Macrophage LRP1 Promotes Diet-Induced Hepatic Inflammation and Metabolic Dysfunction by Modulating Wnt Signaling

Hepatic inflammation is associated with the development of insulin resistance, which can perpetuate the disease state and may increase the risk of metabolic syndrome and diabetes. Despite recent advances, mechanisms linking hepatic inflammation and insulin resistance are still unclear. The low-density lipoprotein receptor-related protein 1 (LRP1) is a large endocytic and signaling receptor that is highly expressed in macrophages, adipocytes, hepatocytes, and vascular smooth muscle cells. To investigate the potential role of macrophage LRP1 in hepatic inflammation and insulin resistance, we conducted experiments using macrophage-specific LRP1-deficient mice (macLRP1−/−) generated on a low-density lipoprotein receptor knockout (LDLR−/−) background and fed a Western diet. LDLR−/−; macLRP1−/− mice gained less body weight and had improved glucose tolerance compared to LDLR−/− mice. Livers from LDLR−/−; macLRP1−/− mice displayed lower levels of gene expression for several inflammatory cytokines, including Ccl3, Ccl4, Ccl8, Ccr1, Ccr2, Cxcl9, and Tnf, and reduced phosphorylation of GSK3α and p38 MAPK proteins. Furthermore, LRP1-deficient peritoneal macrophages displayed altered cholesterol metabolism. Finally, circulating levels of sFRP-5, a potent anti-inflammatory adipokine that functions as a decoy receptor for Wnt5a, were elevated in LDLR−/−; macLRP1−/− mice. Surface plasmon resonance experiments revealed that sFRP-5 is a novel high affinity ligand for LRP1, revealing that LRP1 regulates levels of this inhibitor of Wnt5a-mediated signaling. Collectively, our results suggest that LRP1 expression in macrophages promotes hepatic inflammation and the development of glucose intolerance and insulin resistance by modulating Wnt signaling.

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Voice Disorders are Associated With Stress Among Teachers: A Cross-Sectional Study in Finland

Voice disorders are considered to be more common among teachers than other occupations. However, epidemiological data are scarce and only a few researchers have studied stress as a risk factor in voice disorders in teachers. This paper presents data from a study on Finnish school teachers which investigated the prevalence of voice disorders and evaluated the risk factors for voice disorders, especially stress.

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Predicting Patient Needs for Interdisciplinary Services in a Voice and Swallowing Center

In a subspecialty interdisciplinary voice and swallowing clinic, patient referrals come from a wide variety of disciplines for various reasons, which can make scheduling their initial evaluations challenging. Depending on the nature of complaints and symptoms, patients may best be evaluated either by a single provider (a laryngologist) or by an interdisciplinary team that includes a speech-language pathologist. If not scheduled appropriately, the provider and the patient may lose valuable time, resources, and money.

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Susceptibility-weighted imaging of retinal hemorrhages in abusive head trauma

Abstract

Background

Retinal hemorrhages are one of the most important supportive evidences for abusive head trauma (AHT). Susceptibility-weighted imaging (SWI) is highly suited to identify various forms of intracranial hemorrhage in AHT. However its utility in imaging retinal hemorrhage is not well established.

Objective

SWI is a sensitive sequence for identifying retinal hemorrhage on MRI.

Materials and methods

In this retrospective analysis, 26 consecutive infants and young children with a suspected admission diagnosis of AHT underwent indirect ophthalmoscopy and brain MRI protocol for AHT along with SWI. Brain susceptibility-weighted images of 14 age-matched children were used as controls. For detecting retinal hemorrhage, susceptibility-weighted images of patients and controls were reviewed randomly and independently by two neuroradiologists who were blinded to the history and ophthalmology findings. A pediatric ophthalmologist graded the indirect ophthalmoscopy images.

Results

A diagnosis of AHT was confirmed in all 26 cases from a multidisciplinary meeting. Indirect ophthalmoscopy images were available in 21 cases. Ophthalmoscopy was positive for retinal hemorrhage in the right eye in 18 cases (85.7%) and in the left eye in 16 cases (76.2%). On SWI, retinal hemorrhage was identified in the right eye in 9/21 cases (42.8%) and in the left eye in 8/21 cases (38.1%) of AHT. Analysis of SWI in 21 cases of AHT demonstrated a sensitivity of 50%, specificity of 100%, positive predictive value of 100% and negative predictive value of 32% for detecting retinal hemorrhage.

Conclusion

SWI is moderately sensitive and highly specific for identifying retinal hemorrhage in AHT. Further studies are needed to identify steps to improve the efficiency of SWI in detecting retinal hemorrhage.

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Clinical immunotherapeutic approaches for the treatment of head and neck cancer

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common malignancy worldwide, accounting for more than 550,000 cases and 380,000 deaths annually. The primary risk factors associated with HNSCC are tobacco use and alcohol consumption; nevertheless genetic predisposition and oncogenic viruses also play important roles in the development of these malignancies. The current treatments for HNSCC patients include surgery, chemotherapy, radiotherapy, and cetuximab, and combinations of these.

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Should we fear direct oral anticoagulants more than vitamin K antagonists in simple single tooth extraction? A prospective comparative study

Abstract

Objectives

The aim of this prospective comparative clinical study was to evaluate the effect of oral anticoagulants on peri- and post-operative bleeding during simple single tooth extractions, comparing patients in treatment with vitamin K antagonists (VKAs) and patients assuming direct oral anticoagulants (DOACs).

Materials and methods

Patients under oral anticoagulant therapy needing dental extraction were eligible for entering the study; patients were enrolled following inclusion and exclusion criteria and divided into VKAs and DOAC group according to the anticoagulation therapy. Included patients underwent a simple single dental extraction with elevators and forceps with a maximum surgical time of 15 minutes, without anticoagulation therapy discontinuation. All participants were assessed pre-operatively, during surgery, 30 min minutes and 7 days after surgery. Biological complications were registered and post-extraction bleeding was clinically defined according to Iwabuchi classification. Parametric and non-parametric tests were used to evaluate the variables between the groups.

Results

Sixty-five patients per group were enrolled and 130 teeth were extracted. The two groups were comparable for pre-, peri-, and post-operative variables. Only 1 patient of DOAC group and 2 patients for VKA group needed medical evaluation for post-extractive bleeding. No statistically significant difference resulted in post-operative bleeding events between the groups (p = 0.425).

Conclusions

DOAC and VKA patients showed the same incidence of bleeding complications after simple single tooth extraction. Bleeding events were not statistically significant and not clinically relevant.

Clinical relevance

Patients assuming DOACs can be treated similarly to patients in VKAs therapy with INR index between 2 and 3. Non-ceasing of DOAC therapy seems to be appropriate for simple single dental extractions.

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Antimicrobial photodynamic therapy as adjunct to non-surgical periodontal treatment in smokers: a randomized clinical trial

Abstract

Objectives

This study aims to investigate the additional influence of multiple applications of antimicrobial photodynamic therapy (aPDT) in smokers with chronic periodontitis.

Materials and methods

Twenty smokers with chronic periodontitis were treated in a split-mouth design study with aPDT adjunct to Scaling and Root Planing (SRP) or SRP. aPDT was performed by using a laser light source with 660 nm wavelength associated with a photosensitizer. The applications were performed in four episodes (at days 0, 2, 7, and 14). All patients were monitored for 90 days. Plaque index, probing depth, clinical attachment level, and bleeding on probing were performed at baseline, 30, and 90 days after the SRP. Gingival crevicular fluid and subgingival plaque samples were collected for immunological and microbiological analysis, respectively. Data obtained were statistically analyzed.

Results

aPDT as an adjunct to SRP did not demonstrate statistically significant advantages on clinical parameters when compared with SRP alone. No statistic significant differences between groups were observed (p < 0.05). Levels of anti-inflammatory cytokines and bacterial species were comparable in both groups at day 90 after treatment.

Conclusion

Periodontal treatment with SRP + aPDT in multiples episodes was not able to promote additional clinical, immunological, and microbiological benefits in smokers when compared SRP alone in patients with chronic periodontitis.

