Image findings of anti-neutrophil cytoplasmic antibody-associated vasculitis involving the skull base

AIM

To investigate computed tomography (CT) and magnetic resonance imaging (MRI) features of skull bases involving anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV).

MATERIALS AND METHODS

A retrospective review was undertaken to identify an institutional historical cohort of 17 patients with confirmed AAV who underwent CT or MRI and had skull base involvement between 2002 and 2021. Two radiologists reviewed the extent and features of the lesions, bone changes, and other MRI findings.

RESULTS

A total of 17 patients (12 men; mean age ± standard deviation, 46.5 ± 17.1 years) were selected. AAV presented as infiltrative lesions with involvement at various sites. Most cases involved the paranasal sinuses (PNS; 88%, 15/17), nasopharynx (88%, 15/17), pterygopalatine fossa (82%, 14/17), and parapharyngeal space (82%, 14/17), frequently accompanied by mucosal irregularity of the PNS and nasopharynx (71%, 12/17). Central skull base and temporal bone involvement were seen in 53% (9/17) and 38% (6/16) of cases, respectively. On T1-weighted imaging (WI) and T2WI MRI, all lesions (15/15) showed predominant signal iso-intensity to grey matter.

CONCLUSIONS

Although radiological findings of AAV are non-specific and skull base involvement is less common, AAV may be considered if infiltrative lesions predominantly involving the PNS, nasopharynx, pterygopalatine fossa, and parapharyngeal space with combined bone changes of skull base are seen.

Classification of Alzheimer's disease stage using machine learning for left and right oxygenation difference signals in the prefrontal cortex: a patient-level, single-group, diagnostic interventional trial

OBJECTIVE

Recent evidence shows that indicators testing conventional olfactory function have a high degree of similarity to cognitive function tests and the potential to diagnose early-stage Alzheimer's disease (AD). In this study, the efficacy of functional near-infrared spectroscopy time-series data obtained through olfactory stimulation was investigated as an early diagnostic tool for mild cognitive impairment in AD using random forest, a machine learning algorithm.

PATIENTS AND METHODS

We conducted a patient-level, single-group, diagnostic interventional trial using near-infrared signals measured during olfactory stimulation in the prefrontal cortex of 178 older adults ranging from normal to participants with AD as markers to discriminate AD stages. We first divided the participants into normal older adults, AD mild cognitive impairment, and AD groups using dementia diagnostic criteria such as the Mini-Mental State Examination and Seoul Neuropsychological Screening Battery. We compared the left and right oxygenation difference by calculating the relative oxygenation difference from the change in relative oxygen concentration.

RESULTS

A total of 168 participants met the eligibility criteria: 70 (41.6%) had normal cognitive function; 42 (25%) mild cognitive impairment; 21 (12.5%) mild AD; and 35 (20.8%) moderate AD. A random forest machine learning model was developed to predict the AD stage, with an area under the receiver operating characteristic curve of 90.7% for mild cognitive impairment and AD, 90.99% for mild cognitive impairment, and 93.34% for AD only.

CONCLUSIONS

Based on the classification of the oxygenation difference index of the left and right prefrontal cortices during olfactory stimulation through machine learning, we found that it was possible to detect early-stage mild cognitive impairment in AD. Our results highlight the potential for early AD diagnosis using near-infrared signals from the prefrontal cortex obtained upon olfactory stimulation. Moreover, the results showed high similarity to the existing cognitive function tests and high accuracy in AD stage classification.

Effect of doping and loading Parameters on photocatalytic degradation of brilliant green using Sn doped ZnO loaded CSAC

Sn doped ZnO loaded cotton stalk activated carbon (Sn-ZnO/CSAC) was prepared by chemical precipitation method, and the products were characterized. The XRD resultants confirm that the presence of hexagonal wurtzite phase of the bare ZnO. Furthermore, particular particle size gradually decreases (21.49 nm) due to doping and loading. UV-Vis absorption intensity of doped/loaded sample was red-shifted and then PL intensity is reduced. The photocatalytic performances of bare, Sn-doped ZnO and Sn-ZnO/CSAC was estimated by photodegradation of brilliant green (BG) under sunlight. The photodegradation of BG dye in 120 min over Sn-doped ZnO/CSAC is nearly 96.52%, which is considerably improved than bare ZnO (72.60%), respectively.

Measurement of the Positive Muon Anomalous Magnetic Moment to 0.46 ppm

We present the first results of the Fermilab National Accelerator Laboratory (FNAL) Muon g-2 Experiment for the positive muon magnetic anomaly a_{μ}≡(g_{μ}-2)/2. The anomaly is determined from the precision measurements of two angular frequencies. Intensity variation of high-energy positrons from muon decays directly encodes the difference frequency ω_{a} between the spin-precession and cyclotron frequencies for polarized muons in a magnetic storage ring. The storage ring magnetic field is measured using nuclear magnetic resonance probes calibrated in terms of the equivalent proton spin precession frequency ω[over ˜]_{p}^{'} in a spherical water sample at 34.7 °C. The ratio ω_{a}/ω[over ˜]_{p}^{'}, together with known fundamental constants, determines a_{μ}(FNAL)=116 592 040(54)×10^{-11} (0.46 ppm). The result is 3.3 standard deviations greater than the standard model prediction and is in excellent agreement with the previous Brookhaven National Laboratory (BNL) E821 measurement. After combination with previous measurements of both μ^{+} and μ^{-}, the new experimental average of a_{μ}(Exp)=116 592 061(41)×10^{-11} (0.35 ppm) increases the tension between experiment and theory to 4.2 standard deviations.

Management of isolated recurrence after surgery for pancreatic adenocarcinoma

BACKGROUND

Recurrence of pancreatic cancer after primary pancreatectomy occurs in the vast majority of patients. The role of surgical treatment for recurrent pancreatic cancer is not well established.

METHODS

Patients who underwent primary pancreatectomy with curative intent from 2000 to 2014 at a single large-volume centre were evaluated retrospectively. CT or PET was used to select patients with an isolated recurrence. The clinicopathological features and survival outcomes were compared according to treatment modalities.

RESULTS

Of the 1610 patients with pancreatic cancer who underwent resection, 1346 (83·6 per cent) were diagnosed with recurrent pancreatic cancer. Recurrence was locoregional in 366 patients (27·2 per cent), distant multifocal in 251 (18·6 per cent), distant isolated in 188 (14·0 per cent), locoregional plus distant in 153 (11·4 per cent) and peritoneal seeding in 388 (28·8 per cent). Of the 1346 patients with recurrence, 197 (14·6 per cent) had isolated recurrence; of these, 48 (24·4 per cent of all isolated recurrences; 3·6 per cent of all recurrences) underwent resection. Median survival of the 197 patients after diagnosis of isolated recurrence was 14·7 months; it was longer in patients who underwent surgical resection than among those treated non-surgically (23·5 versus 12·0 months; P = 0·014). Multivariable analysis showed that chemotherapy and resection for recurrence were associated with better prognosis. Median survival after recurrence was longest in the 23 patients with isolated pulmonary recurrence (33·3 months). Survival after recurrence was better in patients who underwent resection of isolated recurrence in the remnant pancreas (median 28·0 versus 12·0 months, P = 0·010) and lung (median 36·5 versus 9·5 months; P = 0·010) than in those who did not undergo resection.

CONCLUSION

Surgical resection may be considered an option for treatment of patients with isolated recurrent pancreatic cancer.

Three-dimensional analysis of tooth movement in Class II malocclusion treatment using arch wire with continuous tip-back bends and intermaxillary elastics

Objective

The aim of this study was to analyze three-dimensional (3D) changes in maxillary dentition in Class II malocclusion treatment using arch wire with continuous tip-back bends or compensating curve, together with intermaxillary elastics by superimposing 3D virtual models.

