Aggressive re-warming at 38.5C following deep hypothermia at 21C increases neutrophil membrane bound elastase activity and pro-inflammatory factor release

Cardiopulmonary bypass (CPB) is often performed under hypothermic condition. The effects of hypothermia and re-warming on neutrophil activity are unclear. This study aimed to compare the effects of different h...

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Effects of the seasonal flooding on riparian soil seed bank in the Three Gorges Reservoir Region: a case study in Shanmu River

The water-level fluctuation in the Three Gorges Reservoir Region has changed dramatically as a result of the hydroelectric project for flood control and power generation. The riparian seasonal hydrological env...

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SHP-2 Phosphatase Prevents Colonic Inflammation by Controlling Secretory Cell Differentiation and Maintaining Host-Microbiota Homeostasis

Abstract

Polymorphisms in the PTPN11 gene encoding for the tyrosine phosphatase SHP-2 were described in patients with ulcerative colitis. We have recently demonstrated that mice with an intestinal epithelial cell-specific deletion of SHP-2 (SHP-2^IEC-KO) develop severe colitis one month after birth. However, the mechanisms by which SHP-2 deletion induces colonic inflammation remain to be elucidated. We generated SHP-2^IEC-KO mice lacking Myd88 exclusively in the intestinal epithelium. The colonic phenotype was histologically analyzed and cell differentiation was determined by electron microscopy and lysozyme or Alcian blue staining. Microbiota composition was analyzed by 16S sequencing. Results show that innate defense genes including those specific to Paneth cells were strongly up-regulated in SHP-2-deficient colons. Expansion of intermediate cells (common progenitors of the Goblet and Paneth cell lineages) was found in the colon of SHP-2^IEC-KO mice while Goblet cell number was clearly diminished. These alterations in Goblet/intermediate cell ratio were noticed two weeks after birth, before the onset of inflammation and were associated with significant alterations in microbiota composition. Indeed, an increase in Enterobacteriaceae and a decrease in Firmicutes were observed in the colon of these mice, indicating that dysbiosis also occurred prior to inflammation. Importantly, loss of epithelial Myd88 expression inhibited colitis development in SHP-2^IEC-KO mice, rescued Goblet/intermediate cell ratio and prevented NFκB hyperactivation and inflammation. These data indicate that SHP-2 is functionally important for the maintenance of appropriate barrier function and host-microbiota homeostasis in the large intestine. This article is protected by copyright. All rights reserved

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Susoctocog Alfa: A Review in Acquired Haemophilia A

Abstract

Intravenous susoctocog alfa (Obizur^®) is a recombinant, B-domain deleted, porcine sequence antihaemophilic factor VIII (FVIII) product that has recently been approved for the treatment of bleeding episodes in adults with acquired haemophilia A (AHA). Intravenous susoctocog alfa was an effective and generally well tolerated treatment for serious bleeding episodes in adult patients with AHA in a multinational, phase II/III trial (n = 28 evaluable). Patients received an initial dose of susoctocog alfa 200 U/kg, with subsequent dosages based on target FVIII trough levels and clinical assessments. All patients had a positive haemostatic response (based on predefined criteria) of the primary bleed 24 h after the first infusion of susoctocog alfa, with the bleed successfully controlled at the time of final dosing in 86 % of patients. The most frequently reported adverse reaction (incidence >5 %) was the development of inhibitory antibodies against susoctocog alfa (porcine FVIII). Overall, 25 % of antibody naive patients developed anti-susoctocog alfa antibodies during the study. No serious treatment-related adverse events, thrombotic events or allergic reactions were reported during the trial. In conclusion, intravenous susoctocog alfa is a useful addition to the limited treatment options available for the management of acute bleeding episodes in adults with AHA.

