The Increase of Circulating PD-1- and PD-L1-Expressing Lymphocytes in Endometriosis: Correlation with Clinical and Laboratory Parameters

The cause of endometriosis remains unknown. However, studies investigating the link between this condition and the immune system revealed several immunological abnormalities focused on cell-mediated immunity. As a major immune checkpoint, programmed cell death protein 1 (PD-1) displays an important inhibitory function in the maintenance of peripheral tolerance. The expression of PD-1 and its ligand (PD-L1) may contribute to continuous T cell activation and development of inflammation and injury of the tissue. To our knowledge, this is the first study evaluating frequencies of PD-1-positive T CD3+ cells (CD4+ and CD8+) and B cells (CD19+) in patients with endometriosis. Peripheral blood (PB) samples from 25 female patients and 20 healthy age and sex-matched subjects serving as controls were used in the study. Using flow cytometric analysis, we assessed the differences in the frequencies of PD-1-positive T and B lymphocytes in the study group and healthy individuals. Alteration of the PD-1/PD-L1 axis may contribute to the pathogenesis of endometriosis, as patients with advanced disease are characterized by higher frequencies of PD-1-positive T and B cells. Expression of PD-1 and PD-L1 on T and B cells could represent the hallmark of immune system reaction to chronic antigenic exposition in patients with endometriosis.

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STING Signaling Promotes Apoptosis, Necrosis, and Cell Death: An Overview and Update

STING is a newly identified intracellular sensor of foreign and endogenous DNA. STING has been recognized as an activator of immune responses by TBK1/IRF3 and NF-κB pathways, and it is suggested to play critical roles in host defense, autoimmune diseases, and tumor immunity. Recent studies have revealed that the outcome of STING activation could vary between distinct cell types and scenarios. STING activation in certain cell types triggered cell death including apoptosis and necrosis. This effect could be critical for preventing unnecessary or excessive inflammatory events and maintaining host immune homeostasis. This review is dedicated to summarize recent evidences in the field of STING-mediated cell death and to demonstrate dual outcomes of STING signaling. Besides canonical immune responses represented by IFN and TNF productions, STING signaling can also induce cell death events in a variety of cell types. The double-faced characteristics of STING signaling requires further exploration and precious regulation before tailoring clinical strategies for associated diseases.

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Anesthetic Management for Medialization Laryngoplasty Performed Under Concurrent Dexmedetomidine, Remifentanil, and Propofol Infusions

Type I thyroplasty, or medialization larygoplasty (ML), is a procedure which improves the voice by medializing a vocal fold with a permanent implant. Anesthetic management of these cases is challenging because patients can require periods of deep sedation followed by fully awake moments for phonation to assess the implant size. We present our experience of ML with or without arytenoid adduction (AA) using a multimodal anesthetic regimen consisting of concurrent infusions of dexmedetomidine, remifentanil, and propofol.

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Nationwide analysis of unplanned 30‐day readmissions after transsphenoidal pituitary surgery

Background

Transsphenoidal pituitary surgery has evolved into a safe procedure with shorter hospitalizations, yet unplanned readmissions remain a quality measure for which there is a paucity of data. We sought to examine rates, timing, etiologic factors, and costs surrounding readmission after transsphenoidal pituitary surgery.

Methods

The Nationwide Readmissions Database (NRD) was queried for patients who underwent transsphenoidal pituitary between January 2013 and November 2013. Patient, procedure, admission, and hospital‐level characteristics were compared for patients with and without unplanned 30‐day readmission. Multivariate logistic regression was used to identify readmission predictors. A total of 8546 patients were included in this retrospective study.

Results

A total of 8546 patients with a median age of 54 years and female predominance were identified, with 742 patients experiencing at least 1 unplanned readmission within 30 days of index admission. Hypertension, hypothyroidism, diabetes, and obesity were common comorbidities among readmitted patients. Readmission was most frequently because of nervous system complications, followed by neurohypophyseal or electrolyte disorders, cerebrospinal fluid leak, hemorrhage, and meningitis. Median length and cost of stay of index admission was greater in the readmission group (p < 0.001). Fluid and electrolyte disorders as well as neurologic disease (most commonly epilepsy or convulsions) present on initial admission were predictive of length of initial stay and readmission (p < 0.001). Median readmission cost was $7723 and was expected to occur within 7 days.

Conclusion

Approximately 8.7% of patients undergoing transsphenoidal pituitary surgery experience an unplanned readmission within 30 days of discharge. Risk factors identified should be considered to reduce preventable readmissions and identify medically complex patients.

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Effect of elderly status on postoperative complications in patients with sinonasal cancer

Background

Elderly patients with multiple comorbidities may be at higher risk of postoperative complications. With an increasingly aging population, more data assessing for predisposing factors are needed in this at‐risk group. In this study, we analyzed the effect of elderly status on relative comorbidities and complications of sinonasal cancer (SNC) patients receiving surgery.

Methods

A retrospective database analysis was performed using cases from the Nationwide Inpatient Sample (NIS) from 2003 to 2012. Patients with a diagnosis of malignant neoplasm of the nasal cavity or paranasal sinuses, who received surgery for sinonasal malignancy, including neck dissections, were selected. Demographics of interest included age, sex, race, type of admission, mean length of stay, and median hospital charges. Elderly and nonelderly patients were compared for differences in rates of acute medical complications, acute surgical complications, and relevant procedures during hospitalization.

Results

Of the 920 cases identified in the NIS, 382 (41.5%) were elderly (≥65 years). Cases of SNC were more frequently seen in males than females (p < 0.001). Elderly patients had significantly higher comorbidity rates compared with nonelderly patients, which included congestive heart failure, hypertension, diabetes, chronic pulmonary disease, and chronic renal failure (p < 0.001 for all). Elderly patients more frequently had postoperative cardiac complications (6.0% vs 0.5%, p < 0.001), but this finding was not statistically significant on multivariate analysis when controlling for race, sex, and comorbidities.

Conclusion

Elderly status is not an independent factor for postoperative complications in patients undergoing surgery for sinonasal malignancy.

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Effect of margin design on fracture load of zirconia crowns

Zirconia‐based restorations are showing an increase as the clinicians' preferred choice at posterior sites because of the strength and esthetic properties of such restorations. However, all‐ceramic restorations fracture at higher rates than do metal‐based restorations. Margin design is one of several factors that can affect the fracture strength of all‐ceramic restorations. The aim of this study was to assess the effect of preparation and crown margin design on fracture resistance. Four groups of bilayer zirconia crowns (with 10 crowns in each group) were produced by hard‐ or soft‐machining technique, with the following four different margin designs: chamfer preparation (control); slice preparation; slice preparation with an additional cervical collar of 0.7 mm thickness; and reduced occlusal thickness (to 0.4 mm) on slice preparation with an additional cervical collar of 0.7 mm thickness. Additionally, 10 hard‐machined crowns with slice preparation were veneered and glazed with feldspathic porcelain. In total, 90 crowns were loaded centrally in the occlusal fossa until fracture. The load at fracture was higher than clinically relevant mastication loads for all preparation and margin designs. The crowns on a chamfer preparation fractured at higher loads compared with crowns on a slice preparation. An additional cervical collar increased load at fracture for hard‐machined crowns.