Methods

The subjects were 20 patients (2 men and 18 women; mean age 20 years 7 months ± 3 years 9 months) with Class II malocclusion treated using 0.016 × 0.022-inch multiloop edgewise arch wire with continuous tip-back bends or titanium molybdenum alloy ideal arch wire with compensating curve, together with intermaxillary elastics. Linear and angular measurements were performed to investigate maxillary teeth displacement by superimposing pre- and post-treatment 3D virtual models using Rapidform 2006 and analyzing the results using paired t-tests.

Results

There were posterior displacement of maxillary teeth (p < 0.01) with distal crown tipping of canine, second premolar and first molar (p < 0.05), expansion of maxillary arch (p < 0.05) with buccoversion of second premolar and first molar (p < 0.01), and distal-in rotation of first molar (p < 0.01). Reduced angular difference between anterior and posterior occlusal planes (p < 0.001), with extrusion of anterior teeth (p < 0.05) and intrusion of second premolar and first molar (p < 0.001) was observed.

Conclusions

Class II treatment using an arch wire with continuous tip-back bends or a compensating curve, together with intermaxillary elastics, could retract and expand maxillary dentition, and reduce occlusal curvature. These results will help clinicians in understanding the mechanism of this Class II treatment.

Efficacy, Immunogenicity, and Safety of a 9-Valent Human Papillomavirus Vaccine: Subgroup Analysis of Participants From Asian Countries

Background

A 9-valent human papillomavirus-6/11/16/18/31/33/45/52/58 (9vHPV) vaccine extends coverage to 5 next most common oncogenic types (31/33/45/52/58) in cervical cancer versus quadrivalent HPV (qHPV) vaccine. We describe efficacy, immunogenicity, and safety in Asian participants (India, Hong Kong, South Korea, Japan, Taiwan, and Thailand) from 2 international studies: a randomized, double-blinded, qHPV vaccine-controlled efficacy study (young women aged 16–26 years; NCT00543543; Study 001); and an immunogenicity study (girls and boys aged 9–15 years; NCT00943722; Study 002).

Methods

Participants (N = 2519) were vaccinated at day 1 and months 2 and 6. Gynecological samples (Study 001 only) and serum were collected for HPV DNA and antibody assessments, respectively. Injection-site and systemic adverse events (AEs) were monitored. Data were analyzed by country and vaccination group.

Results

9vHPV vaccine prevented HPV-31/33/45/52/58–related persistent infection with 90.4%–100% efficacy across included countries. At month 7, ≥97.9% of participants seroconverted for each HPV type. Injection-site AEs occurred in 77.7%–83.1% and 81.9%–87.5% of qHPV and 9vHPV vaccine recipients in Study 001, respectively, and 62.4%–85.7% of girls/boys in Study 002; most were mild to moderate.

Conclusions

The 9vHPV vaccine is efficacious, immunogenic, and well tolerated in Asian participants. Data support 9vHPV vaccination programs in Asia.

Clinical Trials Registration

NCT00543543; NCT00943722.

Long-term survival of pig-to-rhesus macaque renal xenografts is dependent on CD4 T cell depletion

The shortage of available organs remains the greatest barrier to expanding access to transplant. Despite advances in genetic editing and immunosuppression, survival in experimental models of kidney xenotransplant has generally been limited to <100 days. We found that pretransplant selection of recipients with low titers of anti-pig antibodies significantly improved survival in a pig-to-rhesus macaque kidney transplant model (6 days vs median survival time 235 days). Immunosuppression included transient pan-T cell depletion and an anti-CD154-based maintenance regimen. Selective depletion of CD4⁺ T cells but not CD8⁺ T cells resulted in long-term survival (median survival time >400 days vs 6 days). These studies suggested that CD4⁺ T cells may have a more prominent role in xenograft rejection compared with CD8⁺ T cells. Although animals that received selective depletion of CD8⁺ T cells showed signs of early cellular rejection (marked CD4⁺ infiltrates), animals receiving selective CD4⁺ depletion exhibited normal biopsy results until late, when signs of chronic antibody rejection were present. In vitro study results suggested that rhesus CD4⁺ T cells required the presence of SLA class II to mount an effective proliferative response. The combination of low pretransplant anti-pig antibody and CD4 depletion resulted in consistent, long-term xenograft survival.

Cytoprotective Effects of an Aqueous Extracts from Atrina Pectinate Meat in H2O2-Induced Oxidative Stress in a Human Hepatocyte

In the present study, we investigated the antioxidant activity of an aqueous extract from Atrina pectinate meat (APW) against H₂O₂-induced oxidative stress in a human hepatocyte. The extraction yield of APW was 30.01 ± 0.83% and which contained the highest taurine content among free amino acid contents. APW led to the high antioxidant activity showing 2,2-azino-bis(3-ethylbenzthiazoline)-6-sulfonic acid (ABTS) radical scavenging activity, good reducing power and oxygen radical absorbance capacity (ORAC) value. Also, the results showed that APW improved the cell viability decreased by H₂O₂ stimulation as well as the reduction of intracellular reactive oxygen species (ROS) generation in hepatocytes. Additionally, APW up-regulated the production of antioxidant mechanisms related enzymes such as catalase and superoxide dismutase (SOD), compared to the only H₂O₂-treated hepatocytes. Moreover, APW increased the expressions of nuclear Nrf2 and cytosolic HO-1 in H₂O₂-treated hepatocytes. Interestingly, the treatment of ZnPP, a HO-1 inhibitor abolished the cell viability and intracellular ROS generation induced by APW treatment. In conclusion, this study suggests that APW protects H₂O₂ induced oxidative stress via up-regulating of Nrf2/HO-1 signal pathway in hepatocytes.

An Aqueous Extract from Batillus Cornutus Meat Protects Against H2O2-Mediated Cellular Damage via Up-Regulation of Nrf2/HO-1 Signal Pathway in Chang Cells

In this study, we evaluated the protective effects of an aqueous extract from Batillus cornutus meat (BM) against cellular oxidative damage caused by hydrogen peroxide (H₂O₂) in human hepatocyte, Chang cells. First, we prepared an aqueous extract of BM meat (BMW) showing the highest taurine content among free amino acid contents. BMW led to high antioxidant activity showing 2,2-azino-bis(3-ethylbenzthiazoline)-6-sulfonic acid (ABTS) radical scavenging activity, good reducing power and an oxygen radical absorbance capacity (ORAC) value. Also, BMW improved cell viability that was diminished by H₂O₂ exposure, as it reduced the generation of intracellular reactive oxygen species (ROS) in Chang cells. In addition, BMW up-regulated the production of antioxidant enzymes, such as catalase and superoxide dismutase (SOD), compared to H₂O₂-treated Chang cells lacking BMW. Moreover, BMW induced the expressions of nuclear Nrf2 and cytosolic HO-1 in H₂O₂-treated Chang cells. Interestingly, the treatment of ZnPP, HO-1 inhibitor, abolished the improvement in cell viability and intracellular ROS generation mediated by BMW treatment. In conclusion, this study suggests that BMW protects hepatocytes against H₂O₂-mediated cellular oxidative damage via up-regulation of the Nrf2/HO-1 signal pathway.

Long-Term Ultrasound Follow-Up of Incidentally Detected Thyroglossal Duct Cysts in Adults

BACKGROUND AND PURPOSE

There has been no previous study that used ultrasonography for longitudinal changes of thyroglossal duct cysts, to our knowledge. We assessed the prevalence and interval changes in incidentally detected thyroglossal duct cysts in adults.

MATERIALS AND METHODS

From January 2010 to December 2016, we identified 796 ultrasonography radiologic reports from 513 subjects that contained the words "thyroglossal" or "TGDC" among 54,369 participants. Of 513 subjects, 172 (M/F = 103:69, mean age, 53 ± 11 years) who underwent ≥2 sonography studies were enrolled. Two reviewers determined ultrasonography features, including maximal diameter, location, internal echogenicity, wall thickness, and the presence of posterior enhancement, internal septa, and solid components.