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FeedaMail: Microbiology via ola Kala on Inoreader

	Microbiology via ola Kala on Inoreader
	(Sponsor this newsletter) Evaluation and update of cutoff values for methanotrophic pmoA gene sequences Abstract The functional pmoA gene is frequently used to probe the diversity and phylogeny of methane-oxidizing bacteria (MOB) in various environments. Here, we compared the similarities between the pmoA gene and the corresponding 16S rRNA gene sequences of 77 described species covering gamma- and alphaproteobacterial methanotrophs (type I and type II MOB, respectively) as well as methanotrophs from the phylum Verrucomicrobia. We updated and established the weighted mean pmoA gene cutoff values on the nucleotide level at 86, 82, and 71 % corresponding to the 97, 95, and 90 % similarity of the 16S rRNA gene. Based on these cutoffs, the functional gene fragments can be entirely processed at the nucleotide level throughout software platforms such as Mothur or QIIME which provide a user-friendly and command-based alternative to amino acid-based pipelines. Type II methanotrophs are less divergent than type I both with regard to ribosomal and functional gene sequence similarity and GC content. We suggest that this agrees with the theory of different life strategies proposed for type I and type II MOB. Read More » Enhancing pathogen identification in patients with meningitis and a negative Gram stain using the BioFire FilmArray® Meningitis/Encephalitis panel Meningitis with a negative cerebrospinal (CSF) Gram stain represents a diagnostic and therapeutic challenge. The purpose of our study was to evaluate the performance of the BioFire FilmArray® Meningitis/Encephali... Read More »
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Soluble CD14 in cerebrospinal fluid is associated with markers of inflammation and axonal damage in untreated HIV-infected patients: a retrospective cross-sectional study

HIV-associated cognitive impairment has declined since the introduction of combination antiretroviral treatment (cART). However, milder forms of cognitive impairment persist. Inflammation in the cerebrospinal ...

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BioEssays 52016

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BioEssays Next Issue

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BioEssays 52016

Revival of trade - exchange of goods - heralded the end of the Dark Ages in Europe, bringing upon the intellectual awaking of the Renaissance. Likewise, global and local histone turnover is shaping cell-type specific functions in the nervous system, critical for neurological plasticity and cognition, disruptions of which result in disease and intellectual decline, as described by Wenderski and Maze on page 410. Original artwork based on illumination from the 15th century Trattato de Arithmetica, depicting two merchants engaged in (histone) barter transaction, with histone H3/H4 dimer and nucleosome structures depicted (PDB structures 2HUE and AOI1, respectively).

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BioEssays 52016

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Treatment outcomes for patients with Middle Eastern Respiratory Syndrome Coronavirus (MERS CoV) infection at a coronavirus referral center in the Kingdom of Saudi Arabia

Middle Eastern Respiratory Syndrome coronavirus (MERS-CoV) is a poorly understood disease with no known treatments. We describe the clinical features and treatment outcomes of patients with laboratory confirme...

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Mycobacterium tuberculosis Uganda II is more susceptible to rifampicin and isoniazid compared to Beijing and Delhi/CAS families

Mycobacterium tuberculosis Uganda family is the predominant cause of tuberculosis in Uganda. Reasons for this are not clear but are likely to be due to the rampant person-to-person tra...

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Sero-epidemiological assessment of Chlamydia trachomatis infection and sub-fertility in Samoan women

In our recent village-based cross-sectional study, the prevalence of nucleic acid amplification technique (NAAT) diagnosed Chlamydia trachomatis (CT) in sexually active Samoan women was very high (36 %), and test...

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Cost-Effectiveness of Cetuximab for Advanced Esophageal Squamous Cell Carcinoma

by Vincent T. Janmaat, Marco J. Bruno, Suzanne Polinder, Sylvie Lorenzen, Florian Lordick, Maikel P. Peppelenbosch, Manon C. W. Spaander

Background

Costly biologicals in palliative oncology are emerging at a rapid pace. For example, in patients with advanced esophageal squamous cell carcinoma addition of cetuximab to a palliative chemotherapy regimen appears to improve survival. However, it simultaneously results in higher costs. We aimed to determine the incremental cost-effectiveness ratio of adding cetuximab to first-line chemotherapeutic treatment of patients with advanced esophageal squamous cell carcinoma, based on data from a randomized controlled phase II trial.

Methods

A cost effectiveness analysis model was applied based on individual patient data. It included only direct medical costs from the health-care perspective. Quality-adjusted life-years and incremental cost-effectiveness ratios were calculated. Sensitivity analysis was performed by a Monte Carlo analysis.

Results

Adding cetuximab to a cisplatin-5-fluorouracil first-line regimen for advanced esophageal squamous cell carcinoma resulted in an the incremental cost-effectiveness ratio of €252,203 per quality-adjusted life-year. Sensitivity analysis shows that there is a chance of less than 0.001 that the incremental cost-effectiveness ratio will be less than a maximum willingness to pay threshold of €40,000 per quality-adjusted life-year, which is representative for the threshold used in The Netherlands and other developed countries.

