Parvalbumin Interneurons Shape Neuronal Vulnerability in Blunt TBI

Abstract

Excessive excitation has been hypothesized to subsume a significant part of the acute damage occurring after traumatic brain injury (TBI). However, reduced neuronal excitability, loss of neuronal firing, and a disturbed excitation/inhibition balance have been detected. Parvalbumin (PV) interneurons are major regulators of perisomatic inhibition, principal neurons firing, and overall cortical excitability. However, their role in acute TBI pathogenic cascades is unclear. We exploited the chemogenetic Pharmacologically Selective Activation Module and Pharmacologically Selective Effector Module control of PV-Cre⁺ neurons and the Designer Receptors Exclusively Activated by Designer Drug (DREADD) control of principal neurons in a blunt model of TBI to explore the role of inhibition in shaping neuronal vulnerability to TBI. We demonstrated that inactivation of PV interneurons at the instance or soon after trauma enhances survival of principal neurons and reduces gliosis at 7 dpi whereas, activation of PV interneurons decreased neuronal survival. The protective effect of PV inactivation was suppressed by expressing the nuclear calcium buffer PV-nuclear localisation sequence in principal neurons, implying an activity-dependent neuroprotective signal. In fact, protective effects were obtained by increasing the excitability of principal neurons directly using DREADDs. Thus, we show that sustaining neuronal excitation in the early phases of TBI may reduce neuronal vulnerability by increasing activity-dependent survival, while excess activation of perisomatic inhibition is detrimental to neuronal integrity.

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Spreading of Tau Pathology in Sporadic Alzheimer’s Disease Along Cortico-cortical Top-Down Connections

Abstract

By using AT8-immunocytochemistry that visualizes hyperphosphorylated tau protein, we examined neurofibrillary changes related to sporadic Alzheimer's disease (AD) in N = 40 individuals at neurofibrillary tangle (NFT) stages I–IV. We report the presence of abnormal tau changes within solitary pyramidal neurons in layers III and V of the neocortex. These pyramidal cells showed pathology in different cell compartments (dendritic, somatic, axonal) that appeared to occur sequentially: Tau pathology was seen in distal segments of the basal dendrites, then in proximal dendrites, the soma, and, finally, in the axon of affected neurons. These findings are remarkable in that they point to the existence of neurofibrillary changes in regions routinely associated with later NFT stages. In addition, they lend support to the idea that it may be the axons of cortico-cortical top-down neurons in neocortical fields involved in AD that carry and spread abnormal tau seeds in a focused manner (transsynaptically) into the distal dendritic segments of nerve cells following directly in the neuronal chain, thereby sustaining further tau-seeded templating.

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Effects of perineural invasion in prostate needle biopsy on tumor grade and biochemical recurrence rates after radical prostatectomy

Publication date: July 2018
Source:The Kaohsiung Journal of Medical Sciences, Volume 34, Issue 7
Author(s): Serdar Celik, Ozan Bozkurt, Omer Demir, Ozgur Gurboga, Burcin Tuna, Kutsal Yorukoglu, Guven Aslan
To predict local invasive disease before retropubic radical prostatectomy (RRP), the correlation of perineural invasion (PNI) on prostate needle biopsy (PNB) and RRP pathology data and the effect of PNI on biochemical recurrence (BR) were researched. For patients with RRP performed between 2005 and 2014, predictive and pathologic prognostic factors were assessed. Initially all and D'Amico intermediate-risk group patients were comparatively assessed in terms of being T2 or T3 stage on RRP pathology, positive or negative for PNI presence on PNB and positive or negative BR situation. Additionally the effect of PNI presence on recurrence-free survival (RFS) rate was investigated. When all patients are investigated, multivariate analysis observed that in T3 patients PSA, PNB Gleason score (GS) and tumor percentage were significantly higher; in PNI positive patients PNB GS, core number and tumor percentage were significantly higher and in BR positive patients PNB PNI positivity and core number were significantly higher compared to T2, PNI negative and BR negative patients, separately (p < 0.05). When D'Amico intermediate-risk patients are evaluated, for T3 patients PSA and PNB tumor percentage; for PNI positive patients PNB core number and tumor percentage; and for BR positive patients PNB PNI positivity were significantly higher compared to T2, PNI negative and BR negative patients, separately (p < 0.05). Mean RFS in the whole patient group was 56.4 ± 4.2 months for PNI positive and 96.1 ± 5.7 months for negative groups. In the intermediate-risk group, mean RFS was 53.7 ± 5.1 months for PNI positive and 100.3 ± 7.7 months for negative groups (p < 0.001). PNI positivity on PNB was shown to be an important predictive factor for increased T3 disease and BR rates and reduced RFS.



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Simplified scoring system for prediction of mortality in acute suppurative cholangitis

Publication date: July 2018
Source:The Kaohsiung Journal of Medical Sciences, Volume 34, Issue 7
Author(s): Barış Doğu Yıldız, Sabri Özden, Barış Saylam, Fahri Martlı, Mesut Tez
Our objective in this study was to identify the factors contributing to mortality in acute suppurative cholangitis which could be tested easily in every emergency clinic. This is a retrospective study enrolling 104 patients with acute suppurative cholangitis. Demographic and laboratory data were collected for analysis. In univariant analysis red cell distribution width, total bilirubin level, intensive care unit admission was identified as statistically significant (p < 0.05) to predict mortality. Three variables were statistically significant in multivariate analysis: total bilirubin level equal to or more than 6.9 mg/dl, red cell distribution width equal to or more than 14.45%, and admission to intensive care unit. We found a new scoring system for prediction of mortality in acute suppurative cholangitis utilizing only three variables. This would serve as a simplified, rapid way to direct patients for advanced interventions instead of wasting time with more complicated and time consuming multi-variable scoring systems.



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Influence of tidal volume on ventilation distribution and oxygenation during one-lung ventilation

Publication date: July 2018
Source:The Kaohsiung Journal of Medical Sciences, Volume 34, Issue 7
Author(s): Wei Wang, Mei-Ying Xu, Jing-Xiang Wu, Zhan-Qi Zhao




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Instructions to Authors

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Ayurveda metallic-mineral 'Bhasma-associated severe liver injury

Ayurveda Bhasma is a metallic-mineral preparation homogenised with herbal juices or decoctions and modified with heat treatment to apparently detoxify the heavy metals. It is widely recommended for the treatment of many disease conditions by practitioners of complementary and alternative medicine in the absence of good quality clinical trial evidence on its safety and efficacy. Heavy metal-induced liver injury is widely reported in the literature, and heavy metal adulteration of non-Bhasma-related Ayurveda and herbal products has been well described. We report a patient who developed severe liver injury requiring listing for liver transplantation for improved survival, after consumption of Bhasma for dyspepsia. This case describes the first documented case and toxicology analysis of Ayurveda Bhasma associated with severe drug-induced liver injury. Physicians must be alert regarding patient's use of supposedly safe Ayurveda Bhasma that may promote acute severe liver injury in the absence of other known aetiologies.

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Phytobezoar and duodenal ulcer as complication of Duodopa therapy in a patient affected by Parkinsons disease

Continuous duodenal infusion of levodopa/carbidopa intestinal gel (LCIG) is an established treatment to control motor fluctuations in Parkinson's disease. Duodenal infusion allows a steady absorption of the drug in the small bowel, reducing plasmatic fluctuations of levodopa. Some complications may occur during the treatment, often related to intrajejunal percutaneous endoscopic gastrostomy (PEG-J). We report a case of duodenal ulcer associated with a phytobezoar involving the end of jejunal probe, in a patient who underwent PEG-J for LCIG infusion. In the last 2 weeks, the patient suffered from abdominal pain and dyspepsia. Oesophagogastroduodenoscopy showed an ulcerative lesion of the duodenum due to traction of the jejunal tube; the end of the jejunal tube was wrapped in a phytobezoar. This case is interesting because of the extension of the ulcerative lesion due to PEG-J dislocation and because of the subtle symptoms associated with it.

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Just another case of bacterial meningitis... or... is it?

Non-traumatic cerebrospinal fluid (CSF) rhinorrhoea is a rare condition. We describe a case of a 62-year-old woman with pneumococcal bacterial meningitis who later was found to have CSF rhinorrhoea secondary to an eroding skull base tumour, which was proven to be pituitary macroadenoma on biopsy. She recovered well from meningitis without any neurological sequelae and underwent trans-sphenoidal surgery for tumour removal as well as dural repair.

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Ectopic insulinomas in the pelvis secondary to rectum neuroendocrine tumour

We describe a middle-aged woman with recurrent hypoglycaemia, who confirmed with rectum G1 neuroendocrine tumour (NET) 6 years ago. Biochemical assay showed high concentration of serum insulin and C-peptide associated with hypoglycaemia. Because of recurrent hypoglycaemia in June 2015, she underwent a resection of the tail of the pancreas. However, hypoglycaemia attack happened more frequently and severely. ⁶⁸Ga-DOTA-NOC positron emission tomography/CT revealed five foci in the pelvis with intense uptake. Immediately after excision of the pelvic lesions, insulin and C-peptide decreased to normal levels promptly, and therefore, serum glucose increased significantly. Hypoglycaemia was disappeared, and insulin and C-peptide were normal at 2 years follow-up after surgery. Immunohistochemistry validated the primary rectum NET and pelvic tumours expressed with higher insulin, somatostatin receptor and glucagon-like peptide-1. This is the first reported ectopic pelvic insulinomas secondary to rectum NET, which may originate both from neuroendocrine cells in the rectum and pelvic tissues.

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Pineal gland apoplexy mimicking as migraine-like headache

Description 

A 24-year-old female patient presented with acute-onset, vertex headache associated with photophobia, nausea and vomiting. Initially, the headache was mild (pain scale 4/10), but over the next 4–5 hours, the severity of the headache increased to pain scale of 8/10. She had a history of similar headaches of lesser intensity in the past. There was also a strong family history of migraine. Her mother and younger sister used to get similar headaches and got relieved with antimigraine medications. Exact details of her medication history were unavailable since the progression of severity of her headache was gradual. This was unlike thunderclap headache and, in high likelihood, another episode of migraine.

Her vitals were stable. Neurological examination, including funduscopy, was grossly normal

On radiological evaluation, the MRI brain showed T1-weighted hyperintense pineal gland, as seen on the axial view suggestive of intrapineal gland apoplexy (figure 1). The fluid–fluid interface is depicted by the horizontal...