Clinical relevance

Multiple episodes of aPDT adjunctive to non-surgical treatment did not improve significantly the clinical, immunological, and microbiological parameters when compared with SRP alone. More randomized clinical trials are needed to evaluate adjuvant therapies for scaling and root planning in smokers with chronic periodontitis. ClinicalTrials.gov Identifier: NCT03039244

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Voice Disorders are Associated With Stress Among Teachers: A Cross-Sectional Study in Finland

Publication date: Available online 3 November 2018

Source: Journal of Voice

Author(s): Hanna Vertanen-Greis, Eliisa Löyttyniemi, Jukka Uitti

Summary

Objectives

Voice disorders are considered to be more common among teachers than other occupations. However, epidemiological data are scarce and only a few researchers have studied stress as a risk factor in voice disorders in teachers. This paper presents data from a study on Finnish school teachers which investigated the prevalence of voice disorders and evaluated the risk factors for voice disorders, especially stress.

Study Design

A cross-sectional study was conducted among primary and secondary education teachers across Finland.

Methods

Voice disorders were assessed with a seven-item voice questionnaire and stress at work was measured with a validated single-item question.

Results

The prevalence of voice disorders over the 12-month period was 54% in the sample of 1198 primary and secondary education teachers in Finland. Of the teachers, 81% were female, and they suffered more voice disorders than the males. Stress was the most significant explanatory variable with a 3.6-fold risk as regards voice disorders. The association between voice disorders and stress was even stronger than that of asthma, asthma medication, and allergic rhinitis, which are known to cause serious risks for voice disorders in general.

Conclusions

Our results hypothesize that stress may be a multi-dimensional problem associated with various risk factors and result in an even more urgent risk of voice disorders in teachers than estimated. Longitudinal research is needed to investigate the causality between voice disorders and stress among teachers. In addition, it is recommended that in the occupational health care of teachers' consideration should be given to the fact that voice disorders and stress may have a multi-dimensional association.

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Book Review: The Voice Clinic Handbook (second edition)By Tom Harris and David M. Howard, Compton Publishing, United Kingdom, 2018

Publication date: Available online 2 November 2018

Source: Journal of Voice

Author(s): Maude Des Jardins, Lucinda Halstead

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Voice Changes During Pregnancy Trimesters in Iranian Pregnant Women

Publication date: Available online 2 November 2018

Source: Journal of Voice

Author(s): Hamide Ghaemi, Ali Dehqan, Behrooz Mahmoodi-Bakhtiari, Ronald C. Scherer

Abstract

Objective

This study aimed to evaluate the vocal changes in the Iranian pregnant women according to trimesters both objectively and subjectively.

Methods

There were 93 pregnant women and 31 non-pregnant women participants in the study. Thirty-three of the 93 pregnant women were in their first trimester, 31 in their second trimester, and 29 in their third trimester of their pregnancies. Clinical data were collected from the acoustic measurements, aerodynamic assessment, video laryngoscopy examination, and the self-assessment of quality of life related to voice using the Persian Voice Handicap Index (VHI_P). The analysis of variance (ANOVA) test and Kruskal–Wallis test were used for between-group comparisons of the data.

Results

Decreased maximum phonation time (MPT), increased S/Z ratio, increased VHI_P-30 scores, and evidence of vocal fold edema were the parameters that differed significantly only in the third trimester. Acoustic analysis revealed that F0, jitter, shimmer, and noise-to-harmonics ratio (NHR) were not significant across the four groups.

Conclusions

Results showed that decreased MPT, increased S/Z ratio, mild to moderate edema, and a deterioration of the VHI_P-30 score noticeably occurred during the third trimester. The results suggest significant vocal changes toward less stable phonation during the third trimester of pregnancy.

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Phonotraumatic Injury in Fitness Instructors: Risk Factors, Diagnoses, and Treatment Methods

Publication date: Available online 2 November 2018

Source: Journal of Voice

Author(s): Christine Estes, Babak Sadoughi, Rachel Coleman, Debra D'Angelo, Lucian Sulica

Abstract

Summary

Fitness instructors are at risk for phonotraumatic injury caused by a combination of occupation-driven environmental and physiologic factors.

Objectives

This study analyzes phonotraumatic injury in a cohort of fitness instructors to define the spectrum of disease, inform treatment, and make educational recommendations.

Study design

Retrospective chart review.

Methods

Fitness instructors seen over a 2-year period comprised the study population. Stroboscopic findings, recommended treatment modalities, and treatment outcomes, including postoperative recurrence (when applicable) were analyzed. Demographic information (gender, age), past medical history, VHI-10 scores, and concurrent relevant vocal demands (performer vs. non-performer) were reviewed. Descriptive statistics and bivariate analyses with Fisher's exact test and Wilcoxon rank sum test were used to determine statistical significance of various factors in relation to phonotraumatic injury and response to treatment. Cochran-Armitage trend tests were performed to analyze trends in injuries across fitness types in relation to increased vocal demand. Occupational concerns reported by subjects were analyzed descriptively.

Results

The subject cohort consisted of 24 fitness instructors (20F; 4M) who taught a variety of fitness methods. Thirteen subjects (54.2%) were diagnosed with pseudocysts (five unilateral, eight bilateral), five (20.8%) with bilateral midfold masses, five (20.8%) with polyps (four unilateral, one bilateral), and one (4.2%) with cyst. Fourteen subjects (58.3%) were prescribed medication (oral steroids, reflux medication, and/or allergy medication). All were referred for behavioral management. Ten (41.7%) chose surgical intervention after failure to return to satisfactory function with behavioral management; Four (40%) experienced postoperative lesion recurrence. There were no statistically significant findings in relation to demographic information, past medical history, concurrent relevant vocal demands, or occupational vocal demands with choice for surgery. Trend test analysis found that lesions that are typically more likely to require surgical intervention (eg, polyps) tended to be found more frequently as vocal demand increased. The primary occupational concerns reported by subjects were related to amplification (lack of amplification, inadequate amplification/amplification problems) and scheduling (too many consecutive classes without adequate breaks).

Conclusion

Fitness instructors are subject to a variety of phonotraumatic vocal fold injuries, nearly half which require surgical treatment. One in four recurs after such intervention. Instructors could benefit greatly from education on vocal health, strategies to improve and/or reduce voice use while in the fitness environment, and to help aid in recognizing early "red flags" for phonotraumatic injury. Occupational factors that place fitness instructors at risk for phonotraumatic injury (scheduling, environment, amplification) may be improved with education directed to studio owners and managers.

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Innovative Teaching Methods in Radiology—Building on the Experiences of Other Disciplines

Publication date: Available online 3 November 2018

Source: Academic Radiology

Author(s): Jonathan L. Mezrich

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Conventional MR-based Preoperative Nomograms for Prediction of IDH/1p19q Subtype in Low-Grade Glioma

Publication date: Available online 2 November 2018

Source: Academic Radiology

Author(s): Zhenyin Liu, Tao Zhang, Hua Jiang, Wenchan Xu, Jing Zhang

Rationale and Objectives

To develop nomogram models incorporating MR and clinical features for preoperative prediction of isocitrate dehydrogenase (IDH)/1p19q subtype in patients with lower-grade gliomas (LGG).

Materials and methods

We classified LGG (149 patients) into three categories: (1) IDH mutation and 1p/19q codeletion, (2) IDH mutation and no 1p/19q codeletion, and (3) wild-type IDH. The correlation between clinical and MR features and IDH/1p19q subtype was analyzed.

