A back and forth manual aspiration technique using a SOFIA Plus catheter for acute ischemic stroke: technical note

Abstract

Purpose

We describe a new modification of thromboaspiration to facilitate recanalization, referred to as the "back and forth" manual aspiration technique.

Methods

In this technique, the aspiration catheter (SOFIA Plus catheter, MicroVentionInc, Tustin, CA, USA) is positioned adjacent to the occluded segment and then advanced over the thrombus during manual aspiration with a 50-cc syringe.

Results

We evaluated this technique in 15 patients who presented to our institution with acute ischemic stroke (AIS). Final mTICI 2b/3 was achieved in 86.6% of the patients with the sole use of this new aspiration technique. No dissection, rupture, or downstream emboli were associated with the procedure. The mean time from puncture to revascularization was 35 min.

Conclusion

This modified technique with back and forth movements of the SOFIA Plus catheter over the thrombus during aspiration may facilitate thrombectomy in AIS. However, further studies in larger groups are necessary to elucidate its efficacy and to compare with current techniques.

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A randomized clinical trial evaluating maxillary sinus augmentation with different particle sizes of demineralized bovine bone mineral: histological and immunohistochemical analysis

This study was performed to investigate sinus floor augmentation with two different particle sizes of demineralized bovine bone mineral (DBBM) by means of histological and immunohistochemical (IHC) analysis. A randomized clinical trial was conducted involving 10 individuals requiring two-stage bilateral maxillary sinus augmentation for implant installation. The patients were randomly divided into two groups following a split-mouth design: the maxillary sinus on one side was filled with small-sized particles (0.25–1mm) and on the contralateral side with large-sized particles (1–2mm).

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Prevalence of Publication Bias Tests in Speech, Language, and Hearing Research

Purpose

The purpose of this research note is to systematically document the extent that researchers who publish in American Speech-Language-Hearing Association (ASHA) journals search for and include unpublished literature in their meta-analyses and test for publication bias.

Method

This research note searched all ASHA peer-reviewed journals for published meta-analyses and reviewed all qualifying articles for characteristics related to the acknowledgment and assessment of publication bias.

Results

Of meta-analyses published in ASHA journals, 75% discuss publication in some form; however, less than 50% test for publication bias. Further, only 38% (n = 11) interpreted the findings of these tests.

Conclusion

Findings reveal that more attention is needed to the presence and impact of publication bias. This research note concludes with 5 recommendations for addressing publication bias.

Supplemental Material

https://doi.org/10.23641/asha.7268648

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Issue Information

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Automatic graph-based method for localization of cochlear implant electrode arrays in clinical CT with sub-voxel accuracy

Publication date: Available online 13 November 2018

Source: Medical Image Analysis

Author(s): Yiyuan Zhao, Srijata Chakravorti, Robert F. Labadie, Benoit M. Dawant, Jack H. Noble

Abstract

Cochlear implants (CIs) are neural prosthetics that provide a sense of sound to people who experience severe to profound hearing loss. Recent studies have demonstrated a correlation between hearing outcomes and intra-cochlear locations of CI electrodes. Our group has been conducting investigations on this correlation and has been developing an image-guided cochlear implant programming (IGCIP) system to program CI devices to improve hearing outcomes. One crucial step that has not been automated in IGCIP is the localization of CI electrodes in clinical CTs. Existing methods for CI electrode localization do not generalize well on large-scale datasets of clinical CTs implanted with different brands of CI arrays. In this paper, we propose a novel method for localizing different brands of CI electrodes in clinical CTs. We firstly generate the candidate electrode positions at sub-voxel resolution in a whole head CT by thresholding an up-sampled feature image and voxel-thinning the result. Then, we use a graph-based path-finding algorithm to find a fixed-length path that consists of a subset of the candidates as the localization result. Validation on a large-scale dataset of clinical CTs shows that our proposed method outperforms the state-of-art CI electrode localization methods and achieves a mean error of 0.12mm when compared to expert manual localization results. This represents a crucial step in translating IGCIP from the laboratory to large-scale clinical use.

Graphical abstract

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Quality-based UnwRap of SUbdivided Large Arrays (URSULA) for High-Resolution MRI Data

Publication date: Available online 13 November 2018

Source: Medical Image Analysis

Author(s): J. Lindemeyer, A.-M. Oros-Peusquens, N.J. Shah

Abstract

In Magnetic Resonance Imaging, mapping of the static magnetic field and the magnetic susceptibility is based on multidimensional phase measurements. Phase data are ambiguous and have to be unwrapped to their true range in order to exhibit a correct representation of underlying features. High-resolution imaging at ultra-high fields, where susceptibility and phase contrast are natural tools, can generate large datasets, which tend to dramatically increase computing time demands for spatial unwrapping algorithms. This article describes a novel method, URSULA, which introduces an artificial volume compartmentalisation that allows large-scale unwrapping problems to be broken down, making URSULA ideally suited for computational parallelisation. In the presented study, URSULA is illustrated with a quality-guided unwrapping approach. Validation is performed on numerical data and an application on a high-resolution measurement, at the clinical field strength of 3T is demonstrated. In conclusion, URSULA allows for a reduction of the problem size, a substantial speed-up and for handling large data sets without sacrificing the overall accuracy of the resulting phase information.

