A predictive model to distinguish malignant and benign thyroid nodules based on age, gender and ultrasonographic features

Publication date: Available online 4 November 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Fábio Muradás Girardi, Laura Mezzomo da Silva, Cecilia Dias Flores
IntroductionA discussion in literature about a standardized decision support tool for the management of thyroid nodules remains.ObjectiveThe purpose of this study was to create a statistical prediction model for thyroid nodules management.MethodsTwo hundred and four benign and 57 malignant thyroid nodules were selected for a retrospective study. The variables age, gender and ultrasonographic features were examined using univariate and multivariate models. A statistical formula was used to calculate the risk of cancer of each case.ResultsIn multivariate analysis, irregular shape, absence of halo, lower mean age, homogeneous echotexture, microcalcifications and solid content were associated with cancer. After applying the formula, 20 cases (7.6%) with a calculated risk for malignancy ≤3.0% were found, all of them benign. Setting the calculated risk in ≥80%, 21 (8.0%) cases were selected, and in 85.7% of them cancer was confirmed in histopathology. Internal accuracy of the prediction formula was 92.5%.ConclusionsThe prediction formula reached high accuracy and may be an alternative to other decision support tools for thyroid nodule management.



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Does the Zyppah Work? What to Know About New Snoring Tech

Zyppah emerged on the market relatively recently, but has already earned both praise and criticism. With 40 percent of men and 24 percent of women suffering from snoring in the United States, people are desperate for an easy solution, which Zyppah purports to be.

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Grant Robertson: Finance Minister more than Dr No

On the go and no time to finish that story right now? Your News is the place for you to save content to read later from any device. Register with us and content you save will appear here so you can access them to read later.

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Reproducible research practices are underused in systematic reviews of biomedical interventions

To evaluate how often reproducible research practices, which allow others to recreate the findings of studies, given the original data, are used in systematic reviews (SRs) of biomedical research.

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The split-plot design was useful for evaluating complex, multi-level interventions but there is need for improvement in its design and report

To describe the sample size calculation, analysis and reporting of split-plot randomised controlled trials (RCT) in healthcare (trials that use two units of randomisation: one at a cluster-level and one at a level lower than the cluster).

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Characterization of gastrointestinal adverse effects reporting in clinical studies of corticosteroid therapy

To examine whether 159 studies included in a previous meta-analysis reported on gastrointestinal bleeding or perforation in accordance with the the CONSORT extension for reporting harms outcomes (CONSORT Harms recommendations checklist), whether differences were associated with funding source, journal or publication year, and whether the CONSORT Harms checklist is a suitable tool for evaluation of adverse effects reporting.

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A language non-specific speech test to evaluate the speech of cleft patients from different language and cultural backgrounds - A pilot study

Cleft speech tests are not universally available. We have developed a tool to fill this gap, especially in the context of a cleft mission setting. We performed a pilot study to evaluate the test's ability to differentiate between the speech of cleft patients and healthy individuals from three different language backgrounds.We used 78 made-up, nonsensical syllables to evaluate hypernasality, nasal emissions, and consonant errors. Cleft (n = 41) and non-cleft (n = 39) individuals from three countries were included in this study.

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Erratum to “Descendens vagohypoglossi: rare variant of the superior root of ansa cervicalis” [Br J Oral Maxillofac Surg 55 (2017) 834–5]

The publisher regrets that S. B. Nayak's initial appeared incorrectly in the original article. It appears correctly above.

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C-reactive protein concentration as a prognostic factor for inflammation in the management of odontogenic infections

Our aim was to find out if it is possible to correlate the duration of stay in hospital, the severity of infection, involvement of particular anatomical spaces, white cell count, efficacy of surgical treatment, and fever with C-reactive protein (CRP) concentrations on admission. One hundred patients met our inclusion criteria. After their notes had been examined they were subdivided according to whether the infection of the main facial space involved was less severe, moderately severe, or very severe.

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Generations of oral and maxillofacial surgeons have read Maxillofacial Surgery for preparation for their...

Generations of oral and maxillofacial surgeons have read Maxillofacial Surgery for preparation for their FRCS examination or as "the" reference book. This third edition is led by Peter Brennan and continues to provide an update and review of the essential elements that encompass oral and maxillofacial surgical practice.

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Clinical survival of chair-side generated monolithic lithium disilicate crowns:10-year results

Abstract

Objectives

Nowadays, all-ceramic materials are routinely used within the treatment of patients in dentistry. The objective of this prospective clinical trial was the evaluation of chair-side generated monolithic lithium disilicate crowns after 10 years.

Materials and methods

Forty-one posterior full contour crowns made of lithium disilicate ceramics were inserted with a self-adhesive resin cement in 34 patients (20 university/14 private practice) using a chair-side CAD/CAM technique. One crown per patient was randomly selected for evaluation according to the modified US Public Health Service criteria.

Results

After a mean examination time of 10.1 years, 26 crowns were available for re-examination. Within the observation period, five failures occurred due to one crown fracture after 2.9 years, an abutment fracture after 6.0 years, one severe endodontic problem after 6.1 years, a root fracture after 7.0 years, and a replacement of one crown caused by a carious lesion after 10 years. Complications occurred as retention loss of one crown, two carious lesions, and a change in sensibility perception of two abutment teeth. All events were associated with molars. The Kaplan-Meier analysis revealed a survival rate of 83.5% and a complication-free rate of 71.0% after 10 years.

