Reinforcement of Poly-L-lactic acid Electrospun Membranes with Strontium Borosilicate Bioactive Glasses for Bone Tissue Engineering

Publication date: Available online 21 August 2016
Source:Acta Biomaterialia
Author(s): João S. Fernandes, Piergiorgio Gentile, Margarida Martins, Nuno M. Neves, Cheryl Miller, Aileen Crawford, Ricardo A. Pires, Paul Hatton, Rui L. Reis
Herein, for the first time, we combined poly-L-Lactic acid (PLLA) with a strontium borosilicate bioactive glass (BBG-Sr) using electrospinning to fabricate a composite bioactive PLLA membrane loaded with 10% (w/w) of BBG-Sr glass particles (PLLA-BBG-Sr). The composites were characterised by scanning electron microscopy (SEM) and microcomputer tomography (μ-CT), and the results showed that we successfully fabricated smooth and uniform fibres (1 to 3 μm in width) with a homogeneous distribution of BBG-Sr microparticles (< 45μm). Degradation studies (in phosphate buffered saline) demonstrated that the incorporation of BBG-Sr glass particles into the PLLA membranes increased their degradability and water uptake with a continuous release of cations. The addition of BBG-Sr glass particles enhanced the membrane's mechanical properties (69% higher Young modulus and 36% higher tensile strength). Furthermore, cellular in vitro evaluation using bone marrow-derived mesenchymal stem cells (BM-MSCs) demonstrated that PLLA-BBG-Sr membranes promoted the osteogenic differentiation of the cells as demonstrated by increased alkaline phosphatase activity and up-regulated osteogenic gene expression (Alpl, Sp7 and Bglap) in relation to PLLA alone. These results strongly suggest that the composite PLLA membranes reinforced with the BBG-Sr glass particles have potential as an effective biomaterial capable of promoting bone regeneration.Statement of SignificancePLLA membranes were reinforced with 10% (w/w) of strontium-bioactive borosilicate glass microparticles, and their capacity to induce the osteogenic differentiation of bone marrow mesenchymal stem cells (BM-MSCs) was evaluated. These membranes presented an increased: degradability, water uptake, Young modulus and tensile strength. We also demonstrated that these membranes are non-cytotoxic and promote the attachment of BM-MSCs. The addition of the glass microparticles into the PLLA membranes promoted the increase of ALP activity (under osteogenic conditions), as well as the BM-MSCs osteogenic differentiation as shown by the upregulation of Alpl, Sp7 and Bglap gene expression. Overall, we demonstrated that the reinforcement of PLLA with glass microparticles results in a biomaterial with the appropriate properties for the regeneration of bone tissue.

Graphical abstract

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Probing multi-scale mechanical damage in connective tissues using x-ray diffraction

Publication date: Available online 21 August 2016
Source:Acta Biomaterialia
Author(s): Fabio Bianchi, Felix Hofmann, Andrew J. Smith, Mark S. Thompson
The accumulation of microstructural collagen damage following repetitive loading is linked to painful and debilitating tendon injuries. As a hierarchical, semi-crystalline material, collagen mechanics can be studied using x-ray diffraction. The aim of the study was to describe multi-structural changes in tendon collagen following controlled plastic damage (5% permanent strain). We used small angle x-ray scattering (SAXS) to interrogate the spacing of collagen molecules within a fibril, and wide angle x-ray scattering (WAXS) to measure molecular strains under macroscopic loading.Simultaneous recordings of of SAXS and WAXS patterns, together with whole-tissue strain in physiologically hydrated rat-tail tendons were made during increments of in-situ tensile loading. Results showed that while tissue level modulus was unchanged, fibril modulus decreased significantly, and molecular modulus significantly increased. Further, analysis of higher order SAXS peaks suggested structural changes in the gap and overlap regions, possibly localising the damage to molecular cross-links. Our results provide new insight into the fundamental damage processes at work in collagenous tissues and point to new directions for their mitigation and repair.Statement of SignificanceThis article reports the first in-situ loading synchrotron studies on mechanical damage in collagenous tissues. We provide new insight into the nano- and micro-structural mechanisms of damage processes. Pre-damaged tendons showed differential alteration of moduli at macro, micro and nano-scales as measured using X-ray scattering techniques. Detailed analysis of higher order diffraction peaks suggested damage is localised to molecular cross-links. The results are consistent with previous X-ray scattering studies of tendons and also with recent thermal stability studies on damaged material. Detailed understanding of damage mechanisms is essential in the development of new therapies promoting tissue repair.

Graphical abstract

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Design of an Elasticized Collagen Scaffold: A Method to Induce Elasticity in a Rigid Protein

Publication date: Available online 21 August 2016
Source:Acta Biomaterialia
Author(s): Luuk R. Versteegden, Henk R. Hoogenkamp, Roger M. Lomme, Harry van Goor, Dorien M. Tiemessen, Paul J. Geutjes, Egbert Oosterwijk, Wout F. Feitz, Theo G. Hafmans, Nico Verdonschot, Willeke F. Daamen, Toin H. van Kuppevelt
Type I collagen is widely applied as a biomaterial for tissue regeneration. In the extracellular matrix, collagen provides strength but not elasticity under large deformations, a characteristic crucial for dynamic organs and generally imparted by elastic fibers. In this study, a methodology is described to induce elastic-like characteristics in a scaffold consisting of solely type I collagen.Tubular scaffolds are prepared from collagen fibrils by a casting, molding, freezing and lyophilization process. The lyophilized constructs are compressed, corrugated and subsequently chemically crosslinked with carbodiimide in the corrugated position. This procedure induces elastic-like properties in the scaffolds that could be repeatedly stretched five times their original length for at least 1000 cycles. The induced elasticity is entropy driven and can be explained by the introduction of hydrophobic patches that are disrupted upon stretching thus increasing the hydrophobic-hydrophilic interface. The scaffolds are cytocompatible as demonstrated by fibroblast cell culture.In conclusion, a new straightforward technique is described to endow unique elastic characteristics to scaffolds prepared from type I collagen alone. Scaffolds may be useful for engineering of dynamic tissues such as blood vessels, ligaments, and lung.Statement of significanceIn this research report, a methodology is presented to introduce elasticity to biomaterials consisting of only type I collagen fibrils. The method comprises physical compression and corrugation in combination with chemical crosslinking. By introducing elasticity to collagen biomaterials, their application in regenerative medicine may be expanded to dynamic organs such as blood vessels, ligaments and lung. The combination of strength and elasticity in one single natural biomaterial may also "simplify" the design of new scaffolds.

Graphical abstract

Highlights

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Inter-trabecular angle: a parameter of trabecular bone architecture in the human proximal femur that reveals underlying topological motifs

Publication date: Available online 21 August 2016
Source:Acta Biomaterialia
Author(s): Natalie Reznikov, Hila Chase, Yehonatan Ben Zvi, Victoria Tarle, Matthew Singer, Vlad Brumfeld, Ron Shahar, Steve Weiner
Trabecular bone is an intricate 3D network of struts and plates. Although the structure-function relations in trabecular bone have been studied since the time of Julius Wolff, controversy still exists regarding the architectural parameters responsible for its stability and resilience. We present a parameter that measures the angle between two connected trabeculae – the Inter-Trabecular Angle (ITA). We studied the ITA values derived from μCT scans of different regions of the proximal femora of 5 individuals of different age and sex. We show that the ITA angle distribution of nodes with 3 connecting trabeculae has a mean close to 120°, nodes with 4 connecting trabeculae has a mean close to 109° and nodes of higher connectivity have mean ITA values around 100°. This tendency to spread the ITAs around geometrically symmetrical motifs is highly conserved. The implication is that the ITAs are optimized such that the smallest amount of material spans the maximal 3D volume, and possibly by so doing trabecular bone might be better adapted to multidirectional loading. We also draw a parallel between trabecular bone and tensegrity structures - where lightweight, resilient and stable tetrahedron-based shapes contribute to strain redistribution amongst all the elements and to collective impact dampening.Statement of SignificanceThe Inter-Trabecular Angle (ITA) is a new topological parameter of trabecular bone. The ITA characterizes the way trabeculae connect with each other at nodes, regardless of their thickness and shape. The mean ITA value of nodes with 3 trabeculae is close to 120°, of nodes with 4 trabeculae is just below 109°, and the mean ITA of nodes with 5 and more trabeculae is around 100°. Thus the connections of trabeculae trend towards adopting symmetrical shapes. This implies that trabeculae can maximally span 3D space using the minimal amount of material. We draw a parallel between this motif and the concept of tensegrity – an engineering premise to which many living creatures conform at multiple levels of organization.