RESULTS

The mean follow-up time of total 172 lesions was 2.01 ± 1.13 years. Thyroglossal duct cysts ranged from 2 to 32 mm (mean, 8.77 ± 3.83 mm) on the initial ultrasonography examination. On follow-up ultrasonography studies, 14 lesions (8.2%) increased by >2 mm, while most thyroglossal duct cysts (133 lesions, 77.3%) remained stable in size. During the follow-up period, 31 lesions (18.0%) showed interval changes in ultrasonography features. There was no significant relationship between the presence of ultrasonography feature changes and size changes (P = .12).

CONCLUSIONS

On ultrasonography, 0.9% of adults had incidental thyroglossal duct cysts. Most did not increase in size with time despite changes in various ultrasonography features. Therefore, we recommend performing an observation at long intervals of 2-3 years for asymptomatic thyroglossal duct cysts, and we suggest that fine-needle aspiration can be suspended unless suspicious findings of malignancy are detected.

Cone-beam computed tomography analysis of transverse dental compensation in patients with skeletal Class III malocclusion and facial asymmetry

Objective

The purpose of this study was to analyze the transverse dental compensation in reference to the maxillary and mandibular basal bones using cone-beam computed tomography (CBCT) and evaluate the correlations between transverse dental compensation and skeletal asymmetry variables in patients with skeletal Class III malocclusion and facial asymmetry.

Methods

Thirty patients with skeletal Class I (control group; 15 men, 15 women) and 30 patients with skeletal Class III with menton deviation (asymmetry group; 16 men, 14 women) were included. Skeletal and dental measurements were acquired from reconstructed CBCT images using OnDemand3D 1.0 software. All measurements were compared between groups and between the deviated and nondeviated sides of the asymmetry group. Correlation coefficients for the association between skeletal and dental measurements were calculated.

Results

Differences in the ramus inclination (p < 0.001), maxillary canine and first molar inclinations (p < 0.001), and distances from the canine and first molar cusp tips to the midmaxillary or midmandibular planes (p < 0.01) between the right and left sides were significantly greater in the asymmetry group than in the control group. In the asymmetry group, the ramus inclination difference (p < 0.05) and mandibular canting (p < 0.05) were correlated with the amount of menton deviation. In addition, dental measurements were positively correlated with the amount of menton deviation (p < 0.05).

Conclusions

Transverse dental compensation was correlated with the maxillary and mandibular asymmetry patterns. These results would be helpful in understanding the pattern of transverse dental compensation and planning surgical procedure for patients with skeletal Class III malocclusion and facial asymmetry.

Anion gap and base deficit are predictors of mortality in acute pesticide poisoning

BACKGROUND:

Acute pesticide poisoning has long been a serious problem as a method of suicide worldwide. This poisoning is a highly fatal condition that requires a rapid and precise diagnosis for adequate treatment. However, various studies on mortality predictor factors have been insufficient for whole pesticide treatments. We hypothesized that the initial plasma anion gap (AG) and base deficit (BD) are reliable prognostic factors.

METHODS:

A retrospective study analyzed 561 patients with a diagnosis of acute pesticide poisoning between January 1, 2014 and June 30, 2017. The initial AG and BD values were divided into quartiles according to the number of patients. Survival at 30 days from admission was estimated using the Kaplan-Meier survival analysis. Receiver-operator characteristic (ROC) curves were drawn, and the areas under the curve for AG and BD for mortality were calculated.

RESULTS:

Fifty-eight (10.3%) of 561 patients died within 30 days. The highest AG quartile (>22 mEq/L) was associated with an increased risk of 30-day hospital mortality. Compared to patients with an AG less than 14.7 mEq/L, these patients had a 4.18-fold higher risk of 30-day hospital mortality and the highest BD quartile (>7.9 mEq/L) was associated with an increased risk of 30-day hospital mortality. Compared to patients with a BD less than 1.4 mEq/L, these patients had 2.23-fold higher risk of 30-day hospital mortality. The areas under the ROC for AG and BD curve were 0.699 and 0.744, respectively.

CONCLUSIONS:

Initial high AG and BD values could predict mortality and require precise intensive care.

The biological response to laser-aided direct metal-coated Titanium alloy (Ti6Al4V)

Objectives

Laser-engineered net shaping (LENS) of coated surfaces can overcome the limitations of conventional coating technologies. We compared the in vitro biological response with a titanium plasma spray (TPS)-coated titanium alloy (Ti6Al4V) surface with that of a Ti6Al4V surface coated with titanium using direct metal fabrication (DMF) with 3D printing technologies.

Methods

The in vitro ability of human osteoblasts to adhere to TPS-coated Ti6Al4V was compared with DMF-coating. Scanning electron microscopy (SEM) was used to assess the structure and morphology of the surfaces. Biological and morphological responses to human osteoblast cell lines were then examined by measuring cell proliferation, alkaline phosphatase activity, actin filaments, and RUNX2 gene expression.

Results

Morphological assessment of the cells after six hours of incubation using SEM showed that the TPS- and DMF-coated surfaces were largely covered with lamellipodia from the osteoblasts. Cell adhesion appeared similar in both groups. The differences in the rates of cell proliferation and alkaline phosphatase activities were not statistically significant.

Conclusions

The DMF coating applied using metal 3D printing is similar to the TPS coating, which is the most common coating process used for bone ingrowth. The DMF method provided an acceptable surface structure and a viable biological surface. Moreover, this method is automatable and less complex than plasma spraying.

Cite this article: T. Shin, D. Lim, Y. S. Kim, S. C. Kim, W. L. Jo, Y. W. Lim. The biological response to laser-aided direct metal-coated Titanium alloy (Ti6Al4V). Bone Joint Res 2018;7:357–361. DOI: 10.1302/2046-3758.75.BJR-2017-0222.R1.

International Bullous Diseases Group: consensus on diagnostic criteria for epidermolysis bullosa acquisita

BACKGROUND

Epidermolysis bullosa acquisita (EBA) is a complex autoimmune bullous disease disease with variable clinical presentations and multiple possible diagnostic tests, making an international consensus on the diagnosis of EBA essential.

OBJECTIVES

To obtain an international consensus on the clinical and diagnostic criteria for EBA.

METHODS

The International Bullous Diseases Group (IBDG) met three times to discuss the clinical and diagnostic criteria for EBA. For the final voting exercise, 22 experts from 14 different countries voted on 50 different items. When > 30% disagreed with a proposal, a discussion was held and re-voting carried out.

RESULTS

In total, 48 of 50 proposals achieved consensus after discussion. This included nine diagnostic criteria, which are summarized in a flow chart. The IBDG was unable to determine one procedure that would be applicable worldwide. A limitation of the study is that differential diagnosis of bullous systemic lupus erythematosus has not been addressed.

CONCLUSIONS

This first international consensus conference established generally agreed-upon clinical and laboratory criteria defining the clinical classification of and diagnostic testing for EBA. Holding these voting exercises in person with the possibility of discussion prior to voting has advantages in reaching consensus over Delphi exercises with remote voting.

Clinical and genomic landscape of gastric cancer with a mesenchymal phenotype

Gastric cancer is a heterogeneous cancer, making treatment responses difficult to predict. Here we show that we identify two distinct molecular subtypes, mesenchymal phenotype (MP) and epithelial phenotype (EP), by analyzing genomic and proteomic data. Molecularly, MP subtype tumors show high genomic integrity characterized by low mutation rates and microsatellite stability, whereas EP subtype tumors show low genomic integrity. Clinically, the MP subtype is associated with markedly poor survival and resistance to standard chemotherapy, whereas the EP subtype is associated with better survival rates and sensitivity to chemotherapy. Integrative analysis shows that signaling pathways driving epithelial-to-mesenchymal transition and insulin-like growth factor 1 (IGF1)/IGF1 receptor (IGF1R) pathway are highly activated in MP subtype tumors. Importantly, MP subtype cancer cells are more sensitive to inhibition of IGF1/IGF1R pathway than EP subtype. Detailed characterization of these two subtypes could identify novel therapeutic targets and useful biomarkers for prognosis and therapy response.