Conclusions

Addition of cetuximab to a cisplatin-5-fluorouracil first-line regimen for advanced esophageal squamous cell carcinoma is not cost-effective when appraised according to currently accepted criteria. Cost-effectiveness analyses using outcome data from early clinical trials (i.c. a phase II trial) enable pharmaceutical companies and policy makers to gain early insight into whether a new drug meets the current eligibility standards for reimbursement and thereby potential admittance for use in regular clinical practice.

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European Scientific Conference on Applied Infectious Disease Epidemiology (ESCAIDE) 2016 - registration and call for abstracts now open

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Zika virus detection in cerebrospinal fluid from two patients with encephalopathy Martinique February 2016

We report two cases of encephalopathy (one with seizures, one with electroencephalogram changes) in patients with Zika virus infection. The cases occurred on Martinique in February 2016, during the Zika virus outbreak. Awareness of the various neurological complications of Zika virus infection is needed for patients living in areas affected by Zika virus infections or for travellers to these areas.

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Concordance of interim and final estimates of influenza vaccine effectiveness: a systematic review

The World Health Organization's Global Influenza Surveillance and Response System meets twice a year to generate a recommendation for the composition of the seasonal influenza vaccine. Interim vaccine effectiveness (VE) estimates provide a preliminary indication of influenza vaccine performance during the season and may be useful for decision making. We reviewed 17 pairs of studies reporting 33 pairs of interim and final estimates using the test-negative design to evaluate whether interim estimates can reliably predict final estimates. We examined features of the study design that may be correlated with interim estimates being substantially different from their final estimates and identified differences related to change in study period and concomitant changes in sample size, proportion vaccinated and proportion of cases. An absolute difference of?no more than 10% between interim and final estimates was found for 18 of 33 reported pairs of estimates, including six of 12 pairs reporting VE against any influenza, six of 10 for influenza A(H1N1)pdm09, four of seven for influenza A(H3N2) and two of four for influenza B. While we identified inconsistencies in the methods, the similarities between interim and final estimates support the utility of generating and disseminating preliminary estimates of VE while virus circulation is ongoing.

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High specificity of a novel Zika virus ELISA in European patients after exposure to different flaviviruses

The current Zika virus (ZIKV) epidemic in the Americas caused an increase in diagnostic requests in European countries. Here we demonstrate high specificity of the Euroimmun anti-ZIKV IgG and IgM ELISA tests using putative cross-reacting sera of European patients with antibodies against tick-borne encephalitis virus, dengue virus, yellow fever virus and hepatitis C virus. This test may aid in counselling European travellers returning from regions where ZIKV is endemic.

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Importance of timely monitoring of seasonal influenza vaccine effectiveness

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I-MOVE multicentre case-control study 2010/11 to 2014/15: Is there within-season waning of influenza type/subtype vaccine effectiveness with increasing time since vaccination?

Since the 2008/9 influenza season, the I-MOVE multicentre case-control study measures influenza vaccine effectiveness (VE) against medically-attended influenza-like-illness (ILI) laboratory confirmed as influenza. In 2011/12, European studies reported a decline in VE against influenza A(H3N2) within the season. Using combined I-MOVE data from 2010/11 to 2014/15 we studied the effects of time since vaccination on influenza type/subtype-specific VE. We modelled influenza type/subtype-specific VE by time since vaccination using a restricted cubic spline, controlling for potential confounders (age, sex, time of onset, chronic conditions). Over 10,000 ILI cases were included in each analysis of influenza A(H3N2), A(H1N1)pdm09 and B; with 4,759, 3,152 and 3,617 influenza positive cases respectively. VE against influenza A(H3N2) reached 50.6% (95% CI: 30.0-65.1) 38 days after vaccination, declined to 0% (95% CI: -18.1-15.2) from 111 days onwards. At day 54 VE against influenza A(H1N1)pdm09 reached 55.3% (95% CI: 37.9-67.9) and remained between this value and 50.3% (95% CI: 34.8-62.1) until season end. VE against influenza B declined from 70.7% (95% CI: 51.3-82.4) 44 days after vaccination to 21.4% (95% CI: -57.4-60.8) at season end. To assess if vaccination campaign strategies need revising more evidence on VE by time since vaccination is urgently needed.