Graphical abstract

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Effect of the biodegradation rate controlled by pore structures in magnesium phosphate ceramic scaffolds on bone tissue regeneration in vivo

Publication date: Available online 21 August 2016
Source:Acta Biomaterialia
Author(s): Ju-Ang Kim, Lim Jiwon, Raja Naren, Hui-suk Yun, Eui Kyun Park
Similar to calcium phosphates, magnesium phosphate (MgP) ceramics have been shown to be biocompatible and support favorable conditions for bone cells. Micropores below 25 μm (MgP25), between 25 and 53 μm (MgP53), or no micropores (MgP0) were introduced into MgP scaffolds using different sizes of an NaCl template. The porosities of MgP25 and MgP53 were found to be higher than that of MgP0 because of their micro-sized pores. Both in vitro and in vivo analysis showed that MgP scaffolds with high porosity promoted rapid biodegradation. Implantation of the MgP0, MgP25, and MgP53 scaffolds into rabbit calvarial defects (with 4- and 6- mm diameters) was assessed at two times points (4 and 8 weeks), followed by analysis of bone regeneration. The micro-CT and histologic analyses of the 4-mm defect showed that the MgP25 and MgP53 scaffolds were degraded completely at 4 weeks with simultaneous bone and marrow-like structure regeneration. For the 6-mm defect, a similar pattern of regeneration was observed. These results indicate that the rate of degradation is associated with bone regeneration. The MgP25 and MgP53 scaffold-implanted bone showed a better lamellar structure and enhanced calcification compared to the MgP0 scaffold because of their porosity and degradation rate. Tartrate-resistant acid phosphatase (TRAP) staining indicated that the newly formed bone was undergoing maturation and remodeling. Overall, these data suggest that the pore architecture of MgP ceramic scaffolds greatly influence bone formation and remodeling activities and thus should be considered in the design of new scaffolds for long-term bone tissue regeneration.Statement of significanceThe pore structural conditions of scaffold, including porosity, pore size, pore morphology, and pore interconnectivity affect cell ingrowth, mechanical properties and biodegradabilities, which are key components of scaffold in bone tissue regeneration. In this study, we designed hierarchical pore structure of the magnesium phosphate (MgP) scaffold by combination of the 3D printing process, self-setting reaction and salt-leaching technique, and first studied the effect of pore structures of bioceramic scaffolds on bone tissue regeneration through both in vitro and in vivo studies (rabbit calvarial model). The MgP scaffolds with higher porosity promoted more rapid biodegradation and enhanced new bone formation and remodeling activities at the same time.

Graphical abstract

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Colonic content: effect of diet, meals, and defecation

Abstract

Background

The metabolic activity of colonic microbiota is influenced by diet; however, the relationship between metabolism and colonic content is not known. Our aim was to determine the effect of meals, defecation, and diet on colonic content.

Methods

In 10 healthy subjects, two abdominal MRI scans were acquired during fasting, 1 week apart, and after 3 days on low- and high-residue diets, respectively. With each diet, daily fecal output and the number of daytime anal gas evacuations were measured. On the first study day, a second scan was acquired 4 hours after a test meal (n=6) or after 4 hours with nil ingestion (n=4). On the second study day, a scan was also acquired after a spontaneous bowel movement.

Results

On the low-residue diet, daily fecal volume averaged 145 ± 15 mL; subjects passed 10.6 ± 1.6 daytime anal gas evacuations and, by the third day, non-gaseous colonic content was 479 ± 36 mL. The high-residue diet increased the three parameters to 16.5 ± 2.9 anal gas evacuations, 223 ± 19 mL fecal output, and 616 ± 55 mL non-gaseous colonic content (P<.05 vs low-residue diet for all). On the low-residue diet, non-gaseous content in the right colon had increased by 41 ± 11 mL, 4 hours after the test meal, whereas no significant change was observed after 4-hour fast (−15 ± 8 mL; P=.006 vs fed). Defecation significantly reduced the non-gaseous content in distal colonic segments.

Conclusion & Inferences

Colonic content exhibits physiologic variations with an approximate 1/3 daily turnover produced by meals and defecation, superimposed over diet-related day-to-day variations.

Ingestion of unabsorbable residues and defecation produce profound changes in colonic content. The rapid turnover of colonic biomass (about 1/3 daily) indicates a high adaptation potential of microbiota to the intraluminal environment.

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Increased yield pressure in the anal canal during sacral nerve stimulation: a pilot study with the functional lumen imaging probe

Abstract

Background

Sacral nerve stimulation (SNS) is a well-established treatment for fecal incontinence but its mode of action remains obscure. Anal sphincter function is usually evaluated with manometry but resistance to distension may be a more appropriate parameter than luminal pressure. The functional lumen imaging probe allows detailed description of distension properties of the anal canal. Our objective in this study was to characterize the impact of SNS on distension properties of the anal canal in patients with idiopathic fecal incontinence.

Methods

We studied 10 women (median age 64 [44–79] years) with idiopathic fecal incontinence at baseline and during SNS. The luminal geometry of the anal canal was examined with the FLIP at rest and during squeeze and the distensibility of the anal canal was investigated during filling of the bag.

Key results

All patients were successfully treated with SNS and the mean Wexner Incontinence Score was reduced from 14.9 ± 4 to 7.1 ± 4.8 (P<.001). The pressure required to open the narrowest point of the anal canal during distension (yield pressure) increased from 14.5 ± 12.2 mmHg at baseline to 20.5 ± 13.3 mmHg during SNS (P<.01). The pressure-strain elastic modulus increased non-significantly from 2.2 ± 0.5 to 2.9 ± 1.6 kPa, indicating increased stiffness of the anal canal.

Conclusion and inferences

The yield pressure and the resistance to distension increased in response to SNS for idiopathic fecal incontinence. This will inevitably increase the resistance to flow through the anal canal, which may contribute to the benefits of sacral nerve stimulation.

Spatio-temporal diameter map of the anal canal from a single subject. The changing colors from blue to red illustrate increasing diameter.

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Does one day of drinking matter? 21st birthday drinking predicts subsequent drinking and consequences

Publication date: January 2017
Source:Addictive Behaviors, Volume 64
Author(s): Irene M. Geisner, Melissa A. Lewis, Isaac C. Rhew, Angela J. Mittmann, Mary E. Larimer, Christine M. Lee
ObjectiveThere has been ample research on college student risks and consequences related to 21st Birthday Drinking. To date, no studies we are aware of have examined how 21st birthday drinking impacts subsequent drinking and related consequences. This study evaluates the effect of a single night of drinking on peak drinking, heavy drinking, and negative consequences over 12months following the event. Furthermore, we examine if typical drinking behavior prior to 21st birthday moderates the relationship between the event drinking and subsequent use.MethodParticipants included 599 college students (46% male) who intended to consume at least five/four drinks (men/women respectively) on their 21st birthday. Screening and baseline assessments were completed approximately four weeks before turning 21. A follow-up assessment was completed approximately one week after students' birthdays and every 3months for one year thereafter.ResultsThose who drank more on their 21st birthday, also reported higher peak consumption, increased likelihood of consequences, and increased number of consequences throughout the year. Additionally, baseline peak drinking moderated the relationship such that those who drank less at peak occasion prior to turning 21 showed the strongest effects of 21st BD drinking on subsequent consumption.Conclusions21st BD drinking could impact subsequent choices and problems related to alcohol. Interventions are warranted and implications discussed.



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Three-dimensional analysis of jaw kinematic alterations in patients with chronic TMD – disc displacement with reduction

Summary

The study investigated whether chronic TMD patients with disc displacement with reduction (DDR), performing non-assisted maximum jaw movements, presented any changes in their mandibular kinematics with respect to an age-matched control group. Moreover, it was examined whether jaw kinematics and a valid clinic measure of oro-facial functional status have significant associations. Maximum mouth opening, mandible protrusion and bilateral laterotrusions were performed by 20 patients (18 women, 2 men; age, 18–34 years) and 20 healthy controls (17 women, 3 men; age, 20–31 years). The three-dimensional coordinates of their mandibular interincisor and condylar reference points were recorded by means of an optoelectronic motion analyser and were used to quantitatively assess their range of motion, velocity, symmetry and synchrony. Three functional indices (opening–closing, mandibular rototranslation, laterotrusion – right and left – and protrusion) were devised to summarise subject's overall performance, and their correlation with the outcome of a clinical protocol, the oro-facial myofunctional evaluation with scores (OMES), was investigated. TMD patients were able to reach maximum excursions of jaw movements comparable to healthy subjects' performances. However, their opening and closing mandibular movements were characterised by remarkable asynchrony of condylar translation. They had also reduced jaw closing velocity and asymmetric laterotrusions. The functional indices proved to well summarise the global condition of jaw kinematics, highlighting the presence of alterations in TMD-DDR patients, and were linearly correlated with the oro-facial functional status. The jaw kinematic alterations seem to reflect both oro-facial motor behaviour adaptation and a DDR-related articular impairment.

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Longitudinal association of dentition status with dietary intake in Japanese adults aged 75 to 80 years

Summary

Limited information is available on the temporal association between dentition status and dietary intake. The aim of this 5-year prospective cohort study was to investigate whether impaired dentition was associated with subsequent decline in dietary intake in older Japanese adults. Two hundred and eighty-six community-dwelling Japanese individuals, all aged 75 years at baseline, were included in the study. Functional tooth units (FTUs), defined as a pair of opposing natural or prosthetic teeth excluding third molars (range: 0–14), were counted on the basis of baseline dental examinations. Individuals with ≤5 FTUs were defined as having impaired dentition. Dietary intake was assessed at baseline and 5 years later, using a validated dietary questionnaire. Robust regression analyses were used to evaluate the differences in change in dietary intake between participants with and without impaired functional dentition, after adjustment for potential confounders. Sixty-one study participants (21·3 %) were defined as having impaired dentition. Overall, mean values for all estimated dietary variables (energy, nutrients and food groups) declined over time. Notably, individuals with impaired dentition demonstrated a significantly (P < 0·05) greater degree of decline in the intake of multiple nutrients (protein, sodium, potassium, calcium, vitamin A, vitamin E and dietary fibre) and food groups (vegetable and meat) than those without impaired dentition, after adjusting for potential confounders. The results of this study describe the temporal association of impaired dentition with the decline in selected nutrient and food group intake among older Japanese adults.