Results

(1) Multivariate analysis showed that hemorrhage (yes vs no odds ratio [OR]: 12.775), enhancing margin (poorly vs well defined OR: 17.87), and SVZ (SVZ+ vs SVZ− OR: 0.304 were associated with a higher incidence of IDHmut-codel status (All p < 0.05). (2) Multivariate analysis showed that age (≥40 years vs <40 years OR: 0.139), hemorrhage (yes vs no OR: 0.095), enhancing margin (poorly vs well defined OR: 0.275), volume (>60 cm³ vs ≤60 cm³ OR: 5.111), and the shortest distance from the tumor centroid to the edge of the lateral ventricles (CS) (>30 mm vs ≤30 mm OR: 3.766) were associated with a higher incidence of IDHmut-noncodel status. (3) Multivariate analysis showed age (≥40 years vs <40 years OR: 17.311), tumor site (other vs frontal lobe OR: 4.696), volume (>60 cm³ vs ≤60 cm³ OR: 0.188), CS (>30 mm vs ≤30 mm OR: 0.285), necrosis (yes vs no OR: 0.193), and proportion CE tumor (>5% vs ≤5% OR: 5.253) were associated with a higher incidence of IDHwt status. Three nomogram models showed good discrimination (all area under the curve > 0.8) and calibration.

Conclusion

Clinical and MR features may therefore be used to facilitate the preoperative prediction of LGG IDH/1p19q subtype.

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Quantification of Degree of Liver Fibrosis Using Fibrosis Area Fraction Based on Statistical Chi-Square Analysis of Heterogeneity of Liver Tissue Texture on Routine Ultrasound Images

Publication date: Available online 2 November 2018

Source: Academic Radiology

Author(s): Janelle Li, Mustafa Qureshi, Avneesh Gupta, Stephan W. Anderson, Jorge Soto, Baojun Li

Rationale and Objectives

We present a novel method to quantify the degree of liver fibrosis using fibrosis area fraction based on statistical chi-square analysis of heterogeneity of echo texture within liver on routine ultrasound images. We demonstrate, in a clinical study, that fibrosis area fraction derived this way has the potential to become a noninvasive, quantitative radiometric discriminator of normal or low-grade liver fibrosis (Ishak fibrosis score range = F0–3) and advanced liver fibrosis or cirrhosis (Ishak fibrosis score range = F4–6) on routine ultrasound images.

Materials and Methods

This retrospective patient study was institutional review board approved. Ultrasound images of 100 patients (61 males, 39 females; 18–81 years) who underwent nontargeted ultrasound-guided biopsy were randomly divided into two groups: a training group consisted of 31 cases, and a validation group that contained the rest cases. An investigator manually selected a primary region of interest (ROI; approximately 4–6 cm²) in the liver tissue while avoiding nonhepatic parenchyma. The primary ROI contained a large number of secondary ROIs (25 × 25 pixels) to maintain the precision of statistical analysis. Sample variance σ² of image gradient (a texture feature related to the amount of edge structures) was calculated in secondary ROIs in a roster scan fashion. A theoretical derivation was presented to estimate population variance σ02~ of image gradient across the primary ROI from mean gradient µ of secondary ROIs. The χ² (χ² = σ²/σ02~) was computed at each secondary ROI, forming a χ² map of liver tissue heterogeneity. A cut-off value was optimized from datasets in the training group by comparing to the fibrosis grades determined by biopsy. This cut-off value was then applied to the datasets in the validation group to convert the χ² maps into binary images, from which fibrosis area fractions (fraction of fibrosis area to the total area of the primary ROI) were calculated and entered in a statistical analysis.

Results

In the training group, the optimal setting was found to be Tχ2= 6.0, which resulted a maximum discrimination of F0–3 vs F4–6: p < 0.0001, area under curve = 0.985, sensitivity = 93.7%, specificity = 93.3%. When this setting was applied to the datasets in the validation group, a distinct separation was seen between the two classes (p < 0.0001). F0–3 class had an average fibrosis area fraction of 4.7% (1.7%−11.4%), whereas the F4–6 class had an average fibrosis area fraction of 17.3% (9.8%−29.6%). A strong correlation was demonstrated between the fibrosis area fraction and histological fibrosis grade determined by biopsy (area under curve = 0.89, sensitivity = 87.9%, specificity = 90.3%).

Conclusion

The presented method is a promising noninvasive tool for distinguishing normal or low-grade liver fibrosis (F0–3) and advanced liver fibrosis or cirrhosis (F4–6) from routine ultrasound images. These findings support the further development of texture heterogeneity analysis, particularly fibrosis area fraction, as a quantitative biomarker for distinguishing various liver fibrosis grades.

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Recurrent desmoid tumor arising from latissimus dorsi flap: A case report

Publication date: Available online 2 November 2018

Source: Clinical Imaging

Author(s): Arzu Canan, Xiaoqin Wang

Abstract

Fibromatosis or desmoid tumor in the breast is a very rare benign soft tissue tumor. We report a case of recurrent desmoid tumor arising from latissimus dorsi flap after lumpectomy for breast carcinoma. To our knowledge, this is the first case of desmoid tumor arising from the latissimus dorsi flap. Despite its benignity, desmoid tumor is often locally aggressive, therefore timely diagnosis and proper management are very important. Imaging and pathological diagnosis as well as treatment management are discussed. High clinical suspicion and multidisciplinary approach are essential for prompt diagnosis and management. Wide surgical resection is required, but there is no consensus regarding treatment due to limited data.

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Insulin-like growth factor-1 engaged in the mandibular condylar cartilage degeneration induced by experimental unilateral anterior crossbite

Publication date: Available online 3 November 2018

Source: Archives of Oral Biology

Author(s): Dongmei Wang, Hongxu Yang, Mian Zhang, Hongyun Zhang, Lei Lu, Jing Zhang, Xianghong Wan, Meiqing Wang

ABSTRACT

Objective

To investigate the changes in insulin-like growth factor-1 (IGF-1) expression levels in the degenerative mandibular condylar cartilage.

Design

Thirty-six rats were divided into the unilateral anterior crossbite and control groups. The expression levels of IGF-1; IGF-1 receptor (IGF-1R); IGF-binding protein-3 and -5 (IGFBP-3 and -5); proliferating cell nuclear antigen (PCNA); aggrecan; type-I, -II, -VI, and -X collagen; tissue inhibitor of metalloproteinases-1 and -3 (TIMP-1 and -3); metalloproteinases of matrix metalloproteinases-3 and-13 (MMP-3 and -13); a disintegrin and metalloproteinase thrombospondin-4 and -5 (ADAMTS-4 and -5); alkaline phosphatase (ALP); β-glucuronidase; and N-acetyl-β-glucosaminidase in the mandibular condylar cartilage were assessed.

Results

The protein expression levels of IGF-1and IGF-1R were increased from week 4 in the unilateral anterior crossbite group. The mRNA expression level of IGFBP-3 and -5 was upregulated from week 4 and week 2, respectively; that of IGFBP-3 was downregulated at week 8; and that of PCNA, type-II collagen, type-X collagen, aggrecan, TIMP-1, and TIMP-3 was downregulated, whereas that of MMP-3, MMP-13, ADAMTS-4, ADAMTS-5, β-glucuronidase, and N-acetyl-β-glucosaminidase were upregulated from week 2. The positive area size of type-I collagen was increased and that of type VI collagen was decreased from week 2. The positive area size of type X collagen was increased at week 2 but decreased at week 8. The percentage of ALP-positive cells was increased from week 4.

Conclusions

Unilateral anterior crossbite stimulated the multifarious expression of IGF-1 and IGFBP, which may be linked to chondrocyte proliferation and differentiation in the mandibular condylar cartilage that showed progressive degeneration.

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IL-1ß rs1143634 and rs16944 polymorphisms in patients with periodontal disease

Publication date: Available online 3 November 2018

Source: Archives of Oral Biology

Author(s): Małgorzata Mazurek-Mochol, Elżbieta Dembowska, Damian Malinowski, Krzysztof Safranow, Andrzej Pawlik

Abstract

Background

Periodontal disease (PD) is a chronic inflammatory condition caused by pathogenic microflora in a biofilm, often leading to tooth loss. The inflammatory response of periodontal tissues to infection is influenced by both environmental and genetic factors. The interleukin (IL)-1 family of proinflammatory cytokines plays a role in the tissue destruction associated with PD due to their proinflammatory and bone-resorptive properties. In addition, recent studies have indicated that polymorphisms in the genes encoding IL-1 might be associated with greater PD severity. In this study, we examined the association between IL-1ß rs1143634 and rs16944 polymorphisms and PD in non-smoking and smoking patients.