The prognosis and treatment of gastric cancer is complicated by heterogeneity. Here, the authors reveal two molecular subtypes, the mesenchymal subtype associated with poor survival and chemoresistance, and the epithelial phenotype associated with better survival and sensitivity to chemotherapy.

Preparation of “Open/closed” pores of PLGA-microsphere for controlled release of protein drug

Poly(D,L-lactic-co-glycolic acid)  has been extensively used as a controlled release carrier for drug delivery due to its good biocompatibility, biodegradability, and mechanical strength. In this study, porous PLGA microspheres were fabricated by an emulsion-solvent evaporation technique using poly ethylene glycol (PEG) as an extractable porogen and loaded with  protein (lysozyme) by suspending them in protein solution. For controlled release of protein, porous microspheres containing lysozyme were treated with water-miscible solvents in aqueous phase for production of pore-closed microspheres. The surface morphology of microspheres were investigated using scanning electron microscopy (SEM) for confirmation of its porous microstructure structure. Protein property after release was observed by enzymatic activity assay. The pore-closing process resulted in nonporous microspheres which exhibited sustained release patterns over an extended period.

Effect of carbonated water manufactured by a soda carbonator on etched or sealed enamel

Objective

The purpose of this study was to determine the effects of carbonated water on etched or sealed enamel according to the carbonation level and the presence of calcium ions.

Methods

Carbonated water with different carbonation levels was manufactured by a soda carbonator. Seventy-five premolar teeth were randomly divided into a control group and 4 experimental groups in accordance with the carbonation level and the presence of calcium ions in the test solutions. After specimen preparation of the Unexposed, Etched, and Sealed enamel subgroups, all the specimens were submerged in each test solution for 15 minutes three times a day during 7 days. Microhardness tests on the Unexposed and Etched enamel subgroups were performed with 10 specimens from each group. Scanning electron microscopy (SEM) tests on the Unexposed, Etched, and Sealed enamel subgroups were performed with 5 specimens from each group. Microhardness changes in different groups were statistically compared using paired t-tests, the Wilcoxon signed rank test, and the Kruskal-Wallis test.

Results

The microhardness changes were significantly different between the groups (p = 0.000). The microhardness changes in all experimental groups except Group 3 (low-level carbonated water with calcium ions) were significantly greater than those in the Control group. SEM showed that etched areas of the specimen were affected by carbonated water and the magnitude of destruction varied between groups. Adhesive material was partially removed in groups exposed to carbonated water.

Conclusions

Carbonated water has negative effects on etched or sealed enamel, resulting in decreased microhardness and removal of the adhesive material.

Belatacept-Resistant Rejection Is Associated With CD28+ Memory CD8 T Cells

Recently, newer therapies have been designed to more specifically target rejection in an effort to improve efficacy and limit unwanted toxicity. Belatacept, a CD28-CD80/86 specific reagent, is associated with superior patient survival and graft function compared with traditional therapy, but its adoption as a mainstay immunosuppressive therapy has been tempered by increased rejection rates. It is essential that the underlying mechanisms associated with this rejection be elucidated before belatacept is more widely used. To that end, we designed a study in a nonhuman primate kidney transplant model where animals were treated with either a belatacept- or a tacrolimus-based immunosuppressive regimen. Interestingly, we found that elevated pretransplant frequencies of CD28⁺ CD8⁺ T_EMRA cells are associated with rejection on belatacept but not tacrolimus treatment. Further analysis showed that the CD28⁺ CD8⁺ T_EMRA cells rapidly lose CD28 expression after transplant in those animals that go on to reject with the allograft infiltrate being predominantly CD28^- . These data suggest that CD28⁺ memory T cells may be resistant to belatacept, capable of further differentiation including loss of CD28 expression while maintaining effector function. The unique signaling requirements of CD28⁺ memory T cells provide opportunities for the development of targeted therapies, which may synergize with belatacept to prevent costimulation-independent rejection.

Patterns and predictors of persistent opioid use following hip or knee arthroplasty

OBJECTIVE

The relationship between arthroplasty and long-term opioid use in patients with knee or hip osteoarthritis is not well studied. We examined the prevalence, patterns and predictors of persistent opioid use after hip or knee arthroplasty.

METHOD

Using claims data (2004-2013) from a US commercial health plan, we identified adults who underwent hip or knee arthroplasty and filled ≥1 opioid prescription within 30 days after the surgery. We defined persistent opioid users as patients who filled ≥1 opioid prescription every month during the 1-year postoperative period based on group-based trajectory models. Multivariable logistic regression was used to determine preoperative predictors of persistent opioid use after surgery.

RESULTS

We identified 57,545 patients who underwent hip or knee arthroplasty. The mean ± SD age was 61.5 ± 7.8 years and 87.1% had any opioid use preoperatively. Overall, 7.6% persistently used opioids after the surgery. Among patients who used opioids in 80% of the time for ≥4 months preoperatively (n = 3023), 72.1% became persistent users. In multivariable analysis, knee arthroplasty vs hip, a longer hospitalization stay, discharge to a rehabilitation facility, preoperative opioid use (e.g., a longer duration and greater dosage and frequency), a higher comorbidity score, back pain, rheumatoid arthritis, fibromyalgia, migraine and smoking, and benzodiazepine use at baseline were strong predictors for persistent opioid use (C-statistic = 0.917).

CONCLUSION

Over 7% of patients persistently used opioids in the year after hip or knee arthroplasty. Given the adverse health effects of persistent opioid use, strategies need to be developed to prevent persistent opioid use after this common surgery.

4-O-Methylhonokiol Protects HaCaT Cells from TGF-β1-Induced Cell Cycle Arrest by Regulating Canonical and Non-Canonical Pathways of TGF-β Signaling

4-O-methylhonokiol, a neolignan compound from Magnolia Officinalis, has been reported to have various biological activities including hair growth promoting effect. However, although transforming growth factor-β (TGF-β) signal pathway has an essential role in the regression induction of hair growth, the effect of 4-O-methylhonokiol on the TGF-β signal pathway has not yet been elucidated. We thus examined the effect of 4-O-methylhonokiol on TGF-β-induced canonical and noncanonical pathways in HaCaT human keratinocytes. When HaCaT cells were pretreated with 4-O-methylhonokiol, TGF-β1-induced G1/G0 phase arrest and TGF-β1-induced p21 expression were decreased. Moreover, 4-O-methylhonokiol inhibited nuclear translocation of Smad2/3, Smad4 and Sp1 in TGF-β1-induced canonical pathway. We observed that ERK phosphorylation by TGF-β1 was significantly attenuated by treatment with 4-O-methylhonokiol. 4-O-methylhonokiol inhibited TGF-β1-induced reactive oxygen species (ROS) production and reduced the increase of NADPH oxidase 4 (NOX4) mRNA level in TGF-β1-induced noncanonical pathway. These results indicate that 4-O-methylhonokiol could inhibit TGF-β1-induced cell cycle arrest through inhibition of canonical and noncanonical pathways in human keratinocyte HaCaT cell and that 4-O-methylhonokiol might have protective action on TGF-β1-induced cell cycle arrest.

Efficient extraction of oil from droplet microfluidic emulsions

Droplet microfluidic techniques can perform large numbers of single molecule and cell reactions but often require controlled, periodic flow to merge, split, and sort droplets. Here, we describe a simple method to convert aperiodic flows into periodic ones. Using an oil extraction module, we efficiently remove oil from emulsions to readjust the droplet volume fraction, velocity, and packing, producing periodic flows. The extractor acts as a universal adaptor to connect microfluidic modules that do not operate under identical flow conditions, such as droplet generators, incubators, and merger devices.

