Κυριακή 19 Ιουνίου 2022

COL4A1-related brain small-vessel disease, Intracranial Cortical Calcifications

What is COL4A1 disease?
COL4A1-related brain small-vessel disease is characterized by weakening of the blood vessels in the brain. Stroke is often the first symptom of this condition, typically occurring in mid-adulthood.

What is the COL4A1 gene?
The COL4A1 gene provides instructions for making one component of type IV collagen, which is a flexible protein important in the structure of many tissues throughout the body. Specifically, this gene makes the alpha1(IV) chain of type IV collagen.

Patients with chronic parathyroid dysfunction often have intracranial calcification in deep gray matter (GM) and subcortical white matter

What are the symptoms of brain calcification?
Muscle cramping (dystonia), uncontrollable spasmodic irregular movements (chorea), and seizures can also occur. Occasional symptoms include sensory changes, headaches and urinary incontinence. Associated symptoms include loss of contact with reality (psychosis), mood swings and loss of acquired motor skills.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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A proposed algorithm for evaluation and management of pediatric hemophilia patients who present to the emergency department with head trauma

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Abstract

Hemophilia is the deficiency of plasma clotting factor VIII (hemophilia A) or IX (hemophilia B) where management focuses on the prevention and treatment of acute bleeding symptoms and their sequelae. The most concerning risk is for life-threatening bleeding, including intracranial hemorrhage (ICH), which is caused by head trauma. Guidelines exist for the evaluation and management of pediatric head trauma, including the Pediatric Emergency Care Applied Research Network (PECARN) protocol, but limited evidence exists for when hemophilia patients present to the emergency department (ED), specifically with head trauma. Literature is limited regarding ICH and hemophilia, which further supports the culture of uncertainty among providers. The objective of this study is to conduct a retrospective chart review to determine the prevalence and clinical characteristics of ICH, and to describe computed tomography (CT) scan use in hemophilia patients who present to Phoenix Children's Hospital (P CH) ED with head trauma from January 1, 2007 to June 1, 2019. A total of 89 ED visits and 43 patients met inclusion criteria, and prevalence of ICH was determined to be 4% with the patients presenting with varied clinical characteristics and few commonalities. Using these data, we propose a new algorithm to aid clinicians in determining the need for CT scan in pediatric hemophilia patients who present to the ED with head trauma.
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Assessment of periodontitis grade in epidemiological studies using interdental attachment loss instead of radiographic bone loss

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Abstract

Objective

Comparison of grading according to radiographic bone loss (BL) or according to interdental clinical attachment loss (CAL).

Methods

In 100 periodontitis patients of the Department of Periodontology of Goethe-University Frankfurt, Germany periodontitis grade was assigned by i) indirect evidence using BL at the most affected tooth divided by root length and ii) CAL at the most affected tooth divided by root length of the respective tooth type according to root length in German and Swedish cohorts. Resulting quotients were divided by age.

Results

Patients (age: 53.5±10.4 years; 57 females; 16 smokers; no diabetes; stage 78 III, 22 IV) were by either method assigned to grade B or C (BL: 35 B, 65 C; CAL [German]: 23 B, 77 C; [Swedish]: 29 B, 71 C). Using root length (German cohort), agreement was 76% (kappa: 0.427; fair to good /moderate agreement) and 72% (Swedish cohort; kappa: 0.359; poor agreement/fair). Molars were most frequently chosen (BL: 64%; CAL: 71%).

Conclusions

Assignment of periodontitis grade by indirect evidence using BL or CAL using standard root length of the German cohort showed fair to good/moderate agreement. Thus, grade assignment by CAL may be used in epidemiologic studies where radiographs are not available.
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Effects of Artificial Intelligence (AI)‐Assisted Dental Monitoring Intervention in Patients with Periodontitis: A Randomized Controlled Trial

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Abstract

Aim

To evaluate the effects of an at-home AI-assisted dental monitoring application on treatment outcomes in patients with periodontitis.

Materials and methods

Participants with periodontitis were recruited and randomly assigned into an AI (AI; n = 16), AI and human counseling (AIHC; n = 17), or control (CG; n = 20) group. All participants received nonsurgical periodontal treatment. We employed an AI-assisted tool called DENTAL MONITORING® (DM) intervention, a new technological AI monitoring product that utilizes smartphone cameras for intraoral scanning and assessment. Patients in the AI and AIHC groups respectively received additional (a) DM or (b) DM with real-person counseling over three months. Periodontal parameters were collected at baseline and follow-ups. A mixed-design model analyzed the follow-up effects over time.

Results

The AI and AIHC groups respectively exhibited greater improvement in probing pocket depth [Mean diff = −0.9±0.4 and −1.4±0.3, effect size (ES) = 0.76 and 1.98], clinical attachment level (Mean diff = −0.8±0.3 and −1.4±0.3, ES = 0.84 and 1.77) and plaque index (Mean diff = −0.5±0.2 and −0.7±0.2, ES = 0.93 and 1.81) at 3-month follow-up than the CG did. The AIHC group had a greater reduction in probing pocket depth (ES = 0.46) and clinical attachment level (ES = 0.64) at the 3-month follow-up compared with the AI group.

