Prosthetic temporomandibular joint replacement (TJR): Stock or custom? A single institution pilot comparison.

OBJECTIVE: The aim of this study was to compare stock (Biomet-Lorenz Stock, Parsippany, NJ) and custom (TMJ Concepts, Inc., Ventura, CA) total temporomandibular joint (TMJ) replacement prosthetics. METHOD: This was a retrospective cohort study of 17 consecutive patients operated by the same surgeon from 2015 to 2020 comparing stock and custom options for total joint replacement (TJR). The inclusion criteria were patients who documented 1 year of follow-up post-TJR without previous TMJ replacement surgery. The predictor variable was the TMJ prosthetic replacement. The primary clinical outcome variables was pain via Visual Analog Scale (VAS) measured at 1, 3, and 6 months postoperatively and maximum incisal opening measured pre and post-surgery. The other variables were grouped into the following categories: surgery time, length of stay, and unilateral vs bilateral replacements. RESULTS: Our review showed no statistically significant difference in maximum incisal opening, subjective pain score, hospital stay, surgical time, or complication rate between Biomet-Lorenz stock and TMJ Concepts, Inc. custom total joint replacement. Bilateral TJR, irrespective of prosthesis type, did have greater improvement in maximal incisal opening (MIO) compared with unilateral that was statistically significant (P < .05). CONCLUSIONS: There was no statistically significant difference in the pain VAS or MIO using either stock or custom TJR. Both should be considered good surgical options for improvements in patient function and long-term jaw stability.

Molecular profiling identifies targeted therapy opportunities in pediatric solid cancer.

To evaluate the clinical impact of molecular tumor profiling (MTP) with targeted sequencing panel tests, pediatric patients with extracranial solid tumors were enrolled in a prospective observational cohort study at 12 institutions. In the 345-patient analytical population, median age at diagnosis was 12 years (range 0-27.5); 298 patients (86%) had 1 or more alterations with potential for impact on care. Genomic alterations with diagnostic, prognostic or therapeutic significance were present in 61, 16 and 65% of patients, respectively. After return of the results, impact on care included 17 patients with a clarified diagnostic classification and 240 patients with an MTP result that could be used to select molecularly targeted therapy matched to identified alterations (MTT). Of the 29 patients who received MTT, 24% had an objective response or experienced durable clinical benefit; all but 1 of these patients received targeted therapy matched to a gene fusion. Of the diagnostic variants identified in 209 patients, 77% were gene fusions. MTP with targeted panel tests that includes fusion detection has a substantial clinical impact for young patients with solid tumors.

Aetiology and Epidemiology of Maxillofacial Injuries during the Stay-At-Home Period Due To the COVID-19 Pandemic: a Single Center Study.

OBJECTIVES: The aim of this retrospective comparative study was to evaluate the effects of implemented social and public health measures during the COVID-19 pandemic on the incidence and aetiology of maxillofacial injuries. MATERIAL AND METHODS: A retrospective chart review of all the patients who had sustained maxillofacial injuries and presented to the emergency department of Strong Memorial Hospital between March 20th and June 24th, 2019 and 2020, were included in our study. The total study sample comprised of 335 patients (n = 140 in 2019 group, n = 195 in 2020 group). The primary outcome variables of the study were the number of cases and aetiology of maxillofacial injuries. Statistical analysis consisted of descriptive statistics, Chi-square, and two sample t-tests. RESULTS: The number of patients in the 2020 group was higher (n = 195) than the number of patients in the 2019 group (n = 140). Comparatively, there was an increase in the maxillofacial injuries during the stay-at-home period by (n = 55 [39.29%]). Although not statistically significant, the aetiology of injuries differed during the stay-at-home period compared to the normal times. CONCLUSIONS: The number of maxillofacial injuries increased during the period of implemented social and public health measures during the early months of the COVID-19 pandemic. Such knowledge can provide valuable information for the establishment of prevention programs and effective health policies and help in the decision-making process pertaining to resource allocation in a dire situation of the pandemic.

Evidence and explanation for the involvement of the nucleus accumbens in pain processing.

The nucleus accumbens (NAc) is a subcortical brain structure known primarily for its roles in pleasure, reward, and addiction. Despite less focus on the NAc in pain research, it also plays a large role in the mediation of pain and is effective as a source of analgesia. Evidence for this involvement lies in the NAc's cortical connections, functions, pharmacology, and therapeutic targeting. The NAc projects to and receives information from notable pain structures, such as the prefrontal cortex, anterior cingulate cortex, periaqueductal gray, habenula, thalamus, etc. Additionally, the NAc and other pain-modulating structures share functions involving opioid regulation and motivational and emotional processing, which each work beyond simply the rewarding experience of pain offset. Pharmacologically speaking, the NAc responds heavily to painful stimuli, due to its high density of µ opioid receptors and the activation of several different neurotransmitter systems in the NAc, such as opioids, dopamine, calcitonin gene-related peptide, γ-aminobutyric acid, glutamate, and substance P, each of which have been shown to elicit analgesic effects. In both preclinical and clinical models, deep brain stimulation of the NAc has elicited successful analgesia. The multi-functional NAc is important in motivational behavior, and the motivation for avoiding pain is just as important to survival as the motivation for seeking pleasure. It is possible, then, that the NAc must be involved in both pleasure and pain in order to help determine the motivational salience of positive and negative events.