Fabrication, structural, and enhanced mechanical behavior of MgO substituted PMMA composites for dental applications

The most common denture material used for dentistry is poly-methyl-methacrylate (PMMA). Usually, the polymeric PMMA material has numerous biological, mechanical and cost-effective shortcomings. Hence, to resolve such types of drawbacks, attempts have been made to investigate fillers of the PMMA like alumina (Al2O3), silica (SiO2), zirconia (ZrO2) etc. For the enhancement of the PMMA properties a suitable additive is required for its orthopedic applications. Herein, the main motive of this study was to synthesize a magnesium oxide (MgO) reinforced polymer-based hybrid nano-composites by using heat cure method with superior optical, biological and mechanical characteristics. For the structural and vibrational studies of the composites, XRD and FT-IR were carried out. Herein, the percentage of crystallinity for all the fabricated composites were also calculated and found to be 14.79-30.31. Various physical and optical parameters such as density, band gap, Urbach energy, cutoff energy, cutoff wavelength, steepness parameter, electron-phonon interaction, refractive index, and optical dielectric constant were also studied and their values are found to be in the range of 1.21-1.394 g/cm3, 5.44-5.48 eV, 0.167-0.027 eV, 5.68 eV, 218 nm, 0.156-0.962, 4.273-0.693, 1.937-1.932, and 3.752-3.731 respectively. To evaluate the mechanical properties like compressive strength, flexural strength, and fracture toughness of the composites a Universal Testing Machine (UTM) was used and their values were 60.3 and 101 MPa, 78 and 40.3 MPa, 5.85 and 9.8 MPa-m1/2 respectively. Tribological tests of the composites were also carried out. In order to check the toxicity, MTT assay was also carried out for the PM0 and PM15 [(x)MgO + (100 - x) (C5O2H8)n] (x = 0 and 15) composites. This study provides a comprehensive insight into the structural, physical, optical, and biological features of the fabricated PMMA-MgO composites, highlighting the potential of the PM15 composite with its enhanced density, mechanical strength, and excellent biocompatibility for denture applications.

Synergetic effects of boron nitride with waste zirconia: Evaluation of instantaneous fingerprint detection and mechanical properties for biomedical applications

Herein, present study mainly focuses on the synthesis and characterizations of boron nitride reinforced waste zirconia (wZrO2) with different concentrations. Composites were prepared via a scalable solid-state reaction method. Various physical parameters such as density, ionic concentration, polaron radius, and field strength were evaluated. XRD results reveal crystalline nature with a major phase of tetragonal zirconia and as boron nitride is reinforced, the tetragonal transforms into a monoclinic zirconia. Interconnected spherical grains and nanosheets were observed using FESEM. Mechanical characterizations revealed the highest compressive strength of 266 MPa. The latent fingerprints were visualized using a composite on different surfaces, implementing the powder dusting and solution techniques. MTT assay was performed and revealed good biocompatible nature. These results reveal that composite is suitable for fabrication of bioceramics with acceptable mechanical and biological performances. The composite can also be utilized for latent fingerprint detection in forensic science.

Significance of 25(OH) D3 in Early Dental Implant Failure (EDIF) during osseointegration-A systematic review

Bone metabolism is a key factor for successful osseointegration, and low vitamin D levels may negatively impact the process of osseointegration after implant placement. The study was aimed at evaluating the relation of vitamin D levels with dental implant osseointegration and subsequently the success or failure of the implant. The focused questions were-What is the effect of vitamin D levels on successful dental implant osseointegration and what is the effect of vitamin D supplementation on successful implant osseointegration? A search was conducted on PubMed and Google Scholar using the terms "vitamin D," "cholecalciferol," "1,25(OH) D," "dental implant," "osseointegration," and "bone implant contact" for a period of 10 years from 2011 to 2020. Clinical trials, cross-sectional studies, case series, and case reports were included. A total of ten studies were included after the screening process. Five of these studies evaluated the effect of vitamin D supplementation on osseointegration, whereas five only evaluated the effect of vitamin D deficiency on dental implant osseointegration. Only five of these studies reported dental implant failure varying from 7% to 13% in vitamin D deficient/insufficient groups. Positive relationship exists between serum vitamin D levels and dental implant osseointegration; however, few studies failed to report any relation. More prospective clinical research studies as well as randomized controlled trials are needed to show a significant correlation between decreased serum levels of vitamin D and increased risk of dental implant failure in perspective of vitamin D supplementation which can promote the osseointegration of dental implants.

High-'n'-dry? A comparison of cannabis and alcohol use in drivers presenting to hospital after a vehicular collision

DESIGN

This was a prospective observational study.

BACKGROUND AND AIMS

The characteristics of cannabis-involved motor vehicle collisions are poorly understood. This study of injured drivers identifies demographic and collision characteristics associated with high tetrahydrocannabinol (THC) concentrations.

SETTING

The study was conducted in 15 Canadian trauma centres between January 2018 and December 2021.

CASES

The cases (n = 6956) comprised injured drivers who required blood testing as part of routine trauma care.

MEASUREMENTS

We quantified whole blood THC and blood alcohol concentration (BAC) and recorded driver sex, age and postal code, time of crash, crash type and injury severity. We defined three driver groups: high THC (THC ≥ 5 ng/ml and BAC = 0), high alcohol (BAC ≥ 0.08% and THC = 0) and THC/BAC-negative (THC = 0 = BAC). We used logistic regression techniques to identify factors associated with group membership.