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Why not stop looking at bruxism as a black/white condition? Aetiology could be unrelated to clinical consequences

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Factors for tumor progression in patients with skull base chordoma

Abstract

Skull base chordoma is a rare and fatal disease, recurrence of which is inevitable, albeit variable. We aimed to investigate the clinicopathologic features of disease progression, identify prognostic factors, and construct a nomogram for predicting progression in individual patients. Data of 229 patients with skull base chordoma treated by one institution between 2005 and 2014 were retrieved and grouped as primary and recurrent. Kaplan–Meier survival of progression was estimated, taking competing risks into account. Multivariable Cox regression was used to investigate survival predictors. The primary group consisted by 183 cases, gained more benefits on 5-year progression-free survival (PFS) (51%) and mean PFS time (66.9 months) than the recurrent group (46 cases), in which 5-year postrecurrent PFS was 14%, and mean postrecurrent PFS time was 29.5 months. In the primary group, visual deficits, pathological subtypes, extent of bone invasion, preoperative Karnofsky performance scale (KPS) score, and variation in perioperative KPS were identified as independent predictors of PFS. A nomogram to predict 3-year and 5-year PFS consisted of these factors, was well calibrated and had good discriminative ability (adjusted Harrell C statistic, 0.68). In the recurrent group, marginal resection (P = 0.018) and adjuvant radiotherapy (P = 0.043) were verified as protective factors associated with postrecurrent PFS. Factors for tumor progression demonstrated some differences between primary and recurrent cases. The nomogram appears useful for risk stratification of tumor progression in primary cases. Further studies will be necessary to identify the rapid-growth histopathological subtype as an independent predictor of rapid progression.

This is the first attempt to investigate predictors and construct a nomogram for predicting progression in patients with skull base chordoma. Data of 229 patients with skull base chordoma from one institution between 2005 and 2014 were retrospectively analyzed by means of Kaplan–Meier method and Cox regression of SPSS, as well as multiple regression analysis in nomogram development of R software. As a result, visual deficits, pathological subtypes, extent of bone invasion, preoperative Karnofsky performance scale (KPS) score, and variation in perioperative KPS were identified as independent predictors of progression-free survival (PFS) in primary group and were used to construct a nomogram to predict 3-year and 5-year PFS, which was verified to be well calibrated and had good discriminative ability by Harrell C statistic.

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The histological characteristics and clinical outcomes of lung cancer in patients with combined pulmonary fibrosis and emphysema

Abstract

Combined pulmonary fibrosis and emphysema (CPFE) is an important risk factor for lung cancer (LC), because most patients with CPFE are smokers. However, the histological characteristics of LC in patients with CPFE (LC-CPFE) remain unclear. We conducted this study to explore the clinicopathological characteristics of LC-CPFE. We retrospectively reviewed data from 985 patients who underwent resection for primary LC, and compared the clinicopathological characteristics of patients with LC-CPFE and non-CPFE LC. We identified 72 cases of LC-CPFE, which were significantly associated with squamous cell carcinoma (SqCC) histology (n = 46, P < 0.001) and higher tumor grade (n = 44, P < 0.001), compared to non-CPFE LC. Most LC-CPFE lesions were contiguous with fibrotic areas around the tumor (n = 59, 81.9%), and this association was independent of tumor location. Furthermore, dysplastic epithelium was identified in the fibrotic area for 31 (52.5%) LC-CPFE lesions. Moreover, compared to patients with pulmonary fibrosis alone in the non-CPFE group (n = 31), patients with CPFE were predominantly male (P = 0.008) and smokers (P < 0.001), with LC-CPFE predominantly exhibiting SqCC histology (P = 0.010) and being contiguous with the tumor-associated fibrotic areas (P < 0.001). Multivariate analysis revealed that CPFE was an independent predictor of overall survival (hazard ratio: 1.734; 95% confidence interval: 1.060–2.791; P = 0.028). Our results indicate that LC-CPFE has a distinct histological phenotype, can arise from the dysplastic epithelium in the fibrotic area around the tumor, and is associated with poor survival outcomes.

The histology of lung cancer in patients with combined pulmonary fibrosis and emphysema (LC-CPFE) is poorly understood. Our results indicate that LC-CPFE has a distinct histological phenotype, can arise from the dysplastic epithelium, and is associated with poor survival outcomes.

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Model testing for nitrous oxide (N2O) fluxes from Amazonian cattle pastures

Publication date: October 2016
Source:Atmospheric Environment, Volume 143
Author(s): Katharina H.E. Meurer, Uwe Franko, Oliver Spott, C. Florian Stange, Hermann F. Jungkunst
Process-oriented models have become important tools in terms of quantification of environmental changes, for filling measurement gaps, and building of future scenarios. It is especially important to couple model application directly with measurements for remote areas, such as Southern Amazonia, where direct measurements are difficult to perform continuously throughout the year. Processes and resulting matter fluxes may show combinations of steady and sudden reactions to external changes. The potent greenhouse gas nitrous oxide (N2O) is known for its sensitivity to e.g. precipitation events, resulting in intense but short-term peak events (hot moments). These peaks have to be captured for sound balancing. However, prediction of the effect of rainfall events on N2O peaks is not trivial, even for areas under distinct wet and dry seasons. In this study, we used process-oriented models in both a pre-and post-measurement manner in order to (a) determine important periods for N2O-N emissions under Amazonian conditions and (b) calibrate the models to Brazilian pastures based on measured data of environment conditions (soil moisture and Corg) and measured N2O-N fluxes. During the measurement period (early wet season), observed emissions from three cattle pastures did not react to precipitation events, as proposed by the models. Here both process understanding and models have to be improved by long-term data in high resolution in order to prove or disprove a lacking of N2O-N peaks. We strongly recommend the application of models as planning tools for field campaigns, but we still suggest model combinations and simultaneous usage.



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The electrophysiological response to immunoglobulin therapy in chronic inflammatory demyelinating polyneuropathy

Objective

To characterize changes in motor nerve conduction studies (MNCS) and motor unit number index (MUNIX) following treatment with subcutaneous immunoglobulin and to assess whether these changes are related to muscle strength.

Methods

Data from 23 patients participating in a randomized, controlled trial were analyzed. MNCS and MUNIX were performed before and after 12 weeks of treatment. Isokinetic strength (IMS) was measured in various muscles together with grip strength (GS).

Results

Proximally evoked compound muscle action potential (CMAP) amplitudes and MUNIX tended to be better preserved in treated patients (P=.049 and .045). Changes in other parameters did not differ between groups. There was no correlation between changes in electrophysiological parameters and IMS. Changes in GS were related to median nerve motor conduction velocity, distal motor latency, CMAP amplitudes, and distally evoked CMAP duration (P=.013–.035).

Conclusion

Proximally evoked CMAP amplitudes appear to be the best MNCS parameter to assess treatment outcome in chronic inflammatory demyelinating polyneuropathy.

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Primary T-cell immunodeficiency with functional revertant somatic mosaicism in CD247

Publication date: Available online 21 August 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Ana V. Marin, Anaïs Jiménez-Reinoso, Alejandro C. Briones, Miguel Muñoz-Ruiz, Cigdem Aydogmus, Luke J. Pasick, Jorge Couso, Marina S. Mazariegos, Angel F. Alvarez-Prado, Alfonso Blázquez-Moreno, Funda E. Cipe, Sule Haskologlu, Figen Dogu, Matías Morín, Miguel A. Moreno-Pelayo, Félix García-Sánchez, Juana Gil-Herrera, Edgar Fernández-Malavé, Hugh T. Reyburn, Almudena R. Ramiro, Aydan Ikinciogullari, Maria J. Recio, Jose R. Regueiro, Beatriz Garcillán




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Impact of prenatal and postnatal exposure to the pesticide chlorpyrifos on the contraction of rat ileal muscle strips: involvement of an inducible nitric oxide synthase-dependent pathway

Abstract

Background

Prenatal/postnatal exposure to insecticides has been linked to developmental disorders in adulthood. Chlorpyrifos (CPF) is a widely used organophosphorus acetylcholinesterase (AChE)-inhibiting insecticide. The present study established whether prenatal and postnatal exposure to CPF is associated with intestinal motor dysfunction in adult rats.

Methods

Three groups of pregnant rats were exposed to either CPF (1 or 5 mg/kg/day; the CPF1 and CPF5 groups) or vehicle (the control group) by gavage from gestational day 1 until weaning. At weaning, the pups were separated from their dams and individually gavaged (with the same dose) until postnatal day 60. We then measured in vivo intestinal transit and the in vitro contractile responses of ileal smooth muscle strips to electrical field stimulation. Expression of inducible nitric oxide synthase (iNOS) in the ileum was determined using qRT-PCR and immunoblots. Morphometry and AChE assays were also performed.

