Can pulpal floor debonding be detected from occlusal surface displacement in composite restorations?

Publication date: Available online 6 December 2017
Source:Dental Materials
Author(s): João Batista Novaes, Elissa Talma, Estevam Barbosa Las Casas, Wondwosen Aregawi, Lauren Wickham Kolstad, Sue Mantell, Yan Wang, Alex Fok
ObjectivesPolymerization shrinkage of resin composite restorations can cause debonding at the tooth–restoration interface. Theory based on the mechanics of materials predicts that debonding at the pulpal floor would half the shrinkage displacement at the occlusal surface. The aim of this study is to test this theory and to examine the possibility of detecting subsurface resin composite restoration debonding by measuring the superficial shrinkage displacements.MethodsA commercial dental resin composite with linear shrinkage strain of 0.8% was used to restore 2 groups of 5 model Class-II cavities (8-mm long, 4-mm wide and 4-mm deep) in aluminum blocks (8-mm thick, 10-mm wide and 14-mm tall). Group I had the restorations bonded to all cavity surfaces, while Group II had the restorations not bonded to the cavity floor to simulate debonding. One of the proximal surfaces of each specimen was sprayed with fine carbon powder to allow surface displacement measurement by Digital Image Correlation. Images of the speckled surface were taken before and after cure for displacement calculation. The experiment was simulated using finite element analysis (FEA) for comparison.ResultsGroup I showed a maximum occlusal displacement of 34.7±6.7μm and a center of contraction (COC) near the pulpal floor. Group II had a COC coinciding with the geometric center and showed a maximum occlusal displacement of 17.4±3.8μm. The difference between the two groups was statistically significant (p-value=0.0007). Similar results were obtained by FEA. The theoretical shrinkage displacement was 44.6 and 22.3μm for Group I and II, respectively. The lower experimental displacements were probably caused by slumping of the resin composite before cure and deformation of the adhesive layer.SignificanceThe results confirmed that the occlusal shrinkage displacement of a resin composite restoration was reduced significantly by pulpal floor debonding. Recent in vitro studies seem to indicate that this reduction in shrinkage displacement could be detected by using the most accurate intraoral scanners currently available. Thus, subject to clinical validation, the occlusal displacement of a resin composite restoration may be used to assess its interfacial integrity.



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Characterization, mechanistic analysis and improving the properties of denture adhesives

Publication date: Available online 6 December 2017
Source:Dental Materials
Author(s): Afsoon Fallahi, Nona Khadivi, Nima Roohpour, Andrew M. Middleton, Mehdi Kazemzadeh-Narbat, Nasim Annabi, Ali Khademhosseini, Ali Tamayol
ObjectiveDenture adhesives are widely used to avoid the detachment and sliding of dentures. However, the adhesion properties can be affected by variation in mouth conditions such as the level of salivation. The objective of this study was to understand the effect of environmental conditions on the adhesion properties of a commercially available denture adhesive named as Poligrip^® Free manufactured by GlaxoSmithKline Ltd., UK and to identify the reasons for the observed variation in its adhesion strength.MethodsThe failure mechanisms of denture adhesive have been assessed through using different physical, mechanical and thermal characterization experiments. All methods were used in different pH, temperatures, and salivation conditions and at the end, a strategy was proposed to overcome the failure of the paste in hyposalivation as well.ResultsIn vitro models mimicking the denture gingival interface were designed to evaluate the adhesion properties of the investigated adhesive. Changes in the adhesion strength in response to three major factors related to the oral conditions including level of salivation, pH, and temperature were measured. The results of lap shear, tensile test, and internal interactions suggested a cohesion failure, where the lowest adhesion strength was due to hyposalivation. Fourier transform infrared spectroscopy (FTIR) and rheological analysis confirmed the importance of hydrogen bonds and hydration in the adhesion strength of the paste.SignificanceThe investigated scenarios are widely observed in patient using denture adhesives and the clinical reports have indicated the inconsistency in adhesion strength of the commercial products. After identifying the potential reasons for such behavior, methods such as the addition of tripropylene glycol methyl ether (TPME) to enhance internal hydrogen bonds between the polymers are proposed to improve adhesion in the hyposalivation scenario.



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Practical and theoretical considerations on the fracture toughness testing of dental restorative materials

Publication date: Available online 6 December 2017
Source:Dental Materials
Author(s): Renan Belli, Michael Wendler, José I. Zorzin, Ulrich Lohbauer
BackgroundAn important tool in materials research, development and characterization regarding mechanical performance is the testing of fracture toughness. A high level of accuracy in executing this sort of test is necessary, with strict requirements given in extensive testing standard documents. Proficiency in quality specimen fabrication and test requires practice and a solid theoretical background, oftentimes overlooked in the dental community. Aims: In this review we go through some fundamentals of the fracture mechanics concepts that are relevant to the understanding of fracture toughness testing, and draw attention to critical aspects of practical nature that must be fulfilled for validity and accuracy in results. We describe our experience with some testing methodologies for CAD/CAM materials and discuss advantages and shortcomings of different tests in terms of errors in testing the applicability of the concept of fracture toughness as a single-value material-specific property.



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Bonding strategies for MIH-affected enamel and dentin

Publication date: Available online 6 December 2017
Source:Dental Materials
Author(s): Norbert Krämer, Ngoc-Han Nana Bui Khac, Susanne Lücker, Vitus Stachniss, Roland Frankenberger
ObjectivesAim of the present study was to evaluate resin composite adhesion to dental hard tissues affected by molar incisor hypomineralisation (MIH).Methods94 freshly extracted human molars and incisors (53 suffering MIH) were used. 68 teeth (35 with MIH) were used for μ-TBS tests in enamel and dentin, 26 (18 with MIH) for qualitative evaluation. Specimens were bonded with Clearfil SE Bond, Scotchbond Universal, and OptiBond FL. For MIH affected enamel, additional OptiBond FL groups with NaOCl and NaOCl+Icon were investigated. Beside fractographic analysis, also qualitative evaluations were performed using SEM at different magnifications as well as histological sectioning.ResultsHighest μ-TBS values were recorded with dentin specimens (ANOVA, mod. LSD, p<0.05). Results were independent of adhesive and dentin substrate (p>0.05). Pre-test failures did not occur in dentin specimens. Sound enamel specimens exhibited significantly higher μ-TBS values than MIH enamel (p<0.05). The two-step self-etch adhesive (Clearfil SE Bond) and the two-step etch-and-rinse adhesive (Scotchbond Universal) showed the lowest values in affected enamel specimens (p<0.05) with most pre-test failures (p<0.05). OptiBond FL on affected enamel showed better results than Clearfil SE Bond (p<0.05). An additional pre-treatment of affected enamel with NaOCl or NaOCl and Icon did not enhance enamel bonding (p>0.05), however, it caused less pre-test failures (p<0.05). Micromorphological analyses revealed that conventional phosphoric acid etching produces a much less pronounced etching pattern in affected enamel and a porous structure as weak link for the resin-enamel bond was identified.SignificanceBonding to porous hypomineralized MIH enamel is the limiting factor in adhesion to MIH teeth. MIH-affected dentin may be bonded conventionally.



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Photopolymerization of cell-laden gelatin methacryloyl hydrogels using a dental curing light for regenerative dentistry

Publication date: Available online 6 December 2017
Source:Dental Materials
Author(s): Nelson Monteiro, Greeshma Thrivikraman, Avathamsa Athirasala, Anthony Tahayeri, Cristiane M. França, Jack L. Ferracane, Luiz E. Bertassoni
Photopolymerized hydrogels, such as gelatin methacryloyl (GelMA), have desirable biological and mechanical characteristics for a range of tissue engineering applications.ObjectiveThis study aimed to optimize a new method to photopolymerize GelMA using a dental curing light (DL).MethodsLithium acylphosphinate photo-initiator (LAP, 0.05, 0.067, 0.1% w/v) was evaluated for its ability to polymerize GelMA hydrogel precursors (10% w/v) encapsulated with odontoblast-like cells (OD21). Different irradiances (1650, 2300 and 3700mW/cm²) and photo-curing times (5–20s) were tested, and compared against the parameters typically used in UV light photopolymerization (45mW/cm², 0.1% w/v Irgacure 2959 as photoinitiator). Physical and mechanical properties of the photopolymerized GelMA hydrogels were determined. Cell viability was assessed using a live and dead assay kit.ResultsComparing DL and UV polymerization methods, the DL method photopolymerized GelMA precursor faster and presented larger pore size than the UV polymerization method. The live and dead assay showed more than 80% of cells were viable when hydrogels were photopolymerized with the different DL irradiances. However, the cell viability decreased when the exposure time was increased to 20s using the 1650mW/cm² intensity, and when the LAP concentration was increased from 0.05 to 0.1%. Both DL and UV photocrosslinked hydrogels supported a high percentage of cell viability and enabled fabrication of micropatterns using a photolithography microfabrication technique.SignificanceThe proposed method to photopolymerize GelMA cell-laden hydrogels using a dental curing light is effective and represents an important step towards the establishment of chair-side procedures in regenerative dentistry.



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STRO-1 confers myofibroblast transdifferentiation in fibroblasts derived from oral submucous fibrosis

Abstract

Background

STRO-1 is a mesenchymal cell marker present on all clonogenic stromal precursors. Current evidence has indicated that the pathogenesis of fibrotic changes may be mediated by stemness properties. The aim of this study was to investigate the role of STRO-1 in areca quid chewing-associated oral submucous fibrosis (OSF).