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Unusual cause of elbow pain in a baseball pitcher

An adolescent, right hand-dominant, baseball pitcher presented to sports medicine clinic with posterolateral right elbow pain over 4 months. He rated his pain as 8/10 with pitching, especially at the late cocking phase of throwing. Prior to consult, he had rested 3 months from pitching, progressing to strengthening exercises, with no pain relief. On physical examination, he had 120° of active external rotation, 80° of active internal rotation, mild tenderness to palpation over the capitellum and normal elbow radiography. Magnetic resonance arthrogram of the right elbow revealed subtle, posterolateral joint capsular tear and adjacent synovial hypertrophy. The patient was diagnosed with elbow synovial fold syndrome that was causing impingement at the radiocapitellar joint and was referred to an orthopaedic surgeon. Arthroscopy revealed redundant tissue; scar formation at the radiocapitellar joint was debrided. The patient participated in physical therapy for 2 months and was able to start throwing 3 months later.

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Double tongue signs in a case of submandibular space infection

Description

Double tongue signs are a unique physical finding which involve an elevation of floor of the oropharynx caused by a bilateral infection of the submandibular space (a well-known example is Ludwig's angina) (figure 1A).1 2 In this case, an 80-year-old woman with a 10-year history of diabetes mellitus was referred to our emergency department. She presented with swelling from the submandibular region to the neck surface, with a 3-day history of continuous fever, weakness and fatigue. Physical examination revealed neck oedema with erythema and tenderness (figure 1B), without lymphadenopathy. The floor of the oropharynx was clearly swollen and elevated, such that it appeared to be a double tongue; this was erythematous and tender. Enhanced CT of the neck was performed, which revealed bilateral fluid retention with swollen surrounding soft tissues in the submandibular space (figure 2). We...

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Early-stage right temporal lobe variant of frontotemporal dementia: 3 years of follow-up observations

The right temporal lobe variant of frontotemporal dementia (FTD) is an uncommon progressive neurodegenerative disorder. We present the case of a 77-year-old right-handed man who presented with altered behaviour and problems with interpersonal relationships. He had no decline in cognitive function but brain perfusion single-photon emission CT demonstrated distinct hypoperfusion in the right temporal pole. At 2-year follow-up, he could not recognise his wife's relatives; and at 3-year follow-up, he had semantic aphasia. Decreased brain perfusion extended from the right temporal lobe into the contralateral temporal and both frontal lobes. These findings suggest that the right temporal lobe variant of FTD should be considered in elderly patients with altered behaviour and problems with interpersonal relationships, even if dementia is not suspected. The right anterior temporal lobe may play a key role in the onset of the early symptoms of this disease.

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Pseudo-Wellens syndrome secondary to concurrent cannabis and phencyclidine intoxication

Wellens' syndrome is an electrocardiographic pattern of T-wave changes associated with critical stenosis of the proximal left anterior descending artery, signifying imminent risk of an anterior-wall myocardial infarction. The Wellens' electrocardiographic pattern can also be noted in several cardiac and non-cardiac diseases. We chronicle here a unique case of a patient who presented with atypical left chest pain and dizziness for 6 hours. His pain started after he smoked phencyclidine-laced cannabis. Cardiac panel demonstrated normal troponin T levels. Electrocardiogram showed sinus rhythm with new deep biphasic T-wave inversions in anterolateral leads. Coronary angiography showed no pathological processes. Subsequently, ECG changes resolved coincidentally with the resolution of chest pain. He was eventually diagnosed with pseudo-Wellens' syndrome. This paper illustrates that physicians should be vigilant for Wellens' syndrome mimicked by acute phencyclidine and cannabis intoxication. Additionally, we present a review of various aetiologies of pseudo-Wellens' syndrome, especially in patients with substance abuse.

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Suction-induced retinopathy: optical coherence tomography correlations

We report a clinical case of a teenager whose eyes were exposed to highly negative suction pressures for brief seconds. The patient presented with a bilateral cystoid macular oedema associated with a thickening of outer nuclear layer evidenced by optical coherence tomography. The patient's constellation of findings is most easily explained by the abrupt expansion and traction of a cohesive vitreous base onto the retinal layers.

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Inflammatory myofibroblastic tumour: a rare cause of central airway obstruction

Description

A 70-year-old woman with no comorbidities presented with cough, wheezing, exertional dyspnoea and a sensation of throat fullness. She never smoked and was recently diagnosed with asthma based on a normal chest radiograph and pulmonary function testing but failed to improve with bronchodilators and steroids. Her initial chest radiograph was unremarkable, and spirometry suggested a fixed intrathoracic obstruction. CT of the chest obtained after 2 months showed an irregular density in the trachea, 1.4x1.7 cm (figure 1). Flexible bronchoscopy showed a polypoid mass 2–3 cm above the carina adherent to the right wall of the trachea (figure 2). Rigid bronchoscopy with neodymium-doped yttrium aluminium garnet (Nd:YAG) laser photoresection was performed. Given the vascular nature of the tumour, removal was complicated by significant bleeding, which required endobronchial epinephrine and laser coagulation. The patient recovered without further complications. Immunohistochemical staining on the excised tumour was positive for vimentin...

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Second look at Streptococcus sanguinis and the colon

Although the link between Streptococcus bovis bacteraemia and colon cancer is well established, bacteraemia from other viridans group streptococci that commonly colonise colonic mucosa may also herald occult malignancy. We present a case of Streptococcus sanguinis bacteraemia in an elderly man with new anaemia that led to the detection and removal of a high-grade colon neoplasm. This case contributes to a growing body of literature contending that unexplained streptococcal bacteraemia merits a thorough workup that may include relatively invasive procedures such as endoscopy. Diagnostic colonoscopy provides an opportunity to prevent invasive malignancy that may outweigh bleeding and perforation risks in elderly patients.

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Atypical presentation of type B aortic dissection mimicking appendicitis managed medically

This is a case of a 53-year-old male patient with a history of hypertension who developed sudden onset of right lower quadrant pain. On arrival, chest X-ray showed prominent aortic arch without cardiomegaly. CT of the abdomen/pelvis showed aortic dissection in descending aorta without rupture. CT of the chest displayed sparing of ascending and aortic arch. Ultrasound Doppler of the kidney displayed mild renal artery stenosis. Differential diagnosis was acute appendicitis, acute ureteric and severe gastroenteritis. The patient was started on oral blood pressure (BP) medicine to titrate off intravenous nicardipine and esmolol drip. After 10 days, he was switched to oral BP medicine. His leg pain was resolved with normal palpable pulse. One week later, his kidney function worsened. Thus, Lasix and minoxidil were stopped. The patient had no chest/abdominal pain and was tolerating the medicine well during his 2-week follow-up. Acute aortic dissection can be a fatal clinical emergency. Timing is critical during diagnosis and management of patients.

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EBV colitis with ulcerative colitis: a double whammy

We report this case of a 21-year-old immunocompetent man presenting with ulcerative colitis and superimposed Epstein-Barr virus (EBV) colitis. He presented for the first time with symptoms of blood-mixed diarrhoea and raised inflammatory markers. His endoscopic and histological appearances were found to be due to ulcerative colitis for which he was started on standard therapy with intravenous steroids. In spite of this, he continued to be symptomatic and his inflammatory markers continued to rise. A virology screen done showed evidence of previous EBV infection, and in view of poor response to immunosuppression, a superimposed infection was suspected. EBV DNA PCR done on colonic biopsies was found to be positive and the patient was started on intravenous ganciclovir to which he responded well. This case highlights the importance of considering a superimposed infection in patients with poor initial response to steroid therapy in inflammatory bowel disease.

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Adult-onset epileptic aphasia

Aphasia is a language disorder characterised by loss of ability to produce or comprehend written or spoken language. In majority of the cases, it is due to stroke. Aphasia may also present as an ictal or postictal state of temporal or frontal lobe seizures. Nevertheless, its isolated occurrence in individuals without a clear-cut history of seizures raises diagnostic difficulties with important therapeutic implications.

A case of epileptic aphasia is reported in which the diagnosis was confirmed by electroencephalogram with a dramatic therapeutic response to an antiepileptic drug.

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Anomalous aortic origin of a coronary artery with an intraseptal course: novel techniques in haemodynamic assessment

Description

A 7-year-old boy presented to the emergency room after an episode of syncope while at home. Although, it was non-exertional, it lasted 2 min and was preceded by angina-like chest pain. Vitals, physical examination, chest radiograph and ECG were normal. Subsequent cardiology evaluation led to an echocardiogram that showed anomalous origin of the left main coronary artery from the opposite sinus of Valsalva with adjacent ostia which was confirmed on CT angiography. In addition, it showed a long 2.5–3 cm deep intraseptal course of the left anterior descending (LAD) and short intraseptal course of the left circumflex (LCX) artery. Stress nuclear perfusion scan and Holter monitoring were negative, but stress cardiac MRI showed an inducible perfusion defect along the anterior interventricular septal wall most prominent at the mid-ventricular and basilar levels. Coronary angiography (figure 1 and video 1) and intravascular ultrasound demonstrated significant systolic compression of the intraseptal segment...

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Biots breathing associated with acute bacterial meningitis in a child

Description

A 19-month-old boy presented to the emergency room of our hospital with fever and drowsiness following asymmetric focal seizure. On examination the patient was somnolent, had signs of meningeal irritation and intermittent nystagmus. Laboratory examination revealed increased C-reactive protein (200 mg/L), procalcitonin (25.9 ng/mL) and hyponatraemia (132 mEq/L). The initial CT of the brain was normal. Given presumed meningoencephalitis, intravenous dexamethasone, vancomycin, ceftriaxone and acyclovir treatment was started, and the child was admitted to the paediatric intensive care unit. Several hours after the admission, irregular, jerky respirations appeared, consistent with Biot's breathing (figure 1). The patient developed hypertension (129/90 mm Hg) and relative bradycardia (90 bpm). Due to these signs, consistent with increased intracranial pressure, lumbar puncture was deferred and the child received mannitol with notable improvement in his condition. On hospital day 2, lumbar puncture revealed turbid fluid with an opening pressure of 5 cmH₂O, white blood cells...

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Subfoveal congenital hypertrophy of retinal pigment epithelium

Description

A 25-year-old man presented with slight blurring of vision in the right eye (RE), noted 3 years ago. There was no positive systemic history. His best corrected visual acuity was 6/9 in RE and 6/6 in the left eye (LE) at presentation. Anterior segment evaluation was unremarkable in both eyes with normal pupil light reflexes. Fundus evaluation revealed a flat circular lesion beneath the fovea, and was measured to be one-third of the size of the optic nerve head. It was a densely pigmented lesion, black in colour, with a surrounding depigmented whitish halo (figure 1). The LE was within normal range on clinical examination. Spectral domain optical coherence tomography (SD-OCT) of RE revealed the lesion to be irregular but flat with hyper-reflectivity at the level of the retinal pigment epithelium (RPE). Discontinuity of the ellipsoid zone was noted to be overlying some parts of the lesion. These findings were also accompanied...

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A case of massive haemoptysis

Description

A 77-year-old female never-smoker presented with massive haemoptysis. Admission plain chest radiograph was normal.