Materials and methods

This study included 200 patients with PD (130 non-smokers and 70 smokers) and 156 control subjects (124 non-smokers and 32 smokers). Periodontal evaluation included approximal plaque index, modified sulcus bleeding index, probing pocket depth and clinical attachment loss.

Genotyping was utilized for all samples by using allelic discrimination assays with TaqMan® probes on a 7500Fast Real-Time PCR Detection System.

Results

There were no statistically significant differences in the distribution of rs1143634 and rs16944 genotypes and alleles between patients with PD and control subjects, between smoking patients with PD and smoking controls, or between non-smoking patients with PD and non-smoking controls.

Conclusions

The results of this study suggest there is no association between IL-1ß rs1143634 and rs16944 polymorphisms and PD.

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Deregulated phospholipase D2/mammalian target of rapamycin/hypoxia-inducible factor 1 alpha in peripheral T lymphocytes of oral lichen planus correlated with disease severity

Publication date: Available online 3 November 2018

Source: Archives of Oral Biology

Author(s): Fang Wang, Jing Zhang, Gang Zhou

Abstract

Objective

Oral lichen planus (OLP) is a common T lymphocyte-mediated autoimmune disease of unknown etiology. The mammalian target of rapamycin (mTOR) can regulate proliferation, apoptosis, and autophagy of T lymphocytes, therefore impacting the T lymphocyte-mediated immunity. The present study was aimed to investigate the possible association between Akt/mTOR/4E-BP1 (eIF4E-binding protein 1) signaling, phospholipase D (PLD) and hypoxia-inducible factor 1 alpha (Hif-1α) in peripheral T lymphocytes of OLP and the correlation of their expression with the disease severity.

Design

RAE (reticular, atrophic and erosive lesion) scores were used to assess the disease severity of OLP. Akt, mTOR, 4E-BP1, PLD1, PLD2 and Hif-1α expression in peripheral T lymphocytes were measured by using quantitative real-time polymerase chain reaction. Associations of Akt/mTOR/4E-BP1 expression with PLD1, PLD2 and Hif-1α expression were also assessed, respectively. Moreover, correlations of their expression with RAE scores were analyzed.

Results

Expressions of mTOR, 4E-BP1, PLD2 and Hif-1α mRNA were significantly reduced in peripheral T lymphocytes of OLP patients, especially in erosive form. mTOR expression was positively correlated with PLD2 and Hif-1α expression in OLP. Moreover, mTOR, PLD2 and Hif-1α expression were negatively correlated with RAE scores, respectively.

Conclusions

Deregulated PLD2/mTOR/Hif-1α may contribute to the development of OLP and reflect the severity of the disease.

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Blockade of peripheral endothelin receptors abolishes heat hyperalgesia and spontaneous nociceptive behavior in a rat model of facial cancer

Publication date: Available online 2 November 2018

Source: Archives of Oral Biology

Author(s): Caroline Machado Kopruszinski, Renata Cristiane dos Reis, Giles Alexander Rae, Juliana Geremias Chichorro

Abstract

Objective

To improve understanding of the pathophysiology of cancer-induced facial nociception, by evaluating the contribution of peripheral endothelin receptors in tumor-induced facial heat hyperalgesia, increased spontaneous grooming, as well as ongoing nociception in a rat model of facial cancer.

Design

The study was conducted using 396 rats. Facial cancer was induced by inoculating a suspension of Walker-256 cells into the rats' right vibrissal pad. Facial heat hyperalgesia and spontaneous grooming were assessed on day 6, while the conditioned place preference (CPP) test was performed on days 3 to 6 after tumor cells inoculation. Rats received local injections of the non-peptidic dual ET_A/ET_B endothelin receptors antagonist, bosentan (10 and 30 µg/50 µL), single or combined injections of peptidic ET_A and ET_B endothelin receptors antagonists (BQ-123 and BQ-788, at 20 ug/50 µL, each), or of lidocaine (1 mg/50 µl) and morphine (30 µg/50 µL).

Results

Bosentan, lidocaine and morphine local treatment all attenuated tumor-induced heat hyperalgesia (p < 0.05) and spontaneous facial grooming (p < 0.05). However, BQ-123 and BQ-788 did not modify tumor-induced heat hyperalgesia or the spontaneous facial grooming (p > 0.05). Whether this difference in effectiveness is due to receptor affinity or to pharmacokinetic factors still needs to be explored. Local injection of bosentan, lidocaine or morphine failed to control ongoing nociception, as evidenced by the absence of CPP in tumor-bearing rats (p > 0.05).

Conclusion

Endothelins, acting through peripheral ET_A and ET_B receptors, may play a significant role on the development of heat hyperalgesia and increased spontaneous grooming associated to facial cancer in rats.

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Liver-type of tissue non-specific alkaline phosphatase is induced during mouse bone and tooth cell differentiation

Publication date: Available online 2 November 2018

Source: Archives of Oral Biology

Author(s): Tomomi T. Baba, Tatsuo Terashima, Shinichiro Oida

Abstract

Background and objective

Tissue non-specific alkaline phosphatase (TNSALP) contains two types—bone- and liver-type—which are produced from the same gene due to differences in splicing. These two differ in their promoter, but the amino acid sequences of the mature proteins are identical. In this study, we examined the relationship between the two types of TNSALP expression and osteoblast differentiation.

Design

Gene expression of the two types of TNSALP was observed by reverse transcription-polymerase chain reaction. MC3T3-NM4 was sub-cloned from an established mouse osteoblastic cell line in which osteoblast characters do not appear without dexamethasone. The C2C12 mouse myoblastic cell line, which can be induced to osteoblasts with bone morphogenic protein2, and organ-cultured tooth germs were also used in this work.

Results

The gene expression of liver-type TNSALP was observed in only MC3T3-NM4 activated by dexamethasone. For C2C12, the gene expression of bone-type TNSALP was observed even in non-induced conditions where myotubes were formed, whereas the liver-type TNSALP mRNA was only expressed when C2C12 differentiated into osteoblasts by bone morphogenic protein 2. Furthermore, in the organ-cultured tooth germs, the liver-type TNSALP mRNA was expressed according to differentiation of tooth germs.

Conclusion

These results suggest that the liver-type TNSALP mRNA is induced according to differentiation of bone and tooth.

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TiF4 and NaF varnishes induce low levels of apoptosis in murine and human fibroblasts through mitochondrial Bcl-2 family and death receptor signalling

Publication date: Available online 2 November 2018

Source: Archives of Oral Biology

Author(s): Priscila Maria Aranda Salomão, Flávia Amadeu de Oliveira, Daiana Moreli Soares dos Santos, João Paulo Domezi, Thiago José Dionísio, Rodrigo Cardoso de Oliveira, Ana Carolina Magalhães

Abstract

Objectives

This study evaluated the level and mechanism of apoptosis in human gingival fibroblasts (HGF) and murine fibroblasts (NIH/3T3) treated with a titanium tetrafluoride (TiF₄) varnish compared those treated with a sodium fluoride (NaF) varnish.

Methods

Cells were treated with a TiF₄, NaF (both 2.45%F) or placebo varnish for 6 h and were then examined using the TUNEL method. The activities of caspase-3, -8 and -9 were assessed. cDNA for Bax, Bad, Bcl-2 and Fas-L was amplified by quantitative PCR. Bax, Bcl-2 and Fas-L were further detected by western blot analysis.

Results

Both fluorides similarly increased the percentage of apoptosis, while they failed to activate caspases. The Bax/Bcl-2 gene expression ratio was not altered by either fluoride treatment regardless of the type of cell. NaF varnish increased the amplification of the Fas-L gene in NIH/3T3 and HGF cells, while treatment with the TiF₄ varnish resulted in a lower Bad/Bcl-2 expression ratio compared to that of the control for NIH/3T3 cells, but not for HGF cells. No effect of the fluorides was detected in the protein analysis.