Conclusion

Due to the small amount of technical complications and failures, the clinical performance of monolithic lithium disilicate crowns was completely satisfying.

Clinical relevance

The insertion of chair-side fabricated monolithic lithium disilicate crowns can be recommended for long-term use in the posterior region.

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America's Dental Gap Has Left People Relying on Pliers, Chisels, and Whiskey

If you are a current Subscriber and are unable to log in, you may have to create a NEW username and password. To do so, click here and use the "NEW USER" sign-up option.

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C-reactive protein concentration as a prognostic factor for inflammation in the management of odontogenic infections

Publication date: Available online 4 November 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): R. Mirochnik, S. Araida, V. Yaffe, I. Abu El-Naaj
Our aim was to find out if it is possible to correlate the duration of stay in hospital, the severity of infection, involvement of particular anatomical spaces, white cell count, efficacy of surgical treatment, and fever with C-reactive protein (CRP) concentrations on admission. One hundred patients met our inclusion criteria. After their notes had been examined they were subdivided according to whether the infection of the main facial space involved was less severe, moderately severe, or very severe. The relations between degree of severity and CRP concentration on admission (<100mg/L compared with 100+), age (years), sex, and duration of hospital stay (days) were examined using Poisson regression (because the distribution of characteristics, and particularly the duration of stay, were skewed). The overall model was significant (p=0.003). Pearson and deviance chi square tests did not indicate overdispersion (p=0.97 in both cases), which suggested that the assumptions about the Poisson distribution were valid. Log-rank chi square tests indicated that only severity had a significant effect (p=0.0001), and C-reactive protein concentration was not significantly associated with group on admission, age, or sex. The moderately and very severe groups had longer median (range) durations of stay than the less severe group (5 (2-8) compared with 3 (1-8) days, respectively). CRP concentration was not a prognostic factor for the extent of odontogenic infections or presumed duration of stay, but severity scoring was a significant factor in the prediction of duration of stay in hospital.



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Erratum to “Descendens vagohypoglossi: rare variant of the superior root of ansa cervicalis” [Br J Oral Maxillofac Surg 55 (2017) 834–5]

Publication date: Available online 4 November 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): S.B. Nayak, P. Shetty, D. Reghunathan, A.P. Aithal, N. Kumar




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Maxillofacial Surgery, 3rd edition, P. Brennan, H. Schliephake, G. Ghali, L. Cascarini. Churchill Livingstone (2016)

Publication date: Available online 4 November 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Kaveh Shakib




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Model-based optimization of G-CSF treatment during cytotoxic chemotherapy

Abstract

Purpose

Although G-CSF is widely used to prevent or ameliorate leukopenia during cytotoxic chemotherapies, its optimal use is still under debate and depends on many therapy parameters such as dosing and timing of cytotoxic drugs and G-CSF, G-CSF pharmaceuticals used and individual risk factors of patients.

Methods

We integrate available biological knowledge and clinical data regarding cell kinetics of bone marrow granulopoiesis, the cytotoxic effects of chemotherapy and pharmacokinetics and pharmacodynamics of G-CSF applications (filgrastim or pegfilgrastim) into a comprehensive model. The model explains leukocyte time courses of more than 70 therapy scenarios comprising 10 different cytotoxic drugs. It is applied to develop optimized G-CSF schedules for a variety of clinical scenarios.

Results

Clinical trial results showed validity of model predictions regarding alternative G-CSF schedules. We propose modifications of G-CSF treatment for the chemotherapies 'BEACOPP escalated' (Hodgkin's disease), 'ETC' (breast cancer), and risk-adapted schedules for 'CHOP-14' (aggressive non-Hodgkin's lymphoma in elderly patients).

Conclusions

We conclude that we established a model of human granulopoiesis under chemotherapy which allows predictions of yet untested G-CSF schedules, comparisons between them, and optimization of filgrastim and pegfilgrastim treatment. As a general rule of thumb, G-CSF treatment should not be started too early and patients could profit from filgrastim treatment continued until the end of the chemotherapy cycle.

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TiF4 incorporated into a self-etching primer in different concentrations: antimicrobial properties and effects on demineralization inhibition around the enamel-dentin/restoration interface

Publication date: Available online 3 November 2017
Source:Archives of Oral Biology
Author(s): G.L. Abbatepaulo, T.M.M.C. Gangana, E.F. Martinez, C.P. Turssi, FMG França, F.L.B. Amaral, R.T. Basting
PurposeTo evaluate the antimicrobial effect by minimum bactericidal concentration (MBC) of titanium tetrafluoride (TiF4) in an aqueous solution (AS) or incorporated into the primer (P) of a self-etching adhesive system against Streptococcus mutans (Sm) and Lactobacillus casei (Lc); the effect of dentin pre-treatment with TiF4 in an AS or incorporated into the P of CL regarding the potential to inhibit the development of carious lesions at the restoration interface.Materials and methodsFor MBC, AS or P with different concentrations (in %) of TiF4 were used (from 0.0 to 4.0). Also, 50 cavities were prepared at the enamel/dentin junction of third molars, which received the dentin pre-treatments (n=10): Clearfil SE Bond (CL); AS of 2.5%TiF4+CL (AS2.5%); AS of 4%TiF4+CL (AS4%); 2.5%TiF4 incorporated into the P (P2.5%); 4%TiF4 incorporated into the P (P4%). Cavities were restored and submitted to pH cycling for artificial caries lesions induction. Microhardness tests were performed after sectioning the restorations to assess the presence of demineralization in margins.ResultsANOVA and Tukey tests showed that TiF4 in AS presented MBC against Sm and Lc over 2.0%. TiF4 into the P of a self-ething adhesive presented MBC over 1% for Lc. For enamel, CL showed no significant differences in microhardness between the depths.ConclusionsAS had an antimicrobial effect against Sm and Lc over 2.0%. Pretreatment with AS or P did not promote inhibition of demineralization at enamel or dentin restoration interfaces.