Base deficit is a predictor of mortality in organophosphate insecticide poisoning

OBJECTIVE

Organophosphate insecticide (OPI) self-poisoning is a major medical problem in many countries. Several studies have demonstrated that the base deficit (BD) is a prognostic tool that is correlated with the severity of injury and predicted mortality, particularly in trauma patients. Here, we aimed to investigate the prognostic significance of BD in OPI poisoning.

METHODS

This retrospective observational study was conducted between January 1, 2006, and January 31, 2015, at a single emergency department (ED). The BD values were divided into quartiles according to the number of patients: 3 mEq/L or less, 3-5.9 mEq/L, 6-9.9 mEq/L, and 10 mEq/L or greater. Survival at 30 days from ED admission was estimated using the Kaplan-Meier survival analysis.

RESULTS

Among 154 patients, 31 died, yielding a mortality of 20.1%. The highest BD quartile (≥ 10 mEq/L) and the 6-9.9 mEq/L group were associated with an increased risk of 30-day mortality. Patients with a BD of 10 mEq/L or greater had a 5.85-fold higher risk of 30-day mortality and patients with a BD of 6-9.9 mEq/L had a 5.40-fold higher risk of 30-day mortality compared to patients with a BD of 3 mEq/L or less. The area under the curves of the BD and the Acute Physiology and Chronic Health Evaluation II score for mortality were 0.748 (95% confidence interval (CI), 0.660-0.835) and 0.852 (95% CI, 0.789-0.915), respectively.

CONCLUSIONS

This study showed that the BD is a predictor of 30-day mortality in patients with OPI poisoning.

GALNT14 promotes lung-specific breast cancer metastasis by modulating self-renewal and interaction with the lung microenvironment

Some polypeptide N-acetyl-galactosaminyltransferases (GALNTs) are associated with cancer, but their function in organ-specific metastasis remains unclear. Here, we report that GALNT14 promotes breast cancer metastasis to the lung by enhancing the initiation of metastatic colonies as well as their subsequent growth into overt metastases. Our results suggest that GALNT14 augments the self-renewal properties of breast cancer cells (BCCs). Furthermore, GALNT14 overcomes the inhibitory effect of lung-derived bone morphogenetic proteins (BMPs) on self-renewal and therefore facilitates metastasis initiation within the lung microenvironment. In addition, GALNT14 supports continuous growth of BCCs in the lung by not only inducing macrophage infiltration but also exploiting macrophage-derived fibroblast growth factors (FGFs). Finally, we identify KRAS-PI3K-c-JUN signalling as an upstream pathway that accounts for the elevated expression of GALNT14 in lung-metastatic BCCs. Collectively, our findings uncover an unprecedented role for GALNT14 in the pulmonary metastasis of breast cancer and elucidate the underlying molecular mechanisms.

Comparison of the bonding strengths of second- and third-generation light-emitting diode light-curing units

Objective

With the introduction of third-generation light-emitting diodes (LEDs) in dental practice, it is necessary to compare their bracket-bonding effects, safety, and efficacy with those of the second-generation units.

Methods

In this study, 80 extracted human premolars were randomly divided into eight groups of 10 samples each. Metal or polycrystalline ceramic brackets were bonded on the teeth using second- or third-generation LED light-curing units (LCUs), according to the manufacturers’ instructions. The shear bond strengths were measured using the universal testing machine, and the adhesive remnant index (ARI) was scored by assessing the residual resin on the surfaces of debonded teeth using a scanning electron microscope. In addition, curing times were also measured.

Results

The shear bond strengths in all experimental groups were higher than the acceptable clinical shear bond strengths, regardless of the curing unit used. In both LED LCU groups, all ceramic bracket groups showed significantly higher shear bond strengths than did the metal bracket groups except the plasma emulation group which showed no significant difference. When comparing units within the same bracket type, no differences in shear bond strength were observed between the second- and third-generation unit groups. Additionally, no significant differences were observed among the groups for the ARI.

Conclusions

The bracket-bonding effects and ARIs of second- and third-generation LED LCUs showed few differences, and most were without statistical significance; however, the curing time was shorter for the second-generation unit.

Relationship between maturation indices and morphology of the midpalatal suture obtained using cone-beam computed tomography images

Objective

The purpose of this study was to determine whether predicting maturation of the midpalatal suture is possible by classifying its morphology on cone-beam computed tomography (CBCT) images and to investigate relationships with other developmental age indices.

Methods

The morphology of the midpalatal suture was assessed by using CBCT images of 99 patients. Axial plane images of the midpalatal suture were classified into five stages according to the classification scheme. To make the assessment more accurate, the morphology and fusion of the midpalatal suture were additionally investigated on coronal cross-sectional planar images and volume-rendered images. Bone age was evaluated using the hand and wrist method (HWM) and cervical vertebrae method (CVM); dental age (Hellman's index), sex, and chronological age were also assessed. To evaluate relationships among variables, Spearman's rho rank test was performed along with crosstabs using contingency coefficients.

Results

The HWM and CVM showed strong correlations with the maturation stage of the midpalatal suture, while other indices showed relatively weak correlations (p < 0.01). Through crosstabs, the HWM and CVM showed high association values with CBCT stage; the HWM demonstrated slightly higher values (p < 0.0001). Based on the HWM, the midpalatal suture was not fused until stage 6 in both sexes.

Conclusions

Among developmental age indices, the HWM and CVM showed strong correlations and high associations, suggesting that they can be useful in assessing maturation of the midpalatal suture.

Bone cutting capacity and osseointegration of surface-treated orthodontic mini-implants

Objective

The objective of the study was to evaluate the practicality and the validity of different surface treatments of self-drilling orthodontic mini-implants (OMIs) by comparing bone cutting capacity and osseointegration.

Methods

Self-drilling OMIs were surface-treated in three ways: Acid etched (Etched), resorbable blasting media (RBM), partially resorbabla balsting media (Hybrid). We compared the bone cutting capacity by measuring insertion depths into artificial bone (polyurethane foam). To compare osseointegration, OMIs were placed in the tibia of 25 rabbits and the removal torque value was measured at 1, 2, 4, and 8 weeks after placement. The specimens were analyzed by optical microscopy, scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDS).

Results

The bone cutting capacity of the etched and hybrid group was lower than the machined (control) group, and was most inhibited in the RBM group (p < 0.05). At 4 weeks, the removal torque in the machined group was significantly decreased (p < 0.05), but was increased in the etched group (p < 0.05). In the hybrid group, the removal torque significantly increased at 2 weeks, and was the highest among all measured values at 8 weeks (p < 0.05). The infiltration of bone-like tissue surface was evaluated by SEM, and calcium and phosphorus were detected via EDS only in the hybrid group.

Conclusions

Partial RBM surface treatment (hybrid type in this study) produced the most stable self-drilling OMIs, without a corresponding reduction in bone cutting capacity.

Risk of high-grade cervical dysplasia and cervical cancer in women with systemic lupus erythematosus receiving immunosuppressive drugs

Objective Prior studies suggest an increased risk of cervical cancer among women with systemic lupus erythematosus. However, the relationship with immunosuppressive drugs is not well studied in US nationwide cohorts. We compared the risk of high-grade cervical dysplasia and cervical cancer among women with systemic lupus erythematosus who started immunosuppressive drugs versus hydroxychloroquine. Methods We identified systemic lupus erythematosus patients initiating immunosuppressive drugs or hydroxychloroquine using claims data from two US commercial health plans and Medicaid (2000-2012). We used a validated claims-based algorithm to identify high-grade cervical dysplasia or cervical cancer. To account for potential confounders, including demographic factors, comorbidities, medication use, HPV vaccination status, and health care utilization, immunosuppressive drugs and hydroxychloroquine initiators were 1:1 matched on the propensity score. We used inverse variance-weighted, fixed effect models to pool hazard ratios from the propensity score-matched Medicaid and commercial cohorts. Results We included 2451 matched pairs of immunosuppressive drugs and hydroxychloroquine new users in the commercial cohort and 7690 matched pairs in Medicaid. In the commercial cohort, there were 14 cases of cervical dysplasia or cervical cancer among immunosuppressive drugs users and five cases among hydroxychloroquine users (hazard ratio 2.47, 95% CI 0.89-6.85, hydroxychloroquine = ref). In Medicaid, there were 46 cases among immunosuppressive drugs users and 29 cases in hydroxychloroquine users (hazard ratio 1.24, 95% CI 0.78-1.98, hydroxychloroquine = ref). The pooled hazard ratio of immunosuppressive drugs was 1.40 (95% CI 0.92-2.12). Conclusion Among women with systemic lupus erythematosus, immunosuppressive drugs may be associated with a greater, albeit not statistically significant, risk of high-grade cervical dysplasia and cervical cancer compared to patients receiving hydroxychloroquine alone.