Methods

Thirty OSF specimens and ten normal buccal mucosa were examined by immunohistochemistry. The activity of STRO-1 from fibroblasts cultured from normal buccal mucosa (BMFs) and OSF (OSFFs) were measureed and the effects of arecoline, a major areca nut alkaloid, on STRO-1 in BMFs. Compared the activities between sorted STRO-1⁺ cells and STRO-1^- cells from OSFF were measured by collagen gel contraction, migration, invasion abilities, and the expression of α-smooth muscle actin (α-SMA) and pro-α1 (I) chain of type I collagen.

Results

Our results first showed that the expression of STRO-1 was more evident in areca quid chewing-associated OSF than normal buccal mucosa tissues (p<0.05). Arecoline dose-dependently activated the level of STRO-1 in BMFs (p<0.05). The relative expression of STRO-1 was significantly higher in OSFFs compared with BMFs (p<0.05). In addition, the sorted STRO-1⁺ cells from OSFFs exhibited higher collagen gel contraction, migration, and invasion abilities as well as elevated expression of α-SMA and pro-α1 (I) chain of type I collagen than the negative subset (p<0.05).

Conclusion

These findings suggested that the stemness marker STRO-1 may be a crucial factor in the pathogenesis of areca quid chewing-associated OSF.

This article is protected by copyright. All rights reserved.

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Factors influencing the fracture of dental implants

Abstract

Background

Implant fractures are rare but offer a challenging clinical situation.

Purpose

To determine the prevalence of implant fracture and the possible risk factors predisposing an implant to a higher fracture risk.

Materials and Methods

This retrospective study is based on 2670 patients consecutively treated with implant-supported prostheses. Anatomical-, patient-, and implant-related factors were collected. Descriptive statistics and survival analyses were performed. Generalized estimating equations (GEE) evaluated the effect of explanatory variables on implant fracture.

Results

Forty-four implants (out of 10 099; 0.44%) fractured. The mean ± standard deviation time for fracture to occur was 95.1 ± 58.5 months (min-max, 3.8-294.7). Half of the occurrences of fracture happened between 2 and 8 years after implantation. Five factors had a statistically significant influence on the fracture of implants (increase/decrease in fracture probability): use of higher grades of titanium (decrease 72.9%), bruxism (increase 1819.5%), direct adjacency to cantilever (increase 247.6%), every 1 mm increase in implant length (increase 22.3%), every 1 mm increase in implant diameter (decrease 96.9%).

Conclusions

It is suggested that 5 factors could influence the incidence of implant fractures: grade of titanium, implant diameter and length, cantilever, bruxism.

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A retrospective study on clinical and radiological outcomes of oral implants in patients followed up for a minimum of 20 years

Abstract

Background

Very long-term follow-up of oral implants is seldom reported in the literature.

Purpose

To assess oral implant failure rates and marginal bone loss (MBL) of patients followed up for a minimum of 20 years.

Materials and Methods

Implants placed in patients followed up for 20+ years were included. Descriptive statistics, survival analyses, generalized estimating equations were performed. Three-hundred implants were randomly selected for MBL.

Results

1,045 implants (227 patients) were included. Implant location, irradiation, and bruxism affected the implant survival rate. Thirty-five percent of the failures occurred within the first year after implantation, and another 26.8% in the second/third year. There was a cumulative survival rate of 87.8% after 36 years of follow-up. In the last radiological follow up, 35 implants (11.7%) had bone gain, and 35 implants (11.7%) presented at least 3 mm of MBL. Twenty-six out of 86 failed implants with available radiograms presented severe MBL in the last radiological register before implant failure.

Conclusions

Most of the implant failures occurred at the first few years after implantation, regardless of a very long follow up. MBL can be insignificant in long-term observations, but it may, nevertheless, be the cause of secondary failure of oral implants in some cases.

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Intraoral versus extraoral cementation of implant-supported single crowns: Clinical, biomarker, and microbiological comparisons

Abstract

Objectives

Implant supported single metal-ceramic crowns cemented either extraorally or intraorally were comparatively evaluated by clinical, radiologic, biomarker, and microbiological parameters.

Materials and Methods

Twelve patients with bilateral single tooth gap in the maxillary posterior region received two locking-taper implants; 4.5 mm width, 8 mm length. Selection of intraoral (IOC) or extraoral cementation (EOC) using screwless titanium abutments was done randomly. Peri-implant crevicular fluid (PICF), gingival crevicular fluid (GCF) samples were collected from the implants, adjacent teeth, and bleeding on probing, soft tissue thickness, keratinized tissue width were recorded before starting the prosthetic procedures (baseline) and 3, 6 months after implant loading. Crestal bone loss was measured on radiographs taken immediately and 6 months after cementation. Cytokine levels, amounts of bacteria were determined in PICF/GCF samples. Data were tested by appropriate statistical analyses.

Results

Clinical findings were similar in the crowns cemented extraorally or intraorally at all times (P < .05). PICF and GCF data were similar. At 3 month, interleukin-17E and osteoprotegerin levels were lower in the intraorally cemented crowns.

Conclusion

Extraorally and intraorally cemented crowns exhibited similar crestal bone loss after loading. Higher amount of osteoprotegerin at 3 month at the EOC than the IOC sites might bode well for good osseointegration.

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Determination of MIC and Disk Diffusion Quality Control Guidelines for Meropenem-vaborbactam, a Novel Carbapenem/Boronic Acid β-lactamase Inhibitor Combination

Publication date: Available online 5 December 2017
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Erik Munson, Michael D. Huband, Mariana Castanheira, Kelley A. Fedler, Robert K. Flamm
Meropenem-vaborbactam is a carbapenem/cyclic boronic acid β-lactamase inhibitor combination primarily active against Gram-negative bacilli, including those harboring class A serine carbapenemases such as Klebsiella pneumoniae carbapenemase (KPC). A CLSI M23-A4 (tier-2) quality control study established broth microdilution and disk diffusion ranges for reference strains. Two KPC-producing K. pneumoniae ATCC strains are recommended for quality control testing.



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Evaluation of the Diasorin Liaison® XL Zika Capture IgM ELISA for Zika virus serological testing

Publication date: Available online 5 December 2017
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Angela Sloan, David Safronetz, Kai Makowski, Nicole Barairo, Charlene Ranadheera, Kristina Dimitrova, Kimberly Holloway, Emelissa Mendoza, Heidi Wood, Mike Drebot, Ainsley Gretchen, Kamran Kadkhoda
Due to the increase of Zika virus (ZIKV) transmission throughout the world, many commercial kits have recently become available to aid in laboratory diagnosis of ZIKV infections in clinical samples. Here, we analyze the fully-automated Liaison® XL Zika Capture IgM assay against the recommended IgM-capture enzyme-linked immunosorbent assay.



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Presence of Immune Deficiency increases the risk of Hospitalization in Patients with Norovirus Infection

Publication date: Available online 5 December 2017
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Keith A. Sacco, Thanai Pongdee, Matthew J. Binnicker, Mark Espy, Darrell Pardi, Sahil Khanna, Avni Y. Joshi
BackgroundNorovirus is an emerging pathogen causing gastroenteritis. We sought to identify factors associated with clinical outcomes in a cohort of patients with laboratory-confirmed norovirus infection.MethodsWe performed a retrospective chart review of patients with positive norovirus PCR in stool between October 1, 2015 to May 31, 2016.Results128 unique patients were identified during the study period, 64 of whom had immune deficiency, of which only 3 patients had a primary immune deficiency (CVID), while 61 patients had a secondary immune deficiency. 50% of patients with immune deficiency were hospitalized, as compared to only 30% of the non-immune deficient cohort (Odds ratio: 2.1 (1.1–4.18, p=0.04). One-third (32.8%) of the patients had a polymicrobial stool infection and 21.1% had concurrent Clostridium difficile infection. Initial mean total leukocyte count (WBC) was higher in the hospitalized group at 8.40×109/L versus 6.31×109/L in the nonhospitalized group (p=0.049). All 13 patients presenting with fever had symptomatic resolution (p=0.002). The presence of C. difficile infection was correlated with persistent symptoms (OR 2.30 [0.95–5.58], p=0.067). The overall mortality rate among our cohort was 3.13% (4 patients). All deceased patients had secondary immune deficiency and none had C. difficile co-infection.ConclusionsPresence of an immune deficiency increases the risk of hospitalization with norovirus infection. Absence of fever is associated with lower resolution and possibly may contribute to a persistent infectious state. Presence of concomitant C. difficile infection is correlated with a lower overall mortality rate.



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Pain during orthodontic treatment –pharmacological treatments

This Cochrane review of drug interventions for pain during orthodontic treatment including 32 RCTs find that analgesics were effective in reducing pain. However, low quality evidence did not show a difference in effectiveness between systemic NSAIDs compared with paracetamol, or topical NSAIDs compared with local anaesthetic.

The post Pain during orthodontic treatment –pharmacological treatments appeared first on National Elf Service.