FINDINGS

Most injured drivers (70.2%) were THC/BAC-negative; 1274 (18.3%) had THC > 0, including 186 (2.7%) in the high THC group; 1161 (16.7%) had BAC > 0, including 606 (8.7%) in the high BAC group. Males and drivers aged less than 45 years had higher adjusted odds of being in the high THC group (versus the THC/BAC-negative group). Importantly, 4.6% of drivers aged less than 19 years had THC ≥ 5 ng/ml, and drivers aged less than 19 years had higher unadjusted odds of being in the high THC group than drivers aged 45-54 years. Males, drivers aged 19-44 years, rural drivers, seriously injured drivers and drivers injured in single-vehicle, night-time or weekend collisions had higher adjusted odds ratios (aORs) for being in the high alcohol group (versus THC/BAC-negative). Drivers aged less than 35 or more than 65 years and drivers involved in multi-vehicle, daytime or weekday collisions had higher adjusted odds for being in the high THC group (versus the high BAC group).

CONCLUSIONS

In Canada, risk factors for cannabis-related motor vehicle collisions appear to differ from those for alcohol-related motor vehicle collisions. The collision factors associated with alcohol (single-vehicle, night-time, weekend, rural, serious injury) are not associated with cannabis-related collisions. Demographic factors (young drivers, male drivers) are associated with both alcohol and cannabis-related collisions, but are more strongly associated with cannabis-related collisions.

Recent Advances in Additive Manufacturing, Applications and Challenges for Dentistry: A Review

Technological advancement in the field of dentistry has to be proven in new avenues for professionals as well as laboratory programmers. An advanced type of technology is emerging based on digitalization, as a computerized three-dimensional (3-D) model, additive manufacturing also called 3-D printing, allows formation of block pieces by adding material layer-by-layer. The additive manufacturing (AM) approach has offered extreme progress in the broad choice of distinct zones, permitting the production of fragments of all possible varieties of substances such as metal, polymer, ceramic, and composites. The significant goal of current the article is to recapitulate the recent scenarios including the imminent perspective of AM techniques and challenges in dentistry. Moreover, this article reviews the recent developments of 3-D printing advancements along with the advantages and disadvantages. Herein, various AM technologies comprising vat photopolymerization (VPP), material jetting, material extrusion, selective laser sintering (SLS), selective laser melting (SLM), and direct metal laser sintering (DMLS) technologies based powder bed fusion technologies/direct energy deposition/sheet lamination centered on binder jetting technologies were discussed in detail. This paper attempts to provide a balanced view by emphasizing the economic, scientific, and technical challenges and presenting an overview of methods to discuss the similarities based on the authors' continuing research and development.

The De-Ritis ratio is associated with contrast-associated acute kidney injury in patients undergoing elective percutaneous coronary intervention

Background

Preoperative liver dysfunction has been demonstrated as a poor prognostic factor after major surgery. Recent researches discovered that an increased De-Ritis ratio (aspartate aminotransferase-to-alanine aminotransferase ratio) reflects the liver dysfunction and was associated with adverse cardiovascular and renal outcomes. However, there is a lack of data exploring the predictive value of the De-Ritis ratio on contrast-associated acute kidney injury (CA-AKI) in patients undergoing elective percutaneous coronary intervention (PCI).

Purpose

To evaluate the predictive value of the De-Ritis ratio for CA-AKI in patients undergoing elective PCI.

Methods

We conducted a prospective, observational study with 5780 consenting patients undergoing elective PCI from January 2012 to December 2018. CA-AKI was defined as an increase in serum creatinine (SCr) ≥50% or 0.3 mg/dL within 48 hours after contrast medium exposure. The relationship between the De-Ritis ratio and CA-AKI was investigated by logistic regression analysis. The predictive utility of the De-Ritis ratio was determined and compared using the area under the receiver-operating characteristic curve (AUC).

Result

CA-AKI developed in 363 (6.3%) patients. The median De-Ritis ratio was 1.00 (0.77–1.33). The De-Ritis ratio showed an AUC of 0.636 (95% confidence interval (CI): 0.624–0.649; P<0.001) in predicting CA-AKI, which was significantly greater than aspartate aminotransferase (AST) (AUC: 0.636 vs 0.589, p=0.015) and alanine aminotransferase (ALT) (AUC: 0.636 vs 0.506, p<0.001). The best cut-off value of the De-Ritis ratio for predicting CA-AKI was 1.30 with 47.1% sensitivity and 74.7% specificity. Multivariable logistic analysis showed that the De-Ritis ratio >1.30 was a remarkable independent predictor of CA-AKI (OR=1.757, 95% CI, 1.385–2.229, p<0.001) even after adjusting for other CA-AKI risk factors.

Conclusion

The De-Ritis ratio is an independent risk factor for predicting CA-AKI in patients undergoing elective PCI.

Funding Acknowledgement

Type of funding sources: None. ROC for De-Ritis ratio to predict CA-AKIPredictors of CA-AKI

Biological and esthetic outcome of immediate dental implant with the adjunct pretreatment of immediate implants with platelet-rich plasma or photofunctionalization: A randomized controlled trial

Aim

The purpose of the study was to assess biological and esthetic outcomes of immediate dental implant in esthetic zone with the adjunct pretreatment of immediate implants with photofunctionalization or platelet-rich plasma in comparison to standard tapered root form implant without pretreatment.