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Proteomic analysis of dentin–enamel junction and adjacent protein‐containing enamel matrix layer of healthy human molar teeth

The dentin–enamel junction (DEJ) is the border where two different mineralized structures – enamel and dentin – meet. The protein‐rich DEJ, together with the inner enamel region of mature teeth, is known to exhibit higher fracture toughness and crack growth resistance than bulk phase enamel. However, an explanation for this behavior has been hampered by the lack of compositional information for the DEJ and the adjacent enamel organic matrix (EOM). We studied proteomes of the DEJ and EOM of healthy human molars and compared them with dentin and enamel proteomes from the same teeth. These tissues were cut out of tooth sections by laser capture microdissection, proteins were extracted and cleaved by trypsin, then processed by liquid chromatography coupled to tandem mass spectrometry to analyze the proteome profiles of these tissues. This study identified 46 proteins in DEJ and EOM. The proteins identified have a variety of functions, including calcium ion‐binding, formation of extracellular matrix, formation of cytoskeleton, cytoskeletal protein binding, cell adhesion, and transport. Collagens were identified as the most dominant proteins. Tissue‐specific proteins, such as ameloblastin and amelogenin, were also detected. Our findings reveal new insight into proteomics of DEJ and EOM, highly mineralized tissues that are obviously difficult to analyze.

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Interaction between interferon regulatory factor 6 and glycine receptor beta shows a protective effect on developing nonsyndromic cleft lip with or without cleft palate in the Han Chinese population

Single‐nucleotide polymorphisms (SNPs) in protein‐coding regions of genes which were previously reported to be associated with nonsyndromic cleft lip, with or without palate involvement (NSCL/P), were investigated. Twelve candidate loci [platelet‐derived growth factor C (PDGFC), platelet‐derived growth factor subunit A (PDGFA), platelet‐derived growth factor receptor alpha (PDGFRA), glycine receptor alpha 2 (GLRA2), glycine receptor beta (GLRB), ATP binding cassette subfamily A member 4 (ABCA4), MAF bZIP transcription factor B (MAFB), interferon regulatory factor 6 (IRF6), CCDC26 long non‐coding RNA (CCDC26), paired box 7 (PAX7), ventral anterior homeobox 1 (VAX1), and netrin 1 (NTN1)] covering 1.5 Mbp were sequenced in 136 NSCL/P patients and 54 healthy controls. Twenty‐five genomic variants identified were further validated in another 400 NSCL/P and 200 controls. Two SNPs in IRF6 showed a protective effect against the development of NSCL/P (rs12405750, OR = 0.54, 95% CI: 0.41–0.69; and rs2235371, OR = 0.55, 95% CI: 0.43–0.71). The missense variant, rs2235371, alters the conserved amino acid valine to isoleucine at codon 274 (V274I). We observed that SNPs at IRF6 (rs2235371 and rs12405750) and GLRB (rs73856838 and rs72685584) show consistent interaction effects. The association between the missense SNP rs2235371 in gene IRF6 and NSCL/P suggests that this SNP may play an important role as a risk factor for NSCL/P in the Han Chinese populations. The marginal signal near 4q31 detected in previous genome‐wide association studies might be caused by an interaction between the IRF6 and GLRB genes. This interaction needs to be further validated by experimentation in follow‐up studies.

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Titanium dental implants with different collar design and surface modifications: a systematic review on survival rates and marginal bone levels

Abstract

Aim

To compare clinical and radiographic outcomes of dental implants with different neck characteristics.

Methods

A protocol‐oriented search aimed at the question: "In patients subjected to tooth replacement with screw‐type dental implants does the modification of the implant neck macro or micro‐geometry contribute to the improvement of survival rates and maintenance of the peri‐implant marginal bone levels?" Primary outcomes were survival and marginal bone level (MBL) changes evaluated on randomized controlled trials with >10 participants and follow‐up >1 year. Risk of bias was evaluated using the Cochrane Collaboration's tool. The review follows the PRISMA statement.

Results

Forty‐three studies compared: 1. One‐ versus two‐piece implants (N=7); 2. Two‐piece implants with different neck characteristics (machined and rough collars, microthreads, LASER microtexturing) (N=21); 3. Two‐piece implants with macrogeometry modifications (tapering, back‐tapering and scalloping) (N=6). One‐ and two‐piece implants showed similar survival (RR= 0.45, 95% CI: [0.12, 1.66], p=0.23) and MBL changes (WMD=0.09mm, 95% CI: [‐0.27, 0.45], p=0.64) at 1‐year post‐loading. Machined collar implants have higher risk of early failure than rough collar implants (RR= 3.96, 95% CI: [1.12, 13.93], p=0.03) and 0.43mm higher bone resorption (95% CI: [0.0, 0.86], p=0.05). Microthreads (WMD= 0.07mm, 95% CI: [‐0.01, 0.15], p=0.10) and LASER microtexturing (WMD=0.15mm, 95% CI: [‐0.35, 0.65], p=0.56) do not reduce bone resorption. Scalloped implants have 1.26mm higher resorption (95% CI: [0.72, 2.00], p<0.001).

Conclusions

One‐ and two‐piece implants have similar survival and MBL changes. Rough collar implants have lower MBL changes than machined collar implants. Additional modifications to rough collars are irrelevant.

This article is protected by copyright. All rights reserved.

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Original vs. non‐original abutments for screw‐retained single implant crowns: an in vitro evaluation of internal fit, mechanical behaviour and screw loosening

Abstract

Objectives

To assess the internal accuracy, mechanical behaviour under static load and screw loosening before and after cyclic loading of implant‐supported crowns restored with original components or with two compatible non‐original brands.

Materials and Methods

Sixty‐three dental implants were divided into three groups (n = 21 each): Group 1 used original components, and Groups 2 and 3 used non‐original components.

Internal accuracy was measured throughout a cross section of the sample groups (n = 8) using scanning electron microscopy (SEM) to evaluate the fit for implant‐abutments, implant‐crowns and crown‐abutments.

To evaluate load‐bearing capacity, 8 samples from each group were loaded until fracture according to ISO Norm 14801. The removal torque value (RTV) was evaluated in the screws connecting the crown with the abutment and the abutment with the implant before and after cyclic loading in 5 samples from each group. The data were analysed using the Kruskal Wallis test (p < 0.05).

Results

Statistically significant differences were found among the mean crown‐abutment gaps measured in Group 1 (9.3 μm), Group 2 (45.4 μm) and Group 3 (44.9 μm).

Higher values for mean load‐bearing capacity were found in Group 1 (1098 N) than in Groups 2 and 3 (1057 N and 973 N, respectively); however, these differences were not statistically significant.

Original abutment‐implant screws exhibited lower percentages of torque reduction than the non‐originals.