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Reviewer Award

Publication date: December 2017
Source:Journal of Clinical Epidemiology, Volume 92





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Cochrane Qualitative and Implementation Methods Group Guidance Paper 5: Reporting guidelines for qualitative, implementation and process evaluation evidence syntheses

Publication date: Available online 6 December 2017
Source:Journal of Clinical Epidemiology
Author(s): Kate Flemming, Andrew Booth, Karin Hannes, Margaret Cargo, Jane Noyes
ObjectiveTo outline contemporary and novel developments for presentation and reporting of syntheses of qualitative, implementation and process evaluation evidence, and provide recommendations for use of reporting guidelines.Study Design and SettingAn overview of reporting guidelines for qualitative, implementation and process evaluation evidence syntheses drawing on current international literature and the collective expert knowledge of the Cochrane Qualitative and Implementation Methods Group.Results and ConclusionSeveral reporting guidelines exist that can be used or adapted to report syntheses of qualitative, implementation and process evaluation evidence. Methods to develop individual guidance varied. The use of a relevant reporting guideline can enhance the transparency, consistency and quality of reporting. Guidelines exist that are: generic; method specific; and for particular aspects of the reviewing process eg searching. Caution is expressed over the potential for reporting guidelines to produce a mechanistic approach moving the focus away from the content and towards the procedural aspects of the review. The use of a reporting guideline is recommended and a five-step decision flowchart to guide the choice of reporting guideline is provided. Gaps remain in method specific reporting guidelines such as mixed-study, implementation and process evaluation evidence syntheses.



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Guideline on terminology and definitions of updating clinical guidelines: the Updating Glossary

Publication date: Available online 6 December 2017
Source:Journal of Clinical Epidemiology
Author(s): L. Martínez García, H. Pardo-Hernández, A.J. Sanabria, P. Alonso-Coello, K. Penman, E. McFarlane
ObjectiveThe Guidelines International Network (G-I-N) Updating Guidelines Working Group launched an initiative to develop a glossary (the Updating Glossary) with domains, terms, definitions, and synonyms related to updating of clinical guidelines (CGs).Study Design and SettingThe Steering Committee developed an initial list of domains, terms, definitions, and synonyms through brainstorming and discussion. The Panel Members participated in three rounds of feedback to discuss, refine, and clarify the proposed terms, definitions, and synonyms. Finally, Panel Members were surveyed to assess their level of agreement regarding the glossary.ResultsEighteen terms were identified and defined: 1) continuous updating, 2) decision to update, 3) fixed updating, 4) full updating, 5) impact of the new evidence, 6) partial updating, 7) prioritisation process, 8) reporting process, 9) signal for an update, 10) surveillance process, 11) time of validity, 12) timeframe, 13) tools and resources, 14) up to date, 15) update cycle, 16) update unit, 17) updated version, and 18) updating strategy. Consensus was reached for all terms, definitions and synonyms (median agreement scores ≥ 6); except for one term.ConclusionsThe G-I-N Updating Guidelines Working Group assembled the Updating Glossary to facilitate and improve the knowledge exchange among CGs developers, researchers, and users.



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Differences between protocols for randomized controlled trials and systematic reviews

Publication date: Available online 6 December 2017
Source:Journal of Clinical Epidemiology
Author(s): Dawid Pieper, Katharina Allers




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Specific agreement on ordinal and multiple nominal outcomes can be calculated for more than two raters

Publication date: Available online 5 December 2017
Source:Journal of Clinical Epidemiology
Author(s): Henrica C.W. de Vet, Margriet G. Mullender, Iris Eekhout
ObjectiveThe concept of specific agreement has been proposed for dichotomous outcomes for two and more raters. We aim to extend this concept for variables with more than two ordinal or nominal categories and more than two raters.Study design and settingWe used two data sets: 4 plastic surgeons classifying photographs after breast reconstruction on a 5 point ordinal scale; and 6 raters classifying psychiatric patients into 5 diagnostic categories. For m raters, all (i.e. m(m-1)/2) pairwise agreement tables were summed to calculate the observed agreement, specific agreement and conditional probabilities. The 95% confidence intervals were obtained by bootstrapping.ResultsSpecific agreement was calculated for each ordinal or nominal category to examine when one of the raters scored in a specific category, what is the probability that the other raters scored in that same category. And suppose one of the raters scored X1, what is the probability that the other raters scored X1 or any of the other categories (conditional probability). It appeared for example that among the psychiatric disorders, depression and personality disorders were often mixed up, while neurosis was rarely mixed up with schizophrenia.ConclusionThe concept of specific agreement for variables with ordinal and multiple nominal categories provides relevant clinical information. The extension to conditional probabilities of alternative categories broadens the clinical application with examining which categories are most often mixed up.



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Between-trial heterogeneity in meta-analyses may be partially explained by reported design characteristics

Publication date: Available online 5 December 2017
Source:Journal of Clinical Epidemiology
Author(s): K.M. Rhodes, R.M. Turner, J. Savović, H.E. Jones, D. Mawdsley, J.P.T. Higgins
ObjectiveWe investigated the associations between risk of bias judgments from Cochrane reviews for sequence generation, allocation concealment and blinding and between-trial heterogeneity.Study Design and SettingBayesian hierarchical models were fitted to binary data from 117 meta-analyses, to estimate the ratio λ by which heterogeneity changes for trials at high/unclear risk of bias, compared to trials at low risk of bias. We estimated the proportion of between-trial heterogeneity in each meta-analysis that could be explained by the bias associated with specific design characteristics.ResultsUnivariable analyses showed that heterogeneity variances were, on average, increased among trials at high/unclear risk of bias for sequence generation (λˆ 1.14, 95% interval: 0.57 to 2.30) and blinding (λˆ 1.74, 95% interval: 0.85 to 3.47). Trials at high/unclear risk of bias for allocation concealment were on average less heterogeneous (λˆ 0.75, 95% interval: 0.35 to 1.61). Multivariable analyses showed that a median of 37% (95% interval: 0% to 71%) heterogeneity variance could be explained by trials at high/unclear risk of bias for sequence generation, allocation concealment and/or blinding. All 95% intervals for changes in heterogeneity were wide and included the null of no difference.ConclusionOur interpretation of the results is limited by imprecise estimates. There is some indication that between-trial heterogeneity could be partially explained by reported design characteristics, and hence adjustment for bias could potentially improve accuracy of meta-analysis results.



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Editorial Board

Publication date: December 2017
Source:Journal of Clinical Epidemiology, Volume 92





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David Sackett Young Investigator Award

Publication date: December 2017
Source:Journal of Clinical Epidemiology, Volume 92





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Table of Contents

Publication date: December 2017
Source:Journal of Clinical Epidemiology, Volume 92





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From testing to diagnostic strategies and dia-prognostic research

Publication date: December 2017
Source:Journal of Clinical Epidemiology, Volume 92
Author(s): J. André Knottnerus, Peter Tugwell, Andrea C. Tricco, Jessie McGowan




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Acknowledgment of Reviewers

Publication date: December 2017
Source:Journal of Clinical Epidemiology, Volume 92





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Mobile dental clinic plans several stops in Las Vegas Valley

The Ronald McDonald Care Mobile will offer affordable pediatric dental care at two Nevada Health Centers locations. The Ronald McDonald Care Mobile will offer affordable pediatric dental care at two Nevada Health Centers locations.

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Sugar-based collagen membrane cross-linking increases barrier capacity of membranes

Abstract

Objectives

This study examines the permeability and barrier capacity of a sugar cross-linked resorbable collagen membrane ex vivo and in vivo.

Materials and methods

In an ex vivo study, injectable platelet-rich fibrin (i-PRF), a peripheral blood-derived human leukocyte-and-platelet-rich plasma was used to analyze membrane permeability. in vivo subcutaneous implantation in Wistar rats (n = 4 per time point and group) was used to investigate the barrier capacity of the membrane. The induced in vivo cellular reaction was evaluated at 3, 15, and 30 days and compared to sham OP (control) without biomaterial using histological, immunohistochemical, and histomorphometric methods.

Results

Ex vivo, the membrane was impenetrable to leukocytes, platelets, and fibrin from peripheral human blood concentrate (PRF). In vivo, the membrane maintained its structure and remained impervious to cells, connective tissue, and vessels over 30 days. CD-68-positive cell (macrophage) numbers significantly decreased from 3 to 15 days, while from day 15 onwards, the number of multinucleated giant cells (MNGCs) increased significantly. Correspondingly, a rise in implantation bed vascularization from 15 to 30 days was observed. However, no signs of degradation or material breakdown were observed at any time point.

Conclusion

Ex vivo and in vivo results showed material impermeability to cellular infiltration of human and murine cells, which highlights the membrane capacity to serve as a barrier over 30 days. However, whether the induced MNGCs will lead to material degradation or encapsulation over the long term requires further investigation.

Clinical relevance

The data presented are of great clinical interest, as they contribute to the ongoing discussion concerning to what extent an implanted material should be integrated versus serving only as a barrier membrane.

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Editorial Board

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News and announcement

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MRD in multiple myeloma: more questions than answers?

MRD in multiple myeloma: more questions than answers?

MRD in multiple myeloma: more questions than answers?, Published online: 05 December 2017; doi:10.1038/s41408-017-0028-5

MRD in multiple myeloma: more questions than answers?