Graphical abstract

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Multimodal hyper-connectivity of functional networks using functionally-weighted LASSO for MCI classification

Publication date: Available online 13 November 2018

Source: Medical Image Analysis

Author(s): Yang Li, Jingyu Liu, Xinqiang Gao, Biao Jie, Minjeong Kim, Pew-Thian Yap, Chong-Yaw Wee, Dinggang Shen

Abstract

Recent works have shown that hyper-networks derived from blood-oxygen-level-dependent (BOLD) fMRI, where an edge (called hyper-edge) can be connected to more than two nodes, are effective biomarkers for MCI classification. Although BOLD fMRI is a high temporal resolution fMRI approach to assess alterations in brain networks, it cannot pinpoint to a single correlation of neuronal activity since BOLD signals are composite. In contrast, arterial spin labeling (ASL) is a lower temporal resolution fMRI technique for measuring cerebral blood flow (CBF) that can provide quantitative, direct brain network physiology measurements. This paper proposes a novel sparse regression algorithm for inference of the integrated hyper-connectivity networks from BOLD fMRI and ASL fMRI. Specifically, a least absolution shrinkage and selection operator (LASSO) algorithm, which is constrained by the functional connectivity derived from ASL fMRI, is employed to estimate hyper-connectivity for characterizing BOLD-fMRI-based functional interaction among multiple regions. An ASL-derived functional connectivity is constructed by using an Ultra-GroupLASSO-UOLS algorithm, where the combination of ultra-least squares (ULS) criterion with a group LASSO (GroupLASSO) algorithm is applied to detect the topology of ASL-based functional connectivity networks, and then an ultra-orthogonal least squares (UOLS) algorithm is used to estimate the connectivity strength. By combining the complementary characterization conveyed by rs-fMRI and ASL fMRI, our multimodal hyper-networks demonstrated much better discriminative characteristics than either the conventional pairwise connectivity networks or the unimodal hyper-connectivity networks. Experimental results on publicly available ADNI dataset demonstrate that the proposed method outperforms the existing single modality based sparse functional connectivity inference methods.

Graphical abstract

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Role of Iterative Reconstruction Algorithm for the Assessment of Myocardial Infarction with Dual Energy Computed Tomography

Publication date: Available online 12 November 2018

Source: Academic Radiology

Author(s): Gaston A. Rodriguez-Granillo, Alejandro Deviggiano, Carlos Capunay, Macarena De Zan, Carlos Fernandez-Pereira, Patricia Carrascosa

Rationale and Objectives

Low monochromatic energy levels (40 keV) derived from delayed enhancement dual energy cardiac computed tomography (DE-DECT) allow the evaluation of myocardial infarcts (MI) among stable patients, although at the expense of high image noise. We explored whether the application of adaptive statistical iterative reconstruction (ASIR) to 40-keV DE-DECT (unavailable with previous software versions) might improve image quality and detection of MI in stable patients.

Materials and Methods

We prospectively enrolled patients with a history of previous MI, and performed delayed-enhancement cardiac magnetic resonance (DE-CMR) and DE-DECT within the same week. DE-DECT images were reconstructed with 0% and 60% ASIR.

Results

MI was identified in 18 (80%) patients with both DE-CMR and DE-DECT. On a per segment basis, we did not identify significant differences regarding the diagnostic performance of DE-DECT with and without ASIR [area under receiver operating characteristic curve 0.86 vs. 0.83, p = 0.10]. The application of ASIR improved the signal-to-noise ratio of DE-DECT with 0% ASIR compared to DE-DECT with 60% ASIR (6.07 ± 2.1 vs. 11.1 ± 4.5, p < 0.0001). However, qualitative assessment of MI image quality (3.35 ± 1.2, vs. 3.55 ± 1.1, p = 0.10) and diagnostic confidence (4.40 ± 0.9 vs. 4.60 ± 0.8, p = 0.10) were not significantly improved. Using DE-DECT with 60% ASIR, a threshold over 199 HU showed a sensitivity of 67% and a specificity of 92% for the detection of segments with MI.

Conclusion

In this study, DE-DECT allowed accurate detection of MI among stable patients compared with DE-CMR, and the application of ASIR improved signal-to-noise ratio of DE-DECT, although the diagnostic performance showed only non-significant improvements.

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Food OIT is Superior to Food Avoidance

Publication date: Available online 13 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): J. Andrew Bird

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An Ounce of Caution: Superparamagnetic Iron Oxide Nanoparticle Based MRI Contrast Associated Anaphylaxis

Publication date: Available online 13 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Alexander J. Heckman, Anjali Agarwal, Keith A. Sacco, Brett T. Hiroto, Pramod K. Guru

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The Effect of Delayed and Early Diagnosis in Siblings, and Importance of Newborn Screening for SCID

Publication date: Available online 12 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Matthew S. Krantz, Cosby A. Stone, James A. Connelly, Allison E. Norton, Yasmin W. Khan

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Reviewers 2018

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Issue Information

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Author Guidelines

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Corrigendum

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Volume content for 2018

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Secondary alveolar bone grafting in cleft lip and palate: A comparative analysis of donor site morbidity in different age groups

Publication date: Available online 12 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Andrzej Brudnicki, Martin Rachwalski, Łukasz Wiepszowski, Ewa Sawicka

Abstract

Introduction

There is no consensus regarding the optimal timing for secondary alveolar bone grafting for clefts defects. We aimed to investigate the potential correlation between the age of patients during surgery, donor site symptoms, surgical time and hospitalization following this procedure.

Material and methods

The outcome of 195 consecutive alveolar bone grafting procedures among different age groups (mean: 7.1 years; range 1.8-40.5) was retrospectively assessed based on a chart review and purpose-prepared report forms. The association between age, gender and hospitalization following bone harvesting was tested by Spearman rank correlation, while relationships (i.e. between age and pain) were evaluated by logistic regression.

Results

The most frequent donor site complaints included: pain equal to or exceeding that of the recipient site (93%) and gait disturbances (92.5%) immediately after the procedure. Chronic complaints included: iliac contour alteration (40.1%), unsightly scar (23%) and recurring discomfort (2.1%). Statistical analysis showed no correlation between donor site symptoms, their duration or hospitalization time following surgery at different ages, except a higher incidence of significant pain immediately after bone harvesting in older females (r = 0.268; p = 0.030).

Conclusion

Alveolar bone grafting at an earlier age does not increase donor site symptoms, surgical duration or hospitalization following surgery.