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First-principles calculations and thermodynamic modeling of the Yb-Ni binary system

Publication date: December 2017
Source:Calphad, Volume 59
Author(s): Yong-Jie Hu, Yi Wang, Samad A. Firdosy, Kurt E. Star, Jean-Pierre Fleurial, Vilupanur A. Ravi, Zi-Kui Liu
A complete thermodynamic description of the Yb-Ni binary system is developed by means of the CALculation of PHAse Diagram (CALPHAD) method in combination with first-principles calculations based on density functional theory (DFT) and available experimental data in the literature. Finite temperature thermodynamic properties of the Yb-Ni intermetallic compounds are predicted using the quasi-harmonic approach, where first-principles phonon calculations are performed to calculate the lattice vibrational entropy. The associate solution model is used to describe the complex thermodynamic behavior of the liquid phase. The calculated phase diagram agrees well the experimental phase equilibrium data in the literature. By the coupling of CALPHAD modeling with first-principles calculations, the present work provides a more thermodynamically accurate model of the Yb-Ni system when compared to previous models.



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Early pneumopericardium after heart transplantation

Abstract

A 60-year-old woman with a history of dilated cardiomyopathy underwent heart transplantation. One month post-discharge, she presented to clinic with low-grade fever and productive cough. Her chest radiograph showed air-fluid levels in the pericardial silhouette. Transthoracic echocardiogram showed a large complex pericardial collection with no evidence of cardiac tamponade. The patient was urgently taken to the operating room for exploration. A large "egg-shaped" mass in the pericardium measuring 10x12 cm with gaseous material was aspirated. The posterior wall of the mass was firmly adhered to the right atrium, the capsule was incompletely excised. We present the case of a potentially life-threatening complication post-transplantation that required surgical debridement and life-long antibiotic suppressive therapy. To our knowledge, this is the first report of purulent pericardial collection caused by Enterobacter cancerogenous. Further research is required to better understand the biology of this micro-organism and the role it may play as a pathogen in immunocompromised patients following solid-organ transplantation.

This article is protected by copyright. All rights reserved.

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Translating computer-aided design and surgical planning into successful mandibular reconstruction using a vascularized iliac-crest flap

Publication date: Available online 3 November 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Lei Zheng, Xiaoming Lv, Jie Zhang, Shuming Liu, Jianguo Zhang, Yi Zhang
PurposeThis study is to evaluate the computer-aided approach to the reconstruction of mandibular defects using a vascularized iliac-crest flap.Methods and materialsFrom December 2015 to October 2016, 14 patients (8 males and 6 females) aged between 18 and 64 years (median age, 29 years) were treated at the Peking University School and Stomatology Hospital, China. All of the patients were confirmed by histological examination prior to segmental mandibulectomy. Computer-based surgical techniques, including virtual surgical planning, CAD/CAM, rapid prototyping, and intraoperative navigation, were used to restore the anatomical continuity and configuration of the mandible using a vascularized iliac-crest flap. 2 transverse and 1 anterior-posterior (A-P) dimensions were evaluated based on the virtual plan and postoperative CT. The lines from the condylar head to condylar head and from the gonial angle to gonial angle were defined as the transverse dimensions. Measuring a perpendicular line drawn from the mandibular midline to the center point on the condylar head to condylar head measurement was defined as the A-P dimension. Complications were also evaluated during follow-up.ResultsFlap success rate of the patients was 92.9% (13/14), with one flap failure. Post-operation, there were no other serious complications in 13/14 patients who exhibited a good mandibular configuration with good occlusion. Furthermore, the height of bone graft was sufficient for implants. Healing of both the recipient and donor sites with no serious complication was uneventful. The average surgical error in the A-P dimension and transverse dimensions was 1.8±1.0 mm (Range: 0.2 - 3.7 mm), 2.2±1.1 mm (Range: 0.9 – 5.0 mm) and 2.6±1.6 mm (Range: 0.3 – 7.2 mm), respectively.ConclusionsThe use of these digital techniques was found to be a viable option for reconstruction of mandibular defects, but should be interpreted cautiously due to the small number of patients and the relatively short follow-up.



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Antidepressants and suicidal behaviour in late life: a prospective population-based study of use patterns in new users aged 75 and above

Abstract

Purpose

To investigate associations between antidepressant use patterns and risk of fatal and non-fatal suicidal behaviours in older adults who initiated antidepressant therapy.

Method

A national population-based cohort study conducted among Swedish residents aged ≥ 75 years who initiated antidepressant treatment. Patients who filled antidepressant prescriptions between January 1, 2007 and December 31, 2013 (N = 185,225) were followed until December 31, 2014. Sub-hazard ratios of suicides and suicide attempts associated with use patterns of antidepressants, adjusting for potential confounders such as serious depression were calculated using the Fine and Gray regression models.