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Lessons learnt to keep Europe polio-free: a review of outbreaks in the European Union European Economic Area and candidate countries 1973 to 2013

Between 1973 and 2013, 12 outbreaks of paralytic poliomyelitis with a cumulative total of 660 cases were reported in the European Union, European Economic Area and candidate countries. Outbreaks lasted seven to 90 weeks (median: 24 weeks) and were identified through the diagnosis of cases of acute flaccid paralysis, for which infection with wild poliovirus was subsequently identified. In two countries, environmental surveillance was in place before the outbreaks, but did not detect any wild strain before the occurrence of clinical cases. This surveillance nonetheless provided useful information to monitor the outbreaks and their geographical spread. Outbreaks were predominantly caused by poliovirus type 1 and typically involved unvaccinated or inadequately vaccinated groups within highly immunised communities. Oral polio vaccine was primarily used to respond to the outbreaks with catch-up campaigns implemented either nationwide or in restricted geographical areas or age groups. The introduction of supplementary immunisation contained the outbreaks. In 2002, the European region of the World Health Organization was declared polio-free and it has maintained this status since. However, as long as there are non-vaccinated or under-vaccinated groups in European countries and poliomyelitis is not eradicated, countries remain continuously at risk of reintroduction and establishment of the virus. Continued efforts to reach these groups are needed in order to ensure a uniform and high vaccination coverage.

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Pandemic vaccination strategies and influenza severe outcomes during the influenza A(H1N1)pdm09 pandemic and the post-pandemic influenza season: the Nordic experience

During the 2009/10 influenza A(H1N1)pdm09 pandemic, the five Nordic countries adopted different approaches to pandemic vaccination. We compared pandemic vaccination strategies and severe influenza outcomes, in seasons 2009/10 and 2010/11 in these countries with similar influenza surveillance systems. We calculated the cumulative pandemic vaccination coverage in 2009/10 and cumulative incidence rates of laboratory confirmed A(H1N1)pdm09 infections, intensive care unit (ICU) admissions and deaths in 2009/10 and 2010/11. We estimated incidence risk ratios (IRR) in a Poisson regression model to compare those indicators between Denmark and the other countries. The vaccination coverage was lower in Denmark (6.1%) compared with Finland (48.2%), Iceland (44.1%), Norway (41.3%) and Sweden (60.0%). In 2009/10 Denmark had a similar cumulative incidence of A(H1N1)pdm09 ICU admissions and deaths compared with the other countries. In 2010/11 Denmark had a significantly higher cumulative incidence of A(H1N1)pdm09 ICU admissions (IRR:?2.4; 95% confidence interval (CI): 1.9-3.0) and deaths (IRR:?8.3; 95% CI: 5.1-13.5). Compared with Denmark, the other countries had higher pandemic vaccination coverage and experienced less A(H1N1)pdm09-related severe outcomes in 2010/11. Pandemic vaccination may have had an impact on severe influenza outcomes in the post-pandemic season. Surveillance of severe outcomes may be used to compare the impact of influenza between seasons and support different vaccination strategies.

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European Union SHIPSAN ACT Joint Action publishes interim guidance on maritime transport and Zika virus disease

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Multiparameter Analysis-Based Electrochemiluminescent Assay for Simultaneous Detection of Multiple Biomarker Proteins on a Single Interface

Analytical Chemistry

DOI: 10.1021/acs.analchem.6b00878

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Separation of Americium in High Oxidation States from Curium Utilizing Sodium Bismuthate

Analytical Chemistry

DOI: 10.1021/acs.analchem.6b01026

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Ultrasonic Monitoring of Enzyme Catalysis; Enzyme Activity in Formulations for Lactose-Intolerant Infants

Analytical Chemistry

DOI: 10.1021/acs.analchem.5b04673

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Analysis of Intracellular Glucose at Single Cells Using Electrochemiluminescence Imaging

Analytical Chemistry

DOI: 10.1021/acs.analchem.6b01073

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Increasing the uptake of exercise programs in the dialysis unit: a protocol for a realist synthesis

For people with end-stage kidney disease on hemodialysis, exercise during the dialysis treatment (intradialytic exercise) may promote exercise adherence and enhance aspects of the dialysis treatment. However, ...