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Reliable manifestations of increased intracranial pressure in patients with syndromic craniosynostosis

Publication date: Available online 12 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): So Young Kim, Jung Won Choi, Hyung-Jin Shin, So Young Lim

Summary

Purpose

Systematic examination of increased intracranial pressure (ICP) is important during the follow-up period after surgical repair of syndromic craniosynostosis. In these patients, postoperative progress can be unclear due to the involvement of multiple sutures and the high incidence of relapse due to the progressive nature of the disease and to genetic variability. In this study, we investigated the clinical manifestations of increased ICP in syndromic craniosynostosis patients before and after surgery.

Materials And Methods

We collected pre- and post-operative data from patients with syndromic craniosynostosis from January 2004 and December 2014 on the clinical manifestations of increased ICP, namely, the presence of 1) subjective symptoms 2) visual disturbances and papilledema, 3) thumbprinting phenomenon (beaten copper appearance) on skull x-ray, and 4) hydrocephalus on computed tomography.

Results

A total of 17 syndromic craniosynostosis patients were included in this study, and three distinct patterns of disease progress were noted. Among all patients who underwent cranioplasty, the significant finding with regards to clinical manifestations was amelioration of the beaten copper appearance on skull x-ray after surgery. Likewise, among patients with recurrent increased ICP during the postoperative follow-up period, numerous clinical manifestations were noted, including subjective symptoms (33.3%), papilledema (50%), ventricular dilation (66.6%), and a beaten copper appearance on skull x-ray (100%).

Conclusion

Close monitoring to detect increased ICP is important during follow-up of patients with syndromic craniosynostosis. Among non-invasive methods for indirectly assessing ICP post-operatively, a beaten copper appearance on skull x-ray may be a reliable indicator of increased ICP.

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Cyanoacrylate tissue adhesive or silk suture for closure of surgical wound following removal of an impacted mandibular third molar: A randomized controlled study

Publication date: Available online 12 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Afisu A. Oladega, Olutayo James, Wasiu L. Adeyemo

Summary

Aim

The aim of the study was to compare postoperative sequelae and wound healing outcome following closure of surgical wound with either cyanoacrylate tissue adhesive or silk suture.

Methods

Subjects with mesio-angularly impacted mandibular third molar were allocated randomly into 2 equal groups. The control group had wound closure with silk suture and study group with cyanoacrylate tissue adhesive. Subjects were followed up for 7 postoperative days. Post-operative pain, swelling, trismus, bleeding, wound dehiscence and wound infection were evaluated.

Results

Sixty subjects in each group completed the study. No significant difference was observed in the mean post-operative pain, swelling, trismus, wound dehiscence and infection between the 2 groups. There was a statistically significant difference in post-operative bleeding between the 2 groups on post-operative day 1, with more bleeding in the control group.

Conclusions

This study shows that cyanoacrylate tissue adhesive compares favourably with silk suture as a wound closure material. In addition, cyanoacrylate tissue adhesive seems to have beneficial haemostatic effect on post-operative bleeding.

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An in-vitro evaluation of a novel design of miniplate for fixation of fracture segments in the transition zone of parasymphysis-body region of mandible using finite element analysis

Publication date: Available online 12 November 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Abhay Datarkar, Shikha Tayal, Abhishek Thote, Manlio Galie

Summary

The mandibular parasymphysis and body regions are highly dynamic areas. They are constantly subjected to both occlusal and muscular forces. Fractures at this transition zone of the parasymphysis and body region thus represent a special pattern that creates a dilemma for the surgeons — whether to use one miniplate fixation or two miniplates as per Champy's guidelines. Mental nerve paresthesia is a very common complication due to dissection and stretching of the mental nerve in this region. Hence, an in-vitro research study of a novel twin fork design of miniplate is performed, which evaluates the biomechanical behavior using computerized finite element analysis. A comparison is carried out with the conventional design. The results show that the twin fork miniplate produces the lowest stresses — 23.821 MPa — and the least total structural deformation after applying the maximum occlusal bite force. This study concludes that the newly designed miniplate is superior in terms of stability because it shows the least structural deformation, and produces the lowest equivalent stresses on application of maximal occlusal forces. An additional advantage is the preservation of the mental nerve during the plating procedure because the broad end of the Y shape allows atraumatic positioning of the miniplate and hence the fixation of fractured segments.

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Loss of an IgG plasma cell checkpoint in lupus

Publication date: Available online 13 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Jolien Suurmond, Yemil Atisha-Fregoso, Emiliano Marasco, Ashley N. Barlev, Naveed Ahmed, Silvia A. Calderon, Mei Yin Wong, Meggan C. Mackay, Cynthia Aranow, Betty Diamond

Abstract

Background

IgG anti-nuclear antibodies (ANA) are a feature of several autoimmune diseases. These antibodies arise through defects in central or peripheral tolerance checkpoints. The specific checkpoints breached in autoimmune disease are not fully understood.

Objectives

To study whether autoreactive plasma cells in lupus models and SLE patients arise as a consequence of defective antigen-specific selection or a global enhancement of IgG PC differentiation.

Methods and Results

We optimized and validated a novel technique to detect naturally occurring ANA+ B cells and PC. We observed a major checkpoint for generation of ANA+ IgG+ PC in both non-autoimmune mice and healthy human subjects. Interestingly, we observed increased numbers of ANA+ IgG+ PC despite normal tolerance checkpoints in immature and naïve B cells in lupus-prone MRL/lpr and NZB/W mice as well as patients with systemic lupus erythematosus (SLE). This increase was due to increased numbers of total IgG+ PC rather than lack of selection against ANA+ PC.

Conclusion

Using a method that permits quick and accurate quantification of autoreactive B cells and PC in vivo within a native B cell repertoire in mice and humans, we demonstrate the importance of a checkpoint that restricts the generation of IgG plasma cells and protects against IgG ANA. Our observations suggest a fundamentally revised understanding of SLE: that it is a disease of aberrant B cell differentiation rather than a defect in antigen-specific B cell tolerance.