Key Results

At adulthood, the mean body mass was lower in the CPF1 and CPF5 groups than in controls. CPF5 exposure was associated with weaker in vitro contraction of ileal muscle strips, which was reversed by adding the NOS inhibitor (L-NAME). There was no significant intergroup difference in the mean in vivo transit time. Exposure to CPF was associated with greater iNOS expression, lower AChE activity and reduced circular and longitudinal smooth muscle thickness.

Conclusions & Inferences

Prenatal and postnatal exposure to CPF in the rat is associated with weaker contraction of ileal longitudinal smooth muscle via a nitrergic mechanism with increased iNOS expression.

The present study showed that the exposure to chlorpyrifos (CPF), a widely used insecticide, from the first day of gestation to early adulthood, in a rat model, is associated with low EFS-induced ileal contraction, elevated iNOS expression, partial inhibition of AChE activity, and low ileal muscle thickness.

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Comparison of ischemic compression and lumbopelvic manipulation as trigger point therapy for patellofemoral pain syndrome in young adults: A double-blind randomized clinical trial

Publication date: Available online 21 August 2016
Source:Journal of Bodywork and Movement Therapies
Author(s): Shabnam Behrangrad, Fahimeh Kamali
ObjectiveTo compare the effectiveness of ischemic compression (IC) directly to the vastus medialis obliquus (VMO) versus lumbopelvic manipulation (LPM) in improving pain, functional status and sensitivity to mechanical stimulation of the VMO trigger point in patients with patellofemoral pain syndrome (PFPS).Participants40 patients with unilateral PFPS aged 20-30 years were selected randomly among patients with unilateral PFPS referred to physical therapy clinics of Shiraz University of Medical Sciences in Shiraz, Iran, between March 2014 and July 2014. 30 young adults participated. Participants were blinded to treatment allocation, and 15 patients were allocated to either IC or LPM.InterventionsPatients in both groups were treated in three sessions per week. IC consisted of three sets of continuous pressure applied for on the myofascial trigger point (MTrP) of VMO. LPM consisted of supine rotational glide manipulation of the ipsilateral lumbopelvic region of the involved knee.Main outcome measuresNumeric pain rating scale (VAS) for pain intensity, Kujala questionnaire for functional status, and pressure pain threshold (PPT) for sensitivity to mechanical stimulation. All three were recorded before treatment, 1 week, 1 month and 3 months after the last session.ResultsBoth groups showed significant improvement (p<0.05, 95% confidence interval) in pain, functional status and PPT values. However, the IC group showed greater improvements, and outcome measures remained significantly better than in the LPM group during post-intervention follow-up.ConclusionsBoth groups showed improvements throughout the study and follow-up period. However, the IC showed better short-term and long-term effectiveness than LPM for treating PFPS.



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Letter to Editor: Application of neuroplasticity theory through the use of the Feldenkrais Method with a runner with scoliosis and lower quarter pain: Additional respiratory mechanic principle, implication of the Feldenkrais method for clinical practice in neuro-musculoskeletal rehabilitation

Publication date: Available online 21 August 2016
Source:Journal of Bodywork and Movement Therapies
Author(s): Vikram Mohan, Aatit Paungmali, Patraporn Sitilertpisan




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INFERTILITY RISK AND TERATOGENICITY OF MOLECULARLY TARGETED ANTICANCER THERAPY: A CHALLENGING ISSUE

Publication date: Available online 21 August 2016
Source:Critical Reviews in Oncology/Hematology
Author(s): Elena Lorenzi, Matteo Simonelli, Armando Santoro
The growing population of young cancer survivors and a trend toward postponing pregnancy until later in life are shifting areas of focus toward understanding treatment induced sequelae, particularly the effects of cancer and/or treatment on fertility. Whereas the fertility risk of cytotoxic agents for both men and women is well-recognized, the fertility risks and teratogenic potential associated with molecular targeted therapies is not established. We summarize available preclinical and clinical data on the impact of new molecular targeted agents on fertility in both sexes, and their potential teratogenic effects, providing recommendations for clinicians, where possible. Agents were categorized by class and the potential relevance of their target signaling pathways to gonadal maturation discussed.



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Thrombus Degradation by Fibrinolytic Enzyme of Stenotrophomonas sp. Originated from Indonesian Soybean-Based Fermented Food on Wistar Rats

Objective. To evaluate thrombus degrading effect of a fibrinolytic enzyme from food origin Stenotrophomonas sp. of Indonesia. Methods. Prior to animal study, the enzyme safety was tested using cell culture. The effect on expression of tissue plasminogen activator was also analysed in the cell culture. For in vivo studies, 25 Wistar rats were used: normal control, negative control, treatment groups with crude and semipurified enzyme given orally at 25 mg/kg, and positive control group which received Lumbrokinase at 25 mg/kg. Blood clot in the tail was induced by kappa carrageenan injection at 1 mg/kg BW. Results. Experiment with cell culture confirmed the enzyme safety at the concentration used and increased expression of tPA. Decreasing of thrombus was observed in the positive group down to 70.35 ± 23.11% of the negative control animals (100%). The thrombus observed in the crude enzyme treatment was down to 56.99 ± 15.95% and 71.5 ± 15.7% for semipurified enzyme. Scanning electron microscopy showed clearly that bood clots were found in the animals injected with kappa carrageenan; however, in the treatment and positive groups, the clot was much reduced. Conclusions. Oral treatment of enzyme from Stenotrophomonas sp. of Indonesian fermented food was capable of degrading thrombus induced in Wistar rats.

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Frontofacial advancement and bipartition in Crouzon-Pfeiffer and Apert syndromes: impact of fronto-facial surgery upon orbital and airway parameters in FGFR2 syndromes

A major concern in FGFR2 craniofaciosynostosis is oculo-orbital disproportion, such that orbital malformation provides poor accommodation and support for the orbital contents and peri-orbita, leading to insufficient eyelid closure, corneal exposure and eventually to functional visual impairment. Fronto-facial monobloc osteotomy followed by distraction osteogenesis aims to correct midfacial growth deficiencies in Crouzon-Pfeiffer syndrome patients. Fronto-facial bipartition osteotomy followed by distraction is a procedure of choice in Apert syndrome patients.

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A systematic review of soft-to-hard tissue ratios in orthognathic surgery. Part III: Double Jaw Surgery Procedures

The aim was to determine the soft-to-hard tissue ratios in profile view in bimaxillary orthognathic surgical corrections.

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Delayed open reduction and single screw internal fixation as a treatment option in cases of failed non-surgical treatment of bilateral condylar head fractures with fragmentation

To share our experience in the open reduction and single screw internal fixation of delayed bilateral condylar head fractures with fragmentation and evaluate its feasibility and outcomes.

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Trends in Techniques to Avoid Bone Augmentation Surgery: Application of Short Implants, Narrow-diameter Implants and Guided Surgery

Minimally invasive implantology using reduced implant dimensions as well as virtual treatment planning and CAD/CAM stereolithographic templates has gained popularity in recent years. The aim of the present investigation was to analyze prevailing trends in clinical utilization of these graftless therapeutic options.

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Surgical guide for the remodeling of the orbito-naso-frontal bandeau in craniosynostosis surgery

Craniosynostosis is a relatively common condition in which the sutures between the bony plates in the head close too early. It affects around 1 in 2100 children in France (Arnaud et al., 2006; Renier et al., 2006). Craniosynostosis affecting the anterior sutures can not only lead to repercussions in the brain, but also may have an esthetic impact due to deformation of the orbito-naso-frontal bandeau (ONFB).

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Effect of solvent on debromination of decabromodiphenyl ether by Ni/Fe nanoparticles and nano zero-valent iron particles

Abstract

Nano zero-valent iron (nZVI) and its modified nanomaterials are widely used in the degradation of some halogenated organic pollutants. In this study, we explored the effects of different proportions of tetrahydrofuran (THF) (50, 60, 70, 80, 90, and 100 %) on the degradation of decabromodiphenyl ether (BDE209) by Ni/Fe and nZVI nanoparticles with reference to the degradation kinetics, products, and pathway. The results illustrated that the effects of solvent on the degradation of BDE209 were similar when the two kinds of nanomaterials were used, although the Ni/Fe bimetallic nanoparticles exhibited a better catalytic activity compared with the pure nZVI during the degradation of BDE209. The apparent reaction rate constant (k _obs) increased with the proportion of the water in the system, enhancing the degradation of BDE209. In terms of degradation products, a high proportion of THF led to an accumulation of higher-brominated BDEs, inhibiting the further debromination of BDE209. The inhibitory effect of the solvent (THF) can be explained that water played a role of hydrogen donor during the reductive degradation of BDE209 in the THF/water system. However, the proportion of THF in the degradation system posed no effect on the BDE209 debromination pathway and debromination location. The difficulty of para-debromination was observed in all of the solvent systems.