Conclusions

Enhanced fit is expected when original components are used. The original abutments exhibited lower percentages of torque reduction after cyclic loading than non‐originals.

This article is protected by copyright. All rights reserved.

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Impact of a zoledronate coating on early post‐surgical implant stability and marginal bone resorption in the maxilla ‐ a split‐mouth randomized clinical trial

Abstract

Objectives

The objective of this clinical study was to evaluate the effect of a bisphosphonate coating on a titanium implant on the implant stability quotient (ISQ) and the radiographic marginal bone levels at implants during early healing (2 to 8 weeks).

Material and methods

In a randomized double‐blind trial with internal controls, 16 patients received a dental implant coated with zoledronate and one uncoated implant as a control. The coated and uncoated implants which were visually indistinguishable were bone level titanium implants with a moderately rough surface and a micro‐threaded neck. ISQ values were obtained at insertion and at 2, 4, 6, and 8 weeks. Radiographs were obtained at insertion and at 8 weeks. The primary outcome was the difference in ISQ values between the coated implants and the control implants at 4 and 6 weeks, corrected for insertion values. The secondary outcome was loss of marginal bone level from insertion to 8 weeks.

Results

ISQ values remained largely constant over the 8 weeks and there were no significant difference between coated and uncoated implants at any time point. There were 0.12 (SD 0.10) mm marginal bone loss at the control implants and 0.04 (SD 0.08) mm at the coated implants. The difference was 0.17 mm; SD 0.14; p<0.006). On blind qualitative scoring, 13 of the 15 control implants and 2 of 15 coated implants showed small marginal bone defects (p=0.003).

Conclusions

There were no statistically significant differences observed in ISQ values between the coated and uncoated implants during the early healing. There was less marginal bone loss at the coated implants.

This article is protected by copyright. All rights reserved.

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Accuracy of Dual-Energy Virtual Monochromatic CT Numbers: Comparison between the Single-Source Projection-Based and Dual-Source Image-Based Methods

Publication date: December 2018

Source: Academic Radiology, Volume 25, Issue 12

Author(s): Takashi Ueguchi, Ryota Ogihara, Sachiko Yamada

Rationale and Objectives

To investigate the accuracy of dual-energy virtual monochromatic computed tomography (CT) numbers obtained by two typical hardware and software implementations: the single-source projection-based method and the dual-source image-based method.

Materials and Methods

A phantom with different tissue equivalent inserts was scanned with both single-source and dual-source scanners. A fast kVp-switching feature was used on the single-source scanner, whereas a tin filter was used on the dual-source scanner. Virtual monochromatic CT images of the phantom at energy levels of 60, 100, and 140 keV were obtained by both projection-based (on the single-source scanner) and image-based (on the dual-source scanner) methods. The accuracy of virtual monochromatic CT numbers for all inserts was assessed by comparing measured values to their corresponding true values. Linear regression analysis was performed to evaluate the dependency of measured CT numbers on tissue attenuation, method, and their interaction.

Results

Root mean square values of systematic error over all inserts at 60, 100, and 140 keV were approximately 53, 21, and 29 Hounsfield unit (HU) with the single-source projection-based method, and 46, 7, and 6 HU with the dual-source image-based method, respectively. Linear regression analysis revealed that the interaction between the attenuation and the method had a statistically significant effect on the measured CT numbers at 100 and 140 keV.

Conclusions

There were attenuation-, method-, and energy level-dependent systematic errors in the measured virtual monochromatic CT numbers. CT number reproducibility was comparable between the two scanners, and CT numbers had better accuracy with the dual-source image-based method at 100 and 140 keV.

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Tailoring CT Dose to Patient Size: Implementation of the Updated 2017 ACR Size-specific Diagnostic Reference Levels

Publication date: December 2018

Source: Academic Radiology, Volume 25, Issue 12

Author(s): Yan Klosterkemper, Elisabeth Appel, Christoph Thomas, Oliver T. Bethge, Joel Aissa, Patric Kröpil, Gerald Antoch, Johannes Boos

Rationale and Objectives

To use an automatic computed tomography (CT) dose monitoring system to analyze the institutional chest and abdominopelvic CT dose data as regards the updated 2017 American College of Radiology (ACR) diagnostic reference levels (DRLs) based on water-equivalent diameter (Dw) and size-specific dose estimates (SSDE) to detect patient-size subgroups in which CT dose can be optimized.

Materials and Methods

All chest CT examinations performed between July 2016 and April 2017 with and without contrast material, CT of the pulmonary arteries, and abdominopelvic CT with and without contrast material were included in this retrospective study. Dw and SSDE were automatically calculated for all scans using a previously validated in-house developed Matlab software and stored into our CT dose monitoring system. CT dose data were analyzed as regards the updated ACR DRLs (size groups: 21–25 cm, 25–29 cm, 29–33 cm, 33–37 cm, 37–41 cm). SSDE and volumetric computed tomography dose index (CTDIvol) were used as CT dose parameter.

Results

Overall, 30,002 CT examinations were performed in the study period, 3860 of which were included in the analysis (mean age 62.1 ± 16.4 years, Dw 29.0 ± 3.3 cm; n = 577 chest CT without contrast material, n = 628 chest CT with contrast material, n = 346 CT of chest pulmonary, n = 563 abdominopelvic CT without contrast material, n = 1746 abdominopelvic CT with contrast material). Mean SSDE and CTDIvol relative to the updated DRLs were 43.3 ± 26.4 and 45.1 ± 27.9% for noncontrast chest CT, 52.3 ± 23.1 and 52.0 ± 23.1% for contrast-enhanced chest CT, 68.8 ± 29.5 and 70.0 ± 31.0% for CT of pulmonary arteries, 41.9 ± 29.2 and 43.3 ± 31.3% for noncontrast abdominopelvic CT, and 56.8 ± 22.2 and 58.8 ± 24.4% for contrast-enhanced abdominopelvic CT. Lowest dose compared to the DRLs was found for the Dw group of 21–25 cm in noncontrast abdominopelvic CT (SSDE 30.4 ± 21.8%, CTDIvol 30.8 ± 21.4%). Solely the group of patients with a Dw of 37–41 cm undergoing noncontrast abdominopelvic CT exceeded the ACR DRL (SSDE 100.3 ± 59.0%, CTDIvol 107.1 ± 63.5%).

Conclusions

On average, mean SSDE and CTDIvol of our institutional chest and abdominopelvic CT protocols were lower than the updated 2017 ACR DRLs. Size-specific subgroup analysis revealed a wide variability of SSDE and CTDIvol across CT protocols and patient size groups with a transgression of DRLs in noncontrast abdominopelvic CT of large patients (Dw 37–41 cm).

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Comparison of Local Injection of Fresh Frozen Plasma to Traditional Methods of Hemostasis in Minimally Invasive Procedures

Publication date: December 2018

Source: Academic Radiology, Volume 25, Issue 12

Author(s): John Haaga, Shiraz Rahim, Victor Kondray, Jon Davidson, Indravadan Patel, Dean Nakamoto

Rationale and Objectives

To evaluate different techniques for reducing hemorrhagic complications in coagulopathic patients with elevated international normalized ratio having an image-guided percutaneous invasive procedure; techniques included systemic transfusion of fresh frozen plasma (FFP), local injection of FFP, percutaneous injection of gelatin sponge, and percutaneous placements of angiographic coils.