Clinical implication

Therapies for SLE might need to be targeted at IgG plasma cell differentiation rather than antigen-specific tolerance.

Graphical abstract

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Exosome swarms eliminate airway pathogens and provide passive epithelial immunoprotection through nitric oxide

Publication date: Available online 12 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Angela L. Nocera, Sarina K. Mueller, Jules R. Stephan, Loretta Hing, Philip Seifert, Xue Han, Derrick T. Lin, Mansoor M. Amiji, Towia Libermann, Benjamin S. Bleier

Background

Nasal mucosa–derived exosomes (NMDEs) harbor immunodefensive proteins and are capable of rapid interepithelial protein transfer.

Objectives

We sought to determine whether mucosal exposure to inhaled pathogens stimulates a defensive swarm of microbiocidal exosomes, which also donate their antimicrobial cargo to adjacent epithelial cells.

Methods

We performed an institutional review board–approved study of healthy NMDE secretion after Toll-like receptor (TLR) 4 stimulation by LPS (12.5 μg/mL) in the presence of TLR4 inhibitors. Interepithelial transfer of exosomal nitric oxide (NO) synthase and nitric oxide was measured by using ELISAs and NO activity assays. Exosomal antimicrobial assays were performed with Pseudomonas aeruginosa. Proteomic analyses were performed by using SOMAscan.

Results

In vivo and in vitro LPS exposure induced a 2-fold increase in NMDE secretion along with a 2-fold increase in exosomal inducible nitric oxide synthase expression and function through TLR4 and inhibitor of nuclear factor κB kinase activation. LPS stimulation increased exosomal microbiocidal activity against P aeruginosa by almost 2 orders of magnitude. LPS-stimulated exosomes induced a 4-fold increase in NO production within autologous epithelial cells with protein transfer within 5 minutes of contact. Pathway analysis of the NMDE proteome revealed 44 additional proteins associated with NO signaling and innate immune function.

Conclusions

We provide direct in vivo evidence for a novel exosome-mediated innate immunosurveillance and defense mechanism of the human upper airway. These findings have implications for lower airway innate immunity, delivery of airway therapeutics, and host microbiome regulation.

Graphical abstract

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Mast Cell CRF2 Suppresses Mast Cell Degranulation and Limits the Severity of Anaphylaxis and Stress-Induced Intestinal Permeability

Publication date: Available online 12 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Susan D'Costa, Saravanan Ayyadurai, Amelia J. Gibson, Emily Mackey, Mrigendra Rajput, Laura J. Sommerville, Neco Wilson, Yihang Li, Eric Kubat, Ananth Kumar, Hariharan Subramanian, Aditi Bhargava, Adam J. Moeser

Abstract

Background

Psychological stress and heightened MC activation are linked with important immunological disorders including allergy, anaphylaxis, asthma, and functional bowel diseases, but the mechanisms remain poorly defined. We have previously demonstrated that activation of the corticotropin releasing factor (CRF) system potentiates MC degranulation responses during IgE-mediated anaphylaxis and psychological stress, via CRF receptor subtype 1 (CRF₁) expressed on MCs.

Objective

In this study, we investigated the role of CRF receptor subtype 2 (CRF₂) as a modulator of stress-induced MC degranulation and associated disease pathophysiology.

Methods

In vitro MC degranulation assays were performed with bone marrow derived MCs (BMMCs) derived from WT and CRF₂-deficient (CRF₂^-/-) mice and RBL-2H3 MCs transfected with CRF₂-overexpressing plasmid or CRF₂-siRNA. In vivo MC responses and associated pathophysiology in IgE-mediated passive systemic anaphylaxis (PSA) and acute psychological restraint stress were measured in WT, CRF₂^-/-, and MC-deficient Kit^W-sh/W-sh knock-in mice.

Results

Compared with WT mice, CRF2-/- exhibited heightened serum histamine levels and exacerbated PSA-induced anaphylactic responses and colonic permeability. In addition, CRF₂^-/- mice exhibited increased serum histamine and colonic permeability following acute restraint stress. Experiments with BMMCs and RBL-2H3 MCs demonstrated that CRF₂ expressed on MCs suppresses store-operated Ca²⁺ entry (SOCE) signaling and MC degranulation induced by diverse MC stimuli. Experiments with MC-deficient Kit^W-sh/W-sh mice systemically engrafted with WT and CRF₂^-/- BMMCs demonstrated the functional importance of MC-CRF₂ in modulating stress-induced pathophysiology.

Conclusions

MC CRF₂ is a negative, global modulator of stimuli-induced MC degranulation and limits the severity of IgE-mediated anaphylaxis and stress-related disease pathogenesis.

Graphical abstract

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Detection and location of second mesiobuccal canal in permanent maxillary teeth: a cone-beam computed tomography analysis in a Taiwanese population

Publication date: Available online 12 November 2018

Source: Archives of Oral Biology

Author(s): Chi-Chun Su, Ren-Yeong Huang, Yu-Chiao Wu, Wan-Chien Cheng, Ho-Sheng Chiang, Ming-Pang Chung, Yi-Wen Cathy Tsai, Chi-Hsiang Chung, Yi-Shing Shieh

Abstract

Objectives

The aim of this study was to analyze the incidence, symmetry, concurrence of second mesiobuccal canal (MB2) and determine geometric relationships between each orifice of maxillary first and second molars by cone-beam computed tomography (CBCT) analysis.

Methods

A total of 216 qualified individuals' (503 teeth) CBCT image were enrolled in the present study. The consistency of bilateral symmetry and concurrent appearance of MB2 canals were analyzed among individuals with contralateral and adjacent molar teeth. The inter-orifice distances and angulations of first and second molars were also measured.