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Intracoronary des-acyl ghrelin acutely increases cardiac perfusion through a nitric oxide-related mechanism in female anesthetized pigs

Endocrinology, Early Release.


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Retinol-binding protein 4 induces cardiomyocyte hypertrophy by activating TLR4/MyD88 pathway

Endocrinology, Early Release.


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How To Gain Better Control of Your Hot Strip Mill Operations

Steel and aluminum go through several processing steps before they are ready to be formed into finished products. Hot rolling is widely considered the most critical step to make uniform sheet metal of specific thickness, depending on the end use. Hot rolling of steel occurs at very high temperatures, above the recrystallization temperature of the Read the rest of this article

The post How To Gain Better Control of Your Hot Strip Mill Operations appeared first on Accelerating Science.

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What Elements are on the Periodic Table and Why Should I Care?

The Periodic Table was created in 1869 by Russian chemist Dmitry I. Mendeleev. According to a BBC report, Mendeleev realized that the "physical and chemical properties of elements were related to their atomic mass in a 'periodic' way, and arranged them so that groups of elements with similar properties fell into vertical columns in his table." This periodic Read the rest of this article

The post What Elements are on the Periodic Table, and Why Should I Care? appeared first on Accelerating Science.

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Polyethylene Challenges

Polyethylene is the most produced plastic in the world, and is considered strong, safe, and versatile, at least according to PlasticsEurope, the Association of Plastics Manufacturers.  The PlasticsEurope website describes polyethylene as: "… a good insulator, it resists caustic materials, it is almost unbreakable and is environment-friendly. Polyethylene is reliable under every circumstance and it Read the rest of this article

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Testing Stored Cervical Cytology Samples for HPV

Infection with the human papillomavirus (HPV) is a cause of cervical cancer, but only a small percentage of all infections will ultimately lead to cervical cancer if left untreated. In Sweden, women between the ages of 23 and 59 years are invited to undergo screening for cervical cancer every third (ages 23–49) to fifth year (ages 50–59). Since 2009, liquid-based cytology Read the rest of this article

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FSMA Part Three: Imported Foods and Microbiological Testing

When it comes to foodborne illness in the U.S., one source of particular concern is imported food products. According to Dr. Roy Betts in his recent article The Food Safety Modernization Act – Global Impacts for Microbiological Food Safety, approximately 19% of the foods consumed by Americans in 2013 were imported.1,2 CDC data from 2005 Read the rest of this article

The post FSMA, Part Three: Imported Foods and Microbiological Testing appeared first on Accelerating Science.

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Disease progression in recurrent glioblastoma patients treated with the VEGFR inhibitor axitinib is associated with increased regulatory T cell numbers and T cell exhaustion

Abstract

Background

Recurrent glioblastoma is associated with a poor overall survival. Antiangiogenic therapy results in a high tumor response rate but has limited impact on survival. Immunotherapy has emerged as an efficient treatment modality for some cancers, and preclinical evidence indicates that anti-VEGF(R) therapy can counterbalance the immunosuppressive tumor microenvironment.

Methods

We collected peripheral blood mononuclear cells (PBMC) of patients with recurrent glioblastoma treated in a randomized phase II clinical trial comparing the effect of axitinib with axitinib plus lomustine and analyzed the immunophenotype of PBMC, the production of cytokines and expression of inhibitory molecules by circulating T cells.

Results

PBMC of 18 patients were collected at baseline and at 6 weeks after initiation of study treatment. Axitinib increased the number of naïve CD8⁺ T cells and central memory CD4⁺ and CD8⁺ T cells and reduced the TIM3 expression on CD4⁺ and CD8⁺ T cells. Patients diagnosed with progressive disease on axitinib had a significantly increased number of regulatory T cells and an increased level of PD-1 expression on CD4⁺ and CD8⁺ T cells. In addition, reduced numbers of cytokine-producing T cells were found in progressive patients as compared to patients responding to treatment.

Conclusion

Our results suggest that axitinib treatment in patients with recurrent glioblastoma has a favorable impact on immune function. At the time of acquired resistance to axitinib, we documented further enhancement of a preexisting immunosuppression. Further investigations on the role of axitinib as potential combination partner with immunotherapy are necessary.