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Oncolytic virotherapy as an immunotherapeutic strategy for multiple myeloma

Oncolytic virotherapy as an immunotherapeutic strategy for multiple myeloma

Oncolytic virotherapy as an immunotherapeutic strategy for multiple myeloma, Published online: 05 December 2017; doi:10.1038/s41408-017-0020-0

Oncolytic virotherapy as an immunotherapeutic strategy for multiple myeloma

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Reliability of temporal bone high-resolution CT in patients with facial paralysis in temporal bone fracture

Publication date: Available online 5 December 2017
Source:American Journal of Otolaryngology
Author(s): Yaofeng Chen, Kai Zhang, Yanfeng Xu, Yanxu Che, Linna Guan, Yefeng Li
ObjectiveThis study aimed to investigate the reliability of temporal bone high-resolution CT (HRCT) in patients with traumatic facial paralysis.MethodsHRCT with cross-sectional scanning and multi-planar reformation (MPR) was performed on 26 cases with traumatic facial paralysis, and the preoperative imaging manifestations were compared with surgical findings.ResultsPreoperative HRCT revealed fallopian canal damage at the posterior genu in 1 case, geniculate ganglion in 22 cases, labyrinthine segment in 4 cases, tympanic segment in 13 cases and mastoid segment in 0 case, while surgical findings confirmed fallopian canal damage at the posterior genu in 7 cases, geniculate ganglion in 23 cases, labyrinthine segment in 4 cases, tympanic segment in 17 cases and mastoid segment in 7 cases. The accuracy of temporal bone HRCT in revealing damage at those segments of fallopian canal was 14.3%, 95.7%, 100%, 76.5, and 0%, respectively.ConclusionTemporal bone HRCT can generally estimate the extent of damage and provide important information for traumatic facial paralysis before surgery. However, it is unreliable in revealing the damage of fallopian canal at the posterior genu and mastoid segment.



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Intestinal permeability and Ménière's disease

Publication date: Available online 5 December 2017
Source:American Journal of Otolaryngology
Author(s): F. Di Berardino, E. Ciusani, C. Caccia, V. Leoni, U. De Grazia, E. Filipponi, D. Zanetti, L. Elli
PurposeMénière disease (MD) is a multifactorial chronic disabling condition characterized by episodic vertigo, ear fullness, and hearing loss. MD patients often complain of aspecific gastrointestinal symptoms associated with autonomic dysregulation, frequently outweighed by the otological manifestations. Dietary modifications have been reported to improve the typical MD symptoms in some cases. Our purpose was to test the urinary levels of lactulose and mannitol (double sugar test) and the fecal calprotectin, both markers of altered intestinal permeability, in subjects with definite MD in an active and inactive stage.Materials and methodsTwenty-six with definite unilateral MD were studied: 14 patients were symptomatic for at least 3months with moderate to severe vertigo spells and a functional level ≥4; 12 patients had been asymptomatic (no vertigo spells) for at least 3months and had a functional level=1 at the time of testing. Twenty healthy volunteers were recruited as "control group".ResultsLactulose and mannitol absorption was significantly increased in the symptomatic M patients compared to the asymptomatic group (p<0.02 and p<0.004, respectively) and to the controls. FC were also higher than normal only in the symptomatic group. (p<0.01).ConclusionsAn altered intestinal permeability, according to the two assays, was found only in symptomatic MD patients. The rationale for a possible relationship between MD and intestinal permeability is forwarded. The double-sugar test and FC quantification might be implemented in the MD diagnostic workup.



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Symptomatic unilateral vocal fold paralysis following cardiothoracic surgery

Publication date: Available online 6 December 2017
Source:American Journal of Otolaryngology
Author(s): Cassandra Puccinelli, Mara C. Modzeski, Diana Orbelo, Dale C. Ekbom
PurposeUnilateral vocal fold paralysis (UVFP) is a complication associated with cardiothoracic procedures that presents clinically as dysphonia and/or dysphagia with or without aspiration. The literature lacks both data on recovery of mobility and consensus on best management. Herein, our goals are to 1) Identify cardiothoracic procedures associated with symptomatic UVFP at our institution; 2) Review timing and nature of laryngology diagnosis and management; 3) Report spontaneous recovery rate of vocal fold mobility.Materials and methodsRetrospective case series at single tertiary referral center between 2002 and 2015. 141 patients were included who underwent laryngology interventions (micronized acellular dermis injection laryngoplasty and/or type 1 thyroplasty) to treat symptomatic UVFP diagnosed subsequent to cardiothoracic surgery.ResultsPulmonary procedures were most often associated with UVFP (n=50/141; 35.5%). 87.2% had left-sided paralysis (n=123/141). Median time to diagnosis was 42days (x¯=114±348). Over time, UVFP was diagnosed progressively earlier after cardiothoracic surgery. 63.4% of patients (n=95/141) underwent injection laryngoplasty as their initial intervention with median time from diagnosis to injection of 11days (x¯=29.6±54). 41.1% (n=58/141) ultimately underwent type 1 thyroplasty at a median of 232.5days (x¯=367±510.2) after cardiothoracic surgery. 10.2% (n=9/88) of those with adequate follow-up recovered full vocal fold mobility.ConclusionsMany cardiothoracic procedures are associated with symptomatic UVFP, predominantly left-sided. Our data showed poor recovery of vocal fold mobility relative to other studies. Early diagnosis and potential surgical medialization is important in the care of these patients.



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Copyright

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1





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CME Accreditation Page

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1





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Contributors

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1





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Contents

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1





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Forthcoming Issues

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1





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Congenital Vascular Lesions of the Head and Neck

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1
Author(s): Teresa M. O, Milton Waner




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Multidisciplinary Approach to Vascular Anomalies Maximizes Outcomes

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1
Author(s): Sujana S. Chandrasekhar




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Congenital Vascular Lesions of the Head and Neck

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1
Author(s): Teresa M. O, Milton Waner




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Classification and Pathology of Congenital and Perinatal Vascular Anomalies of the Head and Neck

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1
Author(s): Paula E. North

Teaser

Accurate histopathologic description in correlation with clinical and radiological evaluation is required for treatment of vascular anomalies, both neoplastic and malformative. It is important to examine current clinical, histologic, and immunophenotypical features that distinguish the major types of congenital and perinatal vascular anomalies affecting the head and neck. General discussions of pathogenesis and molecular diagnosis must also be taken into account. This article provides an overview of the features that distinguish the major types of congenital and perinatal vascular anomalies affecting the head and neck, and summarizes the diagnostic histopathologic criteria and nomenclature currently applied to these lesions.


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Etiology and Genetics of Congenital Vascular Lesions

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1
Author(s): Angela Queisser, Laurence M. Boon, Miikka Vikkula

Teaser

The detection of somatic, activating genetic mutations to underlie development of vascular tumors and malformations led to a better understanding of their pathophysiology. Proteins encoded by the detected mutated genes activate the two major signaling pathways, also involved in cancer: the RAS/MAPK/ERK pathway and/or the PI3K/AKT/mTOR pathway. This gives a strong basis for studies to repurpose cancer therapeutics to patients with vascular tumors and malformations.


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Imaging of Vascular Lesions of the Head and Neck

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1
Author(s): Jared M. Steinklein, Deborah R. Shatzkes

Teaser

This article provides an overview of imaging findings of common and uncommon vascular lesions in the head and neck and showcases images highlighting imaging findings. Both hemangiomas and vascular malformations are covered.


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Infantile Hemangiomas in the Head and Neck Region

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1
Author(s): Denise M. Adams, Kiersten W. Ricci

Teaser

Infantile hemangiomas (IHs) are benign vascular tumors of infancy most common in the region of the head and neck. Infantile hemangiomas are common; but they are extremely heterogeneous and cause a range of complications depending on their morphology, size, or location. Medical interventions for high-risk patients include topical and systemic therapies, including oral propranolol, which has revolutionized the management of IHs over the past recent years. In the following article, the authors aim to provide a review of the natural history, pathology, complications, syndromes, and medical management of infantile hemangioma.


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Congenital Vascular Tumors

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1
Author(s): Jeremy A. Goss, Arin K. Greene

Teaser

Vascular tumors are benign neoplasms, which result from proliferating endothelial cells. These lesions present during infancy or childhood, may affect any location, and exhibit postnatal growth. Local complications include bleeding, tissue destruction, and pain whereas systemic sequelae include thrombocytopenia, congestive heart failure, and death. Vascular tumors should be differentiated from vascular malformations, which present at birth, have a quiescent endothelium, and grow in proportion to the child. Together, vascular tumors and malformations comprise the field of vascular anomalies.


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Hereditary Hemorrhagic Telangiectasia

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1
Author(s): Thomas Kühnel, Kornelia Wirsching, Walter Wohlgemuth, Ajay Chavan, Katja Evert, Veronika Vielsmeier

Teaser

Hereditary hemorrhagic telangiectasia (HHT) describes the presenting manifestations of a disorder that is characterized by pathologic blood vessels. HHT is inherited as an autosomal dominant trait with variable penetrance. The abnormal vascular structures (dysplasias) can affect all the organs in the human body. The link between a physical stimulus and new lesion development has been established for mucosal trauma owing to nasal airflow turbulence, for ultraviolet exposure to the fingers, and for mechanical trauma to the dominant hand. The pressing question then is whether HHT treatment constitutes a stimulus that is sufficient to trigger new lesion development.


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Psychosocial Impact of Vascular Anomalies on Children and Their Families

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1
Author(s): Alexandra G. Espinel, Nancy M. Bauman

Teaser

Vascular anomalies are divided into tumors and malformations based on their clinical and cytologic attributes. Vascular malformations are further subcategorized as low-flow lymphatic, venous, capillary, or mixed lesions and as high-flow arteriovenous malformations. Treatment is reserved for vascular anomalies that are symptomatic or cosmetically disfiguring, and surgical and nonsurgical treatment options are widely varied with variable outcomes.