Results

The overall incidence of MB2 canal of maxillary molars was 39.2%, in which 45.9% and 32.3% in the first and second molars, respectively. The distribution of MB2 canal in contralateral molar teeth has significant gender difference in second molars (p = 0.024) while analyzing the frequency of MB2 canal appearing in contralateral molar pairs. The simultaneous occurrence of MB2 canal was 22.4% for contralateral molars, and the prevalence of concurrent appearance of MB2 canal in the adjacent molars was 43.4%. After adjusting for gender, age, and tooth type, the inter-orifice distances of mesiobuccal to palatal (odds ratios = 1.891) and to distobuccal (odds ratios = 1.448) canals, demonstrated significant differences between molars with and without MB2 canals.

Conclusions

The clinical significance of the results presents critical information on the geometric features, including inter-orifice distances and angulations between each orifice in maxillary molar teeth. Further studies should be conducted to investigate the exact anatomic coordination between each orifice and its impact on access preparation and external crown morphology.

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PERIODONTAL MECHANORECEPTORS AND BRUXISM AT LOW BITE FORCES

Publication date: Available online 12 November 2018

Source: Archives of Oral Biology

Author(s): Gizem Yilmaz, Christopher Laine, Neslihan Tinastepe, M. Gorkem Ozyurt, Kemal S. Türker

Abstract

Objective

In this study, we examined if 6–9 Hz jaw tremor, an indirect indicator of Periodontal Mechanoreceptor (PMR) activity, is different in bruxists compared to healthy participants during production of a low-level constant bite force.

Methods

Bite force and surface EMG from the masseter muscle were recorded simultaneously as participants (13 patients, 15 controls) held a force transducer between the upper and lower incisors very gently.

Results

Tremor in 6–9 Hz band for bruxists was greater on average compared to controls, but the difference was not significant, both for force recordings and EMG activity.

Conclusions

The low effect sizes measured with the current protocol contrast highly with those of our previous study, where larger, dynamic bite forces were used, and where jaw tremor was markedly different in bruxists compared with controls.

Significance

We have now gained important insight into the conditions under which abnormal jaw tremor can be elicited in bruxism. From a scientific standpoint, this is critical for understanding the 'abnormality' of PMR feedback in bruxism. From a clinical perspective, our results represent progress towards the development of an optimal protocol in which jaw tremor can serve as a biological marker of bruxism.

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Development and use of a mouth gag for oral experiments in rats

Publication date: Available online 12 November 2018

Source: Archives of Oral Biology

Author(s): Ryutaro Kuraji, Shuichi Hashimoto, Hiroshi Ito, Katsuhisa Sunada, Yukihiro Numabe

ABSTRACT

Objective

Rodent models such as mice and rats are often used in investigations of the oral cavity in the fields of periodontology and dental anesthesiology. When various treatments are performed in the oral cavity, it is very important to secure the visual field while keeping the animal's mouth fully opened, in order to ensure the consistency of experimental procedures. Therefore, we developed a standardized gag conforming to various degrees of oral cavity size of different aged rats.

Design

The gag was composed of a rectangular incisor-opening frame constructed from a stainless steel wire with retractors and a dial to alter the opening amounts. Wistar rats (n = 5) aged 4, 8, and 12 weeks were used to evaluate the suitability of the gag in oral cavity. As tests for application of gag in intraoral experiments, the ligature placement around the molars, drug injection into the gingiva, measurement of gingival blood flow rate, and installation of stimulation an electrode for somatosensory-evoked potentials into the molar were performed.

Results

Adjusting the opening dial enabled both the maintenance of open state and more favorable intraoral observation compared with tweezers as a control device in all different types of rats. Furthermore, our gag made it possible to facilitate the insertion of diverse instruments into the oral cavity and to achieve various experimental purposes. The stainless-steel gag can also be autoclaved and dry-heat sterilized.

Conclusion

It was revealed that our mouth gag can be widely applied to various oral experiments in different old aged rats.

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A randomized clinical trial evaluating maxillary sinus augmentation with different particle sizes of demineralized bovine bone mineral: histological and immunohistochemical analysis

Publication date: Available online 13 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): R.S. de Molon, F.S. Magalhaes-Tunes, C.V. Semedo, R.G. Furlan, L.G.L. de Souza, A.P. de Souza Faloni, E. Marcantonio, R.S. Faeda

Abstract

This study was performed to investigate sinus floor augmentation with two different particle sizes of demineralized bovine bone mineral (DBBM) by means of histological and immunohistochemical (IHC) analysis. A randomized clinical trial was conducted involving 10 individuals requiring two-stage bilateral maxillary sinus augmentation for implant installation. The patients were randomly divided into two groups following a split-mouth design: the maxillary sinus on one side was filled with small-sized particles (0.25–1 mm) and on the contralateral side with large-sized particles (1–2 mm). After a healing period of 8 months, 25 implants were placed. During implant site preparation, bone biopsies were obtained from each sinus, perpendicular to the long axis of the implant (buccal–palatal direction), for descriptive and histomorphometric analyses. IHC staining for protein expression of osteocalcin (OCN), vascular endothelial growth factor (VEGF), and tartrate-resistant acid phosphatase (TRAP) was also performed. Histomorphometric analysis revealed no statistically significant difference in the percentage of biomaterial (32.4 ± 8.56% and 38.0 ± 6.92%), newly formed bone (36.1 ± 9.60% and 36.7 ± 5.79%), or connective tissue (30.4 ± 8.63% and 23.8 ± 6.16%) between the small- and large-sized particle groups, respectively. IHC analysis did not reveal differences in the expression of OCN, VEGF, or TRAP. These findings suggest that both particle sizes of DBBM are effective for bone augmentation in the maxillary sinus.