Materials and Methods

Retrospective review of 232 consecutive patients with known coagulopathy undergoing image-guided minimally invasive procedures were selected. Ninety-one patients had local FFP injected, 40 patients underwent local synthetic gelatin injection, 16 patients had percutaneous coil embolization, and 85 patients received systemic FFP. The number of bleeds, complications related to bleeds, and systemic complications were recorded. A 30 cc threshold was used to delineate significant bleeding.

Results

No patients experienced clinically significant or insignificant bleeding with local FFP injection (P value <.05). Other local hemostatic methods (Gelfoam, systemic FFP, and coil embolization) were associated with higher levels of bleeding (12.5%, 17.1%, 37.5%, respectively) and complications (7.5%, 31.4%, 37.5%, respectively). Systemic FFP infusion was associated with respiratory, infectious, and mortal complications.

Conclusions

Local injection of blood products provides a safe and efficacious hemostatic agent to reduce the incidence of postprocedural bleeding. The technique is associated with lower rates of bleeding and systemic complications when compared to other local and systemic techniques. Further randomized prospective studies with a larger patient cohort need to be performed to corroborate these initial findings.

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Does Enhancement or Perfusion on Preprocedure CT Predict Outcomes After Embolization of Hepatocellular Carcinoma?

Publication date: December 2018

Source: Academic Radiology, Volume 25, Issue 12

Author(s): Alessandra Borgheresi, Adrian Gonzalez-Aguirre, Karen T. Brown, George I. Getrajdman, Joseph P. Erinjeri, Anne Covey, Hooman Yarmohammadi, Etay Ziv, Constantinos T. Sofocleous, Franz Edward Boas

Rationale and Objective

The objective of this study was to evaluate whether quantitative enhancement or perfusion measurements on preprocedure triphasic computed tomography (CT) can be used to predict response or overall survival after embolization of hepatocellular carcinoma.

Materials and Methods

The institutional review board approved this retrospective review of 63 patients with hepatocellular carcinoma treated with particle embolization between March 2009 and December 2014. Quantitative enhancement and perfusion measurements were performed on the target tumor and the background liver on the triphasic CT performed before treatment. Microvascular invasion (MVI) and degree of differentiation were determined from a core biopsy specimen. Quantitative enhancement and perfusion values were then correlated with pathology (two-tailed t test), response to embolization on modified Response Evaluation Criteria In Solid Tumors (two-tailed t test), and overall survival after embolization (Cox proportional hazards model).

Results

Arterial enhancement did not predict immediate response or overall survival after embolization. The degree of differentiation or presence of MVI also did not predict immediate response or overall survival after embolization. However, high hepatic artery coefficient or low portal vein coefficient, both in the tumor (P = .011 and P = .004) and in the background liver (P = .015 and P = .009), were associated with worse survival. Hepatic artery coefficient, both in the tumor (P = .025) and in the background liver (P = .013), were independent predictors of survival in a multivariate model including the Child-Pugh score and the BCLC stage.

Conclusions

Tumor and liver perfusion parameters estimated from preprocedure triphasic CT were predictive of survival after embolization. Arterial-phase enhancement and histology (degree of differentiation or MVI) did not predict immediate response or overall survival after particle embolization.

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Breast Lesions Detected via Molecular Breast Imaging: Physiological Parameters Affecting Interpretation

Publication date: December 2018

Source: Academic Radiology, Volume 25, Issue 12

Author(s): Jason G. Ching, Rachel F. Brem

Rationale and Objectives

To evaluate correlations between molecular breast imaging (MBI) descriptor characteristics and positive predictive value (PPV) in detecting breast cancer.

Materials and Methods

A retrospective review was performed on 193 suspicious findings from 153 women (31–81 years) with positive MBI examinations. We assessed associations between (i) lesion pattern (mass vs. nonmass) and PPV; (ii) lesion pattern and suspected likelihood of cancer (low vs. moderate vs. high); (iii) background parenchymal uptake (BPU) (homogeneous vs. heterogeneous) and PPV; (iv) breast density (dense vs. non-dense) and PPV; and (v) BPU and density.

Results

One hundred ten of 153 patients were diagnosed with malignancy or high-risk pathology (PPV1 = 71.9%), and 130/193 biopsies resulted in malignant or high-risk lesions (PPV3 = 67.4%). Biopsies of mass vs. nonmass findings had comparable PPV3 (71.7% vs. 61.3%; P = .0717). Mass findings were correlated with higher suspicion for cancer than nonmass findings (P < .001). There was no significant difference in PPV3 when comparing biopsies from homogeneous vs. heterogeneous BPU (72.5% vs. 60.7%; P = .103). No association was found between patients' BPU and diagnosed cancer or high-risk lesions (P = .513). Biopsies from nondense breasts demonstrated higher PPV3 than biopsies from dense breasts (85.4% vs. 60.6%; P = .0025); patients with nondense breasts were more likely to be diagnosed with cancer or high-risk pathology (PPV1 = 87.8% vs. 66.0%; P = .00844). Dense breasts had a greater association with heterogeneous BPU (P = .0844).

Conclusion

Neither variability in mass or nonmass positive MBI findings, nor variability in BPU on MBI were significant determinants for the probability of malignancy. Dense breasts were associated with lower predictability and heterogeneous BPU on MBI.

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Posterior Inferior Cerebellar Artery Aneurysm: Have You Ever Been Misdiagnosed?

Publication date: December 2018

Source: Academic Radiology, Volume 25, Issue 12

Author(s): Yuan Zhang, Shiqing Sun, Qi Xu, Weihua Feng, Haisong Chen

Rationale and Objectives

The posterior inferior cerebellar artery aneurysm (PICAA), especially distal PICAA, is easily missed by a doctor, leading to misdiagnosis and treatment delays. The objective of this article is to report the computed tomography angiography (CTA) presentations of 30 cases of PICAA proved by digital subtraction angiography (DSA) or surgical operation, and analyze the causes of misdiagnosis of PICAA by CTA.

Materials and Methods

Thirty cases of patients with PICAA that were proved by DSA or surgical operation were included in this study, all of whom underwent CTA before surgical procedure. The relationship between the locations of PICAA and the rates of missed diagnosis by CTA was analyzed. The detection rates of the PICAA by volume rendering (VR) images and original thin axial images of CTA were compared.

Results

Twelve cases (12 of 30, 40%) of aneurysm lied on the proximal end of posterior inferior cerebellar artery (PICA) (border with vertebral artery) and all of them (12 of 12,100%) were clearly displayed on the VR images of CTA and correctly diagnosed by doctors. Eighteen cases (18 of 30, 60%) of aneurysm lied on the distal part of the PICA, whereas only 2 of them (2/18, 11.1%) were displayed on the VR images and correctly diagnosed before surgical procedure. After surgical operation, the respective review of the CTA images demonstrated that all aneurysms (30 of 30, 100%) can be found on the thin axial images after careful observation and are shown on VR images after adjusting the display threshold when the locations of the PICAA through thin axial images were known, including the distal PICAA.