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Outcome Measurement for Vascular Malformations of the Head and Neck

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1
Author(s): Sophie E.R. Horbach, Amber P.M. Rongen, Teresa M. O, Milton Waner, Chantal M.A.M. van der Horst

Teaser

Vascular malformations are congenital anomalies of the vascular and/or lymphatic system that affect the head and neck region. The most common treatment options are sclerotherapy, laser therapy, surgery, and embolization. Because vascular malformations are variable in type, size, extent, and location, it is a challenge to select methods for evaluation of treatment outcome. Without standardized outcome reporting, it is difficult to compare and combine scientific evidence to support therapeutic decision making. Standardized collection and reporting of outcome data are the first steps toward a fair comparison between treatments. This article describes outcome measurements for vascular malformations and initiatives to improve outcome reporting.


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The Role of Surgery in the Management of Infantile Hemangiomas

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1
Author(s): Marcelo Hochman

Teaser

Surgery for the management of infantile hemangiomas has become commonplace. Surgical technique articles are plentiful; however, little has been written about the timing of surgery. Knowledge of the biology of the tumors, data from developmental psychology, and the utility of facial reconstruction provide guidelines for timing of surgical intervention.


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The Surgical Management of Infantile Hemangiomas

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1
Author(s): Milton Waner

Teaser

The surgical management of facial infantile hemangiomas presents a unique challenge. The aim of the surgeon should be to remove the hemangioma and to restore normal facial features. Each of the facial zones has its own special features and challenges. The surgeon should remember that the child started out with normal anatomy and that as the hemangioma proliferated, it displaced and thinned these normal structures and in many cases, expanded adjacent tissue. Hemangiomas do not as a rule, invade adjacent tissues as they proliferate. These facts will help in planning the various surgical approaches.


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Management of Infantile Hemangiomas of the Airway

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1
Author(s): David H. Darrow

Teaser

Infantile hemangiomas (IHs) of the airway are far less common than their cutaneous counterparts, and their symptoms mimic those of viral croup. As a result, by the time these lesions are diagnosed, they are often advanced and causing airway compromise. Fortunately, the evolution of propranolol as an effective and safe pharmacotherapy has simplified management of IH and reduced the likelihood of complications previously seen with steroid therapy and surgery. Nevertheless, the otolaryngologist must be prepared with an alternate plan to manage lesions refractory to pharmacotherapy. This article reviews the clinical presentation and current management of IHs of the airway.


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New Frontiers in Our Understanding of Lymphatic Malformations of the Head and Neck

Publication date: February 2018
Source:Otolaryngologic Clinics of North America, Volume 51, Issue 1
Author(s): Jonathan A. Perkins

Teaser

The future of head and neck lymphatic malformation (HNLM) evaluation and treatment is changing because of 2 decades of clinical research and recent basic science investigation. Basic science investigation using cellular biology and molecular genetics has revealed the genetic cause of some HNLMs, which has created the possibility of medical treatment specific to HNLM. This article summarizes the clinical and basic science research that will likely influence the future of HNLM assessment and treatment.


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Re: Pentoxifylline: a review of its use in osteoradionecrosis

We read with great interest the recent paper by Lyons and Brennan that reviewed the use of pentoxifylline in the management of osteoradionecrosis.1 This promising regimen has had success within our local practice and across several reported case series.

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Schluckbeschwerden bei einer Patientin mit postcricoidaler Raumforderung

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-121342

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Cochlear implant symmetry via template

Current trends in bilateral cochlear implantation (CI) favor a minimally invasive subperiosteal pocket technique. Symmetric receiver-stimulator (R/S) placement is an important goal for bilateral CI, especially with regard to patient satisfaction. In this article, we describe a method easily adopted to achieve optimal symmetry. Upon reviewing the Senior Author's 11 bilateral CI cases using the direct subperiosteal pocket technique with the proposed "mirror template," we found improved symmetry, which translated into high patient and family satisfaction regarding the aesthetics of the symmetric R/S placement.

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Total serum bilirubin levels and sensorineural hearing loss in the US adolescents: NHANES 2007–2010

We aimed to investigate whether current levels of total serum bilirubin are associated with different subtypes of sensorineural hearing loss (SNHL) in adolescents.

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Efficacy of Ferric Carboxymaltose (FCM) 500 mg Dose for the Treatment of Restless Legs Syndrome

There have been four randomized, placebo-controlled, double-blinded studies of intravenous (IV) iron in Restless Legs Syndrome (RLS), all of which delivered a final total dose of 1000 mg of iron. The purpose of this study was to evaluate effects of a lesser total dose (500 mg of iron).

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Sleep disorder risk factors among student athletes

To clarify sleep disorder risk factors among student athletes, this study examined the relationship between lifestyle habits, competition activities, psychological distress and sleep disorders.

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The Optiflow™ interface for chronic CPAP use in children

Continuous positive airway pressure (CPAP) is being increasingly used in children of all age ranges. The limited number of commercially available masks especially in infants and young children may complicate its use and compliance. In this report, we describe our experience with the use of the Optiflow™ (Fisher and Paykel Healthcare) Nasal Cannula attached to a regular CPAP device in the setting of chronic CPAP use. This interface consists of a nasal cannula and was originally designed for the delivery of high-flow oxygen therapy.

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Characteristics and correlates of sleep duration, daytime napping, snoring and insomnia symptoms among 0.5 million Chinese men and women

Inadequate sleep duration and insomnia can affect both physical and mental health. There is limited evidence, however, on characteristics and correlates of sleep patterns and of insomnia in urban and rural China.

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The relationship between excessive daytime sleepiness, disability, and mortality, and implications for life expectancy

To assess the relationship between excessive daytime sleepiness (EDS), disability, mortality, and life expectancy (with and without disability) in a cohort of middle-aged American adults.

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Cochrane Qualitative and Implementation Methods Group Guidance Paper 5: Reporting guidelines for qualitative, implementation and process evaluation evidence syntheses

To outline contemporary and novel developments for presentation and reporting of syntheses of qualitative, implementation and process evaluation evidence, and provide recommendations for use of reporting guidelines.

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Some Cochrane risk of bias items are not important in osteoarthritis trials: A meta-epidemiological study based on Cochrane reviews

To evaluate the impact of bias-related study characteristics on treatment effects in osteoarthritis (OA) trials.

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Differences between protocols for randomized controlled trials and systematic reviews

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Clinical predictors for satisfaction with incus vibroplasty: a preliminary study

Abstract

Objective

We aimed to evaluate the subjective satisfaction after incus vibroplasty and to determine predictive factors affecting patient satisfaction in sensorineural hearing loss.

Design

A retrospective review of audiological data and an additional survey about subjective satisfaction after surgery were performed in 14 patients who underwent incus vibroplasty surgery. A numeric rating scale reflecting the degree of satisfaction after incus vibroplasty, compared with experiences using a conventional hearing aid, was used. Patients who showed median or better satisfaction were deemed the highly satisfied (HS) group, and the others were deemed the less satisfied (LS) group. To find the predictive factors correlated with satisfaction for incus vibroplasty, comparative analysis between two groups was performed.

Results

We found that the numeric rating scale for satisfaction was variable, ranged from 0 to 10, and was negatively correlated with age at operation (p < 0.01). The HS group had a younger age (27.6 ± 22.2 years) and better preoperative air conduction threshold at 250 Hz (20.7 ± 7.9 dB) than the LS group (68.0 ± 9.7 years, 32.1 ± 10.7 dB). The LS group (13.6 ± 9.9 dB) showed a larger change of air–bone gap after surgery than the HS group (5.7 ± 6.7 dB) at 250 Hz (p = 0.12).

Conclusions

Age at operation and the preoperative air conduction threshold level at 250 Hz appear to be potential predictive factors for subjective satisfaction with incus vibroplasty. Furthermore, more conservative selection of candidates and caution during surgery, considering inevitable air–bone gap development postoperatively, may be necessary to achieve higher satisfaction for incus vibroplasty.

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Elevated parathyroid hormone levels after successful parathyroidectomy for primary hyperparathyroidism: a clinical review

Abstract

Introduction

Surgery for primary hyperparathyroidism (PHPT) is traditionally deemed to be successful if serum calcium levels return to normal 6 months after parathyroidectomy. Regular monitoring of serum calcium and parathyroid hormone (PTH) in the follow-up of patients after parathyroidectomy for PHPT has drawn attention to the presence of a normocalcemic group of patients with elevated PTH (NCePTH) during the post-operative period. The etiological factors and mechanisms underlying this condition, its consequences, and the possibility of treatment are the object of this study.

Materials and methods

We conducted an unlimited PubMed search updated on March 31, 2017, which yielded 1628 results. We selected 37 articles, 33 of which included cases of NCePTH in their series and 23 performed statistical studies to assess factors associated with NCePTH.

Results

The maximum mean prevalence of NCePTH in the various series was 23.5%, ranging from 3 to 46%. Many factors were associated with NCePTH. The most important were higher pre-operative PTH, low pre-operative 25 (OH) D3, lower pre-operative creatinine clearance and greater adenoma weight. The origin of NCePTH may be multifactorial, since several factors were implicated in the etiology. NCePTH does not seem to be related to an increase in PHPT recurrence, although this possibility should not be dismissed. Vitamin D deficiency should be corrected. Treatment with calcium supplements seems to be clearly beneficial.