Settings and Design

Patients visiting department of Prosthodontics of a tertiary care health Institution. Design of the study was randomized controlled trial.

Materials and Methods

Ninety subjects who required replacement of maxillary anterior teeth immediately after extraction were selected and randomly divided into three groups: control group and two case groups. Two case groups were treated with immediate implants with pretreatment with Photofunctionalization (PF group) or platelet-rich plasma (PRP group). Delayed loading protocol was followed with prosthesis given after 6 months. Follow-up was performed at 2nd and 4th weeks and 2, 4, 6, and 12 months (P < 0.05). Biological outcomes (mean marginal bone loss, implant stability), esthetic outcome (pink esthetic score and white esthetic score), and success and survival rate were evaluated.

Statistical Analysis Used

Outcomes were compared using one-way ANOVA, while intragroup changes with baseline and follow up were assesed using repeated-measures ANOVA. Statistical analyses were performed using Statistical Package for Social Sciences version 25.0 (SPSS Inc., Chicago, IL, USA). The level of significance was set at <.05.

Results

Mean marginal bone loss was not significantly different in PF group and PRP group than the control group. PF group and PRP group showed significantly greater implant stability as compared to the control group. Pink and white esthetic scores were not significantly different among groups.

Conclusion

Pretreatment of commercial dental implants with PF or PRP exhibited a statistically significant difference in implant stability but not with other outcomes.

Speech intelligibility, nasal resonance, and swallowing ability of maxillectomy patients with customized obturator: A non randomized controlled study

Aim:

To compare speech intelligibility (SI), nasal resonance, and swallowing ability in maxillectomy patients with a customized obturator to the conventional obturator.

Settings and Design:

Non-randomized controlled study.

Materials and Methods:

Forty-eight maxillectomy patients were recruited and assessment of SI, nasal resonance, and swallowing ability was done at three situations: without obturator, with conventional obturator, and with customized obturator. Recordings of unrehearsed conversation, counting from number 1–20 and four sets of Chapel Hill Multilingual Intelligibility Test in the Hindi language were used to assess SI and nasal resonance. SI was evaluated by untrained listeners and graded according to a 6-point scale. Nasal resonance was evaluated by speech pathologists on a 7-point scale of severity. Swallowing ability was evaluated by water drinking test.

Statistical Analysis Used:

One-way ANOVA, Post hoc Bonferroni and Chi square test.

Results:

SI and nasal resonance showed a statistically significant difference between any two groups (P < 0.001). Water drinking time was significantly different between without obturator and with customized obturator (P < 0.001), but the difference was not statistically significant between without obturator and with obturator (P < 0.004).

Conclusion:

SI, nasal resonance, and swallowing ability improved with customized obturator in comparison to the conventional obturator.

Real-world effectiveness of adalimumab in patients with moderate-to-severe hidradenitis suppurativa: the 1-year SOLACE study

BACKGROUND

Long-term, real-word data are needed to help manage patients with hidradenitis suppurativa (HS) through this recurrent, painful and debilitating disease.

OBJECTIVES

To primarily measure real-world effectiveness of adalimumab in HS and to secondarily observe clinical course of HS in the light of patients' response.

METHODS

In SOLACE, adults with moderate-to-severe HS in need for change in ongoing therapy were treated with adalimumab for up to 52 weeks as per physician's medical practice. Treatment effectiveness was measured by Hidradenitis Suppurativa Clinical Response (HiSCR). Inflammatory nodules, abscesses and draining fistulas were counted, Hurley stage was assessed, and disease severity was rated using the International HS Severity Scoring System (IHS4). A post hoc analysis further explored the HiSCR response by abscess and inflammatory nodule (AN) count at baseline (low, medium and high) and gender. Spontaneously reported safety events were collected.

RESULTS

From 23 Canadian centres, 69% of the 138 patients achieved HiSCR at week 24, which increased to 82% and 75% at week 52 in patients with medium and high AN counts, respectively. Gender (4 times the odds for female) and age at HS onset (5% decrease with each additional year) had an effect on achieving HiSCR. Treatment with adalimumab led to an important decrease in number of lesions in responders, with most gains observed in inflammatory nodules, more frequently in the lower body area of patients in the high AN count group. The IHS4 scores of responders were substantially lowered, with a larger decrease in patients of the high AN count group. No new safety signal was detected.

CONCLUSIONS

The effectiveness of adalimumab was maintained during this 1-year period, and an optimal gain was documented for patients with medium and high AN counts. These real-world data support a prompt treatment of HS patients and the use of IHS4 to monitor treatment.

A review of techniques of iris replication and a novel method of fabrication of ocular prosthesis using two different iris location methods

Anophthalmic patients suffer from social, functional, and emotional agony. The role of a maxillofacial prosthodontist is to restore this loss and to restore the self-esteem of such patients. Fabrication of a prosthesis for the anophthalmic cavity can be successful with the judicious use of the materials, the vision, and the skill of the prosthodontist. This article describes various techniques used for iris replication and a novel method to locate the iris, which is the most crucial step to fabricate a natural gaze.