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Internal jugular venous thrombosis due to Trousseaus syndrome as the presenting feature of metastatic prostate carcinoma: a case report

Internal jugular vein thrombosis is a rare vascular event with a potentially fatal outcome. Of the known etiologies, internal malignancies, either known or occult, are well described. Even though malignancies ...

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A carcinoid tumor arising from a mature cystic teratoma in a 25-year-old patient: a case study

Abstract

Background

Mature cystic teratomas (MCTs) are common benign tumors occurring in the ovaries. Malignant transformation of teratomas (TMT) occurs in 1–3 % of all MCTs, usually in postmenopausal women. Squamous cell carcinoma is the most common tumor type. Primary carcinoid tumors of the ovary are uncommon, representing only 0.3 % of all carcinoid tumors and less than 0.1 % of all ovarian cancers.

Case presentation

A carcinoid tumor of the trabecular type arising from a MCT is presented in a 25-year-old woman. TMT was detected incidentally. Histologically, uniform, polygonal cells were arranged in a cord and trabecular pattern. Immunohistochemical staining showed positivity for neuro-specific enolase, synaptophysin, and CD56.

Conclusions

This case represents a very rare example of carcinoid tumor occurring in a woman younger than 30 years of age. Our findings suggest that sufficient tumor sampling is necessary to avoid overlooking small lesions, which, in our case, were not detected on either radiologic or gross examination.

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PCAST Meeting Live

Academy Members: Listen to the President's Council of Advisors on Science and Technology (PCAST) meeting live today to hear about Food and Drug Administration (FDA) regulation of hearing aids. Drs. Ian Windmill, Dave Fabry, Alicia Spoor, and Mead Killion will be among the speakers. 

Tweet

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Disease progression in recurrent glioblastoma patients treated with the VEGFR inhibitor axitinib is associated with increased regulatory T cell numbers and T cell exhaustion

Abstract

Background

Recurrent glioblastoma is associated with a poor overall survival. Antiangiogenic therapy results in a high tumor response rate but has limited impact on survival. Immunotherapy has emerged as an efficient treatment modality for some cancers, and preclinical evidence indicates that anti-VEGF(R) therapy can counterbalance the immunosuppressive tumor microenvironment.

Methods

We collected peripheral blood mononuclear cells (PBMC) of patients with recurrent glioblastoma treated in a randomized phase II clinical trial comparing the effect of axitinib with axitinib plus lomustine and analyzed the immunophenotype of PBMC, the production of cytokines and expression of inhibitory molecules by circulating T cells.

Results

PBMC of 18 patients were collected at baseline and at 6 weeks after initiation of study treatment. Axitinib increased the number of naïve CD8⁺ T cells and central memory CD4⁺ and CD8⁺ T cells and reduced the TIM3 expression on CD4⁺ and CD8⁺ T cells. Patients diagnosed with progressive disease on axitinib had a significantly increased number of regulatory T cells and an increased level of PD-1 expression on CD4⁺ and CD8⁺ T cells. In addition, reduced numbers of cytokine-producing T cells were found in progressive patients as compared to patients responding to treatment.

Conclusion

Our results suggest that axitinib treatment in patients with recurrent glioblastoma has a favorable impact on immune function. At the time of acquired resistance to axitinib, we documented further enhancement of a preexisting immunosuppression. Further investigations on the role of axitinib as potential combination partner with immunotherapy are necessary.

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Lingual Based Four Cornered Flap for Third Molar Surgery

Abstract

Purpose

The aim of this prospective randomized clinical study was to compare the efficacy of lingual based four cornered flap with the commonly used triangular flap for impacted third molar surgery.

Methods

Ten patients with bilateral impacted third molars were randomly treated under local anaesthesia, one side with triangular flap and single layer closure (with 3–0 silk) and other side by raising lingual based four cornered flap and double layer closure, subcutaneously with 5–0 vicryl and mucosa with 3-0 silk. All patients were operated by single surgeon (A. Rai) and suture removal was done after 7 days.

Results

Healing by primary intension takes place when lingual flap and double layer suturing was done, also the patients had less pain, swelling and alveolar osteitis. The visibility was excellent with lingual flap and pocket formation distal to second molar was also less. The only drawback with lingual flap is that it required little less time in comparison to triangular flap.

Conclusion

The lingual based four cornered flap is better than the triangular flap.