Conclusions

NaF and TiF₄, at the studied conditions, similarly induce a low level of apoptosis, with consequent modest activation of the Bcl-2 and Fas-L-dependent signalling pathways. Generally, HGF cells are more susceptible to the fluoride effect than NIH/3T3 cells.

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Activity of Quercetin and Kaemferol against Streptococcus mutans Biofilm

Publication date: Available online 2 November 2018

Source: Archives of Oral Biology

Author(s): Yan Zeng, Anna Nikikova, Hossam Abdelsalam, Jiyao Li, Jin Xiao

Abstract

Objective

Nidus Vespae (NV) is the honeycomb of Polistes Olivaceous, P. Japonicus Saussure, and Parapolybiavaria Fabricius. Previously, we have shown the extract and chemical fractions from NV demonstrated remarkable capacities of inhibiting the acid production of oral bacteria at sub-minimum inhibitory concentration (MIC) concentrations. In searching the most potent anti-caries compounds in NV, we further separated the NV Chl/MeOH fraction and obtained two purified compounds: quercetin and kaemferol. The objective of this study was to assess the effectiveness of quercetin and kaemferol against S. mutans biofilm formation.

Methods

The MIC, minimum biofilm inhibition concentration (MBIC₅₀) and minimum biofilm reduction concentration (MBRC₅₀) against Streptococcus mutans were examined for NV-derived of quercetin and kaemferol. The effectiveness of inhibiting S. mutans biofilm formation was further examined using in vitro biofilm model.

Results

Both quercetin and kaemferol compounds demonstrated anti-biofilm activities when compared to the negative control. They are capable of reducing biofilm dry-weight, total protein, viable cells measured by colony forming unit (CFU), insoluble and soluble glucans formation. The in situ culture pH was less acidic when the biofilms were treated by quercetin and kaemferol. The quercetin and kaemferol demonstrated comparable capability of S. mutans killing in biofilms, compared to chlorhexidine.

Conclusions

The results of this study showed inhibitory activity of quercetin and kaemferol against S. mutans biofilms, suggesting that quercetin and kaemferol might be considered as alternative anti-caries agents in searching novel anti-caries therapeutics.

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Hyperoxia reduces salivary secretion by inducing oxidative stress in mice

Publication date: Available online 2 November 2018

Source: Archives of Oral Biology

Author(s): Ayako Tajiri, Hitoshi Higuchi, Takuya Miyawaki

Abstract

Objective

The aim of this study was to determine the effects of prolonged hyperoxia on salivary glands and salivary secretion in mice.

Design

Male C57BL/6 J mice were kept in a 75% oxygen chamber (hyperoxia group) or a 21% oxygen chamber for 5 days. We measured the secretion volume, protein concentration, and amylase activity of saliva after the injection of pilocarpine. In addition, we evaluated the histological changes induced in the submandibular glands using hematoxylin and eosin and Alcian blue staining and assessed apoptotic changes using the TdT-mediated dUTP nick end labeling (TUNEL) assay. We also compared the submandibular gland expression levels of heme oxygenase-1 (HO-1), superoxide dismutase (SOD)-1, and SOD-2 using the real-time polymerase chain reaction.

Results

In the hyperoxia group, salivary secretion was significantly inhibited at 5 and 10 minutes after the injection of pilocarpine, and the total salivary secretion volume was significantly decreased. The salivary protein concentration and amylase activity were also significantly higher in the hyperoxia group. In the histological examinations, enlargement of the mucous acini and the accumulation of mucins were observed in the submandibular region in the hyperoxia group, and the number of TUNEL-positive cells was also significantly increased in the hyperoxia group. Moreover, the expression levels of HO-1, SOD-1, and SOD-2 were significantly higher in the hyperoxia group.

Conclusion

Our results suggest that hyperoxia reduces salivary secretion, and oxidative stress reactions might be involved in this.

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Editorial Board/Reviewing Committee

Publication date: December 2018

Source: International Journal of Oral and Maxillofacial Surgery, Volume 47, Issue 12

Author(s):

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Experimental peri-implant mucositis around titanium and zirconia implants in comparison to a natural tooth: part 2—clinical and microbiological parameters

Publication date: Available online 2 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): K. Clever, K.A. Schlegel, H. Kniha, G. Conrads, L. Rink, A. Modabber, F. Hölzle, K. Kniha

Abstract

The aim of this study was to assess the clinical and microbiological parameters around dental zirconia and titanium implants compared with natural teeth during experimental plaque accumulation. Clinical parameters were evaluated (gingival index, plaque index, bleeding on probing, and probing pocket depth). Microbiological samples were analyzed for total bacterial cell counts, as well as Tannerella forsythia and Prevotella intermedia counts. A statistically significant difference over time was observed in the groups in terms of the gingival index (P < 0.001), plaque index (P < 0.001), and bleeding on probing (P = 0.039). The lowest mean total number of bacterial cells was measured around the teeth, followed by the zirconia implants; the highest values were found around the titanium implants. T. forsythia and P. intermedia values showed significant changes over time and sessions around the titanium implants. Compared to the soft tissues around zirconia implants and the teeth, those around titanium implants developed a stronger inflammatory response to experimental plaque accumulation in terms of the total number of bacterial cells and T. forsythia and P. intermedia values.

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Hydrophilic modification of sandblasted and acid-etched implants improves stability during early healing: a human double-blind randomized controlled trial

Publication date: Available online 2 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s):

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Combining spectral and temporal modification techniques for speech intelligibility enhancement

Publication date: Available online 2 November 2018

Source: Computer Speech & Language

Author(s): Martin Cooke, Vincent Aubanel, María Luisa García Lecumberri

Abstract

Modifying clean speech prior to output in noisy conditions can lead to substantial intelligibility gains. Most algorithms operate by redistributing energy across the signal, leaving the timing of the underlying speech sounds intact. Other techniques do alter the timing of speech relative to the masker. Both classes of approach – spectral and temporal – lead to a reduction in energetic masking. The current study examines how their combination affects intelligibility. Arguments can be made for both synergy and redundancy, and the presence of distortions introduced by both spectral and temporal approaches might even lead to an antagonistic combination. A cohort of native Spanish listeners identified keywords in sentences in unmodified form and following spectral, temporal and spectro-temporal modification, in the presence of a fluctuating masker. Errors in the spectro-temporal condition were substantially lower than following spectral or temporal modification alone, with a three-fold reduction compared to unmodified speech. Spectro-temporal gains were observed for all phonemes. A glimpse-based model of energetic masking incorporating speech rate changes predicts intelligibility (r=.96), and a glimpsing analysis provides further insights into the distinct mechanisms through which spectral and temporal approaches lead to a release from energetic masking.

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Accuracy of three digital workflows for implant abutment and crown fabrication using a digital measuring technique

Publication date: Available online 3 November 2018

Source: The Journal of Prosthetic Dentistry

Author(s): Stephanie Zeller, David Guichet, Elias Kontogiorgos, William W. Nagy

Abstract

Statement of problem

The accuracy of a full digital workflow using an Atlantis abutment and a milled zirconia crown; a full digital workflow with a 3Shape split-file workflow using a zirconia abutment and crown; and an interrupted digital workflow using an Atlantis abutment and a milled zirconia crown is unclear.

Purpose

The purpose of this in vitro study was to compare 2 full digital workflows relative to an interrupted workflow for restoring an implant with a custom abutment and crown. The secondary purpose of this study was to validate a digital means of measuring internal fit and marginal discrepancy using engineering software programs.

Material and methods

Three workflows were evaluated. The first group, interrupted digital Atlantis (IDA) workflow, included a customized Atlantis abutment that was designed, received, and then rescanned for the definitive crown design. The second group, full digital Atlantis (FDA) workflow, included a customized Atlantis abutment and its corresponding standard tessellation language (STL) file, the Atlantis Core File, which was immediately imported into design software and used for crown design and milling. The third group, full digital split-file (FDSF) workflow, used 3Shape's full digital workflow for abutment and crown design called the split-file workflow, in which the crown and abutment were designed and milled simultaneously. All restorations were evaluated with standardized measurements using a scanning electron microscope (SEM) for 2D measurements, followed by standardized measurements using Geomagic Control, an engineering software program, which facilitated 3D evaluations of the specimens.