Conclusions

Thin axial CT images are most important and reliable for the detection of distal PICAA. Overdependence on three-dimensional VR images of CTA is the main cause of misdiagnosis.

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A Radiomics Signature in Preoperative Predicting Degree of Tumor Differentiation in Patients with Non–small Cell Lung Cancer

Publication date: December 2018

Source: Academic Radiology, Volume 25, Issue 12

Author(s): Xin Chen, Mengjie Fang, Di Dong, Xinhua Wei, Lingling Liu, Xiangdong Xu, Xinqing Jiang, Jie Tian, Zaiyi Liu

Rationale and Objectives

Poorly differentiated non–small cell lung cancer (NSCLC) indicated a poor prognosis and well-differentiated NSCLC indicates a noninvasive nature and good prognosis. The purpose of this study was to build and validate a radiomics signature to predict the degree of tumor differentiation (DTD) for patients with NSCLC.

Materials and Methods

A total of 487 patients with pathologically diagnosed NSCLC were retrospectively included in our study. Five hundred ninety-one radiomics features were extracted from each tumor from the contrast-enhanced computed tomography images. A minimum redundancy maximum relevance algorithm and a logistic regression model were used for dimension reduction, feature selection, and radiomics signature building. The performance of the radiomics signature was assessed using receiver operating characteristic analysis, and the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy were calculated to quantify the association between a signature and DTD. An independent validation set contained 184 consecutive patients with NSCLC.

Results

A nine-radiomics-feature-based signature was built and it could differentiate low and high DTDs in the training set (AUC = 0.763, sensitivity = 0.750, specificity = 0.665, and accuracy = 0.687), and the radiomics signature had good discrimination performance in the validation set (AUC = 0.782, sensitivity = 0.608, specificity = 0.752, and accuracy = 0.712).

Conclusions

A radiomics signature based on contrast-enhanced computed tomography imaging is a potentially useful imaging biomarker for differentiating low from high DTD in patients with NSCLC.

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Variability of CT Airways Measurements in COPD Patients Between Morning and Afternoon: Comparisons to Variability of Spirometric Measurements

Publication date: December 2018

Source: Academic Radiology, Volume 25, Issue 12

Author(s): Maxime Hackx, Elodie Gyssels, Tiago Severo Garcia, Isabelle De Meulder, Marie Bruyneel, Alain Van Muylem, Vincent Ninane, Pierre Alain Gevenois

Rationale and Objectives

Computed tomography (CT) airways measurements can be used as surrogates to spirometric measurements for assessing bronchodilation in a particular patient with chronic obstructive pulmonary disease. Although spirometric measurements show variations within the opening hours of a hospital department, we aimed to compare the variability of CT airways measurements between morning and afternoon in patients with chronic obstructive pulmonary disease to that of spirometric measurements.

Materials and Methods

Twenty patients had pulmonary function tests and CT around 8 am and 4 pm. Luminal area (LA) and wall thickness (WT) of third and fourth generation airways were measured twice by three readers. The percentage of airway area occupied by the wall (WA%) and the square root of wall area at an internal perimeter of 10 mm (√WAPi10) were calculated. The effects of examination time, reader, and measurement session on CT airways measurements were assessed, and the variability of these measurements was compared to that of spirometric measurements.

Results

Variability of LA^3rd and LA^4th was greater than that of spirometric measurements (P values ranging from <.001 to .033). There was no examination time effect on √WAPi10, WT^3rd, LA^4th, or WA%^4th (P values ranging from .102 to .712). There was a reader effect on all CT airways measurements (P values ranging from <.001 to .028), except in WT^3rd (P > .999). There was no effect of measurement session on any CT airway measurement (P values ranging from .535 to >.999).

Conclusion

As the variability of LA^3rd and LA^4th is greater than that of spirometric measurements, clinical studies should include cohorts with larger numbers of patients when considering LA than when considering spirometric measurements as end points.

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It is About "Time": Academic Neuroradiologist Time Distribution for Interpreting Brain MRIs

Publication date: December 2018

Source: Academic Radiology, Volume 25, Issue 12

Author(s): Altaib Al Yassin, Mohammad Salehi Sadaghiani, Suyash Mohan, R. Nick Bryan, Ilya Nasrallah

Rationale and Objectives

Efficiency is central to current radiology practice. Knowledge of report generation timing is essential for workload optimization and departmental staffing decisions. Yet little research evaluates the distribution of activities performed by neuroradiologists in daily work.

Materials and Methods

This observational study tracked radiologists interpreting 358 brain magnetic resonance imaging (MRI) in an academic practice over 9 months. We measured the total duration from study opening to report signing and times for five activities performed during this period: image viewing, report transcription, obtaining clinical data, education, and other. Attendings, fellows, and residents reading studies independently and attendings over-reading trainee-previewed studies were observed.

Results

Ten attendings, 12 fellows, and 13 residents spent a mean of 11, 18, and 16 minutes reading brain MRIs independently. Mean duration was significantly different comparing attendings in all assignments to fellows (18.36 ± 1.05 minutes, p = 0.0001) or residents (16.31 ± 1.11 minutes, p = 0.001) but not between fellows/residents. Mean duration among attendings reading independently versus over-reading trainees was not statistically different. Attendings spent the same time on image viewing (4.07–5.33 minutes) with or without trainees. Attending transcription time was shortest when over-reading trainees (2.24 minutes) and longest when reading independently (4.20 minutes), demonstrating benefit of the draft report. Fellows and Residents spent longer on image viewing (7.14 minutes and 8.06 minutes, respectively) and transcription (7.02 minutes and 5.40 minutes, respectively) than attendings reading independently.

Conclusion

Neuroradiologist time/activity distributions for reading brain MRI studies were measured, setting the stage to establish a benchmark for future reference and suggesting opportunities for greater efficiency. Furthermore, report production time can be decreased when a draft report is available.

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The Impact of Interruptions on Chest Radiograph Interpretation: Effects on Reading Time and Accuracy

Publication date: December 2018

Source: Academic Radiology, Volume 25, Issue 12

Author(s): Rachel M. Wynn, Jessica L. Howe, Linda C. Kelahan, Allan Fong, Ross W. Filice, Raj M. Ratwani

Rationale and Objectives

The objective of this study was to experimentally test the effect of interruptions on image interpretation by comparing reading time and response accuracy of interrupted case reads to uninterrupted case reads in resident and attending radiologists.