Results

During follow-up, 295 suicides and 654 suicide attempts occurred. Adjusted sub-hazard ratios (aSHRs) were increased for both outcomes in those who switched to another antidepressant (aSHR for suicide 2.42, 95% confidence interval 1.65 to 3.55, and for attempt 1.76, 1.32 to 2.34). Elevated suicide risks were also observed in those who concomitantly filled anxiolytics (1.54, 1.20 to 1.96) and hypnotics (2.20, 1.69 to 2.85). Similar patterns were observed for the outcome suicide attempt. Decreased risk of attempt was observed among those with concomitant use of anti-dementia drugs (0.40, 0.27 to 0.59).

Conclusion

Switching antidepressants, as well as concomitant use of anxiolytics or hypnotics, may constitute markers of increased risk of suicidal behaviours in those who initiate antidepressant treatment in very late life. Future research should consider indication biases and the clinical characteristics of patients initiating antidepressant therapy.

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Sunday Routine: How Alisa Kauffman, Geriatric House-Call Dentist, Spends Her Sundays

Because her patients are too old and frail to visit the dentist, Alisa Kauffman travels to them. Dr. Kauffman, 57, has worked exclusively as a geriatric house-call dentist since 2000, caring for patients who are predominantly in their 80s and 90s; more than half have dementia.

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Oral manifestations of systemic disease.

Related Articles

Oral manifestations of systemic disease.

Gen Dent. 2017 Nov-Dec;65(6):23-29

Authors: Gaddey HL

Abstract
On examination, the oral cavity may exhibit manifestations of underlying systemic disease and serve as an indicator of overall health. Systemic diseases with oral findings include autoimmune, hematologic, endocrine, and neoplastic processes. Autoimmune disease may manifest as oral ulcerations, changes in the salivary and parotid glands, and changes in the tongue. Patients with hematologic illnesses may present with gingival bleeding or tongue changes such as glossitis, depending on the etiology. Oral changes associated with endocrine illness are variable and depend on the underlying condition. Neoplastic changes include metastatic lesions to the bony and soft tissues of the oral cavity. Patients with chronic diseases such as gastroesophageal reflux and eating disorders may present with dental erosions that cause oral pain or halitosis. In the pediatric population, oral changes can be related to rare cancers, such as Langerhans cell histiocytosis, or infectious etiologies, such as Kawasaki disease. In both adults and pediatric patients, poor oral health has been linked to poorer health outcomes overall. Thorough history taking and physical examination by dentists may aid in determining the underlying etiology of oral changes and allow for earlier intervention by medical colleagues.

PMID: 29099362 [PubMed - in process]

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Event centrality influences posttraumatic stress disorder symptoms via core beliefs in internally displaced older adults

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Gait motion for naturally curving variously shaped corners

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Clostridium butyricum CGMCC0313.1 Protects against Autoimmune Diabetes by Modulating Intestinal Immune Homeostasis and Inducing Pancreatic Regulatory T Cells.

Related Articles

Clostridium butyricum CGMCC0313.1 Protects against Autoimmune Diabetes by Modulating Intestinal Immune Homeostasis and Inducing Pancreatic Regulatory T Cells.

Front Immunol. 2017;8:1345

Authors: Jia L, Shan K, Pan LL, Feng N, Lv Z, Sun Y, Li J, Wu C, Zhang H, Chen W, Diana J, Sun J, Chen YQ

Abstract
Recent evidence indicates that indigenous Clostridium species induce colonic regulatory T cells (Tregs), and gut lymphocytes are able to migrate to pancreatic islets in an inflammatory environment. Thus, we speculate that supplementation with the well-characterized probiotics Clostridium butyricum CGMCC0313.1 (CB0313.1) may induce pancreatic Tregs and consequently inhibit the diabetes incidence in non-obese diabetic (NOD) mice. CB0313.1 was administered daily to female NOD mice from 3 to 45 weeks of age. The control group received an equal volume of sterile water. Fasting glucose was measured twice a week. Pyrosequencing of the gut microbiota and flow cytometry of mesenteric lymph node (MLN), pancreatic lymph node (PLN), pancreatic and splenic immune cells were performed to investigate the effect of CB0313.1 treatment. Early oral administration of CB0313.1 mitigated insulitis, delayed the onset of diabetes, and improved energy metabolic dysfunction. Protection may involve increased Tregs, rebalanced Th1/Th2/Th17 cells and changes to a less proinflammatory immunological milieu in the gut, PLN, and pancreas. An increase of α4β7(+) (the gut homing receptor) Tregs in the PLN suggests that the mechanism may involve increased migration of gut-primed Tregs to the pancreas. Furthermore, 16S rRNA gene sequencing revealed that CB0313.1 enhanced the Firmicutes/Bacteroidetes ratio, enriched Clostridium-subgroups and butyrate-producing bacteria subgroups. Our results provide the basis for future clinical investigations in preventing type 1 diabetes by oral CB0313.1 administration.

