, has been driven by reliance on in vitro data or animal models, which may not directly correlate to clinical evidence on the importance of biofilms. Limited data presented in human studies have further contributed to the uncertainty. Guidelines for care of chronic wounds with a focus on biofilms are needed to help aid the identification and management of biofilms, providing a clinical focus to support clinicians in improving patient care through evidence-based medicine.

Methods: A Global Wound Biofilm Expert Panel, comprising 10 clinicians and researchers with expertise in laboratory and clinical aspects of biofilms, was identified and convened. A modified Delphi process, based on published scientific data and expert opinion, was used to develop consensus statements that could help identify and treat biofilms as part of the management of chronic non-healing wounds. Using an electronic survey, panel members rated their agreement with statements about biofilm identification and treatment, and the management of chronic non-healing wounds. Final consensus statements were agreed on in a face-to-face meeting.

Results: Participants reached consensus on 61 statements in the following topic areas: understanding biofilms and the problems they cause clinicians; current diagnostic options; clinical indicators of biofilms; future options for diagnostic tests; treatment strategies; mechanical debridement; topical antiseptics; screening anti-biofilm agents; and levels of evidence when choosing anti-biofilm treatments.

Conclusion: This consensus document attempts to clarify misunderstandings about the role of biofilms in clinical practice, and provides a basis for clinicians to recognize biofilms in chronic non-healing wounds and manage patients optimally. A new paradigm for wound care, based on a stepped-down treatment approach, was derived from the consensus statements. This article is protected by copyright. All rights reserved.

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Wnt and frizzled expression during regeneration of internal organs in the holothurian Eupentacta fraudatrix

Several genes of the Wnt and Frizzled families in the holothurian Eupentacta fraudatrix are characterized, and the complete coding sequences of wntA, wnt4, wnt6, wnt16, frizzled1/2/7, frizzled4, and frizzled5/8 are obtained. The dynamics of expression of these genes during regeneration of internal organs after evisceration are studied. Evisceration and the associated damages supposedly induce the expression of wnt16 on third day after evisceration. Genes wntA, wnt4, wnt6, and frizzled1/2/7 upregulate during the period of active morphogenesis (5-7 days after evisceration) and might participate in regulation of tissue and organ formation. The signaling induced via Frizzled5/8 is could be necessary for formation of the anterior (ectodermal) part of the digestive system and development of the calcareous ring on 10^th day after evisceration. Our data suggest that the Wnt signaling pathway plays a significant role in the regulation of regeneration of internal organs in holothurians. This article is protected by copyright. All rights reserved.

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Hearing Aids for Mild-to-Moderate Hearing Loss in Adults

A recent systematic review concluded that hearing aid use in older adults with a mild-to-moderate hearing loss was beneficial in improving everyday situations, general health-related quality of life and improve listening ability with little evidence of harm.

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Silane adhesion mechanism in dental applications and surface treatments: A review

Publication date: Available online 29 September 2017
Source:Dental Materials
Author(s): Jukka Pekka Matinlinna, Christie Ying Kei Lung, James Kit Hon Tsoi
ObjectiveTo give a current review of silane adhesion chemistry, applications of silane coupling agents and related surface pretreatment methods in contemporary dentistry.MethodsSilane coupling agents are adhesion promoters to chemically unify dissimilar materials used in dentistry. Silanes are very effective in adhesion promotion between resin composites and silica-based or silica-coated indirect restorative materials. It is generally accepted that for non-silica-based restorations, surface pretreatment is a mandatory preliminary step to increase the silica content and then, with help of silane, improve resin bonding. This review discusses the silane-based adhesion chemistry, silane applications in dentistry, surface pretreatment methods, and presents the recent development of silane coupling agents.ResultsA silane coupling agent is considered a reliable, good adhesion promoter to silica-based (or silica-coated) indirect restorations. Surface pre-treatment steps, e.g., acid etching for porcelain and tribo-chemical silica-coating for metal alloys, is used before silanization to attain strong, durable bonding of the substrate to resin composite. In clinical practice, however, the main problem of resin bonding using silanes and other coupling agents is the weakening of the bond (degradation) in the wet oral environment over time.SignificanceA silane coupling agent is a justified and popular adhesion promoter (adhesive primer) used in dentistry. The commercial available silane coupling agents can fulfil the requirements in clinical practice for durable bonding. Development of new silane coupling agents, their optimization, and surface treatment methods are in progress to address the long term resin bond durability and are highly important.



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Vascular branches from cutaneous nerve of the forearm and hand: Application to better understanding Raynaud's disease

Abstract

Introduction: Cutaneous nerves have branches called vascular branches (VBs) that reach arteries. VBs are thought to be involved in arterial constriction, and this is the rationale for periarterial sympathectomy as a treatment option for Raynaud's disease. However, the branching patterns and distribution areas of the VBs remain largely unclear. The aim of the present study was to investigate the anatomical structures of the VBs of the cutaneous nerves.