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Chemical composition and surfactant characteristics of marine foams investigated by means of UV-vis, FTIR and FTNIR spectroscopy

Abstract

In this study, we collected the ultraviolet–visible (UV-vis), Fourier transform infrared (FTIR) and Fourier transform near-infrared (FTNIR) spectra of marine foams from different sites and foams produced by marine living organisms (i.e. algae and molluscs) to retrieve information about their molecular and structural composition. UV-vis spectra gave information concerning the lipid and pigment contents of foams. FTIR spectroscopy gave a more detailed qualitative information regarding carbohydrates, lipids and proteins in addition with information about the mineral contents of foams. FTNIR spectra confirmed the presence of carbohydrates, lipids and proteins in foams. Then, due to the higher content of structural information of FTIR spectroscopy with respect to FTNIR and UV-vis, we join the FTIR spectra of marine foams to those of humic substance from marine sediments and to the spectra of foams obtained by living organisms. We submitted this resulting FTIR spectral dataset to statistical multivariate methods to investigate specific aspects of foams such as structural similarity among foams and in addition, contributions from the organic matter of living organisms. Cluster analysis (CA) evidenced several cases (i.e. clusters) of marine foams having high structural similarity with foams from vegetal and animal samples and with humic substance extracted from sediments. These results suggested that all the living organisms of the marine environment can give contributions to the chemical composition of foams. Moreover, as CA also evidenced cases of structural differences within foam samples, we applied two-dimensional correlation analysis (2DCORR) to the FTIR spectra of marine foams to investigate the molecular characteristics which caused these structural differences. Asynchronous spectra of two-dimensional correlation analysis showed that the structural heterogeneity among foam samples depended reasonably on the presence and on the qualitative difference of electrostatic (hydrogen bonds) and nonpolar (van der Waals and π–π) interactions involving carbohydrate proteins and lipids present. The presence and relevance of these interactions agree with the supramolecular and surfactant characteristics of marine organic matter described in the scientific literature.

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Re: Can calcitonin nasal spray reduce the risk of recurrence of central giant cell granuloma of the jaws?—a response

Publication date: Available online 21 August 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): R. Tabrizi




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Painful temporomandibular disorders and central sensitization: implications for management—a pilot study

Publication date: Available online 21 August 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): L.B. Campi, P.C. Jordani, H.L. Tenan, C.M. Camparis, D.A.G. Gonçalves
The objective was to investigate the presence of cutaneous allodynia and hyperalgesia in the trigeminal and extra-trigeminal areas, as a surrogate for central sensitization (CS), in women with a painful temporomandibular disorder (TMD) and without other painful conditions. Painful TMDs, depression, and non-specific physical symptoms (NSPS) were classified according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The amount of pain in the trigeminal and extra-trigeminal areas was determined using a visual analogue scale (0–100mm) after the application of a vibrotactile stimulus and assessment of the pressure pain threshold (PPT). Statistical tests (Fisher's, χ², and Mann–Whitney) were performed, with a significance level of 5%. The sample comprised 45 women (mean age 37.5 years; 16 with a painful TMD) who were free of any headache, fibromyalgia, or other painful condition. Painful TMD was associated with higher pain sensitivity and lower PPT values in the trigeminal (P<0.01) and extra-trigeminal regions (P<0.01). The presence of depression contributed significantly to increased pain sensitivity. The presence of hyperalgesia and allodynia in both the trigeminal and extra-trigeminal regions among women with a painful TMD indicated the presence of CS. Changes involving the central nervous system should be considered during the evaluation and management of patients with a painful TMD.



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Automated wireless video surveillance: an evaluation framework

Abstract

In the past years, surveillance systems have attracted both industries and researchers due to its importance for security. Automated Video Surveillance (AVS) systems are established to automatically monitor objects in real-time. Employing wireless communication in an AVS system is an attractive solution due to its convenient installation and configuration. Unfortunately, wireless communication, in general, has limited bandwidth, not to mention the intrinsic dynamic conditions of the network (e.g., collision and congestion). Many solutions have been proposed in the literature to solve the bandwidth allocation problem in wireless networks, but much less work is done to design evaluation frameworks for such solutions. This paper targets the demand for a realistic wireless AVS system simulation framework that models and simulates most of the details in a typical wireless AVS framework. The proposed simulation framework is built over the well-known NS-3 network simulator. This framework also supports the testing and the evaluation of cross-layer solutions that manages many factors over different layers of AVS systems in the wireless 802.11 infrastructure network. Moreover, the simulation framework supports the collection of many used performance metrics that are usually used in AVS system performance evaluation.

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Interactions between medications employed in treating benign prostatic hyperplasia and food − A short review

Publication date: October 2016
Source:Biomedicine & Pharmacotherapy, Volume 83
Author(s): Paweł Paśko, Tomasz Rodacki, Renata Domagała-Rodacka, Danuta Owczarek
Benign prostatic hyperplasia (BPH) is the most common disease in elderly men. BPH symptoms include frequent urination, urgent tenesmus and urination at night, a weak and interrupted urine flow and a sense of incomplete emptying of the bladder. Alpha- 1 adrenergic receptor antagonists and 5 α-reductase inhibitors form the most important groups of medications employed in BPH. Appropriately managed BPH patients shall be subject to counselling on interactions between agents belonging to these groups, and on particular components of the food they have.The present review has been aimed at assessing potential effects of consumed food, alcohol and fruit juices on the pharmacokinetics and pharmacodynamics of medications for benign prostatic hyperplasia.The authors reviewed the English PubMed database covering the years 1991–2015. Additionally, a digital version of Stockley Drugs Interaction and other electronic databases such as drugs.com and Medscape were also researched; characterisation charts for particular medical products were also analyzed.Pharmacokinetics of extended-release forms of alfuzosin, doxazosin, tamsulosin and silodosin is well known to be food-sensitive. Alfuzosin, tamsulosin and silodosin due to their likely interaction with grapefruit juice and citrus fruits, may intensify adverse effects of the drugs. Alpha-1 adrenergic receptor antagonists are known to interact with alcohol, leading to orthostatic hypotension. For 5 alpha-reductase inhibitors, such as finasteride, or dutasteride, the pharmacokinetic effect due to consumed food is of no clinical importance and thus they may be taken regardless of meals.As in general grapefruit juice and alcohol tend to significantly affect the efficacy and safety of the applied drug therapy, it is highly advisable to be knowledgeable on the subject in order to educate patients.



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Application of nanoparticle technology in the treatment of Systemic lupus erythematous

Publication date: October 2016
Source:Biomedicine & Pharmacotherapy, Volume 83
Author(s): Davood Rostamzadeh, Seyed Rasol Razavi, Shadi Esmaeili, Sanam Dolati, Majid Ahmahi, Sanam Sadreddini, Farhad Jadidi-Niaragh, Mehdi Yousefi
Systemic lupus erythematous (SLE) is a chronic heterogeneous multisystem autoimmune disease characterized by loss of tolerance to self-antigens and production of numerous autoantibodies. Current therapeutic approaches used to treat inflammatory autoimmune diseases are associated with debilitating side effects. In spite of significant advances in therapeutic options and increased understanding of the pathogenesis, novel therapeutic approaches are needed for treatment of SLE. Nanoparticle-based delivery systems that selectively deliver drugs to inflamed tissue or specific cell have the potential to improve drug delivery. This article reviews recent nanotechnology-based therapeutics strategies that are being developed for the treatment of SLE.



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Regulation of oncogenic genes by MicroRNAs and pseudogenes in human lung cancer

Publication date: October 2016
Source:Biomedicine & Pharmacotherapy, Volume 83
Author(s): Yusuf Tutar, Aykut Özgür, Esen Tutar, Lütfi Tutar, Alessandra Pulliero, Alberto Izzotti
Lung cancer is one of the most common mortal cancer types both for men and women. Several different biomarkers have been analyzed to reveal lung cancer prognosis pathways for developing efficient therapeutics and diagnostic agents. microRNAs (miRNAs) and pseudogenes are critical biomarkers in lung cancer and alteration of their expression levels has been identified in each step of lung cancer tumorigenesis. miRNAs and pseudogenes are crucial gene regulators in normal cells as well as in lung cancer cells, and they have both oncogenic and tumor-suppressive roles in lung cancer tumorigenesis. In this study, we have determined the relationship between lung cancer related oncogenes and miRNAs along with pseudogenes in lung cancer, and the results indicate their potential as biological markers for diagnostic and therapeutic purposes.



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Are Hyaluronic acid or Corticosteroid superior to lactated ringers in the short-term for improving function and quality of life after arthrocentesis?

Publication date: Available online 20 August 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Gary F. Bouloux, Jolie Chou, Deepak Krishnan, Tara Aghaloo, Nora Kahenasa, Julie Ann Smith, Helen Giannakopoulos
PurposeAlthough arthrocentesis has been used for the management of patients with temporomandibular joint pain, the benefit of hyaluronic acid or corticosteroid remains uncertain. The purpose of this study is to assess the efficacy of hyaluronic acid (HA), corticosteroid (CS) and lactated ringers solution (LR) after arthrocentesis for changes in Quality of Life (QoL), jaw function (JFLS) and maximum incisal opening (MIO).MethodsThis is a prospective multicenter double blind randomized clinical trial. Consecutive subjects presenting to the oral and maxillofacial departments at Emory University, University of Pennsylvania, University of California Los Angeles, University of Cincinnati and Oregon Health Sciences University were enrolled in the study. Subjects were randomized to HA, CS or placebo. All subjects had arthrocentesis performed followed by the instillation of HA, CS or lactated ringers solution. All subjects were evaluated clinically at one and three months. The outcome variables were QOL, JFLS and MIO. Univariate, bivariate and multivariate statistics were computed with a P value < 0.05 considered significant.ResultsOne hundred and two subjects were enrolled in the study. Four subjects were lost to follow-up leaving 98 subjects for the analysis of data at one month. An additional 51 subjects were lost to follow-up at three months leaving 51 subjects for the data analysis at this time point. There was no difference between the groups for QOL Mental Health Composite Score (MCS) at one (P=0.70) or three (P=0.69) months. There was no difference between groups for the JFLS at one (P=0.71) or three (P=0.98) months. There was no difference between groups for MIO at one (P=0.47) or three (P=0.31) months. All groups showed within group improvements in JFLS and MIO at one and three months.ConclusionArthrocentesis alone is as efficacious as arthrocentesis with HA or CS in improving jaw function and MIO at one and three months. QoL is not improved with arthrocentesis alone or in combination with CS or HA.