Conclusion

Using AI monitoring at home had a positive effect on treatment outcomes for patients with periodontitis. Patients with AI-assisted health counseling exhibited better treatment outcomes than did patients who used AI monitoring alone.

This article is protected by copyright. All rights reserved.
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Soft and hard tissue changes after immediate implant placement with or without a sub‐epithelial connective tissue graft: results from a 6‐months pilot randomized controlled clinical trial

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Abstract

Aim

The present pilot RCT aimed to investigate the influence of a connective tissue graft (CTG) in combination with the immediate implant placement (IIP) on hard and soft tissues healing, without a bone replacement graft in the gap between the implant and the socket walls.

Material and Methods

Thirty patients requiring extraction of one anterior tooth (from premolar to premolar) were randomly assigned to one of the two treatment groups (test: IIP+CTG; control: IIP). Cone-beam computed tomography (CBCT) and optically scans were performed before tooth extraction and at 6-months follow-up. Then, DICOM files were superimposed in order to allow the evaluation of osseous ridge and buccal bone changes, while the superimposition of DICOM and STL (Standard Tessellation Language) files allowed for evaluating of soft tissue contour. For testing the differences between the two groups, the non-parametric test as Wilcoxon rank-sum test, was used.

Results

Twenty-six out of the thirty enrolled patients, attended the 6-month follow-up visit. The 4 patients of control group that were lost to follow-up, were analyzed under the intention-to-treat principle. No statistically significant differences between the groups were observed for the vertical buccal bone resorption (p=0.90), as well as for the horizontal buccal bone resorption at all measured levels. Significant differences were found between test and control groups in the horizontal dimensional changes of osseous ridge at the most coronal aspect (p=0.0003 and p=0.02). Changes of tissue contour ranged between -0.32 and -0.04 mm in the test group, and between -1.94 and -1.08 mm in the control group, while changes of soft tissue thickness varied between 1.33 and 2.42 mm in the test group, and between -0.16 and 0.88 mm in the control group, with statistically significant differences for both variables at all measured levels. At 6 months, the mean volume inc rease was 6.76±8.94 mm3 and 0.16±0.42 mm3 in the test and control groups, respectively, with statistically significant difference.

Conclusions

The findings of the present study indicate that the adjunct of a connective tissue graft at the time of immediate implant placement, without bone grafting, does not influence vertical bone resorption. Within the limits of the present study, it can be suggested that the adjunct of a connective tissue graft at the time of immediate implant placement, without bone grafting, reduces the horizontal changes of the alveolar ridge. Moreover, it allows maintenance of the tissue contour due to an increase in soft tissue thickness.
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Long non‐coding RNA SNHG5 mediates periodontal inflammation through the NF‐κB signaling pathway

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Abstract

Aim

We investigated the role of the long non-coding RNA (lncRNA), small nucleolar RNA host gene 5 (SNHG5), in the pathogenesis of periodontitis.

Materials and methods

A ligature-induced periodontitis mouse model was established, and gingival tissues from patients with periodontitis and healthy controls were collected. Inflammatory cytokines were detected using qRT-PCR and western blotting analyses. Direct interactions between SNHG5 and p65 were detected by RNA pull-down and RNA immunoprecipitation assays. Micro-computed tomography, hematoxylin and eosin staining, and immunohistochemical staining were used to measure periodontal bone loss.

Results

SNHG5 expression was downregulated in human and mouse periodontal tissues compared to that in the healthy controls. In vitro experiments demonstrated that SNHG5 significantly ameliorated tumor necrosis factor-α (TNFα)-induced inflammation. Mechanistically, SNHG5 directly binds to the nuclear factor-kappa B (NF-κB) p65 subunit and inhibits its translocation, thereby suppressing the NF-κB signaling pathway activation and reducing the nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3 inflammasome expression. Locally injecting si-SNHG5 aggravated the periodontal destruction.

Conclusion

This study revealed that SNHG5 mediates periodontal inflammation through the NF-κB signaling pathway, providing a potential therapeutic target for periodontitis treatment.

This article is protected by copyright. All rights reserved.
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Lingual Frenectomy Criteria

The term free-tongue is defined as the length of tongue from the insertion of the lingual frenum into the base of the tongue to the tip of the tongue. Clinically acceptable, normal range of free tongue is greater than 16 mm. 

The ankyloglossia can be classified into 4 classes based on Kotlow's assessment as follows; 
Class I: Mild ankyloglossia: 12 to 16 mm, 
Class II: Moderate ankyloglossia: 8 to 11 mm, 
Class III: Severe ankyloglossia: 3 to 7 mm, 
Class IV: Complete ankyloglossia: Less than 3 mm.2 

Class III and IV tongue-tie category should be given special consideration because they severely restrict the tongue's movement. A normal range of motion of the tongue is indicated by the following criteria: The tip of the tongue should be able to protrude outside the mouth; without clefting, the tip of the tongue should be able to sweep the upper and lower lips easily; without straining, when the tongue is retruded, it should not blanch the tissues lingual to the anterior teeth; and the lingual frenum should not create a diastema between the mandibular central incisors.