Materials and Methods: Forty hands and forearms were examined to assess the branching patterns and distribution areas of the VBs of the superficial branch of the radial nerve (SBRN), the lateral antebrachial cutaneous nerve (LACN), the medial antebrachial cutaneous nerve (MACN), and the palmar cutaneous branch of the ulnar nerve (PCUN).

Results: VBs reaching the radial and ulnar arteries were observed in all specimens. The branching patterns were classified into six types. The mean distance between the radial styloid process and the point where the VBs reached the radial artery was 34.3 ± 4.8 mm in the SBRN and 38.5 ± 15.8 mm in the LACN. The mean distance between the ulnar styloid process and the point where the VBs reached the ulnar artery was 60.3 ± 25.9 mm in the MACN and 43.8 ± 26.0 mm in the PCUN.

Conclusions: This study showed that the VBs of the cutaneous nerves have diverse branching patterns. The VBs of the SBRN had a more limited distribution areas than those of the other nerves. This article is protected by copyright. All rights reserved.

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Genetic heterogeneity of uncharacterized childhood autoimmune diseases with lymphoproliferation

Abstract

Autoimmune diseases in children are rare and can be difficult to diagnose.  Single causative genes have been identified for some pediatric autoimmune diseases. Such orphan diseases may not be diagnosed properly due to the variability of patients' phenotypes. Guidelines for the diagnostic process need to be developed. Fifteen patients with uncharacterized childhood autoimmune diseases with lymphoproliferation that had negative testing for autoimmune lymphoproliferative syndrome were subjected to whole-exome sequencing to identify genes associated with these conditions. Five causative genes, CTLA4, STAT3, TNFAIP3, IKZF1, and PSTPIP1, were identified. These genes should be considered as candidates for uncharacterized childhood autoimmune diseases with lymphoproliferation.

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Children’s Urinary Environmental Carbon Load. A Novel Marker Reflecting Residential Ambient Air Pollution Exposure?

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 7, Page 873-881, October 1, 2017.


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Hyperventilation (Not Ventilator)-induced Lung Injury

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 7, Page 936-937, October 1, 2017.


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Reply: “A Word of Caution Regarding Patient Self-inflicted Lung Injury and Prophylactic Intubation” and “Hyperventilation (Not Ventilator)-induced Lung Injury”

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 7, Page 937-938, October 1, 2017.


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Inflammatory Myofibroblastic Tumor of the Lung. A Rare Primary Lung Cancer

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 7, Page 923-924, October 1, 2017.


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Mold-Specific Concerns Associated with Water Damage for Those with Allergies, Asthma, and Other Lung Diseases

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 7, Page P13-P14, October 1, 2017.


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Integrating Microbiome and Metabolome Data to Understand Infectious Airway Disease

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 7, Page 806-807, October 1, 2017.


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A Word of Caution Regarding Patient Self-inflicted Lung Injury and Prophylactic Intubation

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 7, Page 936-936, October 1, 2017.


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Evaluating Molecular Biomarkers for the Early Detection of Lung Cancer: When Is a Biomarker Ready for Clinical Use? An Official American Thoracic Society Policy Statement

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 7, Page e15-e29, October 1, 2017.


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Looking beyond the Tip of a Tusk: Balancing the Evidence in Prognosis-related Communication

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 7, Page 803-804, October 1, 2017.


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The Timing of Early Antibiotics and Hospital Mortality in Sepsis: Playing Devil’s Advocate

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 7, Page 934-935, October 1, 2017.


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Impact of Point-of-Care Xpert MTB/RIF on Tuberculosis Treatment Initiation. A Cluster-randomized Trial

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 7, Page 901-910, October 1, 2017.


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Physiology of Arousal in Obstructive Sleep Apnea and Potential Impacts for Sedative Treatment

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 7, Page 814-821, October 1, 2017.


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Antibiotics for Sepsis: Does Each Hour Really Count, or Is It Incestuous Amplification?

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 7, Page 800-802, October 1, 2017.


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Insights into Asthma Therapies, Cardiovascular Effects, and Mechanisms from Recent Clinical Trials

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 7, Page 920-922, October 1, 2017.


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Effects of Retinoids on Augmentation of Club Cell Secretory Protein

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 7, Page 928-931, October 1, 2017.


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Reply: The Timing of Early Antibiotics and Hospital Mortality in Sepsis: Playing Devil’s Advocate

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 7, Page 935-936, October 1, 2017.


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Obstructive Sleep Apnea and Retinopathy in Patients with Type 2 Diabetes. A Longitudinal Study

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 7, Page 892-900, October 1, 2017.


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New Guidelines on Noninvasive Ventilation. A Few Answers, and Several More Questions

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 7, Page 811-813, October 1, 2017.


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An Adolescent with Dyspnea and Cough. A Case of Congenital Tracheal Stenosis

American Journal of Respiratory and Critical Care Medicine, Volume 196, Issue 7, Page e30-e31, October 1, 2017.


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Second lung malignancy and Richter syndrome in chronic lymphocytic leukemia: case report and literature review

Chronic lymphocytic leukemia (CLL) is the most frequent lymphoproliferative disease. Transformation into Richter disease and occurrence of second malignancies involving the lungs are rare complications. The ha...