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Age-related changes of the orolabial region in Caucasian women: An anthropometric analysis

Publication date: Available online 20 August 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Christian Doll, Günter Nahles, Jan Oliver Voss, Claudia Sachse, Katja Nelson, Wiebke Damaskos, Susanne Nahles
PurposeAnthropometric data can provide valuable support for the attending physician in planning surgical/nonsurgical aesthetic procedures with regard to the individual age of the patient. The purpose of the present study was to identify age-related orolabial changes in younger and older Caucasian women.Patients and MethodsIn the present cross-sectional study anthropometric landmarks were identified using indirect anthropometry (2D photometry) in younger (≤ 35 years) and older (≥ 50 years) Caucasian women to analyze age-related parameters and proportions of the orolabial region, especially in the lower/upper lip vermilion area. To compare the results between the younger and older population the Mann-Whitney U test was applied.ResultsThe study population consisted of 45 females. The cohort was divided into a younger (24 participants; mean age 27.4 years) and an older (21 participants; mean age 58 years) population to evaluate age-related differences. Increase of the upper lip height, the cutaneous height of the upper lip and cutaneous height of the lower lip were observed in older females. In contrast, the vermilion height of the lower lip was significantly lower with increasing age.ConclusionThese results demonstrate several changes of the orolabial region in Caucasian females with increasing age. The statistically significant decrease of the vermilion height of the lower lip should be given particular attention for (age appropriate) diagnostic and aesthetic/prosthetic treatment planning.



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Are Hyaluronic acid or Corticosteroid superior to lactated ringers in the short-term reduction of temporomandibular joint pain after Arthrocentesis?

Publication date: Available online 20 August 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Gary F. Bouloux, Jolie Chou, Deepak Krishnan, Tara Aghaloo, Nora Kahenasa, Julie Ann Smith, Helen Giannakopoulos
PurposeArthrocentesis has been used for the management of patients with temporomandibular joint (TMJ) pain with good success. The additional use of hyaluronic acid or corticosteroid remains controversial. The purpose of this study is to compare Hyaluronic acid (HA), Corticosteroid (CS) and Lactated Ringers solution (LR) (placebo) after arthrocentesis.MethodsThis is a prospective multicenter double blind randomized clinical trial. Consecutive subjects presenting to the oral and maxillofacial departments at Emory University, University of Pennsylvania, University of California Los Angeles, University of Cincinnati and Oregon Health Sciences University were enrolled in the study. Subjects were randomized to HA, CS or placebo. All subjects had arthrocentesis performed followed by the instillation of HA, CS or lactated ringers solution. Subjects were evaluated clinically at one and three months. The primary outcome variable was pain at one month (VAS). Secondary outcome variables were pain at three months and analgesic consumption. Univariate, bivariate and multivariate statistics were computed with a P value < 0.05 considered significantResultsOne hundred and two subjects were enrolled in the study. Four subjects were lost to follow-up leaving 98 subjects for the final analysis. The mean age of the subjects in the HA, CS and LR groups was 39.6, 44.3 and 51.8 yrs, respectively. (P=0.02). There was no difference in the time to follow-up at one month between the groups (P=0.11). The mean pain reduction in the CS group was 19% (P=0.12) and 36% (P=0.02) for right and left sided procedures, respectively. The mean pain reduction in the HA group was 31% (P=0.01) and 34% (P=0.01) for right and left sided procedures, respectively. The mean pain reduction in the LR group was 43% (P<0.01) and 37% (P<0.01) for right and left sided procedures, respectively. There was no difference in pain reduction between groups (P=0.55). There was no difference in the use of narcotic (P=0.52) or non-steroidal anti-inflammatory drugs (P=0.71) between groups.ConclusionArthrocentesis alone is as efficacious as arthrocentesis with HA or CS in reducing TMJ pain.



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Evaluation of prognostic value and stage migration effect using positive lymph node ratio in gastric cancer

Publication date: Available online 21 August 2016
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Shuhei Komatsu, Daisuke Ichikawa, Masumi Nishimura, Toshiyuki Kosuga, Kazuma Okamoto, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Eigo Otsuji
AimsTo detect the best cut-off value of the positive lymph node ratio (PLNR) for stratifying the prognosis and analyzing its value with regard to stage migration effect using PLNR in gastric cancer.MethodsWe retrospectively analyzed 1069 consecutive gastric cancer patients, who underwent curative gastrectomy with radical lymphadenectomy from 1997 through 2009.Results1) The mean number of dissected lymph nodes was 42.6 in pStage I, 32.4 in pStage II and 37.1 in pStage III. The PLNR of 0.2 was proved to be the best cut-off value to stratify the prognosis of patients into two groups (P < 0.0001; PLNR<0.2 vs. PLNR ≥ 0.2), and patients were correctly classified into four groups: PLNR 0, PLNR 0 - <0.2, PLNR 0.2 - <0.4 and PLNR ≥ 0.4 by the Kaplan-Meier method. 2) Compared patients with the PLNR<0.2, those with the PLNR ≥ 0.2 had a significantly higher incidence of pT3 or greater, pN2 or greater, lymphatic invasion, vascular invasion and undifferentiated cancer. Multivariate analysis showed that the PLNR ≥ 0.2 was an independent prognostic factor [P < 0.0001, HR 2.77 (95% CI: 1.87-4.09)]. 2) The PLNR cut-off value of 0.2 could discriminate a stage migration effect in pN2-N3 and pStage II-III, which patients with PLNR ≥ 0.2 might be potentially diagnosed as a lower stage after gastrectomy.ConclusionThe PLNR contributes to evaluating prognosis and stage migration effect even in a single institute and enable to identify those who need meticulous treatments and follow-up in patients with gastric cancer.



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Arthrocentèse de l’articulation temporomandibulaire et injection(s) intra-articulaire(s) : un état des lieux

Publication date: Available online 21 August 2016
Source:Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale
Author(s): P. Marty, A. Louvrier, E. Weber, P.-A. Dubreuil, B. Chatelain, C. Meyer
IntroductionL'arthrocentèse de l'articulation temporomandibulaire associée à un lavage intra-articulaire et, plus récemment, à l'injection intra-articulaire d'un agent pharmacologique a été développée à partir des années 1990 et est largement utilisée de nos jours pour le traitement des dysfonctions temporomandibulaires (DTM). Le but de notre travail était de répondre à 3 questions : 1. Les lavages intra-articulaires sont-ils efficaces dans le traitement des DTM ? 2. Quels sont les agents pharmacologiques injectables actuellement utilisés en complément de ces lavages et ces injections sont-elles utiles ? 3. Quelle est la place de ces traitements dans la prise en charge des DTM ?Matériel et méthodesUne recherche bibliographique a été réalisée dans la banque de données PubMed avec les mots clés « arthrocentesis » et « temporomandibular joint ». Les 27 articles parus entre 1991 et 2016, indiquant les critères d'inclusion des patients et évaluant de manière objective les résultats cliniques obtenus (ouverture buccale, bruits articulaires, douleur), ont été sélectionnés. Les agents pharmacologiques, quand ils étaient utilisés, étaient notés.Résultats1. Tous les auteurs concluaient à l'efficacité du lavage intra-articulaire. Aucun facteur pronostique de l'efficacité de l'arthrocentèse n'a été démontré. 2. Les principaux agents pharmacologiques utilisés étaient les corticoïdes, l'acide hyaluronique, les morphiniques et le plasma riche en plaquettes. La supériorité du protocole avec injection ne faisait pas l'unanimité auprès de tous les auteurs. Tous les auteurs ayant comparé les protocoles avec et sans injection complémentaire concluaient à une supériorité des protocoles avec injection et ce, quel que soit l'agent utilisé. 3. L'indication majoritaire de ces traitements était les DTM résistants aux traitements non invasifs.DiscussionDe nombreuses études ont prouvé l'efficacité du lavage intra-articulaire dans le traitement des DTM résistants aux traitements non invasifs. L'intérêt de l'adjonction d'un agent pharmacologique n'est pas clairement démontré. Les mécanismes d'action ne sont pas tous élucidés. Aucune supériorité d'un agent pharmacologique par rapport à un autre ne peut être affirmée. La méthodologie des études est très souvent défectueuse : critères d'inclusion peu précis, durée de suivi courte, facteurs de confusion non pris en compte, peu de comparaison entre plusieurs agents pharmacologiques.IntroductionArthocentesis of the temporomandibular joint combined with intra-articular washout and, more recently, intra-articular injection of pharmacological agents has been developed from the 1990s and is nowadays extensively in use for the treatment of temporomandibular dysfunctions (TMDs). The goal of our work was to answer 3 questions: 1. Is intra-articular washout effective for the treatment of TMDs ? 2. What kind of pharmacological agents may nowadays be injected in addition to washout and are these injections useful ? 3. What is the place of these treatments in the treatment strategies of TMDs ?Material and methodsA bibliographic research has been carried out in the PubMed database using following keywords arthrocentesis, temporomandibular joint. The 27 articles published between 1991 and 2016, indicating patient's inclusion criterions and objectively evaluating the clinical results (mouth opening, intra-articular noises, pain) were selected. Pharmacological agents were noticed when used.Results1. All authors concluded to the efficacy of intra-articular washout. No prognostic factor for arthrocentesis efficacy could be identified. 2. Main pharmacological agents used were steroids, hyaluronic acid, morphine-based drugs and platelet rich plasma. Superiority of ith-injection protocols failed to win unanimous support. All authors who compared with- and without-injection protocols concluded to the superiority of with-injection protocols, whatever the agent.DiscussionNumerous studies have proven the efficacy of intra-articular washout for the treatment of TMDs resistant to noninvasive treatments. The advantage of any kind of pharmacological agent is not clear. Mechanisms of action are not all elucidated. No pharmacological agent showed any superiority over another. Study methodologies are often defective: imprecise inclusion criterions, short follow-up, confounding variables not taken into account, few comparison between pharmacological agents.