Materials and Methods

Institutional review board approval was obtained before participant recruitment from an urban academic health-care system during January 2016–March 2016. Eleven resident and 12 attending radiologists examined 30 chest radiographs, rating their confidence regarding the presence or the absence of a pneumothorax. Ten cases were normal (ie, no pneumothorax present), 10 cases had an unsubtle pneumothorax (ie, readily perceivable by a nonexpert), and 10 cases had a subtle pneumothorax. During three reads of each case type, the participants were interrupted with 30 seconds of a secondary task. The total reading time and the accuracy of interrupted and uninterrupted cases were compared. A mixed-factors analysis of variance was run on reading time and accuracy with experience (resident vs attending) as a between-subjects factor and case type (normal, unsubtle, or subtle) and interruption (interruption vs no interruption) as within-subjects factors.

Results

Interrupted tasks had significantly longer reading times than uninterrupted cases (P = .032). During subtle cases, interruptions reduced accuracy (P = .034), but during normal cases, interruptions increased accuracy (P = .038).

Conclusions

Interruptions increased reading times and increased the tendency for a radiologist to conclude that a case is normal for both resident and attending radiologists, demonstrating that interruptions reduce efficiency and introduce patient safety concerns during reads of abnormal cases.

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When Residents Hear the Bell Toll

Publication date: Available online 23 November 2018

Source: Academic Radiology

Author(s): Jared R Shields, Richard B Gunderman

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Machine Learning Algorithms Utilizing Functional Respiratory Imaging May Predict COPD Exacerbations

Publication date: Available online 23 November 2018

Source: Academic Radiology

Author(s): Maarten Lanclus, Johan Clukers, Cedric Van Holsbeke, Wim Vos, Glenn Leemans, Birgit Holbrechts, Katherine Barboza, Wilfried De Backer, Jan De Backer

Rationale and Objectives

Acute chronic obstructive pulmonary disease exacerbations (AECOPD) have a significant negative impact on the quality of life and accelerate progression of the disease. Functional respiratory imaging (FRI) has the potential to better characterize this disease. The purpose of this study was to identify FRI parameters specific to AECOPD and assess their ability to predict future AECOPD, by use of machine learning algorithms, enabling a better understanding and quantification of disease manifestation and progression.

Materials and Methods

A multicenter cohort of 62 patients with COPD was analyzed. FRI obtained from baseline high resolution CT data (unenhanced and volume gated), clinical, and pulmonary function test were analyzed and incorporated into machine learning algorithms.

Results

A total of 11 baseline FRI parameters could significantly distinguish ( p < 0.05) the development of AECOPD from a stable period. In contrast, no baseline clinical or pulmonary function test parameters allowed significant classification. Furthermore, using Support Vector Machines, an accuracy of 80.65% and positive predictive value of 82.35% could be obtained by combining baseline FRI features such as total specific image-based airway volume and total specific image-based airway resistance, measured at functional residual capacity. Patients who developed an AECOPD, showed significantly smaller airway volumes and (hence) significantly higher airway resistances at baseline.

Conclusion

This study indicates that FRI is a sensitive tool (PPV 82.35%) for predicting future AECOPD on a patient specific level in contrast to classical clinical parameters.

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How the brain makes sense beyond the processing of single words – An MEG study

Publication date: Available online 24 November 2018

Source: NeuroImage

Author(s): Annika Hultén, Jan-Mathijs Schoffelen, Julia Uddén, Nietzsche H.L. Lam, Peter Hagoort

Abstract

Human language processing involves combinatorial operations that make human communication stand out in the animal kingdom. These operations rely on a dynamic interplay between the inferior frontal and the posterior temporal cortices. Using source reconstructed magnetoencephalography, we tracked language processing in the brain, in order to investigate how individual words are interpreted when part of sentence context. The large sample size in this study (n = 68) allowed us to assess how event-related activity is associated across distinct cortical areas, by means of inter-areal co-modulation within an individual. We showed that, within 500 ms of seeing a word, the word's lexical information has been retrieved and unified with the sentence context. This does not happen in a strictly feed-forward manner, but by means of co-modulation between the left posterior temporal cortex (LPTC) and left inferior frontal cortex (LIFC), for each individual word. The co-modulation of LIFC and LPTC occurs around 400 ms after the onset of each word, across the progression of a sentence. Moreover, these core language areas are supported early on by the attentional network. The results provide a detailed description of the temporal orchestration related to single word processing in the context of ongoing language.

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Detrended connectometry analysis to assess white matter correlates of performance in childhood

Publication date: Available online 24 November 2018

Source: NeuroImage

Author(s): Brady J. Williamson, Mekibib Altaye, Darren S. Kadis

Abstract

The white matter of the brain develops in a robust, regionally-variant, nonlinear manner during childhood. To relate white matter connectivity to performance, these regional nonlinear effects of age must be accounted for. Here, we identify white matter correlates of gross intellectual functioning using cutting-edge diffusion analyses inside a data-driven two-step regression framework. A total of 98 participants, ages 3–18 years, were included in the analyses. First, white matter connectivity was modeled as a function of age for each fiber direction at each voxel, extracted from the spin distribution function, using a 6^th-order B-spline. The smoothing parameter for each direction was chosen by minimizing generalized cross-validation (GCV), which prevents overfitting while remaining sensitive to potentially nonlinear effects of age. In the second step, the resulting Gaussian residuals were modeled as a function of either full-scale IQ (FSIQ), or of verbal IQ (VIQ) and performance IQ (PIQ), using a linear regression framework (connectometry). Graph theoretical analyses were also performed to assess how each predictor relates to global topological changes, including average clustering coefficient, characteristic path length, global efficiency, average local efficiency, and small worldness. Analyses revealed widespread positive associations between white matter connectivity and FSIQ, including regions of the corpus callosum, fornix, and corticothalamic tracts (FDRq < .05). A separate regression model revealed a selective positive relationship between VIQ and white matter connectivity in predominately frontal tracts (e.g., anterior corticothalamic radiations, fornix, anterior corpus callosum, frontopontine tracts); in contrast, PIQ predicted white matter connectivity in the posterior brain (e.g. parietopontine tracts, posterior corticothalamic radiations, posterior corticostriatal projections), (FDRq < .05). No negative correlations were observed. Graph analyses revealed FSIQ, VIQ while controlling for PIQ, and PIQ while controlling for VIQ increase clustering coefficient, global efficiency, local efficiency, and small worldness, and decrease characteristic path length of the network. Results indicate regional white matter changes related to cognitive skills in childhood, independent of age.

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Neural activity in human visual cortex is transformed by learning real world size

Publication date: Available online 23 November 2018

Source: NeuroImage

Author(s): Marc N. Coutanche, Sharon L. Thompson-Schill

Abstract

The way that our brain processes visual information is directly affected by our experience. Repeated exposure to a visual stimulus triggers experience-dependent plasticity in the visual cortex of many species. Humans also have the unique ability to acquire visual knowledge through instruction. We introduced human participants to the real-world size of previously unfamiliar species, and to the functional motion of novel tools, during a functional magnetic resonance imaging scan. Using machine learning, we compared activity patterns evoked by images of the new items, before and after participants learned the animals' real-world size or tools' motion. We found that, after acquiring size information, participants' visual activity patterns for the new animals became more confusable with activity patterns evoked by similar-sized known animals in early visual cortex, but not in ventral temporal cortex, reflecting an influence of new size knowledge on posterior, but not anterior, components of the ventral stream. Learning the functional motion of new tools did not lead to an equivalent change in activity. Finally, time-points marked by evidence of new size information in early visual cortex were more likely to show size information and greater activation in the right angular gyrus, a key hub of semantic knowledge and spatial cognition. Overall, these findings suggest that learning an item's real-world size by instruction influences subsequent activity in visual cortex and a region that is central to semantic and spatial brain systems.