Three-dimensional evaluation of tooth movement in Class II malocclusions treated without extraction by orthodontic mini-implant anchorage

OBJECTIVE

The aim of this study was to analyze tooth movement and arch width changes in maxillary dentition following nonextraction treatment with orthodontic mini-implant (OMI) anchorage in Class II division 1 malocclusions.

METHODS

Seventeen adult patients diagnosed with Angle's Class II division 1 malocclusion were treated by nonextraction with OMIs as anchorage for distalization of whole maxillary dentition. Three-dimensional virtual maxillary models were superimposed with the best-fit method at the pretreatment and post-treatment stages. Linear, angular, and arch width variables were measured using Rapidform 2006 software, and analyzed by the paired t-test.

RESULTS

All maxillary teeth showed statistically significant movement posteriorly (p < 0.05). There were no significant changes in the vertical position of the maxillary teeth, except that the second molars were extruded (0.86 mm, p < 0.01). The maxillary first and second molars were rotated distal-in (4.5°, p < 0.001; 3.0°, p < 0.05, respectively). The intersecond molar width increased slightly (0.1 mm, p > 0.05) and the intercanine, interfirst premolar, intersecond premolar, and interfirst molar widths increased significantly (2.2 mm, p < 0.01; 2.2 mm, p < 0.05; 1.9 mm, p < 0.01; 2.0 mm, p < 0.01; respectively).

CONCLUSIONS

Nonextraction treatment with OMI anchorage for Class II division 1 malocclusions could retract the whole maxillary dentition to achieve a Class I canine and molar relationship without a change in the vertical position of the teeth; however, the second molars were significantly extruded. Simultaneously, the maxillary arch was shown to be expanded with distal-in rotation of the molars.

Comparative cardiovascular safety of glucagon-like peptide-1 receptor agonists versus other antidiabetic drugs in routine care: a cohort study

AIMS

To evaluate the comparative cardiovascular disease (CVD) safety of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in head-to-head comparisons with dipeptidyl peptidase-4 (DPP-4) inhibitors, sulphonylureas or insulin, when added to metformin, as used in 'real-world' patients with type 2 diabetes mellitus (T2DM).

METHODS

Within a large US commercial health plan database linked to laboratory test results, we identified three pairwise 1 : 1 propensity-score-matched cohorts of patients with T2DM aged ≥18 years treated with metformin who initiated a GLP-1 RA or a comparator, i.e. DPP-4 inhibitor (n = 35 534), second-generation sulphonylureas (n = 28 138) or insulin (n = 47 068), between 2005 and 2013. We examined the association between drug initiation and a composite CVD endpoint, comprising hospitalizations for acute myocardial infarction, unstable angina, stroke or coronary revascularization.

RESULTS

During the course of 1 year, there were 13.9 and 13.7 CVD events per 1000 person-years among propensity-score-matched initiators of GLP-1 RAs versus DPP-4 inhibitors [hazard ratio (HR) 1.02; 95% confidence interval (CI) 0.84-1.24]; and 12.1 versus 14.0 events among initiators of GLP-1 RAs versus sulphonylureas (HR 0.86; 95% CI 0.69-1.08). The effect estimates for GLP-1 RAs versus insulin were sensitive to the adjustment for glycated haemoglobin, after which the HR was 1.01 (95% CI 0.73-1.41). Results were robust across several sensitivity analyses, including an as-treated analysis considering up to 8.7 years of follow-up.

CONCLUSIONS

This large study, performing head-to-head comparisons of GLP-1 RAs with other antidiabetic agents in real-world patients, provides estimates of relative safety precise enough to exclude large differences in CVD risk and adds further understanding to results from recent clinical trials.

On-scene factors that predict severe injury of patients involved in frontal crashes of passenger cars

PURPOSE

We sought to determine on-scene factors that predict severe injury to the occupants of passenger cars involved in frontal crashes.

METHODS

From January 2011 to December 2014, we collected data from patients who were taken to two emergency centres following a frontal motor vehicle crash. Binomial logistic regression was used to model the effects of occupant characteristics (sex, age, body mass index), vehicle damage (according to the collision deformation classification code), and safety devices on severe injuries (injury severity score >15).

RESULTS

Of 344 subjects, 75 (21.8 %) had severe injuries. Sex, seat belt status, extent of vertical crash, intrusion, and deformation extent (DE) were significantly different between severe and non-severe injuries. After adjusting for confounders, non-use of seat belt tripled the odds of severe injury [odds ratio (OR) 2.7, 95 % confidence interval (CI) 1.461-5.105]. DE ≥4 and intrusion increased the risk of severe injury (OR 2.4, 95 % CI 1.120-5.204 and OR 5.2, 95 % CI 2.525-10.780, respectively). A combination model to predict severe injury using intrusion, seat belt use, and DE ≥4 demonstrated 56.0 % sensitivity, 88.9 % specificity, and 58.4 % positive predictive value (AUC = 0.781, 95 % CI 0.734-0.824).

CONCLUSIONS

For passenger cars involved in a frontal crash, intrusion, unbelted status, and DE ≥4 are good predictors of severe injury. Sequential criteria using vehicle DE, seat belt use, and intrusion can be used by first responders to triage patients involved in a frontal collision.

Bone density effects on the success rate of orthodontic microimplants evaluated with cone-beam computed tomography

INTRODUCTION

The purpose of this study was to evaluate the effect of bone densities on the success rate of orthodontic microimplants with cone-beam computed tomography images.

METHODS

We examined 127 orthodontic microimplants implanted into the maxillary buccal alveolar bone of 71 patients (53 female, 18 male; mean age, 19.2 years) with malocclusion. The cortical, cancellous, and total bone densities were measured with Simplant Pro 2011 software (version 13; Materialise, Leuven, Belgium), and the correlations between these measurements and the orthodontic microimplant success rates were evaluated with cone-beam computed tomography.

RESULTS

The overall success rate was 85.0% (108 of 127). Sex, age, and side of placement were not significant factors for success in the results (P >0.05). The density of the cortical bone increased apically (3, 5, and 7 mm) from the alveolar crest, but in the cancellous bone it decreased. Whereas the orthodontic microimplant success rates significantly increased as cancellous bone density and total bone density increased (P <0.01), cortical bone density did not have a significant effect on the success rate (P >0.05).

CONCLUSIONS

The success rate of orthodontic microimplants significantly increased with higher cancellous and total bone densities, whereas cortical bone density did not have a significant effect.

Optimization of a nanotip on a surface for the ultrafast probing of propagating surface plasmons

We theoretically analyze a method for characterizing propagating surface plasmon polaritons (SPPs) on a thin gold film. The SPPs are excited by few-cycle near-infrared pulses using Kretschmann coupling, and a nanotip is used as a local field sensor. This geometry removes the influence of the incident excitation laser from the near fields, and enhances the plasmon electric field strength. Using finite-difference-time-domain studies we show that the geometry can be used to measure SPP waveforms as a function of propagation distance. The effects of the nanotip shape and material on the field enhancement and plasmonic response are discussed.