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Evaluating the Effect of Minimizing Screws on Stabilization of Symphysis Mandibular Fracture by 3D Finite Element Analysis

Abstract

Purpose

The objective of this work is to integrate structural optimization and reliability concepts into mini-plate fixation strategy used in symphysis mandibular fractures. The structural reliability levels are next estimated when considering a single failure mode and multiple failure modes.

Patients and Methods

A 3-dimensional finite element model is developed in order to evaluate the ability of reducing the negative effect due to the stabilization of the fracture. Topology optimization process is considered in the conceptual design stage to predict possible fixation layouts. In the detailed design stage, suitable mini-plates are selected taking into account the resulting topology and different anatomical considerations. Several muscle forces are considered in order to obtain realistic predictions. Since some muscles can be cut or harmed during the surgery and cannot operate at its maximum capacity, there is a strong motivation to introduce the loading uncertainties in order to obtain reliable designs. The structural reliability is carried out for a single failure mode and multiple failure modes.

Results

The different results are validated with a clinical case of a male patient with symphysis fracture. In this case while use of the upper plate fixation with four holes, only two screws were applied to protect adjacent vital structure. This behavior does not affect the stability of the fracture.

Conclusion

The proposed strategy to optimize bone plates leads to fewer complications and second surgeries, less patient discomfort, and shorter time of healing.

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The Role of Dentistry in Disaster Management and Victim Identification: An Overview of Challenges in Indo-Nepal Scenario

Abstract

Background

Recently, natural disasters and terrorist activities have been leading to mass casualty situations unexpectedly around the globe. In addition to the traditional emergency medical services centering around medically trained and paramedic personnel, dental practitioners having vital skills and attributes may be important in responding to a mass casualty situation.

Objective

This paper aims at discussing the role of dentists in disaster management and the role of forensic odontology in the disaster victim identification (DVI), its status in India and some suggestions to develop the plans for same.

Materials and methods

Articles were searched in various medical databases such as Google Scholar, Pubmed Central, Sciencedirect,Wiley online Library, Scopus, Copernicus to gather all relevant information on the subject. Various keywords were used as search tool such as 'Mass disaster', 'Forensic odontology', 'Victim identification'.

Results

The search resulted in total of 170 articles which we reviewed. Due to limitation to the list of references we have constricted our review to only 39 articles for more informative literature and supported the topic of the present manuscript 'The Role of Dentistry in Disaster Management and Victim Identification: An Overview of Challenges in Indo-Nepal Scenario' more specifically.

Conclusion

Every disaster is unique and involves interplay of different factors and circumstances such as nature of disaster, number of victims and extent of body fragmentation that ultimately challenges the disaster response planning. Apart from the victim recovery and evacuation, the disaster response planning must include the established procedures for the identification of the victims of the disaster. The identification of victims essentially relies on forensic anthropology, radiology, DNA typing and fingerprints, as well as odontology.

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Efficacy of Intranasal Dexmedetomidine for Conscious Sedation in Patients Undergoing Surgical Removal of Impacted Third Molar: A Double-Blind Split Mouth Study

Abstract

Background

This study was conducted to evaluate the utility and effectiveness of Intranasal Dexmedetomidine on Sedation status and pain experience of the patients undergoing surgical extraction of impacted third molar.

Materials and Methods

In this double-blind, split mouth study, in 15 patients, evaluations pertaining to classes of third molar impaction was done. Each patient was randomly assigned to receive either intranasal normal saline (placebo group) or intranasal 1.5 µg/kg atomized Dexmedetomidine during the first session. The other regimen was used during the second session. Study was conducted for over a period of 120 min and data for sedation and pain was collected at an interval of 30 min. The collected data was then compared between the two groups within the same patient. Sedation status was assessed by a blinded observer with a modified Observer's Assessment of Alertness/Sedation (OAA/S) 13 scale (Annexure- B). Pain experience was evaluated by Visual Analog Scale (VAS) (Annexure-B). Clinical evaluation for sedation and pain was done by a blinded observer at 30, 60, 90, and 120 min after administration of the intranasal solution. The values were then tabulated, and compared between two visits.

Results

The mean values of OAA score of Dexmedetomidine group were significantly higher as compared to Placebo group with a 'p' value of 0.000. And the mean values of Pain score of Dexmedetomidine group were significantly lower as compared to Placebo group with a 'p' value 0.009.