Assessment of the Healing of Dental Implant Surgical Site Following Low-Level Laser Therapy Using Bioclinical Parameters: An Exploratory Study

The purpose of this study was to evaluate whether low-level laser therapy improves healing of the implant surgical site with clinical and biochemical parameters. Thirty patients with an edentulous space spanning a single tooth were selected. The patients were randomly allocated to 1 of 2 groups: control group and test group. The test group received laser energy at a power of 2 J/cm2 with a total of 4-6 J energy over each implant. Clinical parameters (implant stability quotient, probing index, modified sulcus bleeding index) and osteoprotegerin were assessed at baseline and follow-up intervals (2 weeks, 6 weeks, and 3 months). The test group showed significantly higher implant stability quotient than the control group at 2 weeks (57.93 ± 3.95 vs 35.67 ± 3.08; P < . 01) and 3 months (58.86 ± 3.75 vs 67.06 ± 3.78; P < . 01). A significant rise in osteoprotegerin levels of the test group (686.30 ± 125.36 pg/mL at baseline and 784.25 ± 108.30 pg/mL at 3 months; P < . 01) was seen contrary to significant decline in the control group (839.50 ± 249.08 pg/mL at baseline vs 415.30 ± 78.39 pg/mL at 3 months; P < . 01). Within the limitations of the study, the findings suggest that the healing of peri-implant hard and soft tissues may be enhanced with the use of low-level laser therapy as an explicit modality during the postoperative period.

Treatment of metastatic placental site trophoblastic tumor with surgery, chemotherapy, immunotherapy and coil embolization of multiple pulmonary arteriovenous fistulate

•

Placental site trophoblastic tumor can be resistant to chemotherapy.

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Multidisciplinary care is required for management of advanced disease.

•

Increased PD-L1 expression can help guide use of immunotherapies.

•

Complete responses are possible with aggressive multidisciplinary management.

Placental Site Trophoblastic Tumor (PSTT) is a rare malignancy that often presents with extensive disease and can be resistant to traditional treatments. We present the case of a woman with stage IV PSTT who was initially managed with neoadjuvant chemotherapy followed by tumor debulking. Adjuvant therapy was guided by further pathologic analysis that revealed high levels of staining for PD-L1 as well as the presence of tumor infiltrating lymphocytes (TILs). Subsequently, the patient was treated with traditional chemotherapy with the EP/EMA regimen with the addition of pembrolizumab. The patient’s treatment course was complicated by the development of pulmonary arteriovenous malformations, autoimmune thyroiditis thought to be secondary to immunotherapy, and significant tinnitus secondary to platinum agents. Currently the patient is in follow up and remains in a complete remission.

The impact of impulsivity on weight loss after bariatric surgery: a systematic review

BACKGROUND

Impulsivity has been shown to be associated with obesity through links to pathological eating behavior such as binge eating. The recent literature suggests that impulsivity is linked to poorer outcomes post-bariatric surgery. Impulsivity can be measured in various ways and comprises of three broad domains: impulsive choice, impulsive action, and impulsive personality traits. The aim of this systematic review is to synthesize the current evidence on the impact of impulsivity on post-bariatric surgery weight loss.

METHODS

A literature review was performed in February 2020. Original studies investigating the relationship between impulsivity and weight loss post-bariatric surgery were evaluated.

RESULTS

Ten studies with a total of 1246 patients were analyzed. There were four case-control, four prospective observational and two retrospective observational studies. The postoperative follow-up ranged from 0.5 to 12 years. Eight studies measuring trait impulsivity did not show any association with weight loss post-bariatric surgery, although two studies reported an indirect effect of impulsivity on weight loss mediated via pathological eating behavior. Assessment of impulsive action by two studies showed that post-bariatric surgery weight loss is affected by impulsive action.

CONCLUSION

Impulsivity may adversely affect postoperative outcomes after bariatric surgery. However, this may be specific to state impulsivity or impulsive action rather than trait impulsivity. Patients with a higher state impulsivity may benefit from closer follow-up post-bariatric surgery, as well as cognitive behavioral therapies targeting cognitive control over food.

LEVEL OF EVIDENCE

Level I, systematic review.

[The clinical observation of sirolimus combined with calcineurin inhibitors for steroid-resistant/steroid-dependent extensive cGVHD]

Objective: To observe the efficacy and safety of sirolimus combined with calcineurin inhibitor (CNI) in the treatment of glucocorticoid resistant/dependent extensive chronic graft-versus-host disease (cGVHD) . Methods: A total of 27 patients with steroid-resistant/steroid-dependent extensive cGVHD from November 2015 to January 2019 were enrolled and given sirolimus capsules combined with cyclosporine or tacrolimus to observe the clinical efficacy and adverse events. Results: The median duration of medication was 14.2 months and the mean duration was 16.7 months. The median follow-up time was 20.1 months (12.9-46.1 months) . Following the 6-month follow-up, 3 cases achieved complete response (CR) and 12 cases partial response (PR) . The overall response rate (ORR) was 55.6% ; for progression-free survival (PFS) , PFS-6 reached 88.9% (24/27) , and for overall survival (OS) , OS-6 was 100% . At the 1-year follow-up, there were 5 cases of CR and 11 cases of PR, ORR was 59.3% , PFS-12 reached 62.9% (17/27) , and OS-12 was 100% . The subgroup analysis found that the program was more effective for cGVHD in male donors and the target organ analysis had an advantage in the treatment of oral cavity, skin, and liver rejection. Adverse events were observed: hyperlipidemia 11.1% , oral ulcer 7.4% , fungal infection 11.1% , liver injury 3.7% , renal insufficiency 0, and no new CMV and EB viremia. Conclusion: Sirolimus combined with calcineurin inhibitors is effective in treating steroid-resistant/steroid-dependent extensive cGVHD, especially because adverse reactions (renal toxicity, CMV, EBV infection) are low in number, which is suitable for long-term treatment of cGVHD.