She was haemodynamically stable on presentation but the following morning she had a further large-volume haemoptysis (>500 mL), resulting in respiratory arrest. Following resuscitation, haemoglobin fell from 94 to 66 g/dL. CT angiogram was performed (figure 1).

Figure 1

Sagittal CT angiogram, performed once the patient was stabilised.

She had previously been investigated for small volume haemoptysis and left upper lobe mass-like consolidation, which had fully resolved following a course of antibiotics. Recent bronchoscopy was normal, with no pathological organisms. There was no evidence of malignancy or connective tissue disease, and there was no additional past medical history. CT imaging had been reviewed at a thoracic oncology multi-disciplinary meeting and the previous episode was attributed to non-specific infection.

Question

What is the diagnosis (see figure 1)?

(A) Pulmonary artery...

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Effectiveness of robo-assisted lower limb rehabilitation for spastic patients: A systematic review

Publication date: 15 October 2018
Source:Biosensors and Bioelectronics, Volume 117
Author(s): Divya Shakti, Lini Mathew, Neelesh Kumar, Chitra Kataria
BackgroundThough many rehabilitative treatments are available for treatment of spasticity, thus the effectiveness of different robo-rehabilitative devices needs to be evaluated through a systematic review.ObjectiveThe objective of this study is to focuses on the efficacy of Robot assistive rehabilitation device for the removal of spasticity from the lower limb of Spastic patients.Data SourcessourcesPubMed, Web of Sciences, EMBASE (Excerpta Medical database), CDSR (Cochrane database of systematic reviews), Scopus, IEEE Xplore, Wiley online library, MEDLINE (OvidSP), Science Direct, Springer Link were from January 1980 to September 2017Data ExtractionextractionSeventy-one publications from eleven databases published were selected using keywords Ankle foot, spasticity, robotic rehabilitation, efficacy of robotics and Ankle foot rehabilitation. The review is narrowed down to twenty-six articles which were selected for they focused on effects of Robot assistive rehabilitation device quantitatively.ResultA quantitative study from analyzing 26 studies comprising of 786 subjects is carried out. The major outcome of the effectiveness of the robot assistive therapy for the movement of ankle and functioning of gait is deduced. As the used protocols and treatment procedures vary, made comparative study complex or impracticable.ConclusionRobo-rehabilitation possesses an ability to provide unified therapy protocols with greater ease in comparison to conventional therapies. They continuously prove to be irreplaceable assistant devices when it comes to providing excellent treatment in terms of improvement from this study. Though many mechatronic devices are available but the devices for treatment of early stage rehabilitation of stroke patients is very limited.



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A DNA nanostructured aptasensor for the sensitive electrochemical detection of HepG2 cells based on multibranched hybridization chain reaction amplification strategy

Publication date: 15 October 2018
Source:Biosensors and Bioelectronics, Volume 117
Author(s): Dabin Chen, Duanping Sun, Zhiru Wang, Weiwei Qin, Liang Chen, Ledu Zhou, Yuanqing Zhang
Sensitive detection of cancer cells is beneficial to the early diagnosis of cancer and individual treatment. In the present study, a DNA nanostructured aptasensor was used for the sensitive electrochemical detection of human liver hepatocellular carcinoma cells (HepG2) based on multibranched hybridization chain reaction amplification strategy. We established a well-designed platform by immobilizing DNA tetrahedron, a three-dimensional DNA nanostructure, on the gold electrode to capture HepG2 cells more specifically and efficiently. Meanwhile, functional hybrid nanoprobes consisted of MIL-101@AuNPs (Au nanoparticles), numerous hemin/G-quadruplex DNAzyme from multibranched hybridization chain reaction, and natural horseradish peroxidase (HRP) was designed. The hybrid nanoprobes possessed the functions of specific discernment and enzymatic signal amplification simultaneously. With the help of nanoprobes, HepG2 cells were recognized and captured to form a DNA tetrahedron-cell-nanoprobe sandwich-like structure on the electrode surface. The lower detection limit of this established cytosensor is 5 cells per ml. Moreover, it delivered a broad detection range from 10² to 10⁷ cells per ml. The results revealed that the as-proposed cytosensor may be utilized as a powerful tool for early diagnosis of cancer in the future.



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An approach to the heating dynamics of residues from greenhouse-crop plant biomass originated by tomatoes ( Solanum lycopersicum , L.)

Abstract

The most representative of greenhouse-crop plant biomass residues of tomatoes (Solanum lycopersicum L.) were selected for this study by using X-ray fluorescence spectrometry (XRF) and X-ray powder diffraction (XRD). The heating dynamics in air in the 600–1150 °C range of these residues for the production of renewable energy and the resultant ashes have been investigated. A total of 11 elements were determined by XRF in the biomass ashes and some minor elements. The content of alkaline elements and chlorides decreased as increasing heating temperature and disappeared at 1150 °C. Alkaline salts, NaCl and KCl, were volatilized by heating since 800 °C. The total contents of S and P in the biomass ashes were associated to CaSO₄, and a complex phosphate identified by XRD. CaCO₃ present at 600 °C was decomposed to CaO with disappearance at 1000 °C. By heating, new silicates were formed by solid-state reactions in the biomass residue. The minor elements have been found in a relative proportion lower than 0.9 wt.% and they characterized the obtained ashes, with potential use as micronutrients.

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Impact of Regional Anesthesia on Gastroesophageal Cancer Surgery Outcomes: A Systematic Review of the Literature

Regional anesthesia may play a beneficial role in long-term oncological outcomes. Specifically, it has been suggested that it can prolong recurrence-free survival and overall survival after gastrointestinal cancer surgery, including gastric and esophageal cancer, by modulating the immune and inflammatory response. However, the results from human studies are conflicting. The goal of this systematic review was to summarize the evidence on the impact of regional anesthesia on immunomodulation and cancer recurrence after gastric and esophageal surgery. We conducted a literature search of 5 different databases. Two independent reviewers analyzed the quality of the selected manuscripts according to prespecified inclusion and exclusion criteria. Randomized controlled trials were assessed for potential sources of bias by using the Cochrane Risk of Bias tool. A total of 6 studies were included in the quality analysis and systematic review. A meta-analysis was not conducted for several reasons, including high heterogeneity among studies, low quality of the reports, and lack of standardized outcomes definitions. Although the literature suggests that regional anesthesia has some modulatory effects on the inflammatory and immunological response in the studied patient population, our systematic review indicates that there is no evidence to support or refute the use of epidural anesthesia or analgesia with the goal of reducing cancer recurrence after gastroesophageal cancer surgery. Accepted for publication May 23, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Juan P. Cata, MD, Department of Anaesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Centre, 1515 Holcombe Blvd, Unit 409, Houston, TX 77005. Address e-mail to jcata@mdanderson.org. © 2018 International Anesthesia Research Society

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Metabolic Disorders and Critically Ill Patients

No abstract available

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Epidural Analgesia and Subcutaneous Heparin 3 Times Daily in Cancer Patients With Acute Postoperative Pain

The use of epidural analgesia in conjunction with subcutaneous administration of unfractionated heparin 3 times per day could increase the risk of spinal epidural hematoma, but insufficient patient experience data exist to determine this. We retrospectively reviewed the incidence of spinal epidural hematoma in 3705 cases at our institution over a 7-year period of patients receiving acute postoperative epidural analgesia and heparin 3 times per day. No cases of spinal epidural hematoma were reported (95% CI, 0–0.0009952). Accepted for publication May 23, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Jackson Su, MD, Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Unit 409, 1515 Holcombe Blvd, Houston, TX 77030. Address e-mail to jsu@mdanderson.org. © 2018 International Anesthesia Research Society

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Proceedings From the Society for Advancement of Blood Management Annual Meeting 2017: Management Dilemmas of the Surgical Patient—When Blood Is Not an Option

Vigilance is essential in the perioperative period. When blood is not an option for the patient, especially in a procedure/surgery that normally holds a risk for blood transfusion, complexity is added to the management. Current technology and knowledge has made avoidance of blood transfusion a realistic option but it does require a concerted patient-centered effort from the perioperative team. In this article, we provide suggestions for a successful, safe, and bloodless journey for patients. The approaches include preoperative optimization as well as intraoperative and postoperative techniques to reduce blood loss, and also introduces current innovative substitutes for transfusions. This article also assists in considering and maneuvering through the legal and ethical systems to respect patients' beliefs and ensuring their safety. Accepted for publication April 20, 2018. Funding:None. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Gee Mei Tan, MMED, MBBS, Department of Anesthesiology, University of Colorado, School of Medicine, 13123 E 16th Ave, B090, Aurora, CO 80045. Address e-mail to Geemei.tan@childrenscolorado.org. © 2018 International Anesthesia Research Society

https://ift.tt/2KysexW

Prospective Observational Investigation of Capnography and Pulse Oximetry Monitoring After Cesarean Delivery With Intrathecal Morphine

BACKGROUND: Intrathecal morphine provides excellent analgesia after cesarean delivery; however, respiratory events such as apnea, bradypnea, and hypoxemia have been reported. The primary study aim was to estimate the number of apneas per subject, termed "apnea alert events" (AAEs) defined by no breath for 30–120 seconds, using continuous capnography in women who underwent cesarean delivery. METHODS: We performed a prospective, observational study with institutional review board approval of women who underwent cesarean delivery with spinal anesthesia containing 150-µg intrathecal morphine. A STOP-Bang obstructive sleep apnea assessment was administered to all women. Women were requested to use continuous capnography and pulse oximetry for 24 hours after cesarean delivery. Nasal sampling cannula measured end-tidal carbon dioxide (EtCO2) and respiratory rate (RR), and oxygen saturation (SpO2) as measured by pulse oximetry. Capnography data were defined as "valid" when EtCO2 >10 mm Hg, RR >5 breaths per minute (bpm), SpO2 >70%, or during apnea (AAE) defined as "no breath" (EtCO2, 30 kg/m2/weight >90 kg, and 11% with suspected obstructive sleep apnea (known or STOP-Bang score >3). The duration of normal capnography and pulse oximetry data was mean (SD) (range) 8:28 (7:51) (0:00–22:32) and 15:08 (6:42) (1:31–23:07) hours:minutes, respectively; 6 women did not use the capnography. There were 198 AAEs, mean (SD) duration 57 (27) seconds experienced by 39/74 (53%) women, median (95% confidence interval for median) (range) 1 (0–1) (0–29) per subject. Observation of RR by nurses was ≥14 bpm at all time-points for all women, r = 0.05 between capnography and nurse RR (95% confidence interval, −0.04 to 0.14). There were no clinically relevant adverse events for any woman. Sixty-five women (82%) had complaints with the capnography device, including itchy nose, nausea, interference with nursing baby, and overall inconvenience. CONCLUSIONS: We report 198 AAEs detected by capnography among women who underwent cesarean delivery after receiving intrathecal morphine. These apneas were not confirmed by the intermittent hourly nursing observations. Absence of observer verification precludes distinction between real, albeit nonclinically significant alerts with capnography versus false apneas. Discomfort with the nasal sampling cannula and frequent alerts may impact capnography application after cesarean delivery. No clinically relevant adverse events occurred. Accepted for publication April 26, 2018. Funding: This study was supported by an Investigator Research Grant (VT ID# ISR-2013–10323) from Medtronic, which provided financial support and the capnography equipment. The funding body had no role in the study design, raw data extraction and processing, data analysis or interpretation, writing of the manuscript, or manuscript submission for publication. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). This study was conducted at the Lucile Packard Children's Hospital, Stanford, California. Clinical trial number: clinicaltrials.gov (NCT02417038; April 10, 2015). Institutional review board: Shana Stolarczyk, Research Compliance Office, Stanford University, 3000 El Camino Real, Five Palo Alto Sq, 4th Floor, Palo Alto, CA 94306. E-mail: irbeducation@lists.stanford.edu; Shana.Stolarczyk@stanford.edu. Reprints will not be available from the authors. Address correspondence to Carolyn F. Weiniger, MBChB, Division of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Address e-mail to carolynfweiniger@gmail.com. © 2018 International Anesthesia Research Society

https://ift.tt/2tIaCsW

Opioids for Acute Pain Management in Patients With Obstructive Sleep Apnea: A Systematic Review