Conclusion

The prevalence of NCePTH is high. The causes of secondary hyperparathyroidism should be investigated carefully. Patients require treatment and long-term follow-up.

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Mechanisms of inactivation of the tumour suppressor gene RHOA in colorectal cancer

Mechanisms of inactivation of the tumour suppressor gene RHOA in colorectal cancer

Mechanisms of inactivation of the tumour suppressor gene RHOA in colorectal cancer, Published online: 05 December 2017; doi:10.1038/bjc.2017.420

Mechanisms of inactivation of the tumour suppressor gene RHOA in colorectal cancer

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Quantitative sensory response of the SCM muscle on sustained low level activation simulating co-contractions during bruxing

Publication date: February 2018
Source:Archives of Oral Biology, Volume 86
Author(s): Lydia Eberhard, Sophia Terebesi, Nikolaos Nikitas Giannakopoulos, Daniel Hellmann, Hans-Jürgen Schindler, Marc Schmitter, Doreen Pfau
ObjectiveBruxism is discussed as an etiological factor in the pathogenesis of orofacial and cervical pain. As the sternocleidomastoid muscle (SCM) is co-activated during clenching, our aim was to investigate, whether the muscle loading leads to peripheral or central sensitizations.DesignIn twenty-one healthy female volunteers, somatosensory profiles of the SCM were recorded according to the test battery of the German Research Network on Neuropathic Pain (DFNS) prior to and after an isometric muscle exercise. QST comprised thermal and mechanical stimuli. A submaximal activation of the SCM (15% MVC) was kept for 10min in sitting position. In separate test sessions one month apart, one sham and one verum experiment were conducted in randomized order. During the muscle loading, the parameters cold detection threshold (CDT), mechanical pain sensitivity (MPS) and pressure pain treshold (PPT) were tested and experimental pain recorded by visual analogoue scales (VAS). All test sessions were performed during the follicular phase of the menstrual cycle (day 5), to avoid effects on pain perception. Data were analyzed with Repeated Measures ANOVA (SPSS 22.0)ResultsNo significant changes were found during or after (sham) loading except for stimulus-response-function (SR, P=0.01) and PPT (P=0.02) in the sham test. No effect was observed in the verum experiment (P=0.12 up to 1.0).ConclusionProlonged low level contraction of the SCM does not evoke painful sensitization. In contrast, submaximal muscle activation seems to have a protective effect corresponding to a training effect preventing sensitization.



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Pediatric dental practice receives grant to jumpstart construction

SARASOTA, FL - The Gulf Coast Community Foundation is among the first donors investing in the construction of a much-needed pediatric dental practice in the Sally & Sam Shapiro Babies & Children's Medical Center through a $25,000 grant to The Glasser/Schoenbaum Human Services Center. The Shapiro Medical Center, run by the Health Department and Community Health Centers of Sarasota County, opened in 2014 to provide pediatric medical care for low-income and Medicaid-enrolled children.

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Posterior airway changes following orthognathic surgery in obstructive sleep apnea

The purpose of this systematic review was to describe and compare the different approaches of radiological posterior airway space (PAS) assessment in obstructive sleep apnea (OSA), and analyze the correlations of PAS changes with polysomnographically evaluated parameters following orthognathic surgery.

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Early Development of Emotional Competence (EDEC) Assessment Tool for Children With Complex Communication Needs: Development and Evidence

Purpose

This article introduces and provides initial data supporting "The Early Development of Emotional Competence (EDEC): A tool for children with complex communication needs (CCNs)." The EDEC was developed to raise awareness about the relation of language and emotional competence and to maximize the likelihood that intervention includes language to discuss emotions in ways that are consistent with the values and goals of the family.

Method

First, the theoretical and clinical foundations of the EDEC development were discussed. Then, a description of preferred translation practices was provided, with examples of Korean and Mandarin Chinese translations. Finally, initial data from a pilot study with two sociocultural communities (i.e., 10 American and 10 Korean mothers of children developing typically) were presented to demonstrate the potential of the tool.

Results

The pilot test offered preliminary support for the sensitivity of the EDEC. The tool solicited responses reflecting cultural differences between American and Korean mothers' perception of a child's emotional skills and mother-child conversation about emotions as predicted based on many cross-cultural studies in emotion.

Conclusions

The information elicited from the EDEC shows promise for enabling culturally natural conversation about emotions with appropriate vocabulary and phrases in their augmentative and alternative communication systems.

Supplemental Materials

http://ift.tt/2kox0pI

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Articulatory Kinematic Characteristics Across the Dysarthria Severity Spectrum in Individuals With Amyotrophic Lateral Sclerosis

Purpose

The current study investigated whether articulatory kinematic patterns can be extrapolated across the spectrum of dysarthria severity in individuals with amyotrophic lateral sclerosis (ALS).

Method

Temporal and spatial articulatory kinematic data were collected using electromagnetic articulography from 14 individuals with dysarthria secondary to ALS and 6 typically aging speakers. Speech intelligibility and speaking rate were used as indices of severity.

Results

Temporal measures (duration, speed of articulators) were significantly correlated with both indices of severity. In speakers with dysarthria, spatial measures were not correlated with severity except in 3 measures: tongue movement displacement was more reduced in the anterior–posterior dimension; jaw movement distance was greater in the inferior–superior dimension; jaw convex hull area was larger in speakers with slower speaking rates. Visual inspection of movement trajectories revealed that overall spatial kinematic characteristics in speakers with severe dysarthria differed qualitatively from those in speakers with mild or moderate dysarthria. Unlike speakers with dysarthria, typically aging speakers displayed variable tongue movement and minimal jaw movement.

Conclusions

The current study revealed that spatial articulatory characteristics, unlike temporal characteristics, showed a complicated pattern across the severity spectrum. The findings suggest that articulatory characteristics in speakers with severe dysarthria cannot simply be extrapolated from those in speakers with mild-to-moderate dysarthria secondary to ALS.

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Mechanisms of inactivation of the tumour suppressor gene RHOA in colorectal cancer

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Oncolytic virotherapy as an immunotherapeutic strategy for multiple myeloma

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Dental practice holds soiree to 'get to know the patients'

The Art Soiree with Nick Bodimeade was held last Wednesday, so patients could find out more about the paintings on display at the Ferring Street practice. Sacha Tunks, business development manager, said: "We were graced with the presence of Mr Nick Bodimeade himself, a fabulous artist who currently resides in Lewes.

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MRD in multiple myeloma: more questions than answers?

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August 2001 Volume 51 Supplement 2, Part 1: Erratum

No abstract available

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Treatment with the TGF-b superfamily cytokine MIC-1/GDF15 reduces the adiposity and corrects the metabolic dysfunction of mice with diet-induced obesity

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Nodal Factors Predictive of Recurrence After Thyroidectomy and Neck Dissection for Papillary Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Association of palatine tonsil size and obstructive sleep apnea in adults

ConclusionIn contrast to past studies, subjective PT grade (vs. objective PT volume) was more strongly associated with AHI. These data suggest the space that the tonsils occupy within the oropharyngeal airway, instead of their actual measured volume, may be more predictive of OSA severity in a cohort of U.S. adult patients. Level of Evidence2c. Laryngoscope, 2017 (Source: The Laryngoscope)

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Frank Brown (1943-2017)

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Strategies for survival

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Sumatran tiger survival threatened by deforestation despite increasing densities in parks

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Abergavenny dentist wins award

Dr Thomas was crowned the Best Young Dentist at last year's Private Dentistry Awards and selected by Dentistry Magazine as a Leader of the Future. He has previously been awarded the British Society of Prosthodontics Heraeus-Kulzer Prize for his research on tooth wear, Heart your Smile champion for his volunteer work and now acts as a key opinion leader for Ivoclar, DMG and Zhermack.

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Body Mass Index and Olfactory Fossa Depth in Patients with and without Spontaneous Cerebrospinal Fluid Leaks

Background/Aims: Spontaneous cerebrospinal fluid (SCSF) leaks are associated with a high body mass index (BMI) and an expanded skull base. The purpose of this study is to determine if a correlation exists between BMI and olfactory fossa depth (OFD) in patients with SCSF leaks and those without. Methods: This is a cross-sectional study evaluating the correlation between OFD and BMI in patients with and without SCSF leaks. OFD was measured on computed tomography obtained in temporal proximity to the BMI. Results: Patients with SCSF leaks had a deeper mean OFD than controls (6.39 vs. 5.46 mm, p = 0.013) and a larger BMI (38.2 vs. 30.5, p = 0.0003). Pearson correlation was positive between BMI and OFD in women from the control group (R = 0.319, n = 93, p = 0.002 on the left; R = 0.313, n = 93, p = 0.002 on the right) but insignificant in men. Conclusions: The olfactory fossa is deeper and the BMI higher in patients with SCSF leaks than in those without. Differences were statistically significant. Higher BMI may predict deeper olfactory fossa in women but not in men. These findings suggest expansion of weak points in the skull base as precursors to the development of SCSF leaks in response to elevated CSF pressures, particularly in women.
ORL 2017;79:331-335

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Cooperation and the evolution of hunter-gatherer storytelling

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Mountain hare transcriptome and diagnostic markers as resources to monitor hybridization with European hares

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Long-term monitoring of coral reef fish assemblages in the Western central pacific

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3D endoscopic ear surgery: a clinical pilot study

Abstract

Objective

To evaluate the feasibility and efficacy of a new high-resolution 3D endoscope in endoscopic ear and lateral skull base surgery.