PMID: 29097999 [PubMed]

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Hesperetin on Cell Surface Glycoconjugates Abnormalities and Immunohistochemical Staining with Cytokeratin in 7,12 Dimethylbenz(a)anthracene Induced Hamster Buccal Pouch Carcinogenesis

Abstract

Hesperetin, a naturally occurring citrus flavanone of the bioactive substance, possesses different pharmacological and biochemical activities including anti-cancer and anti-oxidants effect. The aim of the study to investigate that hesperetin on abnormalities of glycoconjugates (protein bound hexose, hexosamine, total sialic acid and fucose), histology (PAS staining) and immunoexpression of cytokeratin during 7,12-dimethylbenz(a)anthracene (DMBA) induced hamster buccal pouch (HBP) carcinogenesis. Oral tumors were developed in the buccal pouches of male golden Syrian hamsters by topical application of 0.5% DMBA thrice a week for 10 weeks and developed morphological alterations depicted as hyperplasia, dysplasia and well-differentiated squamous cell carcinoma formation with noticeable abnormalities of glycoconjugates and cytokeratin. The protective effect of hesperetin against DMBA was evaluated by assessing immunohistochemical expression, histological sections of buccal tissues and the levels of glycoconjugates in the buccal mucosa and plasma were analyzed. Hesperetin administrated orally at a dose of 20 mg/kg b.w. to hamsters treated with DMBA, significantly reduced the status of glycoconjugates and cytokeratin to the near normal range. Overall findings accomplished that hesperetin protects cell surface glycoconjugates abnormalities in DMBA induced HBP carcinogenesis.

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The Mycotoxin Zearalenone Hinders Candida albicans Biofilm Formation and Hyphal Morphogenesis

Abstract

Yeast–mold mycobiota inhabit several natural ecosystems, in which symbiotic relationships drive strategic pathoadaptation. Mycotoxins are metabolites produced by diverse mycotoxigenic fungi as a defense against yeasts, though at times yeasts secrete enzymes that degrade, detoxify, or bio-transform mycotoxins. The present study is focused on the in vitro inhibitory effects of zearalenone (ZEN), a F2 mycotoxin produced by several Fusarium and Gibberella species, on different microbial strains. ZEN exhibited no effect on the planktonic growth or biofilms of several Gram positive and negative bacteria at the tested concentrations. Remarkably, Candida albicans biofilm formation and hyphal morphogenesis were significantly inhibited when treated with 100 µg/mL of ZEN. Likewise, ZEN proficiently disrupted pre-formed C. albicans biofilms without disturbing planktonic cells. Furthermore, these inhibitions were confirmed by crystal violet staining and XTT reduction assays and by confocal and scanning electron microscopy. In an in vivo model, ZEN significantly suppressed C. albicans infection in the nematode Caenorhabditis elegans. The study reports the in vitro antibiofilm efficacy of ZEN against C. albicans strains, and suggests mycotoxigenic fungi participate in asymmetric competitive interactions, such as, amensalism or antibiosis, rather than commensal interactions with C. albicans, whereby mycotoxins secreted by fungi destroy C. albicans biofilms.

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Event centrality influences posttraumatic stress disorder symptoms via core beliefs in internally displaced older adults

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Effect of incisal loading during orthodontic treatment in adults:A randomized control trial.

Effect of incisal loading during orthodontic treatment in adults:A randomized control trial.

Angle Orthod. 2017 Nov 03;:

Authors: Puttaravuttiporn P, Wongsuwanlert M, Charoemratrote C, Lindauer SJ, Leethanakul C

Abstract
OBJECTIVE: To measure the changes in tooth mobility, alveolar bone, and receptor activator of nuclear factor kappa-B ligand (RANKL)/osteoprotegerin (OPG) in the gingival crevicular fluid (GCF) during orthodontic treatment to regain incisal function in the presence and absence of biting exercises.
MATERIALS AND METHODS: Thirty-six females (42.3 ± 6.5 years old) with periodontally compromised upper incisors received orthodontic treatment to obtain ideal incisor relationships. Eighteen subjects in the experimental biting exercise group were instructed to bite a soft plastic roll for 5 min/d; the 18 control subjects were not given plastic rolls. Alveolar bone thickness, height, and density around the upper incisors were assessed at three root levels using cone-beam computed tomography. GCF was collected at the labial and palatal sites of the upper incisors at pretreatment (T0), end of treatment (T1), 1 month after T1 (T2), and 7 months after T1 (T3). RANKL/OPG was determined using enzyme-linked immunosorbent assays.
RESULTS: Labial and palatal bone thickness significantly increased (>twofold) from T1 to T3 in the experimental group at all three root levels (all P < .05). Bone thickness correlated negatively with RANKL/OPG ratio between T1 and T2 (P < .05). Tooth mobility, bone height, and density were not significantly different between T1 and T3.
CONCLUSIONS: Biting exercises significantly increased bone thickness but did not affect tooth mobility, bone height, or density. The RANKL/OPG ratio decreased 1 month after treatment (T2) and correlated with increased bone thickness. ( ClinicalTrials.in.th TCTR20170625001).

PMID: 29099236 [PubMed - as supplied by publisher]

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Does length of intubation before tracheostomy affect intensive care unit length of stay?

Related Articles

Does length of intubation before tracheostomy affect intensive care unit length of stay?

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Sep 27;:

Authors: Young SR, Bouloux GF, Perez SD, Abramowicz S

Abstract
OBJECTIVE: The purpose of this study was to determine if length of intubation before tracheotomy (LIT) affects length of stay in the intensive care unit (ICU).
STUDY DESIGN: This was a retrospective case series of patients who had open tracheotomies at Grady Memorial Hospital by the Oral and Maxillofacial Surgery (OMS) service. Medical records were reviewed to document patient demographic characteristics, etiology for ventilator dependence, and complications. The primary predictor variable was LIT and primary outcome variable was length of stay in ICU after tracheotomy. Statistical analysis was performed (significance P < .05).
RESULTS: There were 115 patients (mean age 54 years) included in the study. The majority received tracheotomies because of prolonged mechanical ventilation secondary to a medical comorbidity. Intraoperative complications were cardiac arrest and difficulty accessing trachea. Postoperative complications were bleeding. Postoperatively, most patients were discharged from the ICU or weaned off mechanical ventilation within 5 days. The correlation between LIT and ICU stay was not statistically significant, but the trend was positive.
CONCLUSIONS: The results of this study indicate that patients undergoing an earlier tracheotomy were more likely to have an earlier discharge from the ICU.