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Malformations congénitales des articulations temporo-mandibulaires et des branches mandibulaires : quand greffer ? Quand distracter ?

Publication date: Available online 21 August 2016
Source:Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale
Author(s): A. Gallucci, N. Graillon, J.M. Foletti, C. Chossegros, F. Cheynet
Les anomalies congénitales des branches mandibulaires et de l'articulation temporo-mandibulaire sont prises en charge chirurgicalement depuis le début du XX^e siècle. Pour autant, les résultats tant morphologiques que fonctionnels restent souvent décevants, expliquant le recours à des interventions itératives. Il n'existe de nos jours toujours pas de réel consensus concernant le type d'intervention à proposer et l'âge de réalisation. Pour les formes les plus mineures, le recours aux chirurgies « classiques » orthognatiques, voire au protocole de distraction ostéogénique semble donner de bons résultats, surtout s'ils sont réalisés en fin de croissance. Dans les formes sévères, il est souvent nécessaire de procéder en plusieurs étapes chirurgicales, le plus souvent en commençant par une greffe chondrocostale, surtout en cas de chirurgie interceptive, réalisée avant la fin de la croissance pour améliorer la qualité de vie du patient.Congenital deformities of the mandibular ramus and of the temporo-mandibular joint are treated by surgery since the early 20th century. However, morphological and functional results are often disappointing, accounting for iterative operations. Today, a clear consensus concerning the type of intervention to be proposed, and at what age it should be carried out does not yet exist. For mild cases, "conventional" orthognathic or osteogenic distraction procedures seem to work well, especially if they are carried out at the end of growth. In severe cases, it is often necessary to proceed in several surgical steps, usually starting with a chondrocostal graft, especially when interceptive surgery, performed before the end of growth, is preferred in order to improve the patient's quality of life.



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Arthropathie temporomandibulaire après infiltration cortisonique in situ

Publication date: Available online 21 August 2016
Source:Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale
Author(s): J. Gagé, A. Gallucci, M. Arnaud, C. Chossegros, J.M. Foletti
IntroductionLes dysfonctions de l'appareil manducateur ou dysfonctionnements temporomandibulaires (DTM) touchent les muscles masticateurs et les articulations temporomandibulaires (ATM). Les DTM sont le plus souvent consécutifs à un trouble occlusal et/ou musculaire et sont alors dits primitifs ou idiopathiques. Plus rarement, les DTM sont consécutifs à des causes locales (traumatisme, infection) ou générales (arthrites rhumatismales) et sont alors dits secondaires. Une cause méconnue de DTM secondaire est l'arthropathie après injections de cortisone dans l'ATM. Nous rapportons un cas de lyse condylienne survenue après une injection intra-articulaire unique de cortisone.ObservationUne femme de 62ans a consulté pour un DTM ancien du côté gauche se manifestant par des douleurs et des bruits articulaires. Elle avait bénéficié un an auparavant d'une injection intra-articulaire de cortisone par son rhumatologue suite à des épisodes de blocages sévères de son ATM gauche. L'examen clinique montrait une limitation de l'ouverture buccale avec latéro-déviation gauche. La diduction droite était impossible. L'orthopantomogramme montrait une lyse du condyle gauche, confirmée par le scanner. L'IRM montrait de plus un disque très remanié déplacé en avant ainsi qu'une inflammation sans épanchement intra-articulaire.DiscussionL'arthropathie temporomandibulaire secondaire aux injections uniques ou répétées de cortisone dans l'ATM est peu connue. Elle réalise un tableau clinique de DTM typique et se caractérise radiologiquement par une lyse osseuse condylienne inflammatoire. Les injections intra-articulaires de corticoïdes ne sont pas anodines. D'autres traitements doivent leur être préférés.IntroductionTemporomandibular disorders (TMDs) affect the masticatory muscles and the temporomandibular joints (TMJs). TMDs most often result from occlusal and/or muscular disorders and are then called primary or idiopathic TMDs. Less frequently, TMDs are related to local (trauma, infection) or general (rheumatoid arthritis) causes and are then called secondary TMDs. A little known iatrogenic cause of secondary TDM is the osteoarthritis that may be induced by intra-articular cortisone injections. We report one case of condylar lysis that occurred after one single intra-articular cortisone injection.ObservationA 62-years-old woman consulted for a long-lasting TMD on the left side manifesting itself through pain and noise. She benefited one year before from an intra-articular injection of cortisone by her rheumatologist for repeated closed lock of her left TMJ. Physical examination showed limited mouth opening with deviation on the left side. Lateral movements on the right side were impossible. The panoramic X-ray showed a condylar lysis on the left side that was on the CT scan. MRI additionally showed an anteriorly displaced and severely reshaped disc and an articular inflammation without intra-articular effusion.DiscussionTMJ osteoarthritis secondary to unique or repeated intra-articular steroid injections are little-known. They are clinically expressed as typical TMDs and characterized on X-rays by condylar lysis and inflammation. Intra-articular injections of steroids are not totally harmless and other treatments must be preferred.



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Prothèses totales des articulations temporomandibulaires

Publication date: Available online 21 August 2016
Source:Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale
Author(s): N. Zwetyenga, S. Amroun, B.-L. Wajszczak, V. Moris
L'articulation temporomandibulaire (ATM) est probablement l'articulation humaine la plus complexe. Comme pour toutes les articulations, son remplacement prothétique peut être indiqué dans certains cas. D'importantes avancées ont été faites dans la conception des prothèses d'ATM durant les trois dernières décennies et les indications ont été précisées. Le but de notre travail était de faire une mise au point sur les possibilités actuelles de remplacement total de l'ATM. Les indications, les contre-indications, les composants prothétiques, les avantages, les inconvénients, les causes d'échec ou de reprise, la planification virtuelle et le protocole chirurgical ont été précisés.The temporomandibular joint (TMJ) is probably the most complex human joint. As in all joints, its prosthetic replacement may be indicated in selected cases. Significant advances have been made in the design of TMJ prostheses during the last three decades and the indications have been clarified. The aim of our work was to make an update on the current total TMJ total joint replacement. Indications, contraindications, prosthetic components, advantages, disadvantages, reasons for failure or reoperation, virtual planning and surgical protocol have been exposed.



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ATM, manducation et ventilation