Methods

Eight patients, five women and three men, were included in this clinical pilot prospective study. Their age was 38 ± 17.3 years (mean ± SD, range 17–54 years). The right side was involved in five cases, and the left side in three cases. There were three cases of chronic otitis, one case of cholesteatoma of the external auditory canal, one case of otosclerosis, one case of cochlear implant surgery, and two cases of stage 2 vestibular schwannoma operated on with a retrosigmoid approach to preserve hearing.

Results

There were no intraoperative or postoperative complications. The new system was used during all procedures without the necessity to switch to a 2D mode. The surgeons felt comfortable using the system and its major advantages were considered to be in measuring the distances for ossicular chain reconstruction and in the sense of depth provided in the middle ear and cerebellopontine angle.

Conclusion

The sense of depth provided by the 3D system is effective in both middle ear and lateral skull base surgery. Further improvements (smaller and/or more angled endoscopes) should be considered for future developments in endoscopic ear surgery.

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In vivo Effects of Repeated Thyronamine Administration in Male C57BL/6J Mice

Objectives: Thyronamines are decarboxylated and deiodinated metabolites of thyroid hormones (THs). Of all possible thyronamine variants, only 3-iodothyronamine (3-T₁AM) and iodine-free thyronamine (T₀AM) have been detected in vivo. While intensive research has been done on the (patho-)physiological action of 3-T₁AM, the role of T₀AM has been studied less intensively. Study Design: We determined whether a single pharmacological dose (50 mg/kg, i.p.) or repeated administration (5 mg/kg/day, i.p., for 7 days) of T₀AM affects metabolism, cardiovascular function, or thermoregulation in male C57BL/6J mice. Since selenium (Se) is important for proper TH function and Se metabolism is affected by TH, we additionally analyzed Se concentrations in liver, serum, and kidney using total reflection X-ray analysis. Results: A single injection of T₀AM had no effect on heart rate, temperature, or activity as assessed by radio telemetry. Likewise, daily administration of T₀AM did not alter body weight, food or water intake, heart rate, blood pressure, brown adipose tissue thermogenesis, or body temperature, and no significant differences in hepatic glycogen content or mRNA expression of genes involved in cardiovascular function or metabolic control were determined. Also, the X-ray analysis of Se concentrations revealed no significant changes. However, hepatic T₀AM was significantly increased in the treated animals. Conclusions: In summary, our data demonstrate that T₀AM elicits no obvious metabolic, cardiovascular, or thermoregulatory activities in mice. As T₀AM does also not interfere with TH or Se metabolism, we conclude that the deiodination of 3-T₁AM to T₀AM constitutes an efficient inactivation mechanism, terminating the actions of the more powerful precursor.
Eur Thyroid J

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Therapeutic targeting of membrane-associated GRP78 in leukemia and lymphoma: preclinical efficacy in vitro and formal toxicity study of BMTP-78 in rodents and primates

Therapeutic targeting of membrane-associated GRP78 in leukemia and lymphoma: preclinical efficacy in vitro and formal toxicity study of BMTP-78 in rodents and primates

Therapeutic targeting of membrane-associated GRP78 in leukemia and lymphoma: preclinical efficacy <i>in vitro</i> and formal toxicity study of BMTP-78 in rodents and primates, Published online: 05 December 2017; doi:10.1038/tpj.2017.46

Therapeutic targeting of membrane-associated GRP78 in leukemia and lymphoma: preclinical efficacy in vitro and formal toxicity study of BMTP-78 in rodents and primates

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Applications of pharmacogenomics in regulatory science: a product life cycle review

Applications of pharmacogenomics in regulatory science: a product life cycle review

Applications of pharmacogenomics in regulatory science: a product life cycle review, Published online: 05 December 2017; doi:10.1038/tpj.2017.47

Applications of pharmacogenomics in regulatory science: a product life cycle review

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MTHFR, TS and XRCC1 genetic variants may affect survival in patients with myelodysplastic syndromes treated with supportive care or azacitidine

MTHFR, TS and XRCC1 genetic variants may affect survival in patients with myelodysplastic syndromes treated with supportive care or azacitidine

MTHFR, TS and XRCC1 genetic variants may affect survival in patients with myelodysplastic syndromes treated with supportive care or azacitidine, Published online: 05 December 2017; doi:10.1038/tpj.2017.48

MTHFR, TS and XRCC1 genetic variants may affect survival in patients with myelodysplastic syndromes treated with supportive care or azacitidine

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Gene expression and linkage analysis implicate CBLB as a mediator of rituximab resistance

Gene expression and linkage analysis implicate CBLB as a mediator of rituximab resistance

Gene expression and linkage analysis implicate CBLB as a mediator of rituximab resistance, Published online: 05 December 2017; doi:10.1038/tpj.2017.41

Gene expression and linkage analysis implicate CBLB as a mediator of rituximab resistance

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Factors affecting operative time in robotic thyroidectomy

Abstract

Background

The purpose of this study was to evaluate factors related to operative time in robotic thyroidectomy.

Methods

We retrospectively analyzed 240 patients who underwent robotic thyroidectomy. The total thyroidectomy cases and lobectomy cases were both categorized into those with long operative times (LOTs; upper 25% of cases) and those with short operative times (SOTs; lower 25%).

Results

Among the total thyroidectomy cases, body mass index (BMI) ≥23 kg/m² (hazard ratio [HR] 5.34; P = .008) and bilateral central neck dissection (CND; HR 14.92; P = .028) were more frequent in the LOT group in multivariate analysis. Among the lobectomy cases, BMI ≥23 kg/m² (HR 12.92; P = .003) and unilateral CND (HR 21.38; P = .017) were the only independent risk factors for prolonged operative time.

Conclusion

Body habitus and clinical nodal status in the central compartment should be considered in deciding the indications for robotic thyroidectomy.

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Nutritional and hematologic markers as predictors of risk of surgical site infection in patients with head and neck cancer undergoing major oncologic surgery

Abstract

Background

Surgical site infection is a complication of surgery for patients with head and neck cancer. We examined the risk factors for surgical site infection in patients undergoing surgery for head and neck cancer.

Methods

The study involved 369 patients who underwent surgery for head and neck cancer. Hematological and nutritional parameters were measured preoperatively and postoperatively. Univariate and multivariate analyses were used to determine the risk factors for surgical site infection.

Results

Of the 369 patients, 104 (28.2%) had surgical site infections: 45 (12.2%) superficial incisional; 6 (1.6%) deep incisional; and 53 (14.4%) organ/space infections. Multivariate analyses showed that history of radiotherapy, weight loss at diagnosis (>5%), preoperative hypoalbuminemia, neutrophil/lymphocyte ratio (NLR), reconstructive surgery, and tracheostomy were the independent factors predictive of surgical site infection. Patients with preoperative low serum albumin levels (<3.3 g/L) had a 3-fold higher risk of surgical site infection.

Conclusion

Our study shows that patient nutritional and hematological markers are associated with the risk of surgical site infection after major surgery for head and neck cancer.

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Growing incidence of thyroid carcinoma in recent years: Factors underlying overdiagnosis

Abstract

There is an increasing incidence of well-differentiated thyroid cancer worldwide. Much of the increase is secondary to increased detection of small, low-risk tumors, with questionable clinical significance. This review addresses the factors that contribute to the increasing incidence and considers environmental, and patient-based and clinician-led influences. Articles addressing the causes of the increased incidence were critically reviewed. A complex interplay of environmental, medical, and social pressures has resulted in increased awareness of the thyroid disease risk, increased screening of thyroid cancers, and increased diagnosis of thyroid cancers. Although there is evidence to suggest that the true disease incidence may be changing slightly, most of the increase is related to factors that promote early diagnosis of low-risk lesions, which is resulting in a significant phenomenon of overdiagnosis. An improved understanding of these pressures at a global level will enable healthcare policymakers to react appropriately to this challenge in the future.

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Pharyngeal perforation after anterior cervical spine surgery treated by transoral endoscopic surgery

Abstract

Background

Anterior cervical fixation has been used since 1967 for multiple pathologies like traumatism, compressive myelopathy, or spinal infections.

Methods

We report the case of a patient who had undergone cervical spine surgery 10 years previously and presented to our clinic with a pharyngeal fistula due to surgical screw displacement that was treated by transoral endoscopic surgery.

Results

The immediate postoperative period occurred without incidence and complete odynophagia resolution. The patient was discharged home the fourth day after surgery. Follow-up after 1 year showed no evidence of spinal fixation hardware mobilization.

Conclusion

We consider the transoral endoscopic approach a feasible low comorbidity technique to treat anterior cervical plate mobilization with pharyngeal and pharyngoesophageal perforations.

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AHNS Series: Do you know your guidelines? Evidence-based management of oral cavity cancers

Abstract

Oral cavity squamous cell carcinoma (OCSCC) is the most common nonmelanoma head and neck cancer in the world, with an estimated 405 000 new cases expected each year. Subsites of the oral cavity include the alveolar ridge, buccal mucosa, anterior tongue, tonsillar pillar, retromolar trigone, hard palate, gingiva, and floor of the mouth. In this issue of the AHNS "Do you know your guidelines?" series, we review the evidence-based approach to the management of oral cavity carcinomas based on the framework provided by the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology.