PMID: 29097138 [PubMed - as supplied by publisher]

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Two dentists close - what next for NHS dental care in Taunton Deane?

If you were a patient at one of those dentists and need help getting an appointment elsewhere, you can call NHS 111 - either dial 111 or call the Somerset Dental Helpline on 0300-1237691 or e-mail dentist4u@sompar.nhs.uk.

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Cultivation of Peptidiphaga gingivicola from subgingival plaque: the first representative of a novel genus of Actinomycetaceae

Summary

A novel bacterium was isolated from the subgingival plaque of a patient with periodontal disease. Bacterial strain BA112^T is a facultative gram-positive coccus. It metabolizes alanine, arginine, glycine, histidine, leucine, proline, serine, and tyrosine, but does not appear to utilize carbohydrates. Urease, esculin, indole, catalase, and nitrate reduction tests were all negative. Major cellular fatty acids were C_18:0, C_12:0, C_16:0, C_18:1w9c, and C_20:0. The genome was sequenced and is 2.4 Mbp in length and has 64% GC content. Based on phylogenetics of the 16S rRNA sequence and concatenated alignments of 37 conserved proteins, BA112^T belongs to the family Actinomycetaceae but is located on a branch of the tree without currently named members. Based on our phenotypic and phylogenetic studies, we propose that BA112^T is the first known representative of a new genus, for which the name Peptidiphaga gingivicola gen. nov., sp. nov. is proposed. The type strain is BA112^T.

This article is protected by copyright. All rights reserved.

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Online fraud victims’ experiences of participating in qualitative interviews

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Nutrition for oral health and oral manifestations of poor nutrition and unhealthy habits.

Nutrition for oral health and oral manifestations of poor nutrition and unhealthy habits.

Gen Dent. 2017 Nov-Dec;65(6):36-43

Authors: Pflipsen M, Zenchenko Y

Abstract
The availability of proper nutrients is critical for the growth, development, maintenance, and repair of healthy dentition and oral tissues. Deficiencies particularly relevant to the dental practice are those in folate and other B complex vitamins; vitamins A, C, and D; calcium; fluoride; and protein. A lack of these nutrients affects nearly every structure in the oral cavity, causing or contributing to scurvy, cleft palate, enamel hypoplasia, poor mineralization, caries, and other pathoses. Damage to the dentition can also be observed in individuals with unhealthy habits; for example, a diet high in sugars will promote processes such as demineralization and caries. Diabetes also can result from a poor diet and is associated with periodontitis and oral candidiasis. Finally, the use of tobacco products and excessive alcohol intake damage the dentition and contribute to a variety of oral diseases, including stomatitis, malnutrition, and squamous cell carcinoma. Knowledge of these relationships will enable the dentist to question patients about dietary habits and provide guidance to encourage a healthy lifestyle.

PMID: 29099364 [PubMed - in process]

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Everolimus Plus Letrozole for Treatment of Patients With HR(+), HER2(-) Advanced Breast Cancer Progressing on Endocrine Therapy: An Open-label, Phase II Trial.

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Everolimus Plus Letrozole for Treatment of Patients With HR(+), HER2(-) Advanced Breast Cancer Progressing on Endocrine Therapy: An Open-label, Phase II Trial.

Clin Breast Cancer. 2017 Sep 19;:

Authors: Safra T, Kaufman B, Kadouri L, Efrat Ben-Baruch N, Ryvo L, Nisenbaum B, Evron E, Yerushalmi R

Abstract
PURPOSE: In the Breast cancer trials of OraL EveROlimus-2 (BOLERO-2) trial, everolimus plus exemestane improved progression-free survival (PFS) in patients with hormone receptor-positive (HR(+)), human epidermal growth factor receptor 2-negative (HER2(-)) advanced breast cancer (ABC) recurring or progressing on/after prior endocrine therapy (ET), suggesting that dual blockade using targeted therapy and ET was an effective treatment option. Here, we investigated the clinical benefit of combining everolimus with different endocrine partner, letrozole, in a similar patient population.
METHODS: In this phase II, open-label, single-arm, multicenter trial, postmenopausal women with HR(+), HER2(-) ABC who had recurrence/progression on/after prior ET received everolimus 10 mg daily and letrozole 2.5 mg daily. The primary end point was objective response rate; key secondary end points included disease-control rate, PFS, overall survival, and safety.
RESULTS: A total of 72 patients were enrolled and followed-up for a median duration of 11.4 months. Everolimus plus letrozole achieved an overall response rate of 23.3% (95% confidence interval [CI], 13.4%-36.0%). The median PFS was 8.8 months (95% CI, 6.6-11.0 months), and the overall survival was 22.9 months (95% CI, 18.5-28.9 months). Disease-control rate was achieved in 51 (85%) patients. The safety profile was consistent with previously published data: The most frequently reported any grade adverse events (AEs) were fatigue (61.1%), stomatitis (54.2%), and rash (33.4%). The most frequently reported grade 3 AEs were stomatitis and anemia (8.3% each), fatigue and diarrhea (5.6% each), and hyperglycemia (4.2%). Only 1 patient had grade 4 AE of anemia.
CONCLUSIONS: Everolimus plus letrozole demonstrated clinical benefit and could be a valid treatment option for postmenopausal women recurring/progressing on prior endocrine therapy.