[The clinical observation of serum specific biomarkers in patients with chronic graft-versus-host disease]

目的

研究异基因造血干细胞移植后患者血清生物标志物表达水平对慢性移植物抗宿主病（cGVHD）早期诊断的价值。

方法

采用液相悬浮芯片法检测接受异基因造血干细胞移植后发生和未发生cGVHD患者5种血清蛋白标志物（IL-1b、IL-16、CXCL9、CCL19、CCL17）表达水平。

结果

相较于未发生cGVHD的对照组，cGVHD患者血清中CXCL9、CCL17表达水平显著升高（P<0.05），其中CCL17与cGVHD的疾病严重程度相关（P<0.001）；CXCL9在皮肤损害的cGVHD患者血清中显著升高（P<0.01），CCL17在肝脏为靶器官的cGVHD患者中表达水平显著升高（P<0.01）。

结论

CXCL9联合CCL17可作为cGVHD的血清生物标志物，对辅助cGVHD诊断和评估严重程度有一定参考价值。

Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea

BACKGROUND

The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking.

AIM

To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards.

METHODS

A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 h were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea onset >48 h after admission). Data on HOD aetiology and management were collected prospectively.

FINDINGS

Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% confidence interval (CI) 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. Nine of 75 tested patients were Clostridium difficile toxin positive (4%). Eighty (35%) patients had a documented medical assessment of diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested vs 38% not tested, P<0.001). One-hundred and forty-four (63%) patients were not isolated following diarrhoea onset.

CONCLUSION

HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients had multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated.

Effect of direct defect closure during laparoscopic inguinal hernia repair ("TEP/TAPP plus" technique) on post-operative outcomes

PURPOSE

Seroma formation and recurrence in large inguinal hernia still remain an important clinical complication despite decades since the advent of mesh repair.

METHODS

In our prospective comparative analysis, we want to evaluate the effect of direct hernia defect closure on surgical outcomes in patients undergoing laparoscopic inguinal hernia repair in two tertiary care institutions in Singapore. The direct hernia defects were closed with non-absorbable sutures incorporating the pseudosac.

RESULTS

A group of 241 patients underwent laparoscopic inguinal hernia mesh repair for a total of 378 direct defects from April 2014 to July 2018. Of these patients, 98 (40.6%) patients underwent hernia repair without closure of their direct defect while 143 (59.4%) patients underwent direct defect closure. No significant differences were observed between the two patient populations' demographic information and the mean operative time. A total of 219 direct defects were closed and 159 direct defects were not repaired. Compared to the group that did not undergo direct defect closure, the group that had closure of the direct defects demonstrated a statistically significant reduction in recurrence (4.4% versus 0.9%, p = 0.036) and seroma formation (12.6% versus 6.4%, p = 0.045).

CONCLUSION

Direct defect closure has proven to be effective in reducing recurrence and seroma formation post-operatively in patients undergoing laparoscopic inguinal hernia repair. Randomized controlled trials will be required to further evaluate these outcomes.

A Review of Magnetic Particle Imaging and Perspectives on Neuroimaging

Magnetic particle imaging is an emerging tomographic technique with the potential for simultaneous high-resolution, high-sensitivity, and real-time imaging. Magnetic particle imaging is based on the unique behavior of superparamagnetic iron oxide nanoparticles modeled by the Langevin theory, with the ability to track and quantify nanoparticle concentrations without tissue background noise. It is a promising new imaging technique for multiple applications, including vascular and perfusion imaging, oncology imaging, cell tracking, inflammation imaging, and trauma imaging. In particular, many neuroimaging applications may be enabled and enhanced with magnetic particle imaging. In this review, we will provide an overview of magnetic particle imaging principles and implementation, current applications, promising neuroimaging applications, and practical considerations.

[Clinicopathologic features of breast lymphoma in core needle biopsy]