Publication date: Available online 21 August 2016
Source:Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale
Author(s): F. Cheynet
L'étude des liens entre articulations temporomandibulaires (ATM), manducation et ventilation et l'implication de ces deux fonctions dans la genèse des dysfonctions temporomandibulaires (DTM) primaires et dans certaines dysmorphies dentofaciales a été initiée en France, il y a plus de 30ans, par le Professeur Raymond Gola. Une fois critiquée, la faiblesse de la littérature scientifique dans ce domaine l'originalité des ATM au sein de l'appareil manducateur est rappelée avec son potentiel d'adaptation aux contraintes biomécaniques très variées selon l'âge et les activités manducatrices durant la journée. Mais la biomécanique de l'appareil manducateur ne s'arrête pas la nuit et les positions de la mandibule et de la tête durant le sommeil doivent être étudiées soigneusement. En cas de ventilation orale nocturne (VON) et de bouche ouverte, la position prédominante de sommeil (générant des forces faibles mais de longue durée) peut s'avérer délétère pour le complexe condylo-discal, pour les muscles environnants et pour les rapports occlusaux. Certaines désunions condylo-discales et malocclusions asymétriques trouvent ainsi leur origine dans cette longue portion de vie qu'est le sommeil, d'autant plus que la VON entraîne avec elle tout un cortège parafonctionnel (langue basse, dyspraxie labio-linguale, exacerbation du bruxisme de sommeil…). Le but de ce travail était de partager notre expérience multidisciplinaire impliquant orthodontistes, chirurgiens maxillo-faciaux, ORL, allergologues, orthophonistes, kinésithérapeutes et radiologues, dans l'étude des conséquences biomécaniques faciales de la ventilation orale nocturne.The study of the relationship between temporomandibular joints (TMJ), mastication and ventilation and the involvement of these two functions in the genesis of primary Temporomandibular Disorders (TMD) and in some dentofacial deformities, was initiated in France, more than 30years, by Professor Raymond Gola. Once criticized the weakness of the scientific literature in this domain, the originality of the TMJ within the masticatory system is recalled with its huge adaptation potential to very different biomechanical constraints according to the age and masticatory activities during the day. But the biomechanics of the masticatory system does not stop at night and the positions of the mandible and head during sleep should be studied carefully. In case of nocturnal mouth breathing with open mouth, the predominant sleeping position (generating small but long-term strengths) may be deleterious to the condyle-disc complex, to the surrounding muscles and the occlusal relationships. Some condyle-disc displacements and asymmetric malocclusions occur in this long portion of life what sleep, especially as oral breathing leads to a lot of dysfunctions (low position of the tongue, labio-lingual dysfunctions, exacerbation of bruxism sleep…). The aim of this work was to share our multidisciplinary experience of the biomechanical consequences of the nocturnal mouth breathing on the face involving orthodontists, maxillofacial surgeons, ENT, allergists, speech therapists, physiotherapists and radiologists.



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Ipsilateral full-thickness skin grafts to repair the donor site defect of a radial forearm free flap: a reflection on technique

Publication date: Available online 21 August 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): O.P. Krishnan, D.A. Mitchell




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Interpersonal violence and synthetic cannabinoids

Publication date: Available online 21 August 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Alexander J. Rickart, Jiten D. Parmar, Stephen T. Crank




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Bilateral hypoplasia of the maxillary sinus: swelling of the nasal mucosa after periapical periodontitis

Hypoplasia (underdevelopment) of the maxillary sinus and aplasia (failure of it to develop at all) are relatively rare and even less common bilaterally.1 The overall prevalence of hypoplasia has been reported as 1.5% - 10.0%, but some studies have reported even lower numbers.2 Dentists and oral surgeons often do not consider them (or conditions resulting from them) when looking at an orthopantogram.

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Pa. photographers offer free family photos for first responders

By Amy Marchiano
The Republican & Herald

SCHUYLKILL HAVEN, Pa. — Wanting to recognize first responders for their contribution to the community, photographers invited them and their families to a free photo shoot.

Ashley Farr, Jen Shaeffer and Melanie Runkle, all of Schuylkill Haven, snapped photos during the Free Photos for First Responders event at Bubeck Park on Friday. Families were invited to take five to six photos during the event.

"They don't even think twice (about responding to 911 calls). I just want them to know that they are respected and appreciated," Farr said.

Farr said she wanted to host the event after she was moved by reading a post online about a wife of a police officer who took a photo of her husband and their children everyday before he went to work.

"They will never know when they will have their last photo," Farr said.

The photos were available for firefighters, police, EMS or correction officers. Farr said the goal was to take photos of 25 families.By 5:30 p.m., at least 10 families attended the event.

A local company donated free 8-by-10 photos for families. Amanda Morris of Triple A Cakes donated and distributed cupcakes.

A corporal from the state police at Schuylkill Haven and his family were the first to get their pictures taken.

Also attending the event were Connie Showalter, 48, of Spring Township, Berks County, and her husband, Sgt. Sean Showalter, 48, of the Northern Berks Regional Police Department, Reading. With them were their children, Ryan, 19, and Kiera, 16. Connie appreciates the chance to get photos of her family.

"When he walks out the door, there is no guarantee he is coming home," she said, which changes your whole perspective on life.

Showalter, who was dressed in his police uniform, said he has been with the police department for 14 years. He appreciated the generosity of the community. He doesn't get a lot of thanks for the job he does but doesn't expect a lot either.

He wants people to know that "we are not bad people. We are just trying to keep order. Without the police it would be chaotic," he said.

Chris Dampman, 32, assistant chief of the Port Clinton Fire Department, was there with his daughter, Serenade Dampman, 8, of Shartlesville, Berks County. Serenade wore his helmet while he wore his turnout gear.

Dampman said he has been with the fire department for 10 years, two as assistant chief, two as captain and six years as a firefighter.

"It's rewarding to help the public out," he said, adding the fire department is always in need of volunteers.

He appreciates that others are giving their time to capture memories for people they might not even know.

Schuylkill EMS paramedic Edward Lizewski, 23, of Pine Grove, and his wife, Brittney, 23, and their children, Landen, 1, Sophia, 3, and Alexandrea, 7, sat on a bench for one of their photos.

"Make sure you smile," Brittney said to her daughters.

Lizewski said he loves what he does, although the hours can be long and that he worked a 12-hour-shift Thursday.

"I love being able to go out and help people and make a difference if they are sick or injured," he said.

Brittney said events like Friday shows the community cares and supports the first responders.

Farr said the photos will be available possibly within a week and that she would like to have another event in the spring at Bubeck Park for those who could not attend Friday.

Copyright 2016 the Republican & Herald

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Inducing a Site Specific Replication Blockage in E. coli Using a Fluorescent Repressor Operator System

We describe here a system utilizing a site-specific, reversible in vivo protein block to stall and collapse replication forks in Escherichia coli. The establishment of the replication block is evaluated by fluorescence microscopy and neutral-neutral 2-dimensional agarose gel electrophoresis is used to visualize replication intermediates.

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Options in treating trigeminal neuralgia: Experience with 195 patients

Publication date: October 2016
Source:Clinical Neurology and Neurosurgery, Volume 149
Author(s): Patrick W. Hitchon, Marshall Holland, Jennifer Noeller, Mark C. Smith, Toshio Moritani, Nivedita Jerath, Wenzhuan He
ObjectiveFor patients with medically unresponsive trigeminal neuralgia (TN), surgical options include microvascular decompression (MVD), radiofrequency rhizotomy (RF), and stereotactic radiosurgery (SRS). In an attempt to identify the risks and benefits and cost inherent with each of the three modalities, we performed a retrospective review of our experience with 195 cases of TN treated over the past 15 years.MethodsSince 2001, 195 patients with previously untreated TN were managed: with MVD in 79, RF in 36, and SRS in 80. All patients reported herein underwent preoperative MRI. Women outnumbered men 122/73 (p=0.045). Follow-up after surgery was 32±46months.ResultsThe patients qualifying for MVD were generally healthier and younger, with a mean age±SD of 57±14, compared to those undergoing RF (75±15) or SRS (73±13, p<0.0001). In case of relapse, medical treatment was always tried and failed prior to consideration of surgical intervention. A second surgical procedure was necessary in 2, 23, and 18 patients initially treated with MVD, RF, and SRS respectively (p<0.0001). In the patients treated with MVD, RF, and SRS, the average number of procedures per patient necessary to achieve pain control was 1.1, 2.0, and 1.3 respectively (p=0.001). There were 7 complications in the patients treated with MVD but no deaths. Numbness was present in 13, 18, and 29 patients treated with MVD, RF, and SRS respectively (p=0.008).ConclusionMVD for TN is the treatment least likely to fail or require additional treatment. Patients who underwent MVD were younger than those undergoing RF or SRS. The highest rate of recurrence of TN was encountered in patients undergoing RF (64%). Facial numbness was least likely to occur with MVD (16%) compared to RF and SRS (50% and 36% respectively).



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Evaluation of pulsing magnetic field effects on paresthesia in multiple sclerosis patients, a randomized, double-blind, parallel-group clinical trial

Publication date: October 2016
Source:Clinical Neurology and Neurosurgery, Volume 149
Author(s): Daryoush Afshari, Nasrin Moradian, Majid khalili, Nazanin Razazian, Arash Bostani, Jamal Hoseini, Mohamad Moradian, Masoud Ghiasian
ObjectivesEvidence is mounting that magnet therapy could alleviate the symptoms of multiple sclerosis (MS). This study was performed to test the effects of the pulsing magnetic fields on the paresthesia in MS patients.Patients and methodsThis study has been conducted as a randomized, double-blind, parallel-group clinical trial during the April 2012 to October 2013. The subjects were selected among patients referred to MS clinic of Imam Reza Hospital; affiliated to Kermanshah University of Medical Sciences, Iran. Sixty three patients with MS were included in the study and randomly were divided into two groups, 35 patients were exposed to a magnetic pulsing field of 4mT intensity and 15-Hz frequency sinusoidal wave for 20min per session 2 times per week over a period of 2 months involving 16 sessions and 28 patients was exposed to a magnetically inactive field (placebo) for 20min per session 2 times per week over a period of 2 months involving 16 sessions. The severity of paresthesia was measured by the numerical rating scale (NRS) at 30, 60days. The study primary end point was NRS change between baseline and 60days. The secondary outcome was NRS change between baseline and 30days.ResultsPatients exposing to magnetic field showed significant paresthesia improvement compared with the group of patients exposing to placebo.ConclusionAccording to our results pulsed magnetic therapy could alleviate paresthesia in MS patients .But trials with more patients and longer duration are mandatory to describe long-term effects.



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