The intrinsic nature of opioids to suppress respiratory function is of particular concern among patients with obstructive sleep apnea (OSA). The association of OSA with increased perioperative risk has raised the question of whether patients with OSA are at higher risk for opioid-induced respiratory depression (OIRD) compared to the general population. The aims of this systematic review were to summarize current evidence with respect to perioperative OIRD, changes in sleep-disordered breathing, and alterations in pain and opioid sensitivity in patients with OSA. A systematic literature search of studies published between 1946 and October 2017 was performed utilizing the following databases: Medline, ePub Ahead of Print/Medline In-process, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PubMed—NOT-Medline and ClinicalTrials.Gov. Of 4321 initial studies, 40 met the inclusion criteria. The Oxford level of evidence was assessed. Overall, high-quality evidence on the comparative impact of acute opioid analgesia in OSA versus non-OSA patients is lacking. The current body of evidence is burdened by significant limitations including risk of bias and large heterogeneity among studies with regard to OSA severity, perioperative settings, outcome definitions, and the presence or absence of various perioperative drivers. These factors complicate an accurate interpretation and robust analysis of the true complication risk. Nevertheless, there is some consistency among studies with regard to a detrimental effect of opioids in the presence of OSA. Notably, the initial 24 hours after opioid administration appear to be most critical with regard to life-threatening OIRD. Further, OSA-related increased pain perception and enhanced opioid sensitivity could predispose patients with OSA to a higher risk for OIRD without overdosing. While high-quality evidence is needed, retrospective analyses indicate that critical, life-threatening OIRD may be preventable with a more cautious approach to opioid use, including adequate monitoring. Accepted for publication May 8, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Stavros G. Memtsoudis, MD, PhD, Departments of Anesthesiology, Critical Care, and Pain Management and Public Health, Hospital for Special Surgery, Weill Cornell Medical College, 535 E 70th St, New York, NY 10021. Address e-mail to memtsoudiss@hss.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2IEpc9M

Practice of Ultrasound-Guided Palpation of Neck Landmarks Improves Accuracy of External Palpation of the Cricothyroid Membrane

BACKGROUND: Ultrasonography can accurately identify the cricothyroid membrane; however, its impact on the subsequent accuracy of external palpation is not known. In this study, we tested the ability of anesthesia participants to identify the midpoint of the cricothyroid membrane using external palpation with and without ultrasound (US)-guided practice. METHODS: Following institutional ethics approval and informed consent, anesthesia participants consisting of anesthesia residents, fellows, and practicing anesthesia assistants underwent didactic teaching on neck landmarks. The participants were then randomized to practice palpation of neck landmarks with US guidance (US group) or without ultrasonography (non-US [NUS] group). After the practice session, each participant identified the cricothyroid membrane using external palpation on the neck of 10 volunteers and marked the anticipated entry point for device insertion (palpation point [PT]). The midpoint of the cricothyroid membrane of each volunteer had been premarked with invisible ink using ultrasonography (US point) by a separate member of the research team. The primary outcome was the accuracy rate defined as the percentage of the attempts with the distance ≤5 mm measured from the PT to US point for the participant. The primary outcome was compared between NUS and US groups using Wilcoxon rank sum test. A mixed-effect logistic regression or mixed-effect linear model was also conducted for outcomes accounting for the clustering and adjusting for potential confounders. RESULTS: Fifteen anesthesia participants were randomized to US (n = 8) and NUS (n = 7) groups. A total of 80 and 61 attempts were performed by the US and NUS groups, respectively. The median accuracy rate in the US group was higher than the NUS group (65% vs 30%; P = .025), and the median PT-US distance in the US group was shorter than in the NUS group (4.0 vs 8.0 mm; P = .04). The adjusted mean PT-US distance in the US group was shorter compared to the NUS group (adjusted mean [95% CI], 3.6 [2.9–4.6] vs 6.8 [5.2–8.9] mm; P

https://ift.tt/2tHh5Es

Dexmedetomidine Versus Remifentanil for Monitored Anesthesia Care During Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Randomized Controlled Trial

BACKGROUND: We hypothesized that, compared to remifentanil, dexmedetomidine used for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) performed under monitored anesthesia care (MAC) in nonintubated patients would result in fewer episodes of major respiratory adverse events (number of episodes of bradypnea, apnea or desaturation) but no difference in satisfaction with perioperative conditions. METHODS: Sixty (American Society of Anesthesiologists physical status I–III) patients scheduled to undergo EBUS-TBNA under MAC were randomized to receive either remifentanil (0.5 µg/kg IV bolus) in 10 minutes, followed by 0.05–0.25 µg/kg/min, or dexmedetomidine (0.4 µg/kg IV bolus) in 10 minutes, followed by 0.5–1.0 µg/kg/h. The primary outcome was the number of major respiratory adverse events (bradypnea, apnea, or hypoxia). The secondary outcomes included hemodynamic variables, discharge time from the postanesthesia care unit, endotracheal lidocaine use, patient's sedation using the Observer Assessment of Alertness/Sedation Scale, operative conditions, operator and patient satisfaction, pain, coughing, vocal cord mobility, recall, and nausea/vomiting. RESULTS: Dexmedetomidine produced significantly fewer episodes of major respiratory events (bradypnea, apnea, or desaturation), with 0 [0–0.5] episodes versus 2 [0–5] (median [interquartile range]) (P = .001), than did remifentanil. Fewer episodes of bradypnea or apnea (dexmedetomidine: 0 [0–0] versus remifentanil: 0 [0–0.5]; P = .031), and fewer episodes of desaturation (dexmedetomidine: 0 [0–0.5] versus remifentanil: 1 [0–4]; P = .039) were recorded in the dexmedetomidine group. The time needed for patients to meet postanesthesia care unit discharge criteria (Aldrete score: 9) after EBUS-TBNA was longer in the dexmedetomidine group (10 [3–37.5] minutes) versus the remifentanil group (3 [3–5] minutes) (P

https://ift.tt/2IEIDiC

Monitoring Depth of Hypnosis: Mid-Latency Auditory Evoked Potentials Derived aepEX in Children Receiving Desflurane-Remifentanil Anesthesia

BACKGROUND: The aepEXplus monitoring system, which uses mid-latency auditory evoked potentials to measure depth of hypnosis, was evaluated in pediatric patients receiving desflurane-remifentanil anesthesia. METHODS: Seventy-five patients, 1–18 years of age (stratified for age; 1–3, 3–6, 6–18 years, for subgroup analyses), were included in this prospective observational study. The aepEX and the bispectral index (BIS) were recorded simultaneously, the latter serving as a reference. The ability of the aepEX to detect different levels of consciousness, defined according to the University of Michigan Sedation Scale, investigated using prediction probability (Pk), and receiver operating characteristic (ROC) analysis, served as the primary outcome parameter. As a secondary outcome parameter, the relationship between end-tidal desflurane and the aepEX and BIS values were calculated by fitting in a nonlinear regression model. RESULTS: The Pk values for the aepEX and the BIS were, respectively, .68 (95% CI, 0.53–0.82) and .85 (95% CI, 0.73–0.96; P = .02). The aepEX and the BIS had an area under the ROC curve of, respectively, 0.89 (95% CI, 0.80–0.95) and 0.76 (95% CI, 0.68–0.84; P = .04). The maximized sensitivity and specificity were, respectively, 81% (95% CI, 61%–93%) and 86% (95% CI, 74%–94%) for the aepEX at a cutoff value of >52, and 69% (95% CI, 56%–81%) and 70% (95% CI, 57%–81%) for the BIS at a cutoff value of >65. The age-corrected end-tidal desflurane concentration associated with an index value of 50 (EC50) was 0.59 minimum alveolar concentration (interquartile range: 0.38–0.85) and 0.58 minimum alveolar concentration (interquartile range: 0.41–0.70) for, respectively, the aepEX and BIS (P = .69). Age-group analysis showed no evidence of a difference regarding the area under the ROC curve or EC50. CONCLUSIONS: The aepEX can reliably differentiate between a conscious and an unconscious state in pediatric patients receiving desflurane-remifentanil anesthesia. Accepted for publication May 8, 2018. Funding: This study was funded by Fonds NutsOhra, Amsterdam, the Netherlands (grant reference number: 1103-060) with an unrestricted project grant and departmental funding. The authors declare no conflicts of interest. Trial registration: https://ift.tt/2tH82DK, NTR2983. Reprints will not be available from the authors. Address correspondence to Yuen M. Cheung, MD, Department of Anesthesiology, Erasmus University Medical Center, Room H-1273, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Address e-mail to y.m.cheung@erasmusmc.nl. © 2018 International Anesthesia Research Society

https://ift.tt/2IDv3Mm

Observation and Experiment: An Introduction to Causal Inference

No abstract available

https://ift.tt/2N8wSnY

Remifentanil Stability

No abstract available

https://ift.tt/2IFwEkL

Cervical Spine Motion During Tracheal Intubation Using an Optiscope Versus the McGrath Videolaryngoscope in Patients With Simulated Cervical Immobilization: A Prospective Randomized Crossover Study