Incarceration of gravid uterus by growing subserosal myoma: case report

Incarceration of gravid uterus is a rare condition, occurring in one in 3,000 to 10,000 pregnancies during second trimester. Incarceration of uterus can cause several complications, such as uterine rupture, labor dystocia, and uncontrollable postpartum hemorrhage. Early diagnosis is important to prevent these complications, but there are no standard treatments of incarceration of gravid uterus. The authors present a case report of incarceration of gravid uterus caused by growing subserosal myoma, which was treated with myomectomy during second trimester.

Comparison of mechanical artificial shrinkage methods in mouse blastocyst vitrification

PURPOSE OF INVESTIGATION

This study was designed to determine which mechanical artificial shrinkage (AS) method, conducted by puncture, pipetting, or aspiration, was effective in increasing the re-expansion rate of mouse blastocysts.

MATERIALS AND METHODS

In each group, 30 mouse blastocysts were used. Before vitrification, the blastocoelic cavity was collapsed by puncture with a micro-needle, pipetting with a micro-glass pipette, and direct aspiration with an ICSI pipette. After thawing, the re-expansion rate of blastocysts was examined for each AS method. Re-expansion rate was checked at three, five, and seven hours after thawing.

RESULTS

The number of re-expanded mouse blastocysts at five hours after thawing was 12 in the puncture with a micro-needle group, 11 in the pipetting with a micro-glass pipette group, and 24 in the direct aspiration with an ICSI pipette group. The cumulative number of re-expanded mouse blastocysts at seven hours after thawing was 20 in the puncture with a micro-needle group, 20 in the pipetting with a micro-glass pipette group, and 28 in the direct aspiration with an ICSI pipette group. There were statistically significant differences in the cumulative number of re-expanded mouse blastocysts between five and seven hours after thawing (p = 0.001 and 0.021, respectively).

CONCLUSIONS

Direct aspiration with an ICSI pipette resulted in a higher re-expansion rate than the puncture and pipetting methods. It can be considered that the direct aspiration method is more convenient and simpler than the other two methods.

Crumbled or mashed feed had no significant effect on the performance of lactating sows or their offspring

Background

Physical and chemical properties of feedstuffs can be changed by feed processing. Moreover, through various mechanisms, feed processing can affect growth performance and feed efficiency of swine, nutrition value of the feed. Weaning-to service-intervals (WSI), subsequent farrowing rates, and total-born litter sizes were determined by feed intake and metabolic state during lactation.

Methods

A total of 20 sows (Landrace × Yorkshire) with an average body weight (BW) of 266.1 kg 4 d before farrowing were used to determine the effect of feed processing on the performance of lactating sows and their offspring. The following two dietary treatments were used: 1) Crumble diet (C); and 2) Mash diet (M). Ten replications were used for each treatment. Back fat thickness of sows was measured 6 cm off the midline at the 10th rib using a real-time ultrasound instrument at 4 d before farrowing, 1 d after farrowing, and during weaning. Sow BW were also checked at 4 d before farrowing, 1 d after farrowing, and during weaning. Fecal score of sows were assessed on d 14. Fecal score of piglets were observed on d 7, 15, and 24. Data were analyzed using t-test procedure of SAS (2014) with sow as experimental unit.

Results

No significant (p > 0.05) difference was observed in the reproduction performance of sows between the two treatments. In addition, there was no significant (p > 0.05) difference in the growth performance of piglets between the two treatments. Fecal score of sows or piglets showed no significant (p > 0.05) difference either.

Conclusions

In conclusion, different feed processing (mash or crumble) did not make any significant difference on the performance of lactation sow or their piglets.

Patients' perception about risks and benefits of antithrombotic treatment for the prevention of venous thromboembolism (VTE) after orthopedic surgery: a qualitative study

Background

The 9th edition of the American College of Chest Physicians’ Antithrombotic Therapy and Prevention of Thrombosis guidelines emphasize the importance of considering the risk–benefit ratio of “patient-important” outcomes. However, little is known about patients’ perception and understanding regarding the different outcomes of antithrombotic treatment after orthopedic surgery, and the factors that influence their decision to use these treatments. Using a series of semi-structured interviews, we explored patients’ understanding and perception concerning the benefits and risks of antithrombotic treatment for the prevention of venous thromboembolism (VTE) after joint replacement surgery.

Methods

A series of semi-structured interviews were conducted with patients who had undergone knee or hip replacement surgery at a tertiary care hospital (Brigham and Women’s Hospital, Boston, MA) in 2014. Discussions were recorded and transcribed. Two investigators independently coded and analyzed the data to identify important themes and concepts using the constant comparative method.

Results

Of 64 patients who were invited, 12 patients (19 %) completed the interviews. The majority of patients (92 %) were aware of the benefits of antithrombotic therapy for reducing the risk of blood clots, while less than half of them had a clear understanding of deep vein thrombosis and pulmonary embolism. While all patients were aware of risk of minor bleeding, only 6 patients (50 %) considered the risk of major bleeding as a possible side effect of antithrombotic treatment. Overall, patients perceived bleeding as a less important outcome than a thrombotic event. The lack of awareness about the risk of major bleeding, the assumption that a short-term exposure would not meaningfully affect bleeding risk, and the assumption that bleeding is a controllable event influenced their perception. Most patients (83 %) stated that their decision to use antithrombotic medications was mainly based on the trust in their physician’s expertise.

Conclusions

Patients perceived thrombotic events as more important outcomes than bleeding events. Patients’ understanding of thrombotic and bleeding events varies and may play a key role in their preferences. The majority of patients stated that trust in their physician’s expertise had a large influence on their decision to use antithrombotic medications.

Anti-inflammatory effects of isoketocharbroic acid from brown alga, Sargassum micracanthum

During our on-going screening program designed to isolate natural compounds from marine environments, we isolated isoketochabrolic acid (IKCA) from Sargassum micracanthum, an important brown algae distributed in Jeju Island, Korea. Furthermore, we evaluated the inhibitory effects of IKCA on nitric oxide (NO) production in lipopolysaccharide (LPS)-triggered macrophages. IKCA strongly inhibited NO production, with an IC₅₀ value of 58.31 μM. Subsequent studies demonstrated that IKCA potently and concentration-dependently reduced prostaglandin E₂ (PGE₂), tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β, and IL-6 cytokine production. In conclusion, to the best of our knowledge, this is the first study to show that IKCA isolated from S. micracanthum has a potent anti-inflammatory activity. Therefore, IKCA might be useful as an anti-inflammatory health supplement or functional cosmetics.

Inactivation of Hippo Pathway Is Significantly Associated with Poor Prognosis in Hepatocellular Carcinoma

PURPOSE

The Hippo pathway is a tumor suppressor in the liver. However, the clinical significance of Hippo pathway inactivation in HCC is not clearly defined. We analyzed genomic data from human and mouse tissues to determine clinical relevance of Hippo pathway inactivation in HCC.

EXPERIMENTAL DESIGN

We analyzed gene expression data from Mst1/2(-/-) and Sav1(-/-) mice and identified a 610-gene expression signature reflecting Hippo pathway inactivation in the liver [silence of Hippo (SOH) signature]. By integrating gene expression data from mouse models with those from human HCC tissues, we developed a prediction model that could identify HCC patients with an inactivated Hippo pathway and used it to test its significance in HCC patients, via univariate and multivariate Cox analyses.

RESULTS

HCC patients (National Cancer Institute cohort, n = 113) with the SOH signature had a significantly poorer prognosis than those without the SOH signature [P < 0.001 for overall survival (OS)]. The significant association of the signature with poor prognosis was further validated in the Korean (n = 100, P = 0.006 for OS) and Fudan University cohorts (n = 242, P = 0.001 for OS). On multivariate analysis, the signature was an independent predictor of recurrence-free survival (HR, 1.6; 95% confidence interval, 1.12-2.28: P = 0.008). We also demonstrated significant concordance between the SOH HCC subtype and the hepatic stem cell HCC subtype that had been identified in a previous study (P < 0.001).