Objective: To investigate the clinicopathologic features and differential diagnosis of breast lymphoma in core needle biopsy. Methods: Seventy-two cases of breast lymphoma in core needle biopsy between 2011 and 2016 were extracted from the pathology database of Fudan University Shanghai Cancer Center. The clinicopathologic features were analyzed. The histological diagnosis of the tumors was based on the WHO classifications of tumors of hematopoietic and lymphoid tissues. Immunohistochemistry and molecular methods were performed to detect related antigens and genes. Results: Seventy-one patients were female and one was male. The median age was 54 years. The tumors were located in the right breast in 32 (44.4%) patients and in the left breast in 40 (55.6%) patients. Seven patients had a previous history of lymphoma. Most of the cases presented as a single and painless breast mass. Sixty-three patients received systemic treatment, and nine patients received systemic therapy after excision. The common morphological feature was that single tumor cells infiltrated the stroma, without cohesiveness between tumor cells, and lacking glandular or nested epithelioid structures. The normal ductal and lobular structures of the mammary gland were typically preserved. The tumor cells in some cases were distributed in single rows, and should be differentiated from invasive carcinoma. All cases were positive for LCA, negative for CK. Sixty-eight cases were classified as B-cell lymphoma, including 63 cases (87.5%) of diffuse large B-cell lymphoma (DLBCL; including 3 cases of EBV-positive DLBCL and 60 cases of DLBCL, NOS), two cases of Burkitt lymphoma, one case of mantle cell lymphoma, one case of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue and one case of precursor B lymphoblastic leukemia/lymphoma. The remaining cases included two peripheral T-cell lymphoma (NOS), one extranodal NK/T cell lymphoma, nasal type and one myeloid sarcoma. In 63 cases of DLBCL, 22 cases (34.9%) expressed germinal center B-cell-like (GCB) phenotype and 41 cases (65.1%) showed non-germinal center B-cell-like (non-GCB) phenotype. Conclusions: Core needle biopsy could be the preferred method for diagnosis of breast lymphoma. Diffuse large B-cell lymphoma is the most common histologic type of breast lymphoma, and non-GCB subtype is more frequent than GCB subtype.

Fluorescence Imaging for Cancer Screening and Surveillance

The advent of fluorescence imaging (FI) for cancer cell detection in the field of oncology is promising for both cancer screening and surgical resection. Particularly, FI in cancer screening and surveillance is actively being evaluated in many new clinical trials with over 30 listed on Clinical Trials.gov . While surgical resection forms the foundation of many oncologic treatments, early detection is the cornerstone for improving outcomes and reducing cancer-related morbidity and mortality. The applications of FI are twofold as it can be applied to high-risk patients in addition to those undergoing active surveillance. This technology has the promise of highlighting lesions not readily detected by conventional imaging or physical examination, allowing disease detection at an earlier stage of development. Additionally, there is a persistent need for innovative, cost-effective imaging modalities to ameliorate healthcare disparities and the global burden of cancer worldwide. In this review, we outline the current utility of FI for screening and detection in a range of cancer types.

Expression of APOB, ADFP and FATP1 and their correlation with fat deposition in Yunnan's top six famous chicken breeds

1. Adipose differentiation related protein (ADFP), fatty acid transport protein 1 (FATP1) and apolipoprotein B (APOB) are suspected to play an important role in determining intramuscular fat and in overall meat quality. 2. Yunnan's top six famous chicken breeds (the Daweishan Mini, Yanjin Black-bone, Chahua, Wuding, Wuliangshan Black-bone and Piao chicken) are known for the high quality of their meat, but little is known about their expression of these three genes. 3. The present study aimed to examine the ADFP, FATP1 and APOB genes in different tissues of these six breeds at different development stages. The subcutaneous fat from the back midline and front, abdominal fat, liver and muscle tissue was sampled at 28, 49, 70, 91 and 112 days. The expression of ADFP, FATP1 and APOB was measured by real-time PCR. 4. The results showed that the expression of the three genes differed depending on age, tissue types and breeds. However, the expression of the three genes correlated with fat traits. In conclusion, the expression of the ADFP, FATP1 and APOB genes is associated with the fat traits of Yunnan's top six chicken breeds. These results could help with molecular marker screening and marker-assisted breeding to improve the quality of poultry for meat production.

Gene expression profiles for a prognostic immunoscore in gastric cancer

Background

Increasing evidence has indicated an association between immune infiltration in gastric cancer and clinical outcome. However, reliable prognostic signatures, based on systematic assessments of the immune landscape inferred from bulk tumour transcriptomes, have not been established. The aim was to develop an immune signature, based on the cellular composition of the immune infiltrate inferred from bulk tumour transcriptomes, to improve the prognostic predictions of gastric cancer.

Methods

Twenty‐two types of immune cell fraction were estimated based on large public gastric cancer cohorts from the Gene Expression Omnibus using CIBERSORT. An immunoscore based on the fraction of immune cell types was then constructed using a least absolute shrinkage and selection operator (LASSO) Cox regression model.

Results

Using the LASSO model, an immunoscore was established consisting of 11 types of immune cell fraction. In the training cohort (490 patients), significant differences were found between high‐ and low‐immunoscore groups in overall survival across and within subpopulations with an identical TNM stage. Multivariable analysis revealed that the immunoscore was an independent prognostic factor (hazard ratio 1·92, 95 per cent c.i. 1·54 to 2·40). The prognostic value of the immunoscore was also confirmed in the validation (210) and entire (700) cohorts.

Conclusion

The proposed immunoscore represents a promising signature for estimating overall survival in patients with gastric cancer.

Immunoscore predicts prognosis

Abstract P4-09-05: Withdrawn

This abstract was withdrawn by the authors.

My experience in an oral and maxillofacial post as a profoundly deaf dental core trainee

This article reviews my experience as a profoundly deaf dental core trainee (DCT) in oral and maxillofacial surgery at Wythenshawe Hospital - working on call, carrying out daily clinics and assisting in theatre. A novel set of challenges presented, such as understanding conversations on the phone and minimising interference from background noise. Support was sought from Occupational Health, Access to Work and FM Hearing Systems, who provided practical advice and technological solutions. This year has improved my confidence and who I am as a person, and as a dentist. Plus, due to my newfound technical support I am able to hear a lot better on the phone now. It is hoped this article this will provide a useful insight for employers on how to support employees with hearing difficulties, and inspire future candidates.