Results

The 2 Atlantis workflows, IDA and FDA, had statistically smaller marginal openings (P=.002) than the FDSF when measured using 2D SEM. The FDA had a statistically smaller 2D SEM marginal gap than the other 2 groups, IDA (P=.002) and FDSF (P=.002). The FDA had a statistically smaller 3D Geomagic marginal gap than the other 2 groups, IDA (P=.004) and FDSF (P=.006). The FDSF had a statistically smaller 3D Geomagic internal fit than the other 2 groups, FDA and IDA (both P=.006).

Conclusions

All 3 workflows evaluated in this study showed clinically acceptable results in terms of mean marginal gap below 120 μm. The SEM evaluation of mean marginal opening revealed that IDA and FDA mean marginal openings were statistically smaller than the FDSF mean marginal opening. SEM and Geomagic measurements revealed that the FDA mean marginal gap was significantly smaller than IDA and FDSF mean marginal gaps. Geomagic evaluation of mean internal fit revealed that the FDSF was significantly smaller than IDA and FDA. The use of Geomagic to measure and evaluate mean marginal gap and mean internal fit as defined in this study proved to be an acceptable form of measurement with statistical validation.

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Bond strength durability of self-adhesive resin cements to zirconia ceramic: An in vitro study

Publication date: Available online 3 November 2018

Source: The Journal of Prosthetic Dentistry

Author(s): Abdulaziz Samran, Ammar Al-Ammari, Shadi El Bahra, Esam Halboub, Sebastian Wille, Matthias Kern

Abstract

Statement of problem

How contamination, cleaning, and artificial aging affect the bond strength of self-adhesive resin cements to zirconia ceramics is unclear.

Purpose

The purpose of this in vitro study was to assess the durability and bond strength of different self-adhesive resin cements to zirconia ceramics subjected to contamination, cleaning, and aging.

Material and methods

A total 192 zirconia ceramic squares were airborne-particle abraded with 50 μm Al₂O₃ at a pressure of 100 kPa. The specimens were then divided into 4 main experimental groups (n=48) according to the type of self-adhesive resin. Specimens in the subgroups (n=16) were exposed to 3 different treatment methods: alcohol bath cleaning only, contamination with saliva and alcohol bath cleaning, and contamination with saliva and cleaning with Ivoclean followed by alcohol bath cleaning. Bonded specimens were stored in distilled water (37°C), either for 3 days with no thermocycling or for 150 days interrupted by 37 500 thermocycles between 5°C and 55°C. After storage, the bond strength was determined using a universal testing machine. Results were analyzed statistically, using nonparametric tests.

Results

After saliva contamination, the tensile bond strength for all specimens decreased significantly (P<.001). Furthermore, after saliva contamination and during 150 days of water storage with thermocycling, all specimens debonded spontaneously. However, use of the cleaning medium (Ivoclean) significantly increased the tensile bond strength for almost all specimens (P<.05).

Conclusions

Saliva contamination significantly negatively influenced the bond strength and durability to zirconia ceramic. Ceramic cleaning using Ivoclean significantly improved the bond strength to saliva contaminated zirconia ceramics.

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Restoration of a single darkened central incisor with a modified ceramic veneer

Publication date: Available online 3 November 2018

Source: The Journal of Prosthetic Dentistry

Author(s): Luis G.B. Albino, Eduardo T. Chaves, Verônica P. Lima, Giana S. Lima

Abstract

Restoring a single darkened central incisor can be challenging. Both direct and indirect options may be acceptable to mask discoloration and achieve functional requirements. This report describes placement of a modified feldspathic porcelain veneer to reproduce the appearance of a maxillary central incisor discolored after trauma.

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Randomized controlled clinical trial of digital and conventional workflows for the fabrication of zirconia-ceramic fixed partial dentures. Part III: Marginal and internal fit

Publication date: Available online 3 November 2018

Source: The Journal of Prosthetic Dentistry

Author(s): Goran I. Benic, Irena Sailer, Marco Zeltner, Janine N. Gütermann, Mutlu Özcan, Sven Mühlemann

Abstract

Statement of problem

Trials comparing the overall performances of digital and conventional workflows in restorative dentistry are lacking.

Purpose

The purpose of the third part of this clinical study was to test whether the fit of zirconia 3-unit frameworks for fixed partial dentures fabricated with fully digital workflows differed from that of metal frameworks fabricated with the conventional workflow.

Material and methods

In each of 10 participants, 4 fixed-partial-denture frameworks were fabricated for the same abutment teeth according to a randomly generated sequence. Digital workflows were applied for the fabrication of 3 zirconia frameworks with Lava, iTero, and Cerec infiniDent systems. The conventional workflow included a polyether impression, manual waxing, the lost-wax technique, and the casting of a metal framework. The discrepancies between the frameworks and the abutment teeth were registered using the replica technique with polyvinyl siloxane. The dimensions of the marginal discrepancy (Discrepancy_marginal) and the internal discrepancy in 4 different regions of interest (Discrepancy_shoulder, Discrepancy_axial, Discrepancy_cusp, and Discrepancy_occlusal) were assessed using a light microscope. Post hoc t tests with Bonferroni correction were applied to detect differences (α=.05).

Results

Discrepancy_shoulder was 96.1 ±61.7 μm for the iTero, 106.9 ±96.0 μm for the Lava, 112.2 ±76.7 μm for the Cerec infiniDent, and 126.5 ±91.0 μm for the conventional workflow. The difference between the iTero and the conventional workflow was statistically significant (P=.029). Discrepancy_occlusal was 153.5 ±66.8 μm for the iTero, 203.3 ±127.9 μm for the Lava, 179.7 ±63.1 μm for the Cerec infiniDent, and 148.8 ±66.8 μm for the conventional workflow. Discrepancy_occlusal was significantly lower for the conventional workflow than for the Lava and the Cerec infindent workflows (P<.01). The iTero resulted in significantly lower values of Discrepancy_occlusal than the Lava and the Cerec infiniDent workflows (P<.01).

Conclusions

In terms of framework fit in the region of the shoulder, digitally fabricated zirconia 3-unit frameworks presented similar or better fit than the conventionally fabricated metal frameworks. In the occlusal regions, the conventionally fabricated metal frameworks achieved a more favorable fit than the CAD-CAM zirconia frameworks.

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Retrospective analysis of porous tantalum trabecular metal–enhanced titanium dental implants

Publication date: Available online 3 November 2018

Source: The Journal of Prosthetic Dentistry

Author(s): Alexander R. Edelmann, Devang Patel, Riley K. Allen, Chad J. Gibson, Al M. Best, Sompop Bencharit

Abstract

Statement of problem

The design of porous tantalum trabecular metal–enhanced titanium (TM) dental implants promises improved osseointegration, especially when grafting materials such as demineralized bone matrix are used; however, studies are lacking.

Purpose

The purpose of this retrospective study was to compare TM implants with conventional titanium alloy (Ti) implants with and without demineralized bone matrix in terms of peri-implant bone remodeling in the first year after implant loading.

Material and methods

A chart review was used for all patients receiving Tapered Screw-Vent Ti and TM implants. Implants were placed and restored by a single provider between 2011 and 2015. Peri-implant bone remodeling was compared by using a paired t test (α=.05).

Results

A total of 82 patients received 205 implants, 44 TM and 161 Ti implants (control). No implants failed in the TM group (survival rate of 100%), and 3 implants in total, 1 immediate, failed in the Ti groups (survival rate of 98.1%). TM implants exhibited a 0.28-mm bone gain on average, whereas the control group demonstrated 0.20 mm of marginal bone loss after the first year of implant loading. Multivariate logistic regression analysis demonstrated that the odds of having bone loss was 64% less (odds ratio: 0.36; 95% confidence interval: 0.14-0.94) in the TM group than in the Ti group after controlling for bone grafting, implant location, immediate placement, bone type, and pretreatment bone level.

Conclusions

TM implants exhibited less peri-implant bone loss than the control Ti implants.