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Cost analysis of oral and maxillofacial free flap reconstruction for patients at an institution in China

Publication date: Available online 12 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): Y. Yang, P.-j. Li, T. Shuai, Y. Wang, C. Mao, G.-y. Yu, C.-b. Guo, X. Peng

Abstract

Free flap transplantation has become a mainstay for the restoration of oral and maxillofacial defects. However, the complexity of the surgical procedure and long hospitalization time result in high hospitalization costs. This study was performed to retrospectively analyse the composition of hospitalization expenses and factors influencing this for 507 patients who underwent oral and maxillofacial free flap transplantation at a representative medical institution in China. The aim was to provide evidence for the reasonable control of expenditure and effective utilization of medical resources, and to gain an indirect reflection of the healthcare model characteristics of public hospitals in China. The average hospitalization cost was found to be US$ 9265 ± 2284. Factors affecting hospitalization expenses were the type of free flap, tracheotomy, postoperative complications, and length of stay. The largest proportion of hospitalization expenses was the cost of materials (44.94%). Although the total hospitalization cost was lower than that in Western countries, the medical burden of patients was higher, and the corresponding medical charges do not fully reflect the value of medical services. We recommend reducing hospitalization expenses and the medical burden by shortening the hospital stay, selecting reasonably priced medical materials, strengthening airway management of patients undergoing tracheotomy, and enhancing the control and treatment of comorbidities in order to reduce the incidence of postoperative complications.

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Comparison of rim-sparing versus rim-removal techniques in deep lateral wall orbital decompression for Graves’ orbitopathy

Publication date: Available online 12 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): S. Zhang, Y. Li, Y. Wang, S. Zhong, X. Liu, Y. Huang, S. Fang, A. Zhuang, J. Sun, H. Zhou, X. Fan

Abstract

The aim of this study was to compare the surgical outcomes of deep lateral orbital decompression using the rim-sparing technique versus the rim-removal technique in Graves' orbitopathy (GO). A retrospective cohort study of 75 orbits in 50 patients with GO was performed. Proptosis, best corrected visual acuity (BCVA), intraocular pressure (IOP), upper and lower lid margin to reflex distances (MRD-1 and MRD-2, respectively), diplopia, ocular restriction, and GO quality of life (GO-QOL) questionnaire results were analyzed pre- and postoperatively. The average proptosis reduction ranged from 3.5 mm to 6.7 mm with the rim-sparing technique and from 3.6 mm to 6.7 mm with the rim-removal technique (P > 0.05). All orbits with dysthyroid optic neuropathy in the rim-sparing group and 87.5% of such orbits in the rim-removal group showed improved BCVA (P = 0.321). Reductions in IOP, MRD-1, and MRD-2 were observed with both techniques. Patients in the rim-sparing group had greater improvements in GO-QOL appearance score (P = 0.043). In conclusion, rim-sparing orbital decompression provides efficacious outcomes with greater improvements in patient quality of life than the rim-removal technique. The rim-sparing technique should be considered as a preferable option because it preserves the integrity of the lateral vertical maxillary buttress and bony protection for the orbital contents.

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Effects of auriculotherapy and midazolam for anxiety control in patients submitted to third molar extraction

Publication date: Available online 12 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): A.G. Dellovo, L.M.A. Souza, J.S. de Oliveira, K.S. Amorim, F.C. Groppo

Abstract

Anxiety is common and still represents a barrier to appropriate professional care for patients requiring dental treatment. The aim of this study was to compare the effects of auriculotherapy and midazolam for the control of anxiety in patients submitted to third molar extractions. This was a randomized, double-blind, controlled, crossover clinical trial. Thirty healthy volunteers requiring bilateral third molar extraction received midazolam 15 mg (oral) and sham auriculotherapy during one session, and a placebo tablet (oral) and auriculotherapy during the other; the sessions were randomized. The level of anxiety was assessed through questionnaires and physical parameters (blood pressure, heart rate, and oxygen saturation (SpO₂)) at three time points: baseline, on the day of surgery, and at follow-up. No significant differences between the protocols were observed for blood pressure and SpO₂. Auriculotherapy induced a lower heart rate than midazolam during some periods. Auriculotherapy induced more events remembered after surgery than midazolam (P < 0.0001). More undesirable effects were observed with midazolam (P < 0.0001). However, patient preference for auriculotherapy (53.3%) was not higher than preference for midazolam (46.7%). Auriculotherapy showed an anxiolytic effect equivalent to the midazolam effect, without the undesirable effects usually attributed to the benzodiazepine.

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Response to the Letter to the Editor regarding “Impact of crack cocaine use on the occurrence of oral lesions and micronuclei”

Publication date: Available online 12 November 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): R.P. Antoniazzi, L.C. Jardim, M.R. Sagrillo, K.L. Ferrazzo, C.A. Feldens

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Pulse Wave Imaging in Carotid Artery Stenosis Human Patients in Vivo

Publication date: Available online 12 November 2018

Source: Ultrasound in Medicine & Biology

Author(s): Ronny X. Li, Iason Z. Apostolakis, Paul Kemper, Matthew D.J. McGarry, Ada Ip, Edward S. Connolly, James F. McKinsey, Elisa E. Konofagou

Abstract—

Carotid stenosis involves narrowing of the lumen in the carotid artery potentially leading to a stroke, which is the third leading cause of death in the United States. Several recent investigations have found that plaque structure and composition may represent a more direct biomarker of plaque rupture risk compared with the degree of stenosis. In this study, pulse wave imaging was applied in 111 (n = 11, N = 13 plaques) patients diagnosed with moderate (>50%) to severe (>80%) carotid artery stenosis to investigate the feasibility of characterizing plaque properties based on the pulse wave-induced arterial wall dynamics captured by pulse wave imaging. Five (n = 5 patients, N = 20 measurements) healthy volunteers were also imaged as a control group. Both conventional and high-frame-rate plane wave radiofrequency imaging sequences were used to generate piecewise maps of the pulse wave velocity (PWV) at a single depth along stenotic carotid segments, as well as intra-plaque PWV mapping at multiple depths. Intra-plaque cumulative displacement and strain maps were also calculated for each plaque region. The Bramwell–Hill equation was used to estimate the compliance of the plaque regions based on the PWV and diameter. Qualitatively, wave convergence, elevated PWV and decreased cumulative displacement around and/or within regions of atherosclerotic plaque were observed and may serve as biomarkers for plaque characterization. Intra-plaque mapping revealed the potential to capture wave reflections between calcified inclusions and differentiate stable (i.e., calcified) from vulnerable (i.e., lipid) plaque components based on the intra-plaque PWV and cumulative strain. Quantitatively, one-way analysis of variance indicated that the pulse wave-induced cumulative strain was significantly lower (p < 0.01) in the moderately and severely calcified plaques compared with the normal controls. As expected, compliance was also significantly lower in the severely calcified plaques regions compared with the normal controls (p < 0.01). The results from this pilot study indicated the potential of pulse wave imaging coupled with strain imaging to differentiate plaques of varying stiffness, location and composition. Such findings may serve as valuable information to compensate for the limitations of currently used methods for the assessment of stroke risk.