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October Highlights/Papers by Junior Investigators/NIH News

American Journal of Respiratory Cell and Molecular Biology, Volume 57, Issue 4, Page iv-iv, October 2017.


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Hepatic Steatosis Accompanies Pulmonary Alveolar Proteinosis

American Journal of Respiratory Cell and Molecular Biology, Volume 57, Issue 4, Page 448-458, October 2017.


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Integrative Genomics of Emphysema-Associated Genes Reveals Potential Disease Biomarkers

American Journal of Respiratory Cell and Molecular Biology, Volume 57, Issue 4, Page 411-418, October 2017.


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Hydrogen Sulfide: A Novel Player in Airway Development, Pathophysiology of Respiratory Diseases, and Antiviral Defenses

American Journal of Respiratory Cell and Molecular Biology, Volume 57, Issue 4, Page 403-410, October 2017.


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Dendritic Cell Trafficking and Function in Rare Lung Diseases

American Journal of Respiratory Cell and Molecular Biology, Volume 57, Issue 4, Page 393-402, October 2017.


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A Novel In Vitro Human Granuloma Model of Sarcoidosis and Latent Tuberculosis Infection

American Journal of Respiratory Cell and Molecular Biology, Volume 57, Issue 4, Page 487-498, October 2017.


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Integrative Genomics of Emphysema-Associated Genes: Are We Closer to Identifying the Genetic Determinants of Lung Function?

American Journal of Respiratory Cell and Molecular Biology, Volume 57, Issue 4, Page 377-378, October 2017.


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A Tale of Two Endoglins: How Does Tail-Less Soluble Endoglin Deregulate Lung Development?

American Journal of Respiratory Cell and Molecular Biology, Volume 57, Issue 4, Page 388-390, October 2017.


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Activation of the Integrated Stress Response and Metabolic Dysfunction in a Murine Model of Sleep Apnea

American Journal of Respiratory Cell and Molecular Biology, Volume 57, Issue 4, Page 477-486, October 2017.


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Does Granulocyte–Macrophage Colony-Stimulating Factor Coordinate a Hepatopulmonary Axis of Lipid Metabolism?

American Journal of Respiratory Cell and Molecular Biology, Volume 57, Issue 4, Page 383-385, October 2017.


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Tides of Blood: Cyclic Changes in Lung Blood Volume during a Single Breath

American Journal of Respiratory Cell and Molecular Biology, Volume 57, Issue 4, Page 386-387, October 2017.


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Perinatal Bacterial Exposure Contributes to IL-13 Aeroallergen Response

American Journal of Respiratory Cell and Molecular Biology, Volume 57, Issue 4, Page 419-427, October 2017.


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A Multiomics Approach to Identify Genes Associated with Childhood Asthma Risk and Morbidity

American Journal of Respiratory Cell and Molecular Biology, Volume 57, Issue 4, Page 439-447, October 2017.


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Synchrotron Imaging Shows Effect of Ventilator Settings on Intrabreath Cyclic Changes in Pulmonary Blood Volume

American Journal of Respiratory Cell and Molecular Biology, Volume 57, Issue 4, Page 459-467, October 2017.


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Putting It Together: Sleep Apnea, the Integrated Stress Response, and Metabolic Dysfunction

American Journal of Respiratory Cell and Molecular Biology, Volume 57, Issue 4, Page 391-392, October 2017.


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Multiomics Approach to Asthma: Navigating the Network

American Journal of Respiratory Cell and Molecular Biology, Volume 57, Issue 4, Page 381-382, October 2017.


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Intra-Amniotic Soluble Endoglin Impairs Lung Development in Neonatal Rats

American Journal of Respiratory Cell and Molecular Biology, Volume 57, Issue 4, Page 468-476, October 2017.


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IFN-γ Influences Epithelial Antiviral Responses via Histone Methylation of the RIG-I Promoter

American Journal of Respiratory Cell and Molecular Biology, Volume 57, Issue 4, Page 428-438, October 2017.


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It All Begins In Utero: Cord Blood Bacterial DNA and T Cell Immunity

American Journal of Respiratory Cell and Molecular Biology, Volume 57, Issue 4, Page 379-380, October 2017.


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EM Nerd-The Case of the Divisive Tincture

  The guiding physiological principles of resuscitation have for so long been based off the restoration of normal macroscopic hemodynamics in the hopes that the reversal of such circulatory perturbations will correct the underlying cellular injustices. And yet time after time such strategies have failed to show definitive benefits when empirically tested. The simple practice […]

EMCrit by Rory Spiegel.