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Use of a dental surveyor to ensure optimal seating of implant overdenture attachments

Publication date: Available online 3 November 2018

Source: The Journal of Prosthetic Dentistry

Author(s): Robert W. Loney, Chris J. Lee, Pierre-Luc Michaud, Tanya J.A. Cook

Abstract

Many implant overdenture attachments accommodate divergent abutments. However, there can be instances where the denture base resin surrounding the abutment may impede seating by binding on the axial surface(s) of the abutment. This article describes the use of a dental surveyor to aid clinicians in determining where the resin denture base might be preventing the seating of overdenture attachments. The surveyor can be used for judicious adjustment to allow optimal seating of the attachments.

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Three-dimensional printed definitive cast for a silicone obturator prosthesis: A clinical report

Publication date: Available online 2 November 2018

Source: The Journal of Prosthetic Dentistry

Author(s): Charles L. Palin, Joseph M. Huryn, Marjorie Golden, Paul R. Booth, Joseph D. Randazzo

Abstract

For patients with head and neck cancer requiring a maxillectomy, obturator prostheses help with quality of life. These patients routinely require adjuvant oncologic treatments with significant adverse effects. Treatment sequelae can leave patients with difficulty speaking and swallowing, reduced salivary function, reduction in maximal incisal opening, and at risk of osteoradionecrosis. A 55-year-old African-American woman presented with significant trismus and reduction in maximal incisal opening after treatment for squamous cell carcinoma of the left maxillary sinus. She had received a left total maxillectomy with adjuvant chemotherapy and radiation treatments. With her reduced opening, she was no longer able to insert her interim obturator prosthesis, which caused difficulty speaking and nasal regurgitation. A cone-beam computed tomography scan was made of the patient's maxillectomy defect. From the Digital Imaging and Communications in Medicine file, a definitive cast was 3-dimensionally printed to fabricate a flexible silicone obturator prosthesis. This treatment has allowed the patient to return to a functional quality of life and could help other patients in similar situations.

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A graph-based lesion characterization and deep embedding approach for improved computer-aided diagnosis of nonmass breast MRI lesions

Publication date: Available online 2 November 2018

Source: Medical Image Analysis

Author(s): Cristina Gallego-Ortiz, Anne L. Martel

Abstract

Nonmass-like enhancements are a common but diagnostically challenging finding in breast MRI. Nonmass-like lesions can be described as clusters of spatially and temporally inter-connected regions of enhancements, so they can be modeled as networks and their properties characterized via network-based connectivity. In this work, we represented nonmass lesions as graphs using a link formation energy model that favors linkages between regions of similar enhancement and closer spatial proximity. However, adding graph features to an existing computer-aided diagnosis (CAD) pipeline incurs an increase of feature space dimensionality, which poses additional challenges to traditional supervised machine learning techniques due to the inability to increase accordingly the number of training datasets. We propose the combination of unsupervised dimensionality reduction and embedded space clustering followed by a supervised classifier to improve the performance of a CAD system for nonmass-like lesions in breast MRI. Our work extends a previoulsy proposed framework for deep embedded unsupervised clustering (DEC) to embedding space classification, with the joint optimization of objective functions for DEC and supervised multi-layered perceptron (MLP) classification. The strength of the method lies in the ability to learn and further optimize an embedded feature representation of lower dimensionality that maximizes the diagnostic accuracy of a CAD lesion classifier to discriminate between benign and malignant lesions. We identified 792 nonmass-like enhancements (267 benign, 110 malignant and 415 unknown) in 411 patients undergoing breast MRI at our institution. The diagnostic performance of the proposed method was evaluated and compared to the performance of a conventional supervised MLP classifier in original feature space. A statistically significant increase in diagnostic area under the ROC curve (AUC) was achieved. Generalization AUC increased from 0.67 ± 0.08 to 0.81 ± 0.10 (21% increase, p-value=4.2×10−8) with the proposed graph-based lesion characterization and deep embedding framework.

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School-based Interventions – Where Do We Go From Here?

Publication date: Available online 3 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Jean-Marie Bruzzese, Meyer Kattan

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IgE to galactose-α-1,3-galactose and the α-Gal syndrome: Insights from Basophil Activation Testing

Publication date: Available online 3 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Jeffrey M. Wilson, Thomas A.E. Platts-Mills

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Ultrasound Imaging of Hepatocellular Adenoma Using the New Histology Classification

Publication date: Available online 3 November 2018

Source: Ultrasound in Medicine & Biology

Author(s): Christoph F. Dietrich, Andrea Tannapfel, Hyun-Jung Jang, Tae Kyoung Kim, Peter N. Burns, Yi Dong

Abstract

Hepatocellular adenoma is a rare benign liver tumor. Predisposing factors include hepatic storage diseases and some genetic conditions. A new histology-based classification has been proposed but to date, the corresponding ultrasound imaging features have not been reported. Here we review the new classification scheme and discuss the corresponding features on contrast-enhanced ultrasound imaging.

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Non-invasive Quantitative Assessment of Muscle Force Based on Ultrasonic Shear Wave Elastography

Publication date: Available online 3 November 2018

Source: Ultrasound in Medicine & Biology

Author(s): Jing Liu, Zhihui Qian, Kunyang Wang, Jianan Wu, Ali Jabran, Luquan Ren, Lei Ren

Abstract

The objective of this study was to investigate the feasibility of using shear wave elastography (SWE) to indirectly measure passive muscle force and to examine the effects of muscle mass and scan angle. We measured the Young's moduli of 24 specimens from six muscles of four swine at different passive muscle loads under different scan angles (0°, 30°, 60° and 90°) using SWE. Highly linear relationships between Young's modulus E and passive muscle force F were found for all 24 muscle specimens at 0^o scan angle with coefficients of determination R² ranging from 0.984 to 0.999. The results indicate that the muscle mass has no significant effect on the muscle E–F relationship, whereas E–F linearity decreases disproportionately with increased scan angle. These findings suggest that SWE, when carefully applied, can provide a highly reliable tool to measure muscle Young's modulus, and could be used to assess the muscle force quantitatively.

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Impact of Food Intake on Liver Stiffness Determined by 2-D Shear Wave Elastography: Prospective Interventional Study in 100 Healthy Patients

Publication date: Available online 2 November 2018

Source: Ultrasound in Medicine & Biology

Author(s): Golo Petzold, Melissa Porsche, Volker Ellenrieder, Steffen Kunsch, Albrecht Neesse

Abstract

The aim was to evaluate the influence of food intake on liver stiffness measurement (LSM), performed with 2-D shear wave elastography (Logiq E9, GE Medical Systems, Wauwatosa, WI, USA). One hundred healthy volunteers were prospectively enrolled. Mean age was 25.8 (19–55) y, and mean body mass index was 22.43 (17.3–30.8) kg/m². Patients fasted for at least 3 h and subsequently ingested a liquid meal of 800 kcal. Liver stiffness and portal vein velocity were measured before and after food intake. Food intake resulted in significantly higher LSM values compared with baseline LSM (5.74 ± 0.94 kPa vs. 4.80 ± 0.94 kPa, p < 0.001). On multiple linear regression analysis, body mass index was significantly positively correlated with the LSM increase after food intake (p = 0.01). No correlation between the increase in LSM and the increase in post-prandial portal vein velocity was observed (r = 0.09). In summary, food intake has a significant influence on LSM. There is an 11% risk of misclassifying non-fasting, healthy patients as having significant fibrosis.