BACKGROUND: In patients with an unstable cervical spine, maintenance of cervical immobilization during tracheal intubation is important. In McGrath videolaryngoscopic intubation, lifting of the blade to raise the epiglottis is needed to visualize the glottis, but in patients with an unstable cervical spine, this can cause cervical spine movement. By contrast, the Optiscope, a rigid video-stylet, does not require raising of the epiglottis during tracheal intubation. We therefore hypothesized that the Optiscope would produce less cervical spine movement than the McGrath videolaryngoscope during tracheal intubation. The aim of this study was to compare the Optiscope with the McGrath videolaryngoscope with respect to cervical spine motion during intubation in patients with simulated cervical immobilization. METHODS: The primary outcome of the study was the extent of cervical spine motion at the occiput–C1, C1–C2, and C2–C5 segments. In this randomized crossover study, the cervical spine angle was measured before and during tracheal intubation using either the Optiscope or the McGrath videolaryngoscope in 21 patients with simulated cervical immobilization. Cervical spine motion was defined as the change in angle at each cervical segment during tracheal intubation. RESULTS: There was significantly less cervical spine motion at the occiput–C1 segment using the Optiscope rather than the McGrath videolaryngoscope (mean [98.33% CI]: 4.7° [2.4–7.0] vs 10.4° [8.1–12.7]; mean difference [98.33% CI]: −5.7° [−7.5 to −3.9]). There were also fewer cervical spinal motions at the C1–C2 and C2–C5 segments using the Optiscope (mean difference versus the McGrath videolaryngoscope [98.33% CI]: −2.4° [−3.7 to −1.2]) and −3.7° [−5.9 to −1.4], respectively). CONCLUSIONS: The Optiscope produces less cervical spine motion than the McGrath videolaryngoscope during tracheal intubation of patients with simulated cervical immobilization. Accepted for publication May 31, 2018. Funding: None. The authors declare no conflicts of interest. Clinical trial number: ClinicalTrials.gov (NCT03120546). Reprints will not be available from the authors. Address correspondence to Tae Kyong Kim, MD, PhD, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno, Seoul 03080, Republic of Korea. Address e-mail to ktkktk@gmail.com. © 2018 International Anesthesia Research Society

https://ift.tt/2tHTCmH

Preoperative High-Dose Methylprednisolone and Glycemic Control Early After Total Hip and Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial

BACKGROUND: To evaluate the effect of a single preoperative dose of 125 mg methylprednisolone (MP) on glycemic homeostasis early after fast-track total hip and knee arthroplasty. METHODS: One-hundred thirty-four patients undergoing elective unilateral total hip arthroplasty and total knee arthroplasty were randomized (1:1) to preoperative intravenous MP 125 mg (group MP) or isotonic saline intravenous (group C). All procedures were performed under spinal anesthesia, using a standardized multimodal analgesic regime. The primary outcome was the change in plasma glucose 2 hours postoperatively, and secondary outcomes included plasma C-peptide concentrations, homeostatic model assessment (HOMA), HOMA-IR (insulin resistance), and HOMA-B (β-cell function). Fasting blood samples were collected at baseline and 2, 6 (nonfasting), 24, and 48 hours after surgery with complete samples from 122 patients (group MP = 62, group C = 60) for analyses. RESULTS: MP patients had increased plasma glucose levels at 2 hours (adjusted mean [95% CI], 7.4 mmol·L−1 [7.2–7.5] vs 6.0 mmol·L−1 [5.9–6.2]; P = .023) and 6 hours (13.9 mmol·L−1 [13.3–14.5] vs 8.4 mmol·L−1 [7.8–9.0]; P

https://ift.tt/2IFwE4f

Apparent Hyperthyroidism Caused by Biotin-Like Interference from IgM Anti-Streptavidin Antibodies

Thyroid, Ahead of Print.


https://ift.tt/2lKRypO

Sobetirome and its Amide Prodrug Sob-AM2 Exert Thyromimetic Actions in Mct8-Deficient Brain

Thyroid, Ahead of Print.


https://ift.tt/2tSicQW

Protective Effect of Metformin Against Thyroid Cancer Development: A Population-Based Study in Korea

Thyroid, Ahead of Print.


https://ift.tt/2lKRzdm

American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults

Thyroid, Ahead of Print.


https://ift.tt/2lGWwDI

Retraction of: Hair Iodine for Human Iodine Status Assessment, Thyroid 24(6);2014:1018–1026; DOI: 10.1089/thy.2012.0499

Thyroid, Ahead of Print.


https://ift.tt/2tSU3tC

Structure of a Thyrotropin Receptor Monoclonal Antibody Variable Region Provides Insight into Potential Mechanisms for its Inverse Agonist Activity

Thyroid, Ahead of Print.


https://ift.tt/2lIo77G

Predicting early death in older adults with cancer

Publication date: September 2018
Source:European Journal of Cancer, Volume 100
Author(s): Rabia Boulahssass, Sebastien Gonfrier, Jean -Marc Ferrero, Marine Sanchez, Véronique Mari, Olivier Moranne, Cyrielle Rambaud, Francine Auben, Jean -Michel Hannoun levi, Jean -Marc Bereder, Isabelle Bereder, Patrick Baque, Jean Michel Turpin, Anne-Claire Frin, Delphine Ouvrier, Delphine Borchiellini, Remy Largillier, Guillaume Sacco, Jerome Delotte, Cyprien Arlaud, Daniel Benchimol, Matthieu Durand, Ludovic Evesque, Abakar Mahamat, Gilles Poissonnet, Jérôme Mouroux, Jérôme Barriere, Emmanuel Benizri, Thierry Piche, Joel Guigay, Eric Francois, Olivier Guerin
BackgroundPredicting early death after a comprehensive geriatric assessment (CGA) is very difficult in clinical practice. The aim of this study was to develop a scoring system to estimate risk of death at 100 days in elderly cancer patients to assist the therapeutic decision.MethodsThis was a multicentric, prospective cohort study approved by an ethics committee. Elderly cancer patients aged older than 70 years were enrolled before the final therapeutic decision. A standardised CGA was made before the treatment decision at baseline. Within 100 days, event (death), oncologic and geriatric data were collected. Multivariate logistic regression was used to select the risk factors for the overall population. Score points were assigned to each risk factor using the β coefficient. Internal validation was performed by a bootstrap method. Calibration was assessed with the Hosmer–Lemeshow goodness of fit test and accuracy with the mean c-statistic.FindingsOne thousand fifty patients (mean age: 82 years) joined the study from April 2012 to December 2014. The independent predictors were metastatic cancers (odds ratio [OR] 2.5; 95% confidence interval [CI], [1.7–3.5] p<0 .001); gait speed<0.8 m/s (OR 2.1; 95% CI [1.3–3.3] p=0.001); Mini Nutritional Assessment (MNA) < 17 (OR 8; 95% CI; [3.7–17.3] p<0.001), MNA ≤23.5 and ≥ 17 (OR 4.4; 95% CI, [2.1–9.1) p<0.001); performance status (PS) > 2 (OR 1.7; 95% CI, [1.1–2.6)] p=0.015) and cancers other than breast cancer (OR 4; 95% CI, [2.1–7.9] p<0.001). We attributed 4 points for MNA<17, 3 points for MNA between ≤23.5 and ≥ 17, 2 points for metastatic cancers, 1 point for gait speed <0.8 m/s, 1 point for PS > 2 and 3 points for cancers other than breast cancer. The risk of death at 100 days was 4% for 0 to 6 points, 24% for 7 to 8 points, 39% for 9 to 10 points and 67% for 11 points.InterpretationTo our knowledge, this is the first score which estimates early death in elderly cancer patients. The system could assist in the treatment decision for elderly cancer patients.



https://ift.tt/2NeRTxw

Training for Medical Oncologists on Shared Decision‐Making About Palliative Chemotherapy: A Randomized Controlled Trial

AbstractBackground.Systemic treatment for advanced cancer offers uncertain and sometimes limited benefit, while the burden can be high. This study examines the effect of shared decision‐making (SDM) training for medical oncologists on observed SDM in standardized patient assessments.Materials and Methods.A randomized controlled trial comparing training with standard practice was conducted. Medical oncologists and oncologists‐in‐training (n = 31) participated in a video‐recorded, standardized patient assessment at baseline (T0) and after 4 months (T1, after training). The training was based on a four‐stage SDM model and consisted of a reader, two group sessions (3.5 hours each), a booster session (1.5 hours), and a consultation card. The primary outcome was observed SDM as assessed with the Observing Patient Involvement scale (OPTION12) coded by observers blinded for arm. Secondary outcomes were observed SDM per stage, communication skills, and oncologists' satisfaction with communication.Results.The training had a significant and large effect on observed SDM in the simulated consultations (Cohen's f = 0.62) and improved observed SDM behavior in all four SDM stages (f = 0.39–0.72). The training improved oncologists' information provision skills (f = 0.77), skills related to anticipating/responding to emotions (f = 0.42), and their satisfaction with the consultation (f = 0.53).Conclusion.Training medical oncologists in SDM about palliative systemic treatment improves their performance in simulated consultations. The next step is to examine the effect of such training on SDM in clinical practice and on patient outcomes.Implications for Practice.Systemic treatment for advanced cancer offers uncertain and sometimes limited benefit, while the burden can be high. Hence, applying the premises of shared decision‐making (SDM) is recommended. SDM is increasingly advocated based on the ethical imperative to provide patient‐centered care and the increasing evidence for beneficial patient outcomes. Few studies examined the effectiveness of SDM training in robust designs. This randomized controlled trial demonstrated that SDM training (10 hours) improves oncologists' performance in consultations with standardized patients. The next step is to examine the effect of training on oncologists' performance and patient outcomes in clinical practice.

https://ift.tt/2KuRHIy

Developing a Roadmap for Interventional Oncology

AbstractInterventional oncology uses image‐guided procedures to enhance cancer care. Today, this specialty plays an increasingly critical role in cancer diagnosis (e.g., biopsy), cancer therapy (e.g., ablation or embolization), and cancer symptom palliation (e.g., nephrostomies or biliary drainages). Although the number of procedures and technical capabilities has improved over the last few years, challenges remain. In this article we discuss the need to advance existing procedures, develop new ones, and focus on several operational aspects that will dictate future interventional techniques to enhance cancer care, particularly by accelerating drug development and improving patient outcomes.Implications for Practice.Interventional oncology is vital for cancer diagnosis, therapy, and symptom palliation. This report focuses on current interventional procedures and techniques with a look toward future improvements that will improve cancer care and patient outcomes.

https://ift.tt/2NdnXl5

Fear of Mastectomy Associated with Delayed Breast Cancer Presentation Among Ghanaian Women