Conclusion

The results of this study clearly indicated that: Intranasally administered Dexmedetomidine was significantly useful and effective to achieve optimal sedation and analgesia during third molar surgery.

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A Rare Case of Multiloculated Cervical Thymic Cyst Masquerading as Tuberculous Adenitis

Abstract

Cervical thymic cysts are among the rarest cysts found in the neck. They usually occur during infancy and childhood, and they are extremely rare in adults. They may be found at any level of the pathway of normal thymic descent, from the angle of the mandible to the superior mediastinum. Being uncommon, they are rarely included in the clinical diagnosis of lateral neck masses and are commonly misdiagnosed as branchial cysts, lymphatic malformations, epidermoid cysts, dermoid cysts, lymphadenitis or neoplastic masses. The diagnosis of cervical thymic cyst is rarely made preoperatively and histopathological examination of the excised specimen is the only definitive means of diagnosis in a majority of the reported cases. We report the clinical presentation and therapeutic management of a rare case of multiloculated cervical thymic cyst in a 24-year-old adult which masqueraded as a tuberculous lympadenitis along with a review of literature.

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A Conservative Surgical Approach in the Management of Longstanding Chronic Protracted Temporomandibular Joint Dislocation: A Case Report and Review of Literature

Abstract

Chronic protracted dislocation of the TMJ is a relatively uncommon but extremely unpleasant and distressing condition for a patient. It is also particularly challenging and difficult to treat as it worsens with time due to continuing spasm of the masticatory muscles and progressive fibrosis, adhesions and consolidation in and around the dislocated joint. No definite guidelines or treatment protocols have been laid down in literature till date, towards management of such dislocations. A range of extensive and invasive surgical procedures such as eminectomy, condylectomy, menisectomy, and various osteotomies of the mandibular ramus and body have been performed to reduce these dislocations. A chronic longstanding unilateral TMJ dislocation in a 64-year-old woman was managed successfully and effectively using a modified, rather conservative surgical technique. The aim was to reduce the dislocated condyle (without excessive manipulation of the intra-articular space or extra-articular joint components); and at the same time, to limit further excessive translation of the condyle and restore physiological TMJ biomechanical constraints, to prevent future recurrence. This was achieved by surgically exposing the dislocated joint and manipulating the anterosuperiorly positioned condyle back into the glenoid fossa, aided by a downward distraction of the mandible; followed by soft tissue tethering of the meniscus and fibrous capsule of the joint to the temporal fascia above. The procedure yielded excellent results without any functional limitations or recurrence, and can hence constitute a viable and effective treatment option which can be attempted prior to resorting to the more invasive surgical procedures as described in literature.

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Hypothyroidism and Prolonged Postoperative Edema After Face-lift Surgery

This review examines whether patients with hypothyroidism are at increased risk for prolonged edema after face-lift surgery.

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Emerging vs Time-Tested Methods of Facial Grading

This study assesses the correlation between scores on the eFACE and the Sunnybrook Facial Grading System among patients with facial paralysis and compares the reliability of both scales.

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Electromechanical Reshaping and Long-term Outcomes

This preclinical trial of a rabbit model of electromechanical reshaping of the auricular ear extends previous evaluations to 6 months and refines reshaping settings to assess the feasibility of this technology.

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Lingual Based Four Cornered Flap for Third Molar Surgery

Abstract

Purpose

The aim of this prospective randomized clinical study was to compare the efficacy of lingual based four cornered flap with the commonly used triangular flap for impacted third molar surgery.

Methods

Ten patients with bilateral impacted third molars were randomly treated under local anaesthesia, one side with triangular flap and single layer closure (with 3–0 silk) and other side by raising lingual based four cornered flap and double layer closure, subcutaneously with 5–0 vicryl and mucosa with 3-0 silk. All patients were operated by single surgeon (A. Rai) and suture removal was done after 7 days.

Results

Healing by primary intension takes place when lingual flap and double layer suturing was done, also the patients had less pain, swelling and alveolar osteitis. The visibility was excellent with lingual flap and pocket formation distal to second molar was also less. The only drawback with lingual flap is that it required little less time in comparison to triangular flap.

Conclusion

The lingual based four cornered flap is better than the triangular flap.

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