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Modulating the Inflammatory Reflex in Rats Using Low-Intensity Focused Ultrasound Stimulation of the Vagus Nerve

Publication date: Available online 2 November 2018

Source: Ultrasound in Medicine & Biology

Author(s): Kelsey M. Wasilczuk, Kelsey C. Bayer, Jesse P. Somann, Gabriel O. Albors, Jennifer Sturgis, L. Tiffany Lyle, J. Paul Robinson, Pedro P. Irazoqui

Abstract

Tumor necrosis factor α (TNF-α) is linked to several chronic inflammatory diseases. Electrical vagus nerve stimulation reduces serum TNF-α levels but may cause chronic nerve damage and requires surgery. Alternatively, we proposed focused ultrasound stimulation of the vagus nerve (uVNS), which can be applied non-invasively. In this study, we induced an inflammatory response in rats using lipopolysaccharides (LPS) and collected blood to analyze the effects of uVNS on cytokine concentrations. We applied one or three 5-min pulsed focused ultrasound stimulation treatments to the vagus nerve (250 kHz, I_SPPA = 3 W/cm²). Animals receiving a single ultrasound application had an average reduction in TNF-α levels of 19%, similar to the 16% reduction observed in electrically stimulated animals. With multiple applications, uVNS therapy statistically reduced serum TNF-α levels by 73% compared with control animals without any observed damage to the nerve. These findings suggest that uVNS is a suitable way to attenuate TNF-α levels.

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Dorsal striatum does not mediate feedback-based, stimulus-response learning: An event-related fMRI study in patients with Parkinson's disease tested on and off dopaminergic therapy

Publication date: 15 January 2019

Source: NeuroImage, Volume 185

Author(s): Nole M. Hiebert, Adrian M. Owen, Hooman Ganjavi, Daniel Mendonça, Mary E. Jenkins, Ken N. Seergobin, Penny A. MacDonald

Abstract

Learning associations between stimuli and responses is essential to everyday life. Dorsal striatum (DS) has long been implicated in stimulus-response learning, though recent results challenge this contention. We have proposed that discrepant findings arise because stimulus-response learning methodology generally confounds learning and response selection processes. In 19 patients with Parkinson's disease (PD) and 18 age-matched controls, we found that dopaminergic therapy decreased the efficiency of stimulus-response learning, with corresponding attenuation of ventral striatum (VS) activation. In contrast, exogenous dopamine improved response selection accuracy related to enhanced DS BOLD signal. Contrasts between PD patients and controls fully support these within-subject patterns. These double dissociations in terms of behaviour and neural activity related to VS and DS in PD and in response to dopaminergic therapy, strongly refute the view that DS mediates stimulus-response learning through feedback. Our findings integrate with a growing literature favouring a role for DS in decision making rather than learning, and unite two literature that have been evolving independently.

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18F-FDG PET/TC en reestadificación y seguimiento de pacientes con sarcomas uterinos

Publication date: Available online 3 November 2018

Source: Revista Española de Medicina Nuclear e Imagen Molecular

Author(s): D. Albano, V. Zizioli, G. Treglia, F. Odicino, R. Giubbini, F. Bertagna

Resumen

Objetivo

Los sarcomas uterinos son tumores raros con mal pronóstico debido a las altas tasas de recurrencia. El papel actual de la ¹⁸F-FDG PET/TC en la vigilancia posterior a la terapia aún no está establecido.

Material y metodos

Cuarenta y una mujeres con sarcoma uterino se sometieron a 73 estudios ¹⁸F-FDG PET/TC para la reestadificación en la presunta recurrencia o durante el seguimiento en pacientes asintomáticos. Los resultados histopatológicos y/o el seguimiento clínico/de imágenes durante al menos 12 meses se consideraron el estándar de referencia. Se calculó la precisión diagnóstica y el impacto clínico de la ¹⁸F-FDG PET/TC.

Resultados

treinta y tres estudios ¹⁸F-FDG PET/TC fueron positivos, mientras que los 40 estudios restantes fueron negativos. La sensibilidad general, la especificidad, el valor predictivo positivo (VP+), el valor predictivo negativo (VP-) y la precisión de la ¹⁸F-FDG PET/TC fueron del 88%, 98%, 97%, 91% y 93%. Considerando pacientes con sospecha clínica o radiológica de recidiva (n = 47) y durante el seguimiento (n = 26) la sensibilidad y especificidad, VP+, VP− y precisión de ¹⁸F-FDG PET/TC fueron del 89%, 100%, 100%, 86% y 94%, y 80%, 95%, 80%, 95% y 92% respectivamente. La ¹⁸F-FDG PET/TC tuvo un impacto clínico positivo en 9/73 (12%) estudios y cambió el manejo clínico en 8/41 (20%) pacientes.

Conclusion

La ¹⁸F-FDG PET/TC es un método preciso para la detección y localización de recidivas a distancia en pacientes con sarcoma uterino con buena sensibilidad y especificidad e impacto significativo en la toma de decisiones clínicas.

Abstract

Purpose

Uterine sarcomas are rare tumors with poor prognosis due to the high recurrence rates. The current role of ¹⁸F-FDG PET/CT in the post-therapy surveillance is not established yet.

Materials and Methods

Forty-one women with uterine sarcoma underwent 73 ¹⁸F-FDG PET/CT for restaging in suspected recurrence or during follow-up in asymptomatic patients. Histopathology results and/or clinical/imaging follow-up for at least 12 months were considered the reference standard. The diagnostic accuracy and clinical impact of ¹⁸F-FDG PET/CT was calculated.

Results

Thirty-three ¹⁸F-FDG PET/CT were positive, while the remaining 40 studies were negative. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of ¹⁸F-FDG PET/CT were 88%, 98%, 97%, 91% and 93%, respectively. Considering patients with clinical or radiological suspicion of recurrence (n = 47) and those during follow-up (n = 26), sensitivity, specificity, PPV, NPV and accuracy of ¹⁸F-FDG PET/CT were 89%, 100%, 100%, 86% and 94%, and 80%, 95%, 80%, 95% and 92%, respectively. ¹⁸F-FDG PET/CT had a positive clinical impact in 9/73 (12%) studies and changed the clinical management in 8/41 (20%) patients.

Conclusions

¹⁸F-FDG PET/CT seems to be an accurate method for detection and localization of local and distant recurrence in patients with uterine sarcoma with good sensitivity and specificity and significant impact on clinical decision making.

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Journal of Oral Pathology &Medicine, Volume 47, Issue 10, Page i-i, November 2018.


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Issue Information

Journal of Oral Pathology &Medicine, Volume 47, Issue 10, Page ii-v, November 2018.


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Deviating dental arch morphology in mild coronal craniosynostosis syndromes

Abstract

Objectives

To determine whether the intramaxillary relationship of patients with Muenke syndrome and Saethre-Chotzen syndrome or TCF12-related craniosynostosis are systematically different than those of a control group.

Material and methods

Forty-eight patients (34 patients with Muenke syndrome, 8 patients with Saethre-Chotzen syndrome, and 6 patients with TCF12-related craniosynostosis) born between 1982 and 2010 (age range 4.84 to 16.83 years) that were treated at the Department of Oral Maxillofacial Surgery, Special Dental Care and Orthodontics, Children's Hospital Erasmus University Medical Center, Sophia, Rotterdam, the Netherlands, were included. Forty-seven syndromic patients had undergone one craniofacial surgery according to the craniofacial team protocol. The dental arch measurements intercanine width (ICW), intermolar width (IMW), arch depth (AD), and arch length (AL) were calculated. The control group existed of 329 nonsyndromic children.

Results

All dental arch dimensions in Muenke (ICW, IMW, AL, p < 0.001, ADmax, p = 0.008; ADman, p = 0.002), Saethre-Chotzen syndrome, or TCF12-related craniosynostosis patients (ICWmax, p = 0.005; ICWman, IMWmax, AL, p < 0.001) were statistically significantly smaller than those of the control group.

Conclusions

In this study, we showed that the dental arches of the maxilla and the mandible of patients with Muenke syndrome and Saethre-Chotzen syndrome or TCF12-related craniosynostosis are smaller compared to those of a control group.

Clinical relevance

To gain better understanding of the sutural involvement in the midface and support treatment capabilities of medical and dental specialists in these patients, we suggest the concentration of patients with Muenke and Saethre-Chotzen syndromes or TCF12-related craniosynostosis in specialized teams for a multi-disciplinary approach and treatment.

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Assessment of peri‐implant defects at titanium and zirconium dioxide implants by means of periapical radiographs and cone beam computed tomography: an in‐vitro examination

Clinical Oral Implants Research, Volume 0, Issue ja, -Not available-.


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