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Accuracy of surgical guides from 2 different desktop 3D printers for computed tomography-guided surgery

Publication date: Available online 12 November 2018

Source: The Journal of Prosthetic Dentistry

Author(s): Björn Gjelvold, Deyar Jallal Hadi Mahmood, Ann Wennerberg

Abstract

Statement of problem

Different factors influence the degree of deviation in dental implant position after computed tomography–guided surgery. The surgical guide–manufacturing process with desktop 3D printers is such a factor, but its accuracy has not been fully evaluated.

Purpose

The purpose of this in vitro study was to evaluate the deviation in final dental implant position after the use of surgical guides fabricated from 2 different desktop 3D printers using a digital workflow.

Material and methods

Twenty 3D-printed resin models were prepared with missing maxillary premolar. After preoperative planning, 10 surgical guides were produced with a stereolithography printer and 10 with a digital light-processing (DLP) printer. A guided surgery was performed; 20 dental implants (3.8×12 mm) were installed, and a digital scan of the dental implants was made. Deviations between the planned and final position of the dental implants were evaluated for both the groups.

Results

A statistically significant difference between stereolithography and DLP were found for deviation at entry point (P=.023) and the vertical implant position (P=.009). Overall lower deviations were found for the guides from the DLP printer, with the exception of deviation in horizontal implant position.

Conclusions

The tested desktop 3D printers were able to produce surgical guides with similar deviations with regard to the final dental implant position, but the DLP printer proved more accurate concerning deviations at entry point and vertical implant position.

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Effect of technetium‐99 conjugated with methylene diphosphonate (99Tc‐MDP) on OPG/RANKL/RANK system in vitro

Abstract

Background

RANKL and RANK play an important role in jaw resorption during the development of the ameloblastomas. Therefore, the aim of this study was to explore the effect of ⁹⁹Tc‑MDP on OPG/RANKL/RANK system on RAW264.7 and MC3T3‐E1 cell lines in vitro, and provide the theoretical basis for the clinical treatment of the jaw ameloblastoma.

Methods

Different concentrations of ⁹⁹Tc‐MDP were used to treat RAW264.7 and MC3T3‐E1 cell lines. The cell proliferative inhibition rate was analyzed by CCK‐8. Cell apoptosis and cell cycle were detected by flow cytometry. Western blot were used to detect the expression of OPG, RANKL and RANK.

Results

Treatment of RAW264.7 cell lines with different concentrations of ⁹⁹Tc‐MDP had inhibitory effects and decreased the expression of RANK protein. The cell proliferation of ⁹⁹Tc‐MDP on MC3T3‐E1cell lines was stronger at 48h than at 24h except for 100μg/ml concentration group. Compared with the concentration of 0.01μg/ml, the treatment of MC3T3‐E1 cells with 100μg/ml ⁹⁹Tc‐MDP showed that the cell proliferative effect decreased at 24h and 48h (P<0.05). After treatment with 0.01μg/ml ⁹⁹Tc‐MDP, the expression of OPG in MC3T3‐E1 cells was significantly increased (P<0.05). Compared with 0.01μg/ml, the expression of RANKL was decreased after treatment with 100μg/ml ⁹⁹Tc‐MDP (P<0.05).

Conclusion

⁹⁹Tc‐MDP can induce apoptosis of RAW264.7 cells and inhibit the expression of RANK protein. The effect of 0.01μg/ml of low concentration of ⁹⁹Tc‐MDP can promote the proliferation of MC3T3‐E1 cells and increase the expression of OPG and RANKL protein. ⁹⁹Tc‐MDP may have adjuvant therapeutic effects on the treatment of jaw ameloblastoma.

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Comparación intraindividual de la PET/TC con 68Ga-DOTATATE vs. PET/TC con 11C-colina en pacientes con cáncer de próstata en recaída bioquímica: evaluación in vivo de la expresión de receptores de la somatostatina

Publication date: Available online 12 November 2018

Source: Revista Española de Medicina Nuclear e Imagen Molecular

Author(s): G. dos Santos, M. García Fontes, H. Engler, O. Alonso

Resumen

Antecedentes y objetivos

Comparar prospectivamente la tasa de detección de la PET/TC con ⁶⁸Ga-DOTATATE versus ¹¹C-colina en pacientes con cáncer de próstata en recaída bioquímica y evaluar in vivo la expresión de receptores de la somatostatina con el fin de planificar terapias dirigidas (¹⁷⁷Lu-DOTATATE).

Material y métodos

Analizamos prospectivamente 64 pacientes con recaída bioquímica (mediana PSA: 4,25 ng/mL). Se realizó una PET/TC con ¹¹C-colina y otra con ⁶⁸Ga-DOTATATE. Se midió el SUVmáx en todas las lesiones. Se consideraron como patrón de referencia las imágenes correlativas, histopatología y/o seguimiento clínico y bioquímico.