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Evaluating ceramic crown margins with digital radiography

Publication date: Available online 29 September 2017
Source:The Journal of Prosthetic Dentistry
Author(s): William Maxwell Wahle, Radi Masri, Carl Driscoll, Elaine Romberg
Statement of problemRadiographs aid in clinically determining crown fit, specifically interproximal margins where tactile and visual methods may be limited. However, investigations of the utility of digital radiographs as a tool for evaluating the marginal openings of ceramic crowns are lacking.PurposeThe purpose of this in vitro study was to assess whether marginal adaptation for ceramic crowns and for metal–ceramic crowns with a metal collar can be identified with digital radiographs.Material and methodsOne lithium disilicate crown, 1 fluorapatite crown, and 1 metal–ceramic crown were fabricated for a maxillary premolar. The crowns were attached to a custom-designed device that allowed the marginal discrepancy to be changed. A total of 10 increments were measured starting at 0 to 20 μm and increasing every 20 μm to a maximum opening of 180 to 200 μm. At each increment, 2 radiographs were made of the crowns, using a digital sensor, 1 perpendicular to and 1 at 80 degrees to the long axis of the tooth. To test whether digital radiographs could be used to accurately identify "acceptable" and "unacceptable" margins, 21 dentists were asked to rate the radiographs as "acceptable" or "unacceptable." The chi square test was used to analyze differences between the dentists' evaluations and the actual marginal opening (α=.05). For the purposes of this study, a marginal discrepancy greater than 80 μm was considered "unacceptable."ResultsOf all marginal discrepancies exceeding 80 μm, 78.6% of the metal–ceramic crown radiographs were incorrectly scored as "acceptable" (P<.001). These radiographs were identified as false positives. Lithium disilicate (66.1%) and fluorapatite (45.8%) crowns were more likely to be incorrectly evaluated as "unacceptable" (P<.001) and identified as false negatives.ConclusionsUsing digital radiographs to evaluate marginal adaptation without clinical examination is not by itself an accurate method of evaluating the marginal fit of complete coverage crowns. The marginal fit of the tested metal–ceramic crowns tended to be evaluated incorrectly as acceptable. The marginal fit of the tested ceramic crowns tended to be evaluated incorrectly as unacceptable.



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In vitro evaluation of the polishing effect and optical properties of monolithic zirconia

Publication date: Available online 28 September 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Yoon-Hyuk Huh, Eul-Chang Yang, Chan-Jin Park, Lee-Ra Cho
Statement of problemThe relationship between surface roughness and the optical characteristics of zirconia prostheses may be affected by the type of shaded block.PurposeThe purpose of this in vitro study was to investigate changes in surface roughness and brightness of monolithic zirconia blocks of different shades after polishing.Material and methodsThe surface roughness averages of 3 different kinds of shaded zirconia blocks (Zenostarof T0 [T0], Zenostar sun [Ts], and Zenostar sun chroma [Tsc]) were compared after surface polishing. Fifteen specimens of differing thicknesses were produced per block. (1 mm and 3 mm). Surface morphology and compositions were analyzed by using filed emission scanning electron microscopy (FE-SEM) and energy dispersive spectrometry. A 1-way ANOVA and the post hoc Scheffé test were performed (α=.05). The correlations between surface roughness and brightness were determined using the Pearson correlation analysis (α=.01).ResultsAfter phased polishing, Ts had the highest average roughness, followed by T0 and then Tsc. A statistically significant difference in roughness was observed between Ts and Tsc (P<.05). Ts exhibited multiple distinct layers in the FE-SEM image. Carbon was detected in the Ts specimens only. Brightness was highest in T0, followed by Ts and then Tsc. A positive correlation was observed between brightness and surface roughness for all specimens (P<.01). This correlation was stronger in the thicker specimens.ConclusionsThe results of this study suggest that polishing affects monolithic zirconia differently depending on shade. The polishing of monolithic zirconia reduces both surface roughness and brightness. The optical properties of monolithic zirconia vary by thickness and can be opaque or translucent.



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Integrating hinge axis approximation and the virtual facial simulation of prosthetic outcomes for treatment with CAD-CAM immediate dentures: A clinical report of a patient with microstomia

Publication date: Available online 29 September 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Katelyn M. Kuric, Bryan T. Harris, Dean Morton, Bruno Azevedo, Wei-Shao Lin
This clinical report describes a digital workflow using extraoral digital photographs and volumetric datasets from cone beam computed tomography (CBCT) imaging to create a 3-dimensional (3D), virtual patient with photorealistic appearance. In a patient with microstomia, hinge axis approximation, diagnostic casts simulating postextraction alveolar ridge profile, and facial simulation of prosthetic treatment outcome were completed in a 3D, virtual environment. The approach facilitated the diagnosis, communication, and patient acceptance of the treatment of maxillary and mandibular computer-aided design and computer-aided manufacturing (CAD-CAM) of immediate dentures at increased occlusal vertical dimension.