PMID: 29097108 [PubMed - as supplied by publisher]

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Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Overlap Induced by Fexofenadine.

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Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Overlap Induced by Fexofenadine.

J Investig Allergol Clin Immunol. 2017 Jun;27(3):191-193

Authors: Teo SL, Santosa A, Bigliardi PL

PMID: 28570227 [PubMed - indexed for MEDLINE]

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Opportunities for Epidemiologists: from Precision Medicine to Population Health

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SIRT3 deacetylates and promotes degradation of P53 in PTEN-defective non-small cell lung cancer

Abstract

Purpose

In non-small cell lung cancer (NSCLC), success of targeted therapy has promoted researches explicitly orientated based on genetic background. Although PTEN deficiency is common in NSCLC, carcinogenesis about such genetic type has not been fully explored. Here, we have found that classical tumor suppressor P53 could be modulated by deacetylase sirtuin-3 (SIRT3) depending on the PTEN condition in NSCLC, which may be a novel breakpoint for handling PTEN deficiency NSCLC.

Methods

First, we examined SIRT3 and P53 expression files in PTEN-deficient NSCLC clinical samples and investigated their correlation. Second, we built SIRT3 high or low expression models in different PTEN conditions by plasmid overexpression or si-RNA interference in NSCLC cell lines and explored the effect of SIRT3 upon P53. Furthermore, we investigated the influence of SIRT3 upon the ubiquitin–proteasome dependent degradation pathway of P53 in PTEN-deficient NSCLC cell lines. Finally, we probed into the deacetylation modification of P53 via SIRT3.

Results

We found that SIRT3 expression was strongly positive and P53 expression was almost negative in PTEN-deficient NSCLC clinical samples. Further, we demonstrated that SIRT3 promoted degradation of P53 in PTEN-deficient NSCLC cell lines via the ubiquitin–proteasome pathway. Finally, we demonstrated that SIRT3 could deacetylate P53 at lysines 320 and 382, which may account for the observed degradation of P53 in PTEN-deficient tumor cells.

Conclusions

We have identified a novel mechanism by which P53 was inactivated via SIRT3 in PTEN-deficient cells. This may shed light on the mechanisms underlying the malignancy of PTEN-deficient NSCLC.

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Cohort Profile: The 2015 Pelotas (Brazil) Birth Cohort Study

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Lopinavir plus nucleoside reverse-transcriptase inhibitors, lopinavir plus raltegravir, or lopinavir monotherapy for second-line treatment of HIV (EARNEST): 144-week follow-up results from a randomised controlled trial

Publication date: Available online 3 November 2017
Source:The Lancet Infectious Diseases
Author(s): James G Hakim, Jennifer Thompson, Cissy Kityo, Anne Hoppe, Andrew Kambugu, Joep J van Oosterhout, Abbas Lugemwa, Abraham Siika, Raymond Mwebaze, Aggrey Mweemba, George Abongomera, Margaret J Thomason, Philippa Easterbrook, Peter Mugyenyi, A Sarah Walker, Nicholas I Paton
BackgroundMillions of HIV-infected people worldwide receive antiretroviral therapy (ART) in programmes using WHO-recommended standardised regimens. Recent WHO guidelines recommend a boosted protease inhibitor plus raltegravir as an alternative second-line combination. We assessed whether this treatment option offers any advantage over the standard protease inhibitor plus two nucleoside reverse-transcriptase inhibitors (NRTIs) second-line combination after 144 weeks of follow-up in typical programme settings.MethodsWe analysed the 144-week outcomes at the completion of the EARNEST trial, a randomised controlled trial done in HIV-infected adults or adolescents in 14 sites in five sub-Saharan African countries (Uganda, Zimbabwe, Malawi, Kenya, Zambia). Participants were those who were no longer responding to non-NRTI-based first-line ART, as assessed with WHO criteria, confirmed by viral-load testing. Participants were randomly assigned to receive a ritonavir-boosted protease inhibitor (lopinavir 400 mg with ritonavir 100 mg, twice per day) plus two or three clinician-selected NRTIs (protease inhibitor plus NRTI group), protease inhibitor plus raltegravir (400 mg twice per day; protease inhibitor plus raltegravir group), or protease inhibitor monotherapy (plus raltegravir induction for first 12 weeks, re-intensified to combination therapy after week 96; protease inhibitor monotherapy group). Randomisation was by computer-generated randomisation sequence, with variable block size. The primary outcome was viral load of less than 400 copies per mL at week 144, for which we assessed non-inferiority with a one-sided α of 0·025, and superiority with a two-sided α of 0·025. The EARNEST trial is registered with ISRCTN, number 37737787.FindingsBetween April 12, 2010, and April 29, 2011, 1837 patients were screened for eligibility, of whom 1277 patients were randomly assigned to an intervention group. In the primary (complete-case) analysis at 144 weeks, 317 (86%) of 367 in the protease inhibitor plus NRTI group had viral loads of less than 400 copies per mL compared with 312 (81%) of 383 in the protease inhibitor plus raltegravir group (p=0·07; lower 95% confidence limit for difference 10·2% vs specified non-inferiority margin 10%). In the protease inhibitor monotherapy group, 292 (78%) of 375 had viral loads of less than 400 copies per mL; p=0·003 versus the protease inhibitor plus NRTI group at 144 weeks. There was no difference between groups in serious adverse events, grade 3 or 4 adverse events (total or ART-related), or events that resulted in treatment modification.InterpretationProtease inhibitor plus raltegravir offered no advantage over protease inhibitor plus NRTI in virological efficacy or safety. In the primary analysis, protease inhibitor plus raltegravir did not meet non-inferiority criteria. A regimen of protease inhibitor with NRTIs remains the best standardised second-line regimen for use in programmes in resource-limited settings.FundingEuropean and Developing Countries Clinical Trials Partnership (EDCTP), UK Medical Research Council, Instituto de Salud Carlos III, Irish Aid, Swedish International Development Cooperation Agency, Instituto Superiore di Sanita, Merck, ViiV Healthcare, WHO.