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Advances in gradient echo myelin water imaging at 3T and 7T

Publication date: Available online 23 November 2018

Source: NeuroImage

Author(s): Hyeong-Geol Shin, Se-Hong Oh, Masaki Fukunaga, Yoonho Nam, Doohee Lee, Woojin Jung, Minju Jo, Sooyeon Ji, Joon Yul Choi, Jongho Lee

Abstract

Gradient echo myelin water imaging (GRE-MWI) is an MRI technique to measure myelin concentration and involves the analysis of signal decay characteristics of the multi-echo gradient echo data. The method provides a myelin water fraction as a quantitative biomarker for myelin. In this work, a new sequence and post-processing methods were proposed to generate high quality GRE-MWI images at 3T and 7T. In order to capture the rapidly decaying myelin water signals, a bipolar readout GRE sequence was designed with "gradient pairing," compensating for the eddy current effects. The flip angle dependency from the multi-compartmental T₁ effects was explored and avoided using a 2D multi-slice acquisition with a long TR. Additionally, the sequence was tested for the effects of inflow and magnetization transfer and demonstrated robustness to these error sources. Lastly, the temporal and spatial B₀ inhomogeneity effects were mitigated by using the B₀ navigator and field inhomogeneity corrections. Using the method, high-quality myelin water images were successfully generated for the in-vivo human brain at both field strengths. When the myelin water fraction at 3T and 7T were compared, they showed a good correlation (R²≥ 0.88; p < 0.001) with a larger myelin water fraction at 7T. The proposed method also opens the possibility of high resolution (isotropic 1.5 mm resolution) myelin water mapping at 7T.

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Transcranial direct current stimulation (tDCS) selectively modulates semantic information during reading

Publication date: January 2019

Source: Brain and Language, Volume 188

Author(s): Jacqueline Cummine, Carol A. Boliek, Tessa McKibben, Aamn Jaswal, Marc F. Joanisse

Abstract

The left angular gyrus has long been implicated in semantic processing. Here we tested whether or not transcranial direct current stimulation (tDCS) over the left angular gyrus modulated reading performance. Adult readers (N = 77) (1) read aloud words that varied in degree of imageability, a semantic word property known to activate the angular gyrus, and (2) completed an N-back task (control task). Individuals were randomly assigned to either the anodal, cathodal or sham stimulation conditions. We found that anodal (p = 0.001) and cathodal (p < 0.001) stimulation impacted how imageability facilitates reading times such that readers who showed the largest imageability effects pre-stimulation showed the greatest reduction in these effects post-stimulation. No effects of stimulation were found in the sham group (p > 0.05) or for the control task (i.e., N-back; p > 0.05). These findings indicate that reading pathways can be modulated via brain stimulation (tDCS) to shift individuals' sensitivity to word-level characteristics, namely imageability.

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Three-dimensional endodontic guide for adhesive fiber post removal: A dental technique

Publication date: Available online 23 November 2018

Source: The Journal of Prosthetic Dentistry

Author(s): Lucas Moreira Maia, Gil Moreira Júnior, Rodrigo de Castro Albuquerque, Vinicius de Carvalho Machado, Nelson Renato França Alves da Silva, Débora Drummond Hauss, Rodrigo Richard da Silveira

Abstract

This dental technique describes a protocol for adhesive fiber post removal using a prototyped endodontic guide. The removal of an adhesive fiber post is an important step for endodontic retreatment and the resolution of prosthetic problems. Computer-aided design and computer-aided manufacturing (CAD-CAM) technology was used to generate guides with prototyping and is a useful tool for fiber post removal.

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Color and translucency of zirconia infrastructures and porcelain-layered systems

Publication date: Available online 23 November 2018

Source: The Journal of Prosthetic Dentistry

Author(s): Elif Figen Koçak, Yurdanur Uçar, Cem Kurtoğlu, William M. Johnston

Abstract

Statement of problem

A good color match combined with a proper translucency match results in excellent esthetics for a metal-free restoration, yet basic color and translucency comparisons between available zirconia systems are not well described.

Purpose

The purpose of this in vitro study was to compare the color and translucency of commercially available zirconia materials.

Material and methods

Eight specimen disks were formed in each of the single-layer (0.5-mm thick) groups and double-layer (0.5-mm zirconia with 1.0-mm porcelain) groups for each of 5 zirconia-based substructure systems. Colors on black, gray, and white backings were used to obtain CIEDE2000 color differences between the zirconia systems in the layering groups and to obtain relative translucency parameter (RTP) values. Color differences were compared with perceptibility and acceptability thresholds, and comparisons in RTP were made using analyses of variance and the Bonferroni corrected Student t tests (α=.05).

Results

The Shrout-Fleiss random set reliability for the duplicate L* determinations was 0.9992, 0.9756 for a*, and 0.9959 for b*. Although some mean color differences were below or at the perceptibility threshold, most differences were at or above the acceptability threshold. For the single-layer configuration, 1 material system had higher RTP values than every other material (P<.001), and another material had lower RTP values than every other material (P<.001).

Conclusions

The results of this study present significant differences in both color and translucency among 5 ceramic substrate systems when studied in single layers. Perceivable and often unacceptable differences in color were also found among these materials when layered with porcelain. It is concluded that the esthetics of restorations which use a ceramic substrate is notably affected by the ceramic system used.

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Effect on patient satisfaction of mandibular denture tooth arrangement in the neutral zone

Publication date: Available online 23 November 2018

Source: The Journal of Prosthetic Dentistry

Author(s): Wafa'a R. Al-Magaleh, Amal A. Swelem, Mohamed H. Abdelnabi, Abdulbaset Mofadhal

Abstract

Statement of problem

The effect of the neutral zone (NZ) technique on different functional aspects (masticatory performance, speech, and muscle activity) has been studied objectively. Subjectively, some studies reported that their participants felt that NZ dentures were more stable, retentive, and comfortable than conventionally fabricated dentures. These studies, however, lacked a measurable assessment scale or a specifically designed questionnaire.

Purpose

The purpose of this within-subject, crossover clinical trial was to investigate patient satisfaction levels in edentulous patients after rehabilitation with dentures fabricated using the NZ concept as compared with conventional dentures using a specific, question-oriented patient satisfaction questionnaire.