CONCLUSIONS

Inactivation of the Hippo pathway in HCC is significantly associated with poor prognosis.

Coulomb Impurity Problem of Graphene in Strong Coupling Regime in Magnetic Fields

We investigate the Coulomb impurity problem of graphene in strong coupling limit in the presence of magnetic fields. When the strength of the Coulomb potential is sufficiently strong the electron of the lowest energy boundstate of the n = 0 Landau level may fall to the center of the potential. To prevent this spurious effect the Coulomb potential must be regularized. The scaling function for the inverse probability density of this state at the center of the impurity potential is computed in the strong coupling regime. The dependence of the computed scaling function on the regularization parameter changes significantly as the strong coupling regime is approached.

Stability of Anomalous States of a Local Potential in Graphene

Graphene Landau levels have discrete energies consisting zero energy chiral states and non-zero energy states with mixed chirality. Each Landau level splits into discrete energies when a localized potential is present. A simple scaling analysis suggests that a localized potential can act as a strong perturbation, and that it can be even more singular in graphene than in ordinary two-dimensional systems of massful electrons. Parabolic, Coulomb, and Gaussian potentials in graphene may have anomalous boundstates whose probability density has a sharp peak inside the potential and a broad peak of size magnetic length l outside the potential. The n = 0 Landau level with zero energy has only one anomalous state while the n = ±1 Landau levels with non-zero energy have two (integer quantum number n is related to the quantized Landau level energies). These anomalous states can provide a new magnetospectroscopic feature in impurity cyclotron resonances of graphene. In the present work we investigate quantitatively the conditions under which the anomalous states can exist. These results may provide a guide in searching for anomalous states experimentally.

Accuracy of three-dimensional printing for manufacturing replica teeth

Objective

Three-dimensional (3D) printing is a recent technological development that may play a significant role in orthodontic diagnosis and treatment. It can be used to fabricate skull models or study models, as well as to make replica teeth in autotransplantation or tooth impaction cases. The aim of this study was to evaluate the accuracy of fabrication of replica teeth made by two types of 3D printing technologies.

Methods

Fifty extracted molar teeth were selected as samples. They were scanned to generate high-resolution 3D surface model stereolithography files. These files were converted into physical models using two types of 3D printing technologies: Fused deposition modeling (FDM) and PolyJet technology. All replica teeth were scanned and 3D images generated. Computer software compared the replica teeth to the original teeth with linear measurements, volumetric measurements, and mean deviation measurements with best-fit alignment. Paired t-tests were used to statistically analyze the measurements.

Results

Most measurements of teeth formed using FDM tended to be slightly smaller, while those of the PolyJet replicas tended to be slightly larger, than those of the extracted teeth. Mean deviation measurements with best-fit alignment of FDM and PolyJet group were 0.047 mm and 0.038 mm, respectively. Although there were statistically significant differences, they were regarded as clinically insignificant.

Conclusions

This study confirms that FDM and PolyJet technologies are accurate enough to be usable in orthodontic diagnosis and treatment.

Effects of Palm Kernel Expellers on Productive Performance, Nutrient Digestibility, and White Blood Cells of Lactating Sows

This experiment was conducted to investigate the effects of palm kernel expellers on productive performance, nutrient digestibility, and changes in white blood cells (WBC) of lactating sows. A total of 14 sows (200±12 kg of average body weight [BW]; 2.5 of average parity) were used and moved from gestation room to farrowing room on d 109 of gestation. Sows were randomly assigned to 2 dietary treatments in a completely randomized design. The treatments were a diet based on corn and soybean meal (CON) and CON added with 20% of palm kernel expellers (PKE). Sows were fed the treatments for 28 days (weaning) after farrowing. Blood was collected from each sow and 4 randomly selected piglets from each sow before farrowing or on d 3, 7, or 14 of lactation. Sows were fed respective treatments containing 0.2% chromic oxide from d 15 to 21 of lactation. Fecal samples were collected daily for the last 3 days after the 4-d adjustment period. Measurements were performances and WBC changes of sows and litter, nutrient digestibility of sows, and daily diarrhea of litter. Sows fed PKE had greater average daily feed intake (7.38 vs 7.10 kg/d; p<0.05) and lost less BW (−6.85 vs −8.54 kg; p<0.05) and backfat depth (−0.42 vs −0.71 mm; p<0.05) than those fed CON. However, there were no differences on digestibility of dry matter, nitrogen, and energy and weaning to estrus interval of sows fed either CON or PKE. Piglets from sows fed PKE gained more BW (203 vs 181 g/d; p = 0.08) and had less frequency of diarrhea (6.80 vs 8.56%; p = 0.07) than those from sows fed CON. On the other hand, no difference was found on preweaning mortality of piglets from sows fed either CON or PKE. Sows fed PKE had lower number of WBC (9.57 vs 11.82 ×10³/μL; p = 0.09) before farrowing than those fed CON, but no difference on d 3 and 7. Similarly, piglets from sows fed PKE had also lower number of WBC (7.86 vs 9.80 ×10³/μL; p<0.05) on d 14 of lactation than those from sows fed CON, but no difference on d 3 and 7. In conclusion, addition of 20% palm kernel expellers to lactation diet based on corn and soybean meal had no negative effects on productive performance, nutrient digestibility, and WBC changes of lactating sows.

Effects of Palm Kernel Expellers on Growth Performance, Nutrient Digestibility, and Blood Profiles of Weaned Pigs

This experiment was conducted to investigate the effects of palm kernel expellers on growth performance, nutrient digestibility, and blood profiles of weaned pigs. A total of 88 weaned pigs (6.94±0.76 kg body weight [BW]; 28 d old) were randomly allotted to 2 dietary treatments (4 pigs/pen; 11 replicates/treatment) in a randomized complete block design (sex as a block). The dietary treatments were a typical nursery diet based on corn and soybean meal (CON) and CON added with 20% of palm kernel expellers (PKE). Pigs were fed for 6 wk using a 3-phase feeding program with declining diet complexity and with phases of 1, 2, and 3 wk, respectively. Blood was collected from randomly selected 2 pigs in each pen before weaning and on d 7 after weaning. Pigs were fed respective dietary treatments containing 0.2% chromic oxide from d 29 to 35 after weaning. Fecal samples were collected from randomly selected 2 pigs in each pen daily for the last 3 days after the 4-d adjustment period. Measurements were growth performances, digestibility of dry matter, nitrogen and energy, white and red blood cell counts, packed cell volume, and incidence of diarrhea. The PKE increased average daily gain (ADG) (246 vs 215 g/d; p = 0.06) and average daily feed intake (ADFI) (470 vs 343 g/d; p<0.05) and decreased gain-to-feed ratio (G:F) (0.522 vs 0.628 g/g; p<0.05) during phase 2 compared with CON, but did not affect growth performance during phase 1 and 3. During overall experimental period, PKE increased ADG (383 vs 362 g/d; p = 0.05) and ADFI (549 vs 496 g/d; p<0.05) compared with CON, but did not affect G:F. However, no differences were found on digestibility of dry matter, nitrogen, and energy between CON and PKE. The PKE reduced frequency of diarrhea (15% vs 25%; p = 0.08) for the first 2 wk after weaning compared with CON. Similarly, PKE decreased white blood cells (8.19 vs 9.56×10(3)/μL; p = 0.07), red blood cells (2.92 vs 3.25×10(6)/μL; p = 0.09), and packed cell volume (11.1% vs 12.6%; p = 0.06) on d 7 after weaning compared with CON. In conclusion, addition of 20% palm kernel expellers to nursery diet based on corn and soybean meal had no negative effects on growth performance, nutrient digestibility, and blood profiles of weaned pigs.