AbstractBackground.Breast cancer is the leading cause of cancer mortality among women globally. Most women in Ghana present with advanced stage disease. The aim of this study is to characterize sociocultural factors associated with delayed presentation.Materials and Methods.Qualitative study (grounded theory, constant comparative method) using individual in‐depth interviews with breast cancer patients seen at the Korle Bu Teaching Hospital in Accra, Ghana. Interviews were conducted in English and three local languages. We achieved theoretical saturation with 31 participants.Results.The mean length of delay reported by patients was approximately 1 year. Five recurrent themes were related to delayed presentation: (a) Women with a confirmed breast cancer diagnosis delay treatment because of the fear of mastectomy due to self and societal stigma; (b) role of the church as a social support system given the societal stigma associated with breast cancer; (c) study participants expressed some awareness of breast cancer, but with varying depths of breast cancer knowledge encompassing both myths and misconceptions about breast cancer; (d) most patients present late because they do not associate a "painless" breast lump with possible breast malignancy; and (e) delayed presentation linked to significant financial burden associated with breast cancer treatment.Conclusion.Despite current efforts to increase breast cancer awareness, the fear of mastectomy remains one of the main reasons for delayed presentation. Successful breast cancer education programs will need to be framed within the broader sociocultural dimensions of femininity that address some of the stigma associated with mastectomy reported in the Ghanaian context.Implications for Practice.Most women in Ghana present with advanced‐stage disease. The aim of this study was to characterize sociocultural factors associated with delayed presentation. Although several quantitative studies have been conducted on delays in presentation in sub‐Saharan Africa (SSA), this study is one of the few to identify fear of mastectomy as a reason for delayed presentation. Anecdotal data from current clinical experiences in SSA suggest that this is still an issue that has not been adequately reported and addressed in most SSA countries. The research results presented here will hopefully guide health providers and national organizations in designing breast cancer education programs in Ghana and other parts of SSA.

https://ift.tt/2KynGrm

Occlusion, temporomandibular disorders, and orofacial pain: An evidence-based overview and update with recommendations

Publication date: Available online 29 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Michael J. Racich
This paper presents an overview of dental disciplines involved in the treatment of orofacial pain, temporomandibular disorders (TMD), and occlusion and provides an evidence-based contemporary update of their interrelationships. English language peer-reviewed articles were identified using PubMed. Key words bruxism, implants, occlusion, orofacial pain, orthodontics, prosthodontics, restorative dentistry, and TMD were used.



https://ift.tt/2IAkkCt

Replacement of maxillary incisor crowns over discolored substrates in a single visit with a CAD-CAM system and lithium silicate ceramic

Publication date: Available online 29 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Gustavo Dartora, Pedro Henrique Wentz Tretto, Rodrigo Varella de Carvalho, Atais Bacchi
Discolored substrates constitute a challenge to the esthetics of the definitive restoration. Because of technique sensitivity, the generally prolonged treatment time is a drawback to both the patient and the dentist. The technique described presents the replacement of ceramic maxillary incisors crowns over discolored substrates in a single visit by using a milling machine. Translucent blocks of a lithium silicate ceramic reinforced with zirconium dioxide particles were used. Intraoral scans of the trial restorations and of the tooth preparations were performed. The crown parameters were defined in the software. Ceramic blocks were milled in the presintered phase and characterized. The crowns were cemented at the end of the appointment with excellent esthetics.



https://ift.tt/2KkkzY9

Comparison of marginal fit between CAD-CAM and hot-press lithium disilicate crowns

Publication date: Available online 29 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Eran Dolev, Yoli Bitterman, Avi Meirowitz
Statement of problemHot-pressing and computer-aided design and computer-aided manufacturing (CAD-CAM) are major techniques for the fabrication of lithium disilicate crowns. They exhibit different accuracies regarding marginal fit, an important factor in restoration survival. However, studies comparing the marginal fit of different fabrication methods are lacking.PurposeThe purpose of this in vitro study was to compare the marginal discrepancy (MD) and absolute marginal discrepancy (AMD) of lithium disilicate crowns produced by the hot-press and CAD-CAM techniques.Material and methodsThirty (30) typodont teeth were divided into 2 groups. Fifteen teeth were scanned with the CEREC Omnicam intraoral scanner, and crowns were fabricated with the CEREC MC XL chairside CAD-CAM milling unit from IPS e.max CAD blocks. Fifteen typodont teeth were sent to a dental laboratory, and lithium disilicate crowns were fabricated from IPS e.max press ingots using the hot-press technique. The 30 crowns were cemented and then sectioned with a precision saw. The MD and AMD were measured for each crown with a light microscope. One-way ANOVA was conducted to analyze significant differences in crown marginal fit between the fabrication systems (α=.05).ResultsFor the CAD-CAM technique, the mean values of the AMD measurements were 115 μm, and for the hot-press technique, 130 μm. The MD measurements were 87 μm for the CAD-CAM technique and 90 μm for the hot-press technique. One-way ANOVA revealed no significant differences between the fabrication methods regarding marginal fit (P>05).ConclusionsNo significant differences were found between the fabrication methods tested. Both the CAD-CAM and hot-press techniques for producing monolithic lithium disilicate crowns produced MD values of less than 120 μm, within the clinically acceptable range.



https://ift.tt/2KuO7OC

A digital technique for fabricating an interim implant-supported fixed prosthesis immediately after implant placement in patients with complete edentulism

Publication date: Available online 29 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Ji-Hyeon Oh, Xueyin An, Seung-Mi Jeong, Byung-Ho Choi
The conversion of a denture into an interim implant-supported, screw-retained restoration has become the standard method for immediate interim restoration in patients with complete edentulism. The most critical steps of the denture conversion process are the creation of appropriate denture access holes to prevent displacement of the denture by the interim cylinders and removal of the denture flanges to facilitate both good esthetics and accessibility for oral hygiene after the denture is connected to the interim cylinders. This article presents a digital technique for designing and fabricating an interim implant-supported, fixed prosthesis for edentulous patients. The interim prosthesis has cylinder access holes that are digitally prefabricated and a denture flange part that is designed to be easily sectioned. This technique facilitates more straightforward and efficient immediate restoration for edentulous patients after implant placement.



https://ift.tt/2KzeNkD

Retentive strength and marginal discrepancies of a ceramic-reinforced calcium phosphate luting agent: An in vitro pilot study

Publication date: Available online 29 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Rishabh P. Acharya, Steven M. Morgano, Allyn C. Luke, Saul Weiner
Statement of problemInformation on the properties of a relatively new luting agent with a unique formulation (ceramic-reinforced calcium phosphate) is limited.PurposeThe purpose of this in vitro study was to compare the retentive strengths and marginal discrepancies of a ceramic-reinforced calcium phosphate luting agent (CM) with a self-adhesive resin luting agent (RX) and to determine and compare the mode of failure of dislodged cemented copings.Material and methodsForty extracted human molar teeth were prepared to receive zirconia copings. After cementation, the specimens were divided into 4 subgroups (n=10): CM A (axial loading), CM OA (off-axis loading), RX A (axial loading), and RX OA (off-axis loading). For each subgroup, 9 of the specimens received experimental treatment (thermocycling and dynamic loading), and the tenth received no experimental treatment. Eight copings were pulled off in a universal testing machine (MTS Insight; MTS). The ninth specimen was treated experimentally but was not pull tested. The marginal discrepancy and the dentin interface of the specimens that were not pull tested were analyzed with scanning electron microscopy and energy dispersion spectroscopy. The mode of failure of the dislodged copings was also subjectively evaluated.ResultsThe mean retentive strengths were 5.92 MPa for CM A, 5.81 MPa for CM OA, 5.75 MPa for RX A, and 5.69 MPa for RX OA. The marginal discrepancy recorded for both CM and RX ranged from 30 to 45 μm, (mean, 36 ±4.6 μm). Energy dispersion spectroscopy analysis showed the presence of calcium, phosphorus, silicon, and aluminum for the CM marginal discrepancy and the presence of aluminum in the dentinal tubules adjacent to the CM. Calcium and phosphorus were detected in lesser amounts adjacent to the RX marginal discrepancy. The mode of failure for CM was primarily adhesive to the tooth preparation, and, for RX, the failure mode was predominantly adhesive to the coping.ConclusionsCM had statistically significantly higher mean retentive strength compared with RX. Subgroups loaded axially had statistically significantly higher retentive strengths compared with those loaded off axis.



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Use of finite element analysis for the assessment of biomechanical factors related to pain sensation beneath complete dentures during mastication

Publication date: Available online 29 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Jaroslaw Żmudzki, Grzegorz Chladek, Piotr Malara
Statement of problemThe pain commonly suffered by denture wearers during mastication is not documented in the objective biomechanical criteria for the pressure pain threshold.PurposeThe purpose of this finite element analysis study was to determine whether the pressures developed beneath a removable mandibular complete denture during mastication would exceed the average pressure pain threshold in patients for whom the denture foundation had an acceptable load-bearing capacity.Material and methodsA patient with an acceptable load-bearing denture foundation was modeled with finite element analysis. The denture/mucosa interface was modeled as a sliding or detaching interface. A convex mandibular residual ridge, resilient mucosa, and denture were modeled in computer-aided design (CAD) software using curves and cross sections. A unilateral vertical occlusal load of 100 N was assumed only for model verification, and an oblique mastication load of 141 N was assumed for simulated mastication with balanced articulation. The nonworking-side occlusal contact was simulated in 2 situations: prompt nonworking-side occlusal contact and delayed nonworking-side occlusal contact by setting an initial distance of 0.1 mm or 1 mm between the denture and a flat solid above the nonworking side.ResultsThe denture was held to the mucosa under vertical force and a maximum pressure of 203 kPa. The denture was tilted under an oblique mastication load and achieved stability through nonworking-side occlusal contact. This means that the denture was supported not only by the denture foundation but also by the nonworking-side occlusal contact and had a downwardly directed stabilizing reaction force. The denture was weakly supported on the delayed nonworking-side occlusal contact compared with the prompt nonworking-side occlusal contact and weakly supported on the denture foundation. In delayed nonworking-side occlusal contact, the pressure beneath the denture was 783 kPa (>pressure pain threshold) compared with 484 kPa (<pressure pain threshold) in prompt nonworking-side occlusal contact. Despite the lower reaction force of the foundation in delayed nonworking-side occlusal contact, the pressure beneath the denture increased, indicating a reduction in the load transfer area due to the inclined position of the denture. Friction on the mucosal surface was over 14-fold higher for the delayed nonworking-side occlusal contact.ConclusionsThe pressure beneath a removable mandibular complete denture exceeded the average pressure pain threshold and was supported with a large slide, which produced friction. Although the value of the load on the occlusal side did not change, the pressure under the denture increased and the force of nonworking-side occlusal contact decreased because of increasing distance to nonworking-side occlusal contact.