Flapless vs flapped implant insertion in patients with controlled type 2 diabetes subjected to delayed loading: 1-year follow-up results from a randomised controlled trial

PURPOSE

To compare the outcome of dental implants placed following full-thickness flap surgery with flapless surgery in controlled type 2 diabetic patients.

MATERIALS AND METHODS

A total of 92 controlled type 2 diabetic patients, who needed missing mandibular first molars to be replaced by implants, were selected for a single-centre, parallel group, double-blinded randomised controlled trial. Patients were randomly allocated into two groups: flap (46 patients) vs flapless (46 patients) implant placement. Implants were loaded with metal-ceramic crowns, 4 months after placement in both groups.

OUTCOME MEASURES

Implant and crown success, complications, post-operative pain and swelling, plaque index, sulcular bleeding index, pocket depth and HbA1c level. Follow up examinations were made after 24 h, and on the third and seventh days for soft tissue healing, pain and swelling evaluation; then at 6 months and 12 months (after loading) for dental plaque, sulcular bleeding, pocket depth, and HbA1c level evaluation.

RESULTS

After 16 months of implant placement, no dropouts occurred. Five implants failed, two in the flap group and three in the flapless group (4.34% vs 6.52%, McNemar test P = 1, difference = 0.4457, 95% CI of difference = 4.554 to 47.234). Seven prosthesis failures occurred, three in the flap group and four in the flapless group (McNemar test P = 1; difference = 0.4239; 95% CI of difference = 29.95 to 3.86). Two patients in each group were affected by complications. There were statistically insignificant differences in the incidence of complications between the groups (McNemar test P = 1; difference = 0.457; 95% CI of difference = 90.75 to 5.33). After 24 h, the flapped group patients showed significantly greater pain compared with the flapless group (24 h: P = 0.017, difference = 0.37 and 95% CI = 0.673 to -0.067). After the third and seventh postoperative days, the mean pain level in both groups decreased linearly after the treatments (third day: P = 0.183, difference = 0.19 and 95% CI = -0.472 to 0.092; seventh day: P = 0.225, difference = 0.09 and 95% CI = -0.237 to 0.056). The frequency of post-operative swelling "some + a lot" at the third day was significantly higher in the full thickness flap group compared with the flapless group (P = 0.002, difference = 0.1835 and 95% CI = -0.0409 to 0.4079). Most of the cases in either of the study groups demonstrated no swelling (P =1.00, difference = 0.00 and 95% CI = -0.3034 to 0.3034) on the seventh post-operative day. The mean plaque index (6 months: 1.00 ± 0.47 vs 0.83 ± 0.79, P = 0.230, difference = 0.17 and 95% CI = -0.450 to 0.110 and 12 months: 1.30 ± 0.67 vs 1.04 ± 0.86, P = 0.123, difference = 0.26 and 95% CI = 0.593 to 0.073), mean sulcular bleeding index (6 months: 1.40 ± 0.52 vs 1.04 ± 0.83, P = 0.018, difference = 0.36 and 95% CI = 0.658 to 0.062 and 12 months: 1.90 ± 0.48 vs 1.17 ± 0.57, P = < 0.001, difference = -0.73 and 95% CI = -0.958 to -0.503) and pocket depth (6 months: 1.30 ± 0.26 vs 1.17 ± 0.25, P = 0.021, difference = -0.13 and 95% CI = - 0.240 to- 0.012 and 12 months: 1.95 ± 0.28 vs 1.56 ± 0.17, P = < 0.001, difference = -0.39 and 95% CI = -0.490 to -0.290) in both groups increased after the treatment and the increase was evident higher in full thickness flap group than flapless group.

CONCLUSIONS

On the basis of these results, it was concluded that flapless surgical technique could be considered for dental implant placement in type 2 diabetic patients to reduce post-operative pain and swelling.

Crestal Bone Loss under Delayed Loading of Full Thickness Versus Flapless Surgically Placed Dental Implants in Controlled Type 2 Diabetic Patients: A Parallel Group Randomized Clinical Trial

PURPOSE

To compare crestal bone loss around dental implants using a delayed loading protocol. Bone loss was compared in patients following conventional full thickness flap and flapless surgery in controlled type 2 diabetic patients.

MATERIALS AND METHODS

Eighty-eight type 2 diabetic patients satisfying predetermined inclusion and exclusion criteria were selected for this single center, parallel group study after obtaining institutional review board approval and informed consent. These patients were randomly divided into two groups. Group I consisted of patients undergoing full thickness flap surgery for implant placement, and group II consisted of patients undergoing flapless surgery for implant placement. The mean age, duration of diabetes, glycosylated hemoglobin levels, and male-to-female ratio in both groups were matched and compared statistically. Dental implants were placed followed by delayed loading (4 months) in both groups. Crestal bone loss was assessed with intraoral periapical radiographs with the help of computer software (DBSWIN viewer). Actual implant length acted as the radiographic index, and implant-abutment junctions were used as a reference point for all measurements. Mesial and distal bone levels at baseline, 6, and 12 months post implant placement of the two groups were determined. Mesial and distal crestal bone loss from baseline to 6 and 12 months were calculated and compared with Tukey test using SPSS v15.0 statistical analysis software.