Resultados

La tasa de detección global por paciente fue del 48,43% para ⁶⁸Ga-DOTATATE y de 46,87% para ¹¹C-colina. Los resultados fueron concordantes en 53 casos (82,81%). El SUV máximo de la ¹¹C-colina fue significativamente mayor que el correspondiente al ⁶⁸Ga-DOTATATE para todas las lesiones concordantes (n = 130): 6,17 (1,7-15,5) versus 4,38 (1,37-26,7), mediana (rango), para cada radiotrazador, respectivamente (P < 0,0001). Los valores por paciente de sensibilidad y especificidad fueron los mismos para ambas técnicas: 0,82 (0,65-0,93) y 0,9 (0,73-0,98), respectivamente. Aunque la diferencia no fue estadísticamente significativa, la sensibilidad fue menor para pacientes con niveles de PSA inferiores: 0,63 vs. 0,89; p = 0,13. Se encontró una correlación significativa entre el SUVmáx de ambos trazadores (r = 0,41, n = 130, p < 0,0001).

Conclusiones

La PET/TC con ⁶⁸Ga-DOTATATE y la PET/TC con ¹¹C-colina parecen poseer alta capacidad de detección de lesiones patológicas en la evaluación de los pacientes con cáncer de próstata en recaída bioquímica. Se necesitan más estudios con el fin de probar el posible valor clínico complementario de estas técnicas PET/TC, y para el ⁶⁸Ga-DOTATATE para la potencial planificación de terapias mediadas por los receptores de somatostatina (¹⁷⁷Lu-DOTATATE).

Abstract

Background and objectives

To prospectively compare the detection rate of ⁶⁸Ga-DOTATATE versus ¹¹C-choline PET/CT in patients with prostate cancer in biochemical relapse, and to evaluate somatostatin receptor expression in vivo to plan targeted therapies (¹⁷⁷Lu-DOTATATE).

Material and methods

We prospectively analysed 64 patients with biochemical relapse (median PSA: 4.25 ng/mL). A PET/CT was performed with ¹¹C-choline, and another with ⁶⁸Ga-DOTATATE. The SUVmax was measured in all lesions. The correlative images, histopathology and/or clinical and biochemical follow-up were taken as the reference standard.

Results

The overall detection rate per patient was 48.43% for ⁶⁸Ga-DOTATATE and 46.87% for ¹¹C-choline. The results were concordant in 53 cases (82.81%). The maximum SUV of ¹¹C-choline was significantly higher than that of ⁶⁸Ga-DOTATATE for all the concordant lesions (n=130): 6.17 (1.7-15.5) versus 4.38 (1.37-26.7), median (range) for each radiotracer, respectively (p < .0001). The sensitivity and specificity values per patient were the same for both techniques: 0.82 (0.65-0.93) and 0.9 (0.73-0.98), respectively. Although the difference was not significant, the sensitivity was lower in patients with lower PSA levels: 0.63 vs. 0.89; p=.13. A significant correlation was found between the SUVmax of both tracers (r = 0.41, n = 130, p <.0001).

Conclusions

⁶⁸Ga-DOTATATE PET/CT and ¹¹C-choline PET/CT seem to have a high capacity to detect pathological lesions in the assessment of patients with prostate cancer with biochemical relapse. Further studies are required to test the potential complementary value of these PET/CT techniques, and to evaluate the potential role of ⁸Ga-DOTATATE for planning somostatin receptor-mediated therapies (¹⁷⁷Lu-DOTATATE).

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Coordinative patterns underlying cross-linguistic rhythmic differences

Publication date: Available online 12 November 2018

Source: Journal of Phonetics

Author(s): Leonardo Lancia, Georgy Krasovitsky, Franziska Stuntebeck

Abstract

We propose a new approach to characterize cross-linguistic differences in the rhythmic structure of speech utterances by studying the degree of coordination between the production of syllables and the production of prosodic prominence at the level of the word. With this approach we compare languages traditionally considered as stress-timed (English and German) and syllable-timed (French and Italian), as well as a language that on the basis of phonological considerations does not seem to belong to either class (Polish). We analyzed recorded narrations elicited with the Pear Story technique from 26 speakers (on average 5 per language) under two elicitation conditions. The results suggest that processes underlying the production of syllables and those underlying the production of prosodic prominence are more tightly coordinated in the Germanic languages analyzed than in Romance languages. The status of Polish on the other hand is more ambiguous because while its results differ from Romance languages, the differences depend on the condition of elicitation. Overall our results suggest that the coordination between syllable production and prominence production is a pertinent dimension for the discrimination of the rhythmic characteristics of languages.

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Reply: “Developmental venous anomaly depicted incidentally in fetal MRI and confirmed in post-natal MRI”

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Novel mutations identified in patients with tooth agenesis by whole‐exome sequencing

Abstract

Objectives

To identify potentially pathogenic mutations for tooth agenesis by whole‐exome sequencing.

Subjects and Methods

Ten Chinese families including 5 families with ectodermal dysplasia (syndromic tooth agenesis) and 5 families with selective tooth agenesis were included. Whole‐exome sequencing was performing using genomic DNA. Potentially pathogenic mutations were identified after data filtering and screening. The pathogenicity of novel variants were investigated by segregation analysis, in silico analysis and functional studies.

Results

One novel mutation (c.441_442insACTCT) and three reported mutations (c.252delT, c.463C>T, and c.1013C>T) in EDA were identified in families with ectodermal dysplasia. The novel EDA mutation was co‐segregated with phenotype. A functional study revealed that NF‐κB activation was compromised by the identified mutations. The secretion of active EDA was also compromised detecting by western blotting. Novel Wnt10A mutations (c.521T>C and c.653T>G) and EVC2 mutation (c.1472C>T) were identified in families with selective tooth agenesis. The Wnt10A c.521T>C mutation and the EVC2 c.1472C>T mutation were considered as pathogenic for affecting highly conserved amino acids, co‐segregated with phenotype and predicted to be disease‐causing by SIFT and PolyPhen2. Moreover, several reported mutations in PAX9, Wnt10A and FGFR3 were also detected.

Conclusions

Our study expanded our knowledge on tooth agenesis spectrum by identifying novel variants.

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