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Adhesive evaluation of three types of resilient denture liners bonded to heat-polymerized, autopolymerized, or CAD-CAM acrylic resin denture bases

Publication date: Available online 29 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Jung Eun Choi, Tracey E. Ng, Chloe K.Y. Leong, Hansol Kim, Pu Li, John Neil Waddell
Statement of problemLevels of bond strength between different types of resilient denture liner materials bonded to different denture base acrylic resins, CAD-CAM acrylic resins in particular, have not been well reported.PurposeThe purpose of this study was to measure the tensile bond strength and durability of various combinations of 3 different resilient denture liners bonded to 3 different poly(methyl methacrylate) denture base materials.Material and methodsThe tensile bond strength of 3 resilient denture liners, namely Ufi Gel SC, Silagum-Comfort, and Vertex Soft, combined with heat-polymerized (Vertex Rapid Simplified), autopolymerized (Vertex Self-Curing), and computer-aided design and computer-aided manufacturing (CAD-CAM) (IvoBase CAD) denture base resins were tested by using a universal testing machine (total N=138). Half of the specimens were thermocycled between 5°C and 55°C for 1500 cycles before testing. After testing, modes of failure and interface surfaces were examined using light microscopy and scanning electron microscopy, respectively. Thermogravimetric analysis was carried out to analyze the differences in content between the 3 different denture base acrylic resins.ResultsThe mean tensile bond strength values ranged from 0.36 ±0.1 MPa to 1.51 ±0.46 MPa. CAD-CAM denture base materials showed the lowest range of bond strength when coupled to resilient denture liners (0.36 to 0.42 MPa). No statistically significant differences (P=.74) were found in bond strength between the thermocycled (0.71 ±0.23 MPa) and non-thermocycled groups (0.74 ±0.21 MPa). Silicone-based resilient denture liners exhibited the highest tensile strength with each type of denture resin. All 3 types of failure modes (adhesive, cohesive, and mixed modes) were observed.ConclusionsSilicone-based resilient denture liners produced the highest tensile bond strength to all denture bases tested. Resilient denture liners bonded to CAD-CAM denture bases produced the weakest tensile bond strengths. Thermocycling did not produce statistically significant differences in tensile bond strength of the resilient denture liners to the denture base resins.



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Osteogenesis ability of CAD-CAM biodegradable polylactic acid scaffolds for reconstruction of jaw defects

Publication date: Available online 29 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Mohamed H. Helal, Hebatullah D. Hendawy, Rowan A. Gaber, Nourhan R. Helal, Moustafa N. Aboushelib
Statement of problemReconstruction of alveolar bony defects is difficult using grafting materials in a powder form. A biodegradable scaffold material might simplify the procedure.PurposeThe purpose of this in vivo study was to evaluate osteogenesis ability of a biodegradable CAD-CAM–fabricated polylactic acid (PLA) scaffold enriched with calcium phosphate salts including hydroxyapatite (HA) and beta tricalcium phosphate (β-TCP) used to reconstruct mandibular defects in a dog model.Material and methodsSurgical defects were made bilaterally in the mandible of male beagle dogs. Computerized tomography images were obtained for determination of the 3-dimensional shape of the defects after 3 months of healing. Porous PLA scaffolds were fabricated by milling custom-made CAD-CAM blocks into the desired shape. After milling, half of the scaffolds were prepared by filling the pores of the scaffolds by a mixture of HA and β-TCP. Scaffolds were inserted in the mandibular defects bilaterally. After a healing time of 8 weeks, the bone-scaffold interface was analyzed histomorphometrically to detect the amount of new bone formation. Stained histological sections were examined using a computer software and depth of new bone formation was assessed (n=14, α=.05).ResultsHistomorphometric analysis revealed that enriched scaffolds with calcium phosphates had significantly (t=4.4, P<.001) higher amounts of new bone formation (1.3 ±0.33 mm) compared with the controls (0.7 ±0.39 mm). Average new bone growth in enriched scaffolds was 1.3 mm while almost half this value was observed in uncoated scaffolds, 0.7 mm.ConclusionsWithin the limitations of this animal study, HA and β-TCP enhanced osteogenesis ability of CAD-CAM–fabricated PLA scaffolds.



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Retention force and deformation of an innovative attachment model for mini-implant–retained overdentures

Publication date: Available online 29 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Mariana L.C. Valente, Marcos V.W. Shimano, José A.M. Agnelli, Andréa C. dos Reis
Statement of problemThe gradual loss of retention and the need for periodic replacement of attachment-system components are the most frequent complications in implant-supported overdentures.PurposeThe purpose of this in vitro study was to develop a new attachment system for overdentures with polymeric materials and compare its retention and deformation with a conventional O-ring attachment system.Material and methodsA matrix with 2 mini-implants with ball abutments was used to simulate the mandibular border during a fatigue resistance test. A total of 60 polyacetal (n=20), polytetrafluoroethylene (n=20), and conventional O-ring (n=20) attachments were captured in pairs with acrylic resin and subjected to 3625 insertion and removal cycles, simulating 30 months of overdenture use. The internal and external deformations of the attachments were assessed using an optical stereomicroscope. One-way ANOVA and the Tukey honestly significant difference tests were used for statistical evaluation (α=.05).ResultsThe polyacetal attachment system showed the highest retention (P<.001), followed by the O-ring and polytetrafluoroethylene attachments. The O-ring attachments exhibited the lowest deformation (P<.001), and the polyacetal attachments had the highest internal deformation (P<.001).ConclusionsThe newly developed polyacetal attachment model increased the retention of mini-implant–retained overdentures, and despite the deformation experienced, the retention period appears to be better than that of conventional systems.



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Accuracy of 3-dimensional computer-aided manufactured single-tooth implant definitive casts

Publication date: Available online 29 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Michele Buda, Manuel Bratos, John A. Sorensen
Statement of problemThe integration of the digital workflow into routine prosthodontic practice for single-tooth implant surgery and fixed prosthesis fabrication has occurred at a remarkable pace in the last 5 years. With the greater demands of esthetics and precision, the definitive implant analog cast must ensure accurate implant positioning as well as an accurate relationship to adjacent teeth.PurposeThe purpose of this in vitro study was to evaluate the accuracy of the 3-dimensional (3D) implant position of definitive casts produced by 3D printing and analog technology.Material and methodsA master patient model was created from a dentate typodont. The maxillary left central incisor was removed, and a Straumann RC implant was positioned for a screw-retained prosthesis. A laboratory scanner with an accuracy of 5 μm was used for all scanning. A scanbody was connected to the master model implant and scanned to create a master patient file, which served as the control master patient for all comparisons. The two 3D printing systems used for this study were the Statasys Objet500 (group OBJ), an industrial Polyjet production system, and the Formlabs Formlab 2 (group FORM), a budget SLA Vat system. In addition, a conventional gypsum cast (group GYP) with an implant analog was made with elastomeric impression material. With a sample size of 10 per group, each gypsum cast and 2 printed group casts were scanned with the D2000 laboratory scanner 5 times per cast. Convince software (3Shape) was used for 3D analysis to calculate accuracy. The following variables were measured: implant analog vertical displacement, horizontal displacement of implant platform and apex, degree of tilting in the vertical axis, and rotational position change around the vertical axis. Means and standard deviations were calculated for trueness. One-way ANOVA and the post hoc t test with Bonferroni correction were used to investigate any significant differences among the experimental groups (α=.05).ResultsFor vertical displacement of the implant body, group OBJ had the lowest value of –30 ±24 μm. The values obtained for OBJ and FORM were significantly different from that obtained for GYP (P<.05). For horizontal displacement of the implant shoulder, Group OBJ had the lowest value, 85 ±12 μm, and the difference among these groups was significantly different (P<.05). The value for horizontal displacement of the implant apex was 123 ±25 μm for group OBJ and not significantly different from that obtained for group GYP (136 ±40 μm) but significantly different from that obtained for group FORM (326 ±54 µm). Also, the analysis of implant body tilting in the vertical axis showed significant differences between the values obtained for groups GYP and OBJ and between the values obtained for groups OBJ and FORM. With regard to implant rotational position change around the vertical axis, the values obtained for the gypsum cast and group FORM were not statistically different from those obtained for the master patient control model (P>.05). However, the implant orientation of group OBJ was significantly different from the orientation of groups GYP and FORM (P<.05). The actual clinical relevance of these printing system discrepancies is yet to be determined because the level of clinical acceptable discrepancy in the x, y, and z vectors is still undefined.ConclusionsThis study showed statistically significant differences in accuracy among the implant analog cast fabrication systems; however; the level of clinical acceptable discrepancy is still undefined. Although further research is needed, this study supports the conclusion that the Polyjet industrial printing system was more accurate than the conventional implant analog gypsum cast.



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Comparison of user satisfaction and image quality of fixed and mobile camera systems for 3-dimensional image capture of edentulous patients: A pilot clinical study

Publication date: Available online 29 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Irena Sailer, Shiming Liu, Roland Mörzinger, Marcel Lancelle, Thabo Beeler, Markus Gross, Chenglei Wu, Vincent Fehmer, Murali Srinivasan
Statement of problemAn evaluation of user satisfaction and image quality of a novel handheld purpose-built mobile camera system for 3-dimensional (3D) facial acquisition is lacking.PurposeThe purpose of this pilot clinical study was to assess and compare the effectiveness between a handheld mobile camera system designed for facial acquisition and a fixed static camera arrangement by comparing the time effectiveness and the operator and participant preference for the 2 techniques of image capture.Material and methodsCompletely edentulous participants (n=12: women=7, men=5; mean age: 74.6 years) were included in this pilot study. Images were captured with and without the prostheses in situ while maintaining "serious" and "full-smile" facial expressions. Images were captured using a mobile and a static system. The working times for the participant installation and image captures were recorded. Operator and participant perceptions of the entire experience were recorded by using visual analog scale questionnaires. Nonparametric tests were used for statistical analyses (α=.05).ResultsThe installation time was significantly shorter for the mobile system (static=24 ±13 seconds; mobile=10 ±10 seconds), but the differences in the image capture times were not statistically significant (static: 29 ±5 seconds; mobile: 40 ±18 seconds). Operator preference was in favor of the mobile system with regard to working time (P=.002), difficulty in using (installation: P=.002; handling: P=.045), and camera weight (P=.002); however, they preferred the static arrangement for image quality (P=.003) and comfort (P=.013). The participants rated the entire photographic experience favorably, and 10 of 12 participants preferred the static camera over the mobile one.ConclusionsDespite the complexity of the installation, the static system was evaluated better for image quality; the mobile system was easier in installation and handling. The operators preferred the mobile system, and the participants preferred the static system.