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Accuracy of digitally fabricated trial dentures

Publication date: Available online 29 September 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Timea Wimmer, Marlis Eichberger, Nina Lümkemann, Bogna Stawarczyk
Statement of problemInformation about the accuracy of digital computer-aided design and computer-aided manufacturing (CAD-CAM) complete dentures is scarce.PurposeThe purpose of this in vitro study was to assess the reproducibility of the occlusion of wax dentures fabricated with digital steps and the contraction behavior of wax trial dentures processed with combined conventional-digital steps. These were compared with those fabricated completely conventionally in terms of storage duration.Material and methodsFive sets of maxillary and mandibular wax trial dentures were milled from a gingiva-colored wax blank (Ceramill D-Wax, Amann Girrbach AG) using the Ceramill Motion 2 System (Amann Girrbach), scanned, and matched by best-fit triangulation for each of the 5 denture pairs. Processing deformation was measured and the maximum deviations calculated. A 3-dimensional color-coded mapping of the differences between each pair of dentures was generated. Five sets of maxillary and mandibular wax trial dentures were processed with digital steps, and 5 sets of maxillary and mandibular wax trial dentures were fabricated in the conventional way with the help of a silicone index from a CAM-fabricated wax trial denture to standardize the wax amount. All dentures were scanned immediately after waxing and after 1 week of storage. After surface matching, the deformation was measured, and the milled wax bases were compared with those conventionally fabricated. Data were interpreted using descriptive statistics.ResultsThe occlusion of wax trial dentures fabricated with digital steps was not reproducible. The deviations in the maxillary dentures were mostly marginal, with exceptions for single teeth/tooth groups in denture No. 2 (occlusal areas of teeth in second quadrant, second molars) and No. 4 (central incisor and canine in second quadrant inclined to palatal side, and first premolar in first quadrant and first molar in second quadrant displayed greater deviations). Among the mandibular dentures, denture Nos. 4 and 5 the central incisor (fourth quadrant) inclined to the labial side. Additionally, in denture No. 5 the lateral incisor (fourth quadrant) inclined to the lingual side.ConclusionsIn digitally fabricated dentures, the manual placing of the teeth into the denture base sockets can lead to deviations from the planned arrangement. The deviations were greater in the area of the denture bases in the conventionally fabricated dentures compared with those processed with combined conventional-digital steps. The milled wax bases showed better contraction behavior than the conventionally fabricated wax bases.



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Influence of spark erosion on the fit of screw-retained Co-Cr fixed complete denture frameworks veneered with different materials

Publication date: Available online 29 September 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Anna Gabriella Camacho Presotto, Luciana Valadares Oliveira, Marina Xavier Pisani, Valentim Adelino Ricardo Barão, Marcelo Ferraz Mesquita
Statement of problemSpark erosion is a fit corrective technology that can be used even after the veneering material has been applied. The framework does not require sectioning, thus preserving its mechanical resistance. However, the spark erosion effect on veneered Co-Cr fixed complete denture (FCD) frameworks has not been investigated.PurposeThe purpose of this in vitro study was to evaluate whether spark erosion is effective in improving marginal fit on screw-retained Co-Cr FCD frameworks veneered with different materials. A comparison between ceramic applications and simulated ceramic firing cycles was also investigated.Material and methodsForty FCD frameworks were fabricated with a Co-Cr alloy. Four groups (n=10) were obtained according to the veneer material used on frameworks: HR (heat-polymerized resin); LR (light-polymerized resin); C (ceramic); and SC (simulated ceramic firing cycle). The spark erosion process was conducted for all groups. The marginal fit was analyzed according to the single-screw test protocol, and the measurements were performed at 3 evaluation times: initial, after veneer material application, and after spark erosion process. The results were submitted to a 2-way repeated measures ANOVA and the Tukey honest significant differences test (α=.05).ResultsPoorer marginal fit (in micrometers) was noted after veneer material application, where the HR and C groups presented the worst values (HR: 170; LR: 72; C: 165; SC: 86; P<.05). The spark erosion process was effective in improving the fit for all groups (HR: 109; LR: 52; C: 110; SC: 60; P<.05).ConclusionsSpark erosion improved the fit of Co-Cr FCD frameworks veneered with different materials. An actual ceramic application should be used to assess distortions generated by veneer material application instead of using only simulated ceramic firing cycles.



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An up to 50-year follow-up of crown and veneer survival in a dental practice

Publication date: Available online 29 September 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Ryan C. Olley, Manoharan Andiappan, Peter Frost
Statement of problemIndirect restorations are an important treatment in dental practice, but long-term survival studies are lacking.PurposeThe purpose of this retrospective study was to report on the outcome of indirect restorations, which were followed up annually for up to 50 years in a dental practice.Material and methodsA retrospective survival study was undertaken at a mixed National Health Service (NHS)/private dental practice in London, UK. Data were collected for restorations placed between 1966 and 1996 by 1 experienced operator. It was a requirement that patients had been followed up annually with clinical and radiographic examinations for up to 50 years. Patients were enrolled on a strict preventive policy and had excellent oral hygiene. Oral hygiene, restoration location, sensitivity, occlusion, and other details (preparation design, taper, cement used) were recorded. Restoration outcome was recorded as successful and surviving, unknown, or failed. The data were described descriptively. Kaplan-Meier survival curves and hazard curves were used to assess the survival of crowns and the probability of failure over time.ResultsA total of 223 restorations were placed in 47 patients between 1966 and 1996 and reviewed annually for up to 50 years (until 2016). These restorations included 154 metal-ceramic crowns (101 posterior and 53 anterior), 25 posterior gold crowns, 22 anterior ceramic veneers, and 22 anterior ceramic crowns. Restorations were in occlusion. The mean survival for metal-ceramic crowns was estimated as 47.53 years (95% confidence interval [CI]: 45.59-49.47 years). Failures in metal-ceramic crowns (n=6, 3.9%) were due to periapical periodontitis. The remaining restoration types had 100% survival at 50 years.ConclusionsThis study showed that the survival of crowns and veneers is high over 50 years in clinical practice with annual follow-up and good oral hygiene. The proportion of teeth with loss of vitality, confirmed clinically and with radiographs, was minimal.