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The unexpected success of NRTIs in second-line treatment

Publication date: Available online 3 November 2017
Source:The Lancet Infectious Diseases
Author(s): Andrew M Hill, Francois Venter




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Drug-associated hyperpigmentation of the oral mucosa: report of 4 cases.

Publication date: Available online 3 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Konstantinos I. Tosios, Eleni-Marina Kalogirou, Alexandra Sklavounou
ObjectiveTo describe four patients with oral mucosa hyperpigmentation associated with four drug classes and review the literature.Study DesignTwo patients under imatinib and hydroxychloroquine treatment exhibited diffuse palatal hyperpigmentation, while two patients medicated with minocycline and golimumab showed multifocal pigmented macules. In all cases biopsies were performed.ResultsMicroscopically, in all cases there was no increase in the number of melanocytes in the epithelium and pigment granules were present in the lamina propria. The pigment granules in minocycline- and golimumab-associated hyperpigmentation were seen in the superficial lamina propria and reacted for silver but not iron, while in imatinib- and hydroxychloroquine-associated hyperpigmentation were found in the reticular lamina propria and reacted both for silver and iron. A review of the literature found 38 cases of oral mucosa hyperpigmentation attributed to minocycline, 23 to imatinib, one to hydroxychloroquine without microscopic documentation, and none to golimumab.ConclusionThe temporal relationship between pigmentation and drug onset, resolution following drug withdrawal and exclusion of other causes support the diagnosis of drug-induced hyperpigmentation. Microscopic examination may be contributory to diagnosis, as there are differences among drugs in the distribution of pigment granules and their histochemical reactions.



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A preliminary immunohistochemical study of signal transducer and activator of transcription (STAT) proteins in primary oral malignant melanoma

Publication date: Available online 3 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Nikolaos G. Nikitakis, Ioannis Gkouveris, Erofili Papadopoulou, Argyrios Daskalopoulos, Alexandra Sklavounou
ObjectivePrimary oral malignant melanoma (POMM) is a rare type of malignancy with a very poor prognosis, the molecular pathogenesis of which remains elusive. The aim of this study was to assess the expression status of signal transducers and activators of transcription (STAT) proteins in POMM.Study DesignSix POMMs were included in the study. Total protein levels of STAT1, 3 and 5a, as well as the tyrosine phosphorylated (activated) form of STAT3 (pSTAT3), were assessed immunohistochemically.ResultsImmunohistochemical evaluation of total STAT3 revealed diffuse and strong cytoplasmic and nuclear expression in the majority of tumor cells of all cases, while activated pSTAT3 showed mostly mild nuclear expression in 5-40% of malignant melanocytes in all cases. Evaluation of STAT1 and STAT5a showed mainly mild cytoplasmic expression in the absence of nuclear localization.ConclusionThe demonstration of aberrant STAT3 expression and activation in oral malignant melanocytes supports a possible role of this molecule in POMM. In contrast, STAT5a shows only limited cytoplasmic expression mitigating against its involvement in POMM. Also, STAT1 low levels may have implications for POMM sensitivity to interferon (IFN)-based therapeutic strategies, considering the role of this molecule in cutaneous melanoma immunotherapy.



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Influence of glutamate-evoked pain and sustained elevated muscle activity on blood oxygenation in the human masseter muscle

This study aimed to investigate the effect of glutamate-evoked masseter muscle pain on intramuscular oxygenation during rest and sustained elevated muscle activity (SEMA). Seventeen healthy individuals participated in two sessions in which they were injected with glutamate and saline in random order. Each session was divided into three, 10-min periods. During the first (period 1) and the last (period 3) 10-min periods, participants performed five intercalated 1-min bouts of masseter SEMA with 1-min periods of 'rest'. At onset of the second 10-min period, glutamate (0.5 ml, 1 M; Ajinomoto, Tokyo, Japan) or isotonic saline (0.5 ml; 0.9%) was injected into the masseter muscle and the participants kept the muscle relaxed in a resting position for 10 min (period 2). The hemodynamic characteristics of the masseter muscle were recorded simultaneously during the experiment by a laser blood-oxygenation monitor. The results demonstrated that glutamate injections caused significant levels of self-reported pain in the masseter muscle; however, this nociceptive input did not have robust effects on intramuscular oxygenation during rest or SEMA tasks. Interestingly, these findings suggest an uncoupling between acute nociceptive activity and hemodynamic parameters in both resting and low-level active jaw muscles. Further studies are needed to explore the pathophysiological significance of blood-flow changes for persistent jaw-muscle pain conditions.

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