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ASCO 2017—highlights of gynecological cancer

Summary

At this year's ASCO annual meeting several important studies in the field of gynecological cancer were presented. Here we report a personal selection of the most interesting and clinically relevant data.

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Correlation between mandibular bone density and skeletal bone density in a Catalonian postmenopausal population.

Correlation between mandibular bone density and skeletal bone density in a Catalonian postmenopausal population.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Nov 29;:

Authors: Estrugo-Devesa A, Segura-Egea J, García-Vicente L, Schemel-Suárez M, Blanco-Carrrión Á, Jané-Salas E, López-López J

Abstract
OBJECTIVES: The aim of this study was to determine if the mandible (MD) experiences reductions in bone mineral density (BMD) similar to the lumbar spine (LS) and femoral neck (FN) in a postmenopausal population.
STUDY DESIGN: A total of 137 postmenopausal women underwent 3 types of densitometric examinations: LS, FN, and MD as measured in 3 regions (MD-R1, MD-R2, and MD-R3), as well as the entire mandible (MD-Net) using a dual photon bone X-ray densitometer. Densitometry of the LS and FN were performed according to the protocol of the International Society for Clinical Densitometry. Mandibular densitometry was performed using a modification of a previous technique, placing the patient in the left lateral decubitus position, with the head supported by a 13-cm-thick cushion above the temporomandibular joint.
RESULTS: Significant correlations were found between densitometry results for the LS and the MD, with P values of .021 at MD-R1 (ramus); .001 at MD-R2 (body); .050 at MD-R3 (symphysis), and .001 at MD-Net (total mandibular density). No correlation was found between mandibular and FN densitometry (P > .05).
CONCLUSIONS: According to the results, for this population, it can be affirmed that the MD responds to osteoporosis in ways similar to the LS.

PMID: 29198430 [PubMed - as supplied by publisher]

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The potential benefits from respiratory gating for breast cancer patients regarding target coverage and dose to organs at risk when applying strict dose limits to the heart: results from the DBCG HYPO trial

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The management and survival outcomes of nasopharyngeal cancer in the Nordic countries

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Concurrent new drug prescriptions and prognosis of early breast cancer: studies using the Danish Breast Cancer Group clinical database

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DBCG hypo trial validation of radiotherapy parameters from a national data bank versus manual reporting

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Influence of specific comorbidities on survival after early-stage breast cancer

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Breast cancer patient advocacy in Denmark

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Palliative treatment with carboplatin as late line therapy to patients with metastatic breast cancer

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Quality of life and care needs in women with estrogen positive metastatic breast cancer: a qualitative study

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The accuracy of preoperative staging of the axilla in primary breast cancer: a national register based study on behalf of Danish Breast Cancer Group (DBCG)

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Provision of data from the clinical database and of biological material from the tumor bank of the Danish Breast Cancer Cooperative Group 2008–2017

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An inter-observer Ki67 reproducibility study applying two different assessment methods: on behalf of the Danish Scientific Committee of Pathology, Danish breast cancer cooperative group (DBCG)

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The clinical database and implementation of treatment guidelines by the Danish Breast Cancer Cooperative Group in 2007–2016

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Influence of intra-tumoral heterogeneity on the evaluation of BCL2, E-cadherin, EGFR, EMMPRIN, and Ki-67 expression in tissue microarrays from breast cancer

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Aurora kinase A as a possible marker for endocrine resistance in early estrogen receptor positive breast cancer

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Occult breast cancer in breast reduction specimens

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The ability of PAM50 risk of recurrence score to predict 10-year distant recurrence in hormone receptor-positive postmenopausal women with special histological subtypes

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Speech-language pathologists as determiners of the human right to diversity in communication for school children in the US

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Is there a sex-shift in prevalence of allergic rhinitis and comorbid asthma from childhood to adulthood? A meta-analysis

Allergic rhinitis and asthma as single entities affect more boys than girls in childhood but more females in adulthood. However, it is unclear if this prevalence sex-shift also occurs in allergic rhinitis and...

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AliveCor Merges the EKG with the Apple Watch Through KardiaBand

 

 

Here's an interesting bit of info from the healthcare sector.  As FitBit & other platforms begin to see sales level off, the idea of portable healthcare updates are still popular with consumers.

 

To that end, AliveCor has announced the KardiaBand.  The company had previously released the Kardia which is an EKG monitor that connects wirelessly to your smartphone.  The KardaBand moves that same technology to the band of your Apple Watch for even easier access.

 

           

 

 

Both devices are pictured above.  They are FDA approved and have show some serious benefits for patients suffering with AFib.  To learn about the devices, check out the company website.  

 

The press release on the Kardia platform gives a pretty good indication of the benefits it provides:

 

New Research Confirms Significance of AliveCor's 30 Second EKG

App Based, FDA-cleared, EKG technology substantiated by top researchers to detect possible Atrial Fibrillation (AFib), including those in previously undiagnosed cases; Breakthrough for population suffering from AFib without knowing it.

September 6, 2017 – Mountain View, CA – AliveCor, the leader in FDA-cleared personal electrocardiogram (EKG) technology, today announced the results of four clinical research presentations that demonstrate AliveCor's hyper-fast, 30 second, digital EKG can positively impact and potentially even save the lives of millions of people around the world who suffer from Atrial Fibrillation (AFib). As a medtech leader, AliveCor uses advanced artificial intelligence, mobile, cloud, and micro-electrode technology to change the dynamic in cardiac care. AliveCor empowers patients worldwide to proactively manage heart health and provide the potential to vastly improve the quality of care in the fight against heart disease. AliveCor's Kardia Mobile enables patients and their care teams to easily, quickly, and inexpensively detect and manage possible AFib, the single leading cause of stroke and heart failure. "Over 35 million people around the world unknowingly suffer from Atrial Fibrillation," said AliveCor CEO Vic Gundotra. "AFib is widely understood to be the leading predictor of stroke and heart failure. AliveCor's app based digital EKG enables patients to conveniently and precisely detect AFib and to deliver clinical grade EKGs to their health care providers."
Key Kardia Mobile-focused findings from the 2017 European Society of Cardiology Congress In Barcelona include:

• Patients using Kardia Mobile had a 4X increase in AFib Detection: Professor Julian Halcox of Swansea University Hospital in Wales presented The REHEARSE-AF Study at ESC with simultaneous publication in Circulation, The Journal of the American Heart Association. This randomized study provided AliveCor Kardia units to 500 seniors, who used them to record two EKGs per week for a year and compared the results to 500 seniors who received conventional care from their General Practitioner. At the end of the year, the Kardia group had a 4-fold increase in AFib diagnosis compared to the control group, thereby enabling the initiation of potentially life-saving anticoagulant therapy.
• Cleveland clinic study shows Kardia Mobile AFib detection accuracy similar to that of physicians. Dr. Khaldoun Tarakji from the Cleveland Clinic presented the iREAD Study which evaluated the accuracy of the AliveCor automatic AFib algorithm versus expert cardiology over-read of both the Kardia recordings and 12-lead EKGs. Dr. Tarakji found that the Kardia algorithm in 52 patients had a 96.6% sensitivity and a 94% specificity compared to a cardiology over-read of the simultaneous 12-lead EKGs for the diagnosis of AFib. Additionally, over 93% of the patients found the Kardia to be easy to use and that it "lessened AFib-diagnosis anxiety."
• Kardia Mobile is able to detect more patients with AFib that were previously undiagnosed: Dr. Bryan Yan of The Chinese University of Hong Kong presented research of over 12,000 patients 65 and older. He found that at each 30-second EKG using Kardia Mobile, his team was able to identify more and more patients with previously undiagnosed AFib. This result demonstrates the empirical value of convenient, inexpensive self-screening using Kardia Mobile.
• Patients find Kardia Mobile easy to use: Dr. Ngai Yin Chan of Princess Margaret Hospital in Hong Kong presented the AFinder Study which used community volunteers to perform opportunistic screening for AFib using AliveCor's Kardia Mobile in over 10,000 Hong Kong citizens age 50 and older. 244 participants were found to have AFib, with 74 of those previously undiagnosed. This study validates, that using Kardia Mobile, that volunteer senior citizens who were not medical professionals could perform medical screening of their peers with successful identification of a serious medical condition.

AliveCor's FDA-cleared Kardia Mobile continues to be the most clinically-validated EKG solution on the market and is currently recommended by physicians at top cardiovascular health systems in the U.S. For more information: http://ift.tt/227h1Fy.

About AliveCor
AliveCor, Inc. is pioneering the creation of FDA-cleared machine learning techniques to enable proactive heart care and is recognized around the world for transforming cardiac care. The FDA-cleared Kardia Mobile is the most clinically validated mobile EKG solution on the market and is recommended by leading cardiologists and used by people worldwide for accurate EKG recordings. This simple-to-use mobile device and app-based service provides instant analysis for detecting atrial fibrillation (AF) and normal sinus rhythm in an EKG. Kardia Pro is the first AI-enabled platform for doctors to monitor patients for the early detection of atrial fibrillation, the most common cardiac arrhythmia that leads to a five times greater risk of stroke. AliveCor was recognized by Fast Company as one of 2017's most innovative companies in health (#3). AliveCor is a privately-held company headquartered in Mountain View, Calif. For more information, please visit alivecor.com.

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