Ankyloglossia was also found associated in cases with some rare syndromes such as X-linked cleft palate syndrome, Kindler syndrome, van der Woude syndrome, and Opitz syndrome.Nevertheless, most ankyloglossias are observed in persons without any other congenital anomalies or diseases.
The difficulties in articulation are evident for consonants and sounds like "s, z, t, d, l, j, zh, ch, th, dg" and it is especially difficult to roll an "r".



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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
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Effectiveness of Tongue‐tie Assessment Tools in Diagnosing and Fulfilling Lingual Frenectomy Criteria: A Systematic Review

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ABSTRACT

It is unclear how effective tongue-tie classification assessment tools are in diagnosing symptomatic tongue-tie and fulfilling lingual frenectomy criteria. The purpose of this systematic review is to determine and evaluate any association between tongue-tie severity, as measured by pre-treatment assessment tools, and post-operative outcome following tongue-tie division. PubMed, EMBASE, and the Cochrane search engines were used to retrieve articles published between 1947 and 2021. Included studies consisted of patients with symptomatic tongue-tie, assessment by either the Coryllos, Kotlow, or Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) classification tool, and tongue-tie division. A total of 205 abstracts were identified; 31 studies met the criteria for a full-text review, of which, only 14 studies met the criteria for data extraction and analysis. Six studies used the HATLFF, 2 studies used the Kotlow, 5 studies used the Coryllos, and 1 study used a combinati on of both Kotlow and Coryllos methods. Significant heterogeneity was evident across all studies. No statistical correlation between the two variables could be determined. Although tongue-tie division procedures appear to provide benefits in breastfeeding and speech, there are no data to suggest a statistically significant association between the severity of tongue-tie, and the correct identification of patients who would benefit from tongue-tie division. © 2022 Australian Dental Association.
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Intraosseous Ameloblastic Fibro-dentinoma an aggressive demeanor in a two-year-old

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Publication date: Available online 18 June 2022

Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology

Author(s): Pushkar Waknis, Supriya Kheur, Madhura Shekatkar, Kripa Gupta, Luke Kale, Mamatha Reddy
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Linear IgA bullous dermatosis with desquamative gingivitis: A case report and literature review

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Publication date: Available online 17 June 2022

Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology

Author(s): Kana Kashima, Yoshihiro Morita, Mao Suzuki, Hiroko Kinosada, Yuka Matsumiya-Matsumoto, Itsuro Kato, Kazuhide Matsunaga, Narikazu Uzawa
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Clinical Significance and Molecular Annotation of Cellular Morphometric Subtypes in Lower Grade Gliomas discovered by Machine Learning

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Abstract
BACKGROUND
Lower grade gliomas (LGG) are heterogenous diseases by clinical, histological, and molecular criteria. We aimed to personalize the diagnosis and therapy of LGG patients by developing and validating robust cellular morphometric subtypes (CMS) and to uncover the molecular signatures underlying these subtypes.
METHODS
Cellular morphometric biomarkers (CMBs) were identified with artificial intelligence technique from TCGA-LGG cohort. Consensus clustering was used to define CMS. Survival analysis was performed to assess the clinical impact of CMBs and CMS. A nomogram was constructed to predict 3- and 5- year overall survival (OS) of LGG patients. Tumor mutational burden (TMB), and immune cell infiltration between subtypes were analyzed using the Mann-Whitney test. The double-blinded validation for important immunotherapy-related biomarkers were executed using immunohistochemistry (IHC).
RESULTS
We developed a mac hine learning pipeline to extract CMBs from whole slide images of tissue histology; identifying and externally validating robust CMS of LGGs in multi-center cohorts. The subtypes had independent predicted OS across all three independent cohorts. In the TCGA-LGG cohort, patients within the poor-prognosis subtype responded poorly to primary and follow-up therapies. LGGs within the poor-prognosis subtype were characterized by high mutational burden, high frequencies of copy number alterations, and high levels of tumor-infiltrating lymphocytes and immune checkpoint genes. Higher levels of PD-1/PD-L1/CTLA-4 were confirmed by immunohistochemical staining. In addition, the subtypes learned from LGG demonstrates translational impact on glioblastoma (GBM).
CONCLUSIONS
We developed and validated a framework (CMS-ML) for CMS discovery in LGG associated with specific molecular alterations, immune micro-environment, prognosis, and treatment response.
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Effect of new biological patch in repairing intrauterine adhesion and improving clinical pregnancy outcome in infertile women: study protocol for a randomized controlled trial

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Endometrial fibrosis caused by intrauterine adhesion (IUA) can lead to hypomenorrhea, amenorrhea, and even infertility and abortion. The postoperative recurrence rate of severe IUA remains high, giving rise to...
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