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Stress distribution of single-implant–retained overdenture reinforced with a framework: A finite element analysis study

Publication date: Available online 28 September 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Camilla F. Amaral, Rafael S. Gomes, Renata C.M. Rodrigues Garcia, Altair A. Del Bel Cury
Statement of problemStudies have demonstrated the effectiveness of a single-implant–retained mandibular overdenture for elderly patients with edentulism. However, due to the high concentration of stress around the housing portion of the single implant, this prosthesis tends to fracture at the anterior region more than the 2-implant–retained mandibular overdenture.PurposeThe purpose of this finite-element analysis study was to evaluate the stress distribution in a single-implant–retained mandibular overdenture reinforced with a cobalt-chromium framework, to minimize the incidence of denture base fracture.Material and methodsTwo 3-dimensional finite element models of mandibular overdentures supported by a single implant with a stud attachment were designed in SolidWorks 2013 software. The only difference between the models was the presence or absence of a cobalt-chromium framework at the denture base between canines. Subsequently, the models were imported into the mathematical analysis software ANSYS Workbench v15.0. A mesh was generated with an element size of 0.7 mm and submitted to convergence analysis before mechanical simulation. All materials were considered to be homogeneous, isotropic, and linearly elastic. A 100-N load was applied to the incisal edge of the central mandibular incisors at a 30-degree angle. Maximum principal stress was calculated for the overdenture, von Mises stress was calculated for the attachment and implant, and minimum principal stress was calculated for cortical and cancellous bone.ResultsIn both models, peak stress on the overdenture was localized at the anterior intaglio surface region around the implant. However, the presence of the framework reduced the stress by almost 62% compared with the overdenture without a framework (8.7 MPa and 22.8 MPa, respectively). Both models exhibited similar stress values in the attachment, implant, and bone.ConclusionsA metal framework reinforcement for a single-implant–retained mandibular overdenture concentrates less stress through the anterior area of the prosthesis and could minimize the incidence of fracture.



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Evaluation of fracture resistance of inlay-retained fixed partial dentures fabricated with different monolithic zirconia materials

Publication date: Available online 29 September 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Hilal Siriner Gumus, Nilufer Tulin Polat, Guler Yildirim
Statement of problemData are lacking on the fracture resistance of monolithic zirconia inlay-retained fixed partial dentures as a conservative treatment for a single missing tooth.PurposeThe purpose of this in vitro study was to evaluate the fracture resistance of inlay-retained fixed partial dentures produced from 3 different monolithic zirconia materials and based on 2 preparation types and applications with and without thermocycling.Material and methodsA model with missing right and left mandibular first molars was used for different cavity preparations. A tube-shaped cavity and a box-shaped cavity were prepared. Seventy-two epoxy resin casts were prepared from an additional silicone impression. Twenty-four inlay-retained fixed partial dentures from each monolithic zirconia material (Prettau, Zirkonzahn; Katana, Noritake; and Copran, Whitepeaks) were fabricated for each preparation type and cemented to their epoxy model with dual-polymerizing adhesive resin cement; 50% of all specimens were thermocycled for 10000 cycles. The specimens were subjected to a fracture resistance test using a universal testing machine with a crosshead speed of 0.5 mm/min. Fracture surfaces were examined with scanning electron microscopy (SEM), and a specimen from each group was examined for structural changes with differential thermal analysis (DTA).ResultsNo statistically significant differences in terms of fracture resistance were found among brands with both cavity designs and with and without thermal cycles (P>.05). However, SEM and DTA results showed some changes in monolithic zirconia structure after 1 year of aging.ConclusionsThe brands and cavity preparation types for single posterior tooth loss generated similar fracture resistance.



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Effect of brushing and thermocycling on the shade and surface roughness of CAD-CAM ceramic restorations