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Load-bearing capacity of simulated Locator-retained overdenture system

Publication date: Available online 29 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Mona Gibreel, Lippo V.J. Lassila, Timo O. Närhi, Leila Perea-Lowery, Pekka K. Vallittu
Statement of problemAcrylic resin overdenture bases usually fracture because of stress concentrations at the area of the abutments.PurposeThe purpose of this study was to evaluate the reinforcing effect of bidirectional woven electrical glass (E-glass) fiber weaves with a different number of layers and different locations on the load-bearing capacity of simulated Locator-retained overdenture specimens.Material and methodsTest specimens with a centrally located metal housing for a Locator stud attachment were fabricated from autopolymerizing acrylic resin (polymethylmethacrylate based) and reinforced with bidirectional woven E-glass fiber layers. The control group specimens were fabricated without fiber reinforcement. The 2L group had 2 layers of E-glass fiber weaves and was divided according to the fiber location within the specimens as follows: 2L-A subgroup with 2 fiber layers above the metal housing; 2L-N subgroup with 2 fiber layers adjacent to the housing; and 2L-A+2L-N subgroup with 2 fiber layers above and 2 fiber layers adjacent to the housing. The 4L group had 4 layers of E-glass fiber weaves and was divided according to the fiber location as follows: 4L-A subgroup with 4 fiber layers above the housing; 4L-N subgroup with 4 fiber layers adjacent to the housing; and 4L-A+4L-N subgroup with 4 fiber layers above and 4 fiber layers adjacent to the housing. Dry specimens were submitted to a 3-point static loading test, and the mean flexural strength, flexural modulus, and strain values were analyzed with 1-way ANOVA and Tukey post hoc tests (α=.05). Two-way ANOVA was conducted to detect the influence of the number and location of the reinforcing layers (α=.05).ResultsThe results revealed a significant difference (P<.001) in flexural strength values between the control group (92.4 ±14 MPa) and the 2 subgroups, 4L-A (116 ±7.3 MPa) and 4L-A+4L-N (117.1 ±6 MPa), with a significant effect only from the number of the reinforcing layers (P<.001) and not the location (P=.153). No significant differences were found with flexural modulus (P=.195) and strain values (P=.174) among the tested groups.ConclusionsThe load-bearing capacity of a Locator-retained overdenture can be significantly increased by placing 4 layers of bidirectional woven E-glass fiber weaves either only above the metal housing or in both locations above and adjacent to the metal.



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In vitro retention of prefabricated and individually formed posts: A pilot study

Publication date: Available online 29 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Ivana Parčina Amižić, Ivana Miletić, Anja Baraba, Yuwei Fan, Dan Nathanson
Statement of problemData on the retention of individually formed fiber-reinforced composite posts (everStick) cemented with self-adhesive cement are lacking.PurposeThe purpose of this in vitro study was to investigate the pull-out strength of 2 different fiber-reinforced composite posts (prefabricated and individually formed) cemented into extracted teeth with self-adhesive resin cement.Material and methodsThirty extracted single-rooted human teeth were decoronated, endodontically treated, and prepared with post spaces of equal length. Prepared specimens were divided into 2 groups (n=15 each) based on the type of post: commercially prefabricated fiber posts (GC) and individually formed resin posts (using GC reinforcing fibers). Self-adhesive resin cement (G-CEM LinkAce; GC) was used to cement all posts. Each post was held with moderate pressure, and root surfaces were light polymerized for 20 seconds (650 mW/cm²). After cementation, the specimens were stored in saline solution for 30 days. Treated teeth were kept in water for 24 hours before pull-out testing parallel to the longitudinal axis of the posts. Data were analyzed using the Student t test (α=.05) and the coefficient of variance as the ratio of the standard deviation to the mean.ResultsThe mean pull-out retention strength was 185.7 ±61.2 N for the prefabricated fiber posts and 98.9 ±56.5 N for the individually formed fiber posts (P=.026).ConclusionsThe prefabricated fiber posts exhibited significantly higher retention forces than the individually formed posts.



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Digital workflow to rehabilitate worn dentition on a non-hinge simulated patient

Publication date: Available online 29 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Ramtin Sadid-Zadeh, Anthony Alexander
This report describes the complete mouth rehabilitation of worn dentition by using a digital workflow on a non-hinge simulated patient. A dentiform was used to simulate a patient with loss of occlusal vertical dimension. Physical diagnostic waxing along with a digital workflow was then used to re-establish the occlusal vertical dimension at the interim and definitive restoration stages.



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Combination of digital photographs for the identification of the screw-access hole of cement-retained implant restorations

Publication date: Available online 29 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Konstantinos Michalakis, Hiroshi Hirayama




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Should the restoration of adjacent implants be splinted or nonsplinted? A systematic review and meta-analysis

Publication date: Available online 29 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Victor E. de Souza Batista, Fellippo R. Verri, Cleidiel A.A. Lemos, Ronaldo S. Cruz, Hiskell F.F. Oliveira, Jéssica M.L. Gomes, Eduardo P. Pellizzer
Statement of problemThe decision to splint or to restore independently generally occurs during the planning stage, when the advantages and disadvantages of each clinical situation are considered based on the proposed treatment. However, clinical evidence to help clinicians make this decision is lacking.PurposeThe purpose of this systematic review and meta-analysis was to assess the marginal bone loss, implant survival rate, and prosthetic complications of splinted and nonsplinted implant restorations.Material and methodsThis study was designed according to the Cochrane criteria for elaborating a systematic review and meta-analysis and adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Also, this review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42017080162). An electronic search in the PubMed/MEDLINE, Cochrane Library, and Scopus databases was conducted up to November 2017. A specific clinical question was structured according to the population, intervention, comparison, outcome (PICO) approach. The addressed focused question was "Should the restoration of adjacent implants be splinted or nonsplinted?" The meta-analysis was based on the Mantel-Haenszel and inverse variance methods to assess the marginal bone loss, implant survival, and prosthetic complications of splinted and nonsplinted implant restorations.ResultsNineteen studies were selected for qualitative and quantitative analyses. A total of 4215 implants were placed in 2185 patients (splinted, 2768; nonsplinted, 1447); the mean follow-up was 87.8 months (range=12-264 months). Quantitative analysis found no significant differences between splinted and nonsplinted restorations for marginal bone loss. The assessed studies reported that 75 implants failed (3.4%), of which 24 were splinted (99.1% of survival rate) and 51 were nonsplinted (96.5% of survival rate). Quantitative analysis of all studies showed statistically significant higher survival rates for splinted restorations than for nonsplinted restorations. Ceramic chipping, screw loosening, abutment screw breakage, and soft tissue inflammation were reported in the selected studies. The quantitative analysis found no statistically significant difference in the prosthetic complications of splinted and nonsplinted restorations.ConclusionsWithin the limitations of this systematic review and meta-analysis, it was concluded that there was no difference in the marginal bone loss and prosthetic complications of splinted and nonsplinted implant restorations; this is especially true for restorations in the posterior region. However, splinted restorations were associated with decreased implant failure.



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Fracture resistance and 2-body wear of 3-dimensional–printed occlusal devices

Publication date: Available online 29 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Anna-Maria Lutz, Rüdiger Hampe, Malgorzata Roos, Nina Lümkemann, Marlis Eichberger, Bogna Stawarczyk
Statement of problemPolymeric material for 3-dimensional printing can be used to fabricate occlusal devices. However, information about fracture resistance and wear is scarce.PurposeThe purpose of this in vitro study was to investigate the fracture resistance and 2-body wear of 3-dimensional–printed (3DP) (FotoDent splint; Dreve Dentamid GmbH), milled polymethylmethacrylate (CAM) (Temp Basic; Transpa 95H16, Zirkonzahn GmbH), and conventionally fabricated polymethylmethacrylate (CAST) (Castdon; Dreve Dentamid GmbH) occlusal devices.Material and methodsA total of 96 occlusal devices were prepared according to the 3 different manufacturing techniques 3DP, CAM, and CAST (n=32). For each manufacturing technique, specimens were further divided into initial fracture resistance tests (n=16) and artificial aging in the mastication simulator (50 N, 37°C) with 2-body wear followed by fracture resistance tests (n=16). The fracture resistance was determined using a universal testing machine (1 mm/min). The wear was measured after 20 000 and 120 000 mastication cycles with the replica technique, mapped with a laser scanner, and quantified in R software. Data were analyzed using a 2-way ANOVA followed by a 1-way ANOVA with Scheffé or Games-Howell post hoc tests, repeated measures ANOVA with corrected Greenhouse-Geisser P values, and the Levene, Mann-Whitney, and paired t tests (α=.05).ResultsCAM presented higher initial fracture resistance than 3DP or CAST (P<.001). After mastication simulation, CAM followed by 3DP showed higher fracture resistance than CAST (P<.001). Mastication simulation decreased the fracture resistance for CAM and CAST (P<.001) but not for 3DP (P=.78). Three-dimensional–printed occlusal devices showed the highest material volume loss, followed by CAM and the lowest in CAST (P<.001).ConclusionsThree-dimensional–printed occlusal devices showed lower wear resistance and lower fracture resistance than those milled or conventionally fabricated. Therefore, only short-term application in the mouth is recommended. Further developments of occlusal device material for 3-dimensional printing are necessary.



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In vivo biocompatibility of an interim denture resilient liner containing antifungal drugs

Publication date: Available online 29 June 2018
Source:The Journal of Prosthetic Dentistry
Author(s): Juliana Hotta, Gustavo Pompermeier Garlet, Tania Mary Cestari, Jozely Francisca Mello Lima, Vinícius Carvalho Porto, Vanessa Migliorini Urban, Karin Hermana Neppelenbroek
Statement of problemAntifungal agents incorporated into interim denture resilient liners have been suggested as an adjunct treatment for denture stomatitis (DS). However, before applying this protocol to humans, biocompatibility analysis of such drugs in animal models is required.PurposeThe purpose of this animal study was to evaluate the in vivo biocompatibility of an interim resilient liner modified with minimum inhibitory concentrations (MICs) of antifungal drugs for Candida albicans biofilm.Material and methodsSixty Wistar rats were divided into 6 groups (n=5): PC=positive control/no protocol; IOD (intraoral device)=rats using an acrylic resin palatal device (PD); Tru=rats using a PD relined with Trusoft; and Ny (nystatin), Chx (chlorhexidine diacetate), and Ke (ketoconazole) groups=rats using a PD relined with Trusoft + drug MICs. The rats were sacrificed at 7 or 14 days of trial. Histopathological qualitative analysis was performed by comparing photomicrographs of histological sections of the intermolar region. Morphological changes in the epithelium and keratin were quantitatively analyzed by computerized planimetry, and data were analyzed by using 2-way ANOVA and the Tukey HSD test (α=.05).ResultsQuantitative analysis showed that only PD containing Ke significantly decreased the thickness and area of the keratin compared with the other groups (P<.001), which showed no differences between each other (P>.05). These results agreed with those of qualitative analysis.ConclusionsIncorporation of MICs of Ny and Chx in Trusoft did not induce histopathological changes in the rat palatal mucosa, suggesting the in vivo biocompatibility of this DS treatment.



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