Material and methods

The clinical trial included 52 participants. Each received one set of conventional dentures and another fabricated based on the NZ concept with a 1-month wash-out period. Participants randomly chose 1 of 2 closed opaque envelopes with 2 denture sequences, either conventional then NZ or NZ then conventional. Hence, participants were blinded to the dentures they wore. Patient satisfaction with each denture type was assessed 6 weeks after insertion by a blinded staff member using a 5-scale questionnaire developed for the most important functional aspects (esthetics, masticatory ability, retention, stability, speech, and comfort). The Wilcoxon Signed Rank test was used to compare the satisfaction scores of the 2 denture types (α=.05).

Results

Patient satisfaction scores were significantly higher with the NZ dentures than with the conventional dentures in all aspects; P=.001 for question 2 (opinion of denture appearance) and P<.001 for all other questions.

Conclusions

NZ dentures offer significantly higher levels of patient satisfaction than conventional dentures in all functional aspects (retention, stability, masticatory ability, and speech) as well as in comfort and appearance.

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Influence of different implant-abutment connection designs on the mechanical and biological behavior of single-tooth implants in the maxillary esthetic zone: A systematic review

Publication date: Available online 23 November 2018

Source: The Journal of Prosthetic Dentistry

Author(s): Bruna M. Vetromilla, Lucas P. Brondani, Tatiana Pereira-Cenci, César D. Bergoli

Abstract

Statement of problem

A consensus regarding which implant-abutment connection type would perform best in the anterior maxilla is lacking.

Purpose

The purpose of this systematic review was to determine the best implant-abutment connection type for anterior single-tooth implants considering esthetics, success, and survival rates.

Material and methods

An electronic search was conducted in MEDLINE, Scopus, Embase, and the Cochrane Library databases to identify clinical studies on single-tooth implants with external and internal hexagon, and/or Morse taper connections. These studies needed to describe at least one of the following outcomes: esthetic score, survival/success rate, or marginal bone loss. The included studies and reports were assessed for bias using the Cochrane risk of bias tool.

Results

Of the 891 articles identified, 29 were selected and analyzed. The most common technical complications were abutment screw loosening and crown-cement loosening, while dehiscence and recession were the most common biological complications. The most frequent complications were dehiscence for external hexagon, crown-cement loosening for the internal hexagon, and ceramic fracture for the Morse taper. Esthetics were favorable for all connections, but the internal hexagon performed better. However, better results for marginal bone loss, success, and survival were found for the Morse taper. The global annual failure rate was 0.90% and 0.2% for Morse taper, 0.3% for external hexagon, and 2.2% for internal hexagon.

Conclusions

This review suggests that Morse taper performs better for survival, success, and marginal bone loss. Internal hexagon performed better for esthetic parameters. Additional controlled studies are needed to provide stronger evidence because the evidence generated in this study was considered low.

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Development of a Pediatric Asthma Predictive Index for Hospitalization

Publication date: Available online 24 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Tiffany Jean, Su-Jau Yang, William W. Crawford, Scott H. Takahashi, Javed Sheikh

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Measurement of exhaled nitric oxide in young children with NIOX VERO

Publication date: Available online 23 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Kathleen Rickard, Margot MacDonald-Berko, Robert Anolik, Neal Jain, Craig La Force, Richard L. Wasserman

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The creation of a new vowel category by adult learners after adaptive phonetic training

Publication date: January 2019

Source: Journal of Phonetics, Volume 72

Author(s): Izabelle Grenon, Mikio Kubota, Chris Sheppard

Abstract

Native Japanese speakers often perceive English vowels based on their duration, whereas native speakers use spectral cues (formant frequencies). The current study examined whether 23 Japanese adult learners of English could create a new vowel category along the spectral dimension after phonetic training with the English vowels /i/-/ɪ/ as in beat and bit. As in previous training studies, the Japanese trainees improved their ability to categorize the vowels in tokens included in the training, and were able to generalize to novel tokens and talkers. A cue-weighting task confirmed that the Japanese trainees categorized the vowels based on temporal cues before training, presumably because vowel duration is used phonologically in Japanese. While 12 of the Japanese trainees still relied on vowel duration to distinguish the English vowels after training, 11 of them successfully created a new vowel category along the spectral dimension. However, their category boundary between /i/-/ɪ/ was set at a different location from that of native speakers. We interpret these results as providing evidence that it is possible for late inexperienced learners to create new phonetic categories with phonetic training, but that the new categories may be subject to phonetic category dissimilation, an effect previously documented with early bilinguals.

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Apolipoprotein E, periodontal disease and the risk for atherosclerosis: a review

Publication date: Available online 23 November 2018

Source: Archives of Oral Biology

Author(s): L.C. Pereira, J.C.R Nascimento, J.M.C. Rêgo, K.M. Canuto, M.E. Crespo-Lopez, J.I. Alvarez Leite, A. Baysan, R.B. Oriá

Abstract

The association between cardiovascular and periodontal diseases is characterized by chronic inflammatory processes, with a high prevalence worldwide and complex genetic-environment interactions. Although apolipoprotein E4 (ApoE4), one of the isoforms coded by a polymorphic APOE gene, has been widely recognized as a risk factor for cardiovascular diseases and as an immunoinflammatory factor, but less is known regarding how ApoE4 affects atherosclerosis in periodontitis patients. The aim of this review was to investigate the potential underlying mechanisms related to APOE4 that could increase the risk of periodontal disease and, ultimately, of atherosclerosis. There have only been a few studies addressing apoE polymorphisms in patients with chronic periodontitis. To date, no studies have been performed that have assessed how ApoE4 affects atherosclerotic disease in chronic periodontitis patients. Although clinical studies are warranted, experimental studies have consistently documented the presence of periodontal pathogens, which are usually found in the oral cavity and saliva, in the atherosclerotic plaques of ApoE-deficient mice. In addition, in this review, the potential role of the APOE4 allele as an example of antagonistic pleiotropy during human evolution and its relation to oral health is discussed.

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The Microbiome in Atopic Dermatitis

Publication date: Available online 23 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Amy S. Paller, Heidi H. Kong, Patrick Seed, Shruti Naik, Tiffany C. Scharschmidt, Richard L. Gallo, Thomas Luger, Alan D. Irvine

Abstract

As an interface with the environment, the skin is a complex ecosystem, colonized by many microorganisms that coexist in an established balance. The cutaneous microbiome inhibits colonization with pathogens such as S. aureus and is a crucial component for function of the epidermal barrier. Moreover, crosstalk between commensals and the immune system is now recognized, as microorganisms can modulate innate, as well as adaptive, immune responses. Host-commensal interactions also have an impact on the developing immune system in infants and subsequently the occurrence of diseases such as asthma and atopic dermatitis. Later in life, the cutaneous microbiome contributes to the development and course of skin disease. Accordingly, in patients with atopic dermatitis, a decrease in microbiome diversity correlates with disease severity and increased colonization with pathogenic bacteria such as S. aureus. Early clinical studies suggest that topical application of commensal organisms (e.g., S. hominis or R. mucosa) reduces atopic dermatitis severity and support an important role for commensals in decreasing S. aureus colonization in patients with atopic dermatitis. Advancing knowledge of the cutaneous microbiome and its function in modulating the course of skin disorders such as atopic dermatitis may result in novel therapeutic strategies.

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