Publication date: Available online 29 September 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Judy Chia-Chun Yuan, Valentim Adelino Ricardo Barão, Alvin G. Wee, Maria F. Alfaro, Fatemeh S. Afshari, Cortino Sukotjo
Statement of problemThe effects of toothbrushing (B) and thermocycling (TC) on the surface texture of different materials with various fabrication processes have been investigated. However, studies of computer-aided design and computer-aided manufacturing (CAD-CAM) ceramic restorations are limited.PurposeThe purpose of this in vitro study was to evaluate the effect of B and TC on the color stability and surface roughness of extrinsically characterized and glazed CAD-CAM ceramic restorations.Material and methodsLithium disilicate CAD ceramic (n=90) and zirconia ceramic (n=90) were studied. All specimens were crystallized/sintered, characterized, and glazed following the manufacturer's recommendation. The specimens were divided into 9 different groups: B, TC, and a combination of B plus TC (B+TC). Brushing was performed at 50 000, 100 000, and 150 000 cycles, simulating an oral environment of 5, 10, and 15 years. Thermocycling was performed at 6000, 12 000, and 18 000 cycles, simulating an oral environment of 5, 10, and 15 years. Brushing plus TC was performed with the combination of the 50 000 cycles of B, then 6000 cycles of TC, and 10 000 cycles of B, then 12 000 cycles of TC, and 15 000 cycles of B, then 18 000 cycles of TC. The color and surface roughness of each specimen were measured before and after all interventions with simulated cycles. Color differences (ΔE) and surface roughness (ΔRa) data were analyzed using 2-way ANOVA, followed by the least significant difference test (α=.05). The correlation between ΔE and ΔRa was statistically analyzed using the Pearson correlation analysis.ResultsWithin the lithium disilicate CAD groups, intervention did not result in any significant differences in color change (P>.05). Within the zirconia groups, a 15-year clinical simulation revealed significantly higher ΔE values than a simulated 5-year exposure (P=.017). Increased simulated cycles showed significantly higher Ra values for all groups. Within the zirconia groups, B revealed significantly smoother surfaces than TC (P<.001) and B+TC interventions (P<.001). For the zirconia, simulating B+TC for15 years revealed significantly higher Ra values than the groups of B+TC for 5 years (P<.001) and B+TC for 10 years (P=.003). No correlation (lithium disilicate CAD, r=.079; P=.462; zirconia, r=.001; P=.989) was found between the color change and surface roughness.ConclusionsFor both lithium disilicate CAD and zirconia, color changes were below the selected clinical perceptible threshold (ΔE=2.6) after all intervention and simulated cycles. All mean surface roughness measurements were below 0.2 μm. Generally, the surface of both lithium disilicate CAD and zirconia became rougher. No correlation was found between color difference and surface roughness for either material.



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A clinical technique for virtual articulator mounting with natural head position by using calibrated stereophotogrammetry

Publication date: Available online 29 September 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Walter Y.H. Lam, Richard T.C. Hsung, Winnie W.S. Choi, Henry W.K. Luk, Leo Y.Y. Cheng, Edmond H.N. Pow
Accurate articulator-mounted casts are essential for occlusion analysis and for fabrication of dental prostheses. Although the axis orbital plane has been commonly used as the reference horizontal plane, some clinicians prefer to register the horizontal plane with a spirit level when the patient is in the natural head position (NHP) to avoid anatomic landmark variations. This article presents a digital workflow for registering the patient's horizontal plane in NHP on a virtual articulator. An orientation reference board is used to calibrate a stereophotogrammetry device and a 3-dimensional facial photograph with the patient in NHP. The horizontal plane can then be automatically registered to the patient's virtual model and aligned to the virtual articulator at the transverse horizontal axis level. This technique showed good repeatability with positional differences of less than 1 degree and 1 mm in 5 repeated measurements in 1 patient.



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Clinical assessment of fractured implant abutment screws: The Bernese silicone replica technique

Publication date: Available online 29 September 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Kensuke Igarashi, Kelvin I. Afrashtehfar
Fractured implant abutment screws can be retrieved with repair or rescue devices. However, whether the screw was completely retrieved or the inner implant body was damaged may be uncertain. A silicone replica technique was recently implemented in Bern and may be the most predictable method available at the moment for clinically assessing the internal implant body. This technique is straightforward and precise and may help dentists determine the internal implant condition when managing a fractured screw.



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Marginal and internal fit of pressed lithium disilicate inlays fabricated with milling, 3D printing, and conventional technologies

Publication date: Available online 29 September 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Foudda R. Homsy, Mutlu Özcan, Marwan Khoury, Zeina A.K. Majzoub
Statement of problemThe subtractive and additive computer-aided design and computer-aided manufacturing (CAD-CAM) of lithium disilicate partial coverage restorations is poorly documented.PurposeThe purpose of this in vitro study was to compare the marginal and internal fit accuracy of lithium disilicate glass-ceramic inlays fabricated with conventional, milled, and 3-dimensional (3D) printed wax patterns.Material and methodsA dentoform mandibular first molar was prepared for a mesio-occlusal ceramic inlay. Five groups of 15 inlays were obtained through conventional impression and manual wax pattern (group CICW); conventional impression, laboratory scanning of the stone die, CAD-CAM milled wax blanks (group CIDW) or 3D printed wax patterns (group CI3DW); and scanning of the master preparation with intraoral scanner and CAD-CAM milled (group DIDW) or 3D printed wax patterns (group DI3DW). The same design was used to produce the wax patterns in the last 4 groups. The replica technique was used to measure marginal and internal adaptation by using stereomicroscopy. Mixed-model ANOVA was used to assess differences according to the groups and discrepancy location (α=.05).ResultsGroup DIDW showed the smallest marginal discrepancy (24.3 μm) compared with those of groups CICW (45.1 μm), CIDW (33.7 μm), CI3DW (39.8 μm), and DI3DW (39.7 μm) (P<.001). No statistically significant differences were detected among groups CICW, CIDW, CI3DW, and DI3DW relative to the marginal discrepancy. The internal discrepancy was significantly larger than the marginal discrepancy within all groups (P<.001).ConclusionsLithium disilicate glass-ceramic inlays produced from digital impressions and subtractive milling of wax patterns resulted in better marginal and internal fit accuracy than either conventional impression/fabrication or additive 3D manufacturing. Three-dimensional printed wax patterns yielded fit values similar to those of the conventionally waxed inlays.