RESULTS

Tukey test revealed similar (not statistically different) mean mesial crestal bone loss between the two groups after 6 months (0.47 ± 0.08 mm vs. 0.36 ± 0.13 mm, p = 0.576) and after 12 months (1.56 ± 0.25 mm vs. 1.50 ± 0.22 mm, p = 0.891). The mean distal bone loss resulting between the two groups was not statistically different at 6 months (0.44 ± 0.08 mm vs. 0.35 ± 0.12 mm, p = 0.687) and at 12 months (1.57 ± 0.23 mm vs. 1.61 ± 0.22 mm, p = 0.947).

CONCLUSIONS

The results of this clinical randomized control trial indicated that in controlled type 2 diabetic patients, levels of crestal bone loss around dental implants placed following conventional full thickness flap surgery was comparable to crestal bone loss around dental implants placed with the flapless surgical technique. More clinical studies are required regarding controlled type 2 diabetics with larger sample sizes, for long time periods to obtain more predictable results.

Invasive fungal rhinosinusitis with palatal erosion in an elderly edentulous patient with uncontrolled diabetes: report of a rare case

OBJECTIVES

To report a rare case of chronic invasive fungal rhinosinusitis with palatal erosion.

BACKGROUND

Restoring and maintaining oral health of diabetic elderly patients with increased risk of infections is a challenge to the dentist. Patients suffering from uncontrolled diabetes are susceptible to fungal infections. Palatal erosion due to fungal rhinosinusitis is rare.

MATERIALS AND METHODS

Case report of a 65 years old illiterate female patient from low socio-economic strata, suffering from uncontrolled diabetes and poor systemic health presenting with chronic invasive fungal rhinosinusitis leading to palatal erosion.

CONCLUSION

Such a case is a diagnostic challenge to a dentist. Therefore understanding the disease process and its possible outcomes is desirable. The treatment warrants a multidisciplinary approach.

Changes in alveolar bone density around immediate functionally and nonfunctionally loaded implants

STATEMENT OF PROBLEM

Few studies compare the radiographic changes in bone density associated with immediate implant loading protocols.

PURPOSE

The purpose of this longitudinal study was to quantitatively assess radiographic changes in alveolar bone density around immediate functionally and nonfunctionally loaded implants.

MATERIAL AND METHODS

A prospective longitudinal study was conducted in which 20 participants with partially edentulous mandibles received implants that were immediately loaded either functionally (IFL) or nonfunctionally (INFL). Standardized intraoral periapical radiographs were made at baseline, 3, and 6 months. These were digitized and analyzed using the histogram tool of the GNU Image Modulation Program for changes in alveolar bone density at crestal and lateral apical levels around the implant.

RESULTS

An increase in the mean lateral apical pixel grayscale values of 4.68 ±0.80 at 3 months and 4.15 ±0.29 at 6 months was observed with IFL, while INFL demonstrated an increase of 5.66 ±0.53 at 3 months and 6.07 ±0.59 at 6 months. A decrease in the mean crestal pixel grayscale values of -24.40 ±7.41 with IFL and -16.86 ±5.14 with INFL was found from baseline to 3 months.

CONCLUSIONS

On the basis of this longitudinal study, it was concluded that immediate loading stimulated alveolar bone formation at 6 months after implant placement. The immediate functional loading of implants resulted in a significantly greater degree of bone demineralization at the alveolar crest from implant placement up to 3 months compared with immediate nonfunctional loading.

Zirconia based dental ceramics: structure, mechanical properties, biocompatibility and applications

Zirconia (ZrO₂) based dental ceramics have been considered to be advantageous materials with adequate mechanical properties for the manufacturing of medical devices.

An In Vivo 24-Month Study to Compare Crestal Bone Loss and Pocket Depth of Platform-Switched Implants Placed in Maxillary Anterior and Mandibular Posterior Regions

PURPOSE

To analyze and compare crestal bone loss and pocket depth around platform-switched implants placed at two intraoral locations.

MATERIALS AND METHODS

Eighty platform-switched implants, 40 in the maxillary anterior region (group - ANT) and 40 in the mandibular posterior region (group - POST), were placed in healthy men aged between 25 and 45 years, and restored following two-stage surgical and progressive loading protocols. Digital radiographs for crestal bone level assessment and pocket depths on facial, mesial, distal, and palatal/lingual sites around the implant were recorded at definitive restoration cementation (baseline) and 6-month follow-up. Difference in pre- and post-periodontal pocket depths and crestal bone loss levels were measured and analyzed statistically using SPSS v.16.0, applying the Mann-Whitney test (p < 0.05 considered significant).

RESULTS

Mean bone loss was significantly higher in group ANT (1.2 ± 0.3 mm) than in group POST (0.7 ± 0.02 mm). Palatal pocket depth increase was significantly greater in the ANT group (p = 0.01), and distal pocket depth increase was significantly greater for the POST group (p = 0.002).

CONCLUSION

The amount of bone loss noted in the maxillary anterior region compared to the mandibular posterior region was significantly more. This could possibly be because of greater vertical cantilever and offset loads in the anterior compared to the posterior region. Significantly greater pocket depth in mandibular posterior distal and maxillary anterior palatal regions could be related to oral hygiene maintenance issues.