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Effect of polymerization temperature on the properties of autopolymerizing resin

Publication date: Available online 28 September 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Koji Morita, Hiroki Tsuka, Kan Kato, Kazuhiro Tsuga
Statement of problemThe polymerization conditions of an autopolymerizing resin affect its physical properties, and at chairside, 3 different methods are commonly used: cooling in cold water, warming in warm water, and heating in hot water. However, the effects of polymerization temperature on the physicomechanical properties of autopolymerizing resin are unclear.PurposeThe purpose of this in vitro study was to determine the effect of polymerization temperature on the physicomechanical properties of autopolymerizing resin, including shrinkage, water absorption, surface roughness, amount of residual monomer, and flexural strength.Material and methodsThe experiment was designed to simulate a direct technique commonly used for the fabrication of interim crowns. Autopolymerizing resin specimens were made according to the powder-to-liquid ratio recommended by the manufacturer and soaked in water at 13°C, 37°C, or 60°C for 2 minutes to mold the resin until polymerization was completed 4 minutes after mixing. Shrinkage, water absorption rate, surface roughness, residual monomer, and flexural strength were measured immediately after polymerization and after 1, 3, and 7 days in distilled water at 37°C. Differences among these properties among the 3 different temperatures groups were statistically analyzed by using 1-way ANOVA and the Tukey honest significant difference test (α=.05).ResultsShrinkage tests showed that the 13°C group had significantly lower shrinkage (P=.004 for 37°C and P<.001 for 60°C) than the other groups immediately after specimen preparation. The 13°C group had significantly higher surface roughness after 0 (P<.001 for 37°C and P<.001 for 60°C), 1 (P=.025 for 37°C and P=.012 for 60°C), 3 (P<.001 for 37°C and P<.001 for 60°C), and 7 days (P<.001 for 37°C and P<.001 for 60°C) than those in the other groups and significantly higher water absorption rates (P=.033 for 37°C and P<.001 for 60°C) than the other groups during the 7 days after fabrication. However, the 13°C group showed significantly higher weight percentage of residual monomers than the 60°C group at 0 (P<.001) and 1 day (P<.001). Finally, 3-point bend tests showed that the 13°C group had significantly lower flexural strength at 0 (P<.001), 1 (P<.001), 3 (P<.001), and 7 days (P<.001) than the other groups.ConclusionsThe temperature environment during dental chairside polymerization of the autopolymerizing resin affected the physicomechanical properties of shrinkage, water absorption rate, surface roughness, residual monomer, and flexural strength.



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Oral health-related quality of life and masticatory function after conventional prosthetic treatment: A cohort follow-up study

Publication date: Available online 28 September 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Teresa Palomares, Javier Montero, Eva M. Rosel, Ramón Del-Castillo, Juan I. Rosales
Statement of problemThe impact of conventional prosthetic treatment on both the objective and subjective assessments of mastication as well as on well-being is unclear.PurposeThe purpose of this clinical study was to compare the impact on oral health-related quality of life and masticatory function in participants treated with conventional dental prostheses.Material and methodsA total of 72 patients requiring prosthetic rehabilitation were enrolled by referral from the Faculty of Dentistry at the University of Granada, Spain. At baseline, demographic, behavioral, and clinical (prosthetic status, occlusal units) data were collected. In addition, the scores for quality of life, oral satisfaction, masticatory ability (Leake index), and masticatory performance (after 5, 10, and 15 cycles of bicolored chewing gum) were obtained. These records were obtained again at 6 to 8 weeks after insertion of the prostheses.ResultsThe findings revealed that patients treated with fixed prostheses had better quality of life and better masticatory function than patients treated with removable prostheses. This result was even more pronounced for those treated with complete dentures. For all items, most of the treated patients improved the quality of life (average, 8.6 of the 4 items), although only between 5% and 15% of patients, especially those with a removable prosthesis, commented on functional impact after receiving treatment. Generally, masticatory performance was improved between 7% and 18% and was highly correlated not only with the number of natural teeth (r=0.61) and occlusal units (r=0.51) but also with subjective variables such as mastication satisfaction (r=0.31), impact on quality of life (r=0.30), or masticatory ability (r=0.30).ConclusionsTreatment with fixed prostheses achieved better results regarding quality of life, oral satisfaction, and masticatory function than treatment with removable prostheses. A moderate but significant correlation exists between the objective and subjective assessments of the masticatory functions.



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