A successful implant-supported fixed prosthesis in a patient with osteopetrosis: A clinical report.

Osteopetrosis (marble bone disease) is a family of rare genetic disorders characterized by impaired osteoclast function leading to hyperdense, hypovascular, brittle bone. Typical imaging shows increased bone mass and thickened cortical and trabecular bone. Bones are more prone to fracture and osteomyelitis may develop. When considering dental implant placement in a patient with osteopetrosis, the potential for bony fracture and/or osteomyelitis should be considered along with the decreased likelihood of successful osseointegration because of hypovascularity. This clinical report describes an unusual imaging presentation and successful osseointegration of multiple dental implants supporting an implant-supported fixed mandibular prosthesis with long-term survival.

Forward and reverse mutations in stages of cancer development.

BACKGROUND: Massive occurrences of interstitial loss of heterozygosity (LOH) likely resulting from gene conversions were found by us in different cancers as a type of single-nucleotide variations (SNVs), comparable in abundance to the commonly investigated gain of heterozygosity (GOH) type of SNVs, raising the question of the relationships between these two opposing types of cancer mutations. METHODS: In the present study, SNVs in 12 tetra sample and 17 trio sample sets from four cancer types along with copy number variations (CNVs) were analyzed by AluScan sequencing, comparing tumor with white blood cells as well as tissues vicinal to the tumor. Four published "nontumor"-tumor metastasis trios and 246 pan-cancer pairs analyzed by whole-genome sequencing (WGS) and 67 trios by whole-exome sequencing (WES) were also examined. RESULTS: Widespread GOHs enriched with CG-to-TG changes and associated with nearby CNVs and LOHs enriched with TG-to-CG changes were observed. Occurrences of GOH were 1.9-fold higher than LOH in "nontumor" tissues more than 2 cm away from the tumors, and a majority of these GOHs and LOHs were reversed in "paratumor" tissues within 2 cm of the tumors, forming forward-reverse mutation cycles where the revertant LOHs displayed strong lineage effects that pointed to a sequential instead of parallel development from "nontumor" to "paratumor" and onto tumor cells, which was also supported by the relative frequencies of 26 distinct classes of CNVs between these three types of cell populations. CONCLUSIONS: These findings suggest that developing cancer cells undergo sequential changes that enable the "nontumor" cells to acquire a wide range of forward mutations including ones that are essential for oncogenicity, followed by revertant mutations in the "paratumor" cells to avoid growth retardation by excessive mutation load. Such utilization of forward-reverse mutation cycles as an adaptive mechanism was also observed in cultured HeLa cells upon successive replatings. An understanding of forward-reverse mutation cycles in cancer development could provide a genomic basis for improved early diagnosis, staging, and treatment of cancers.

A national survey of nurse practitioners' patient satisfaction outcomes.

BACKGROUND: The research findings about nurse practitioner (NP) patient experiences (satisfaction) are limited to small sample sizes from local community clinics. No national studies with large sample sizes were found. PURPOSE: To analyze responses from the Consumer Assessment of Healthcare Providers and Systems survey and compare the patient experiences from four different provider categories. METHODS: Secondary data analysis was completed on survey responses from 53,885 patients. FINDINGS: In the sample, medical doctor providers were disproportionately represented in greater number than NPs, doctor of osteopathy, or physician assistant. Further analysis comparing patient experiences between providers revealed NP to be rated significantly higher than their colleagues. DISCUSSION: Recognizing the factors associated with patient satisfaction with their providers can lead to improvements in patient-provider interactions that can result in increased quality of care. CONCLUSION: Policy makers should find opportunities to employ NP in primary care settings and achieve greater patient satisfaction that can influence outcomes associated with patient-centered care initiatives.

Academic nursing administrators' workplace satisfaction and intent to stay.

BACKGROUND: In nursing education, the academic administrator is critical given the multitude of challenges associated with program delivery (e.g., shortages of faculty, strict and changing regulations for program accreditation, and the sheer demand for more nurses). Unfortunately, with the focus on recruiting and retaining new novice faculty to teach students, academic nursing administrators have been overlooked in recent studies. PURPOSE: As such, this study aims to explore the workplace satisfaction and intent to stay of academic nursing administrators by considering their relation to a variety of demographic and work related variables. METHODS: A secondary data source was used from the Collaborative on Academic Careers in Higher Education (COACHE). One-way Analysis of Variance (ANOVA) with post hoc Fisher's Least Significant Difference tests and t-tests were used in the analysis. DISCUSSION/CONCLUSION: Results indicate that several modifiable work factors positively relate to both job satisfaction and intent to stay.

Imaging approach for jaw and maxillofacial bone tumors with updates from the 2022 World Health Organization classification.

Jaw and maxillofacial bone lesions encompass a wide variety of both neoplastic and non-neoplastic pathologies. These lesions can arise from various tissues, including bone, cartilage, and soft tissue, each presenting distinct challenges in diagnosis and treatment. While some pathologies exhibit characteristic imaging features that aid in diagnosis, many others are nonspecific. This overlap often necessitates a multimodal imaging approach, combining techniques such as radiographs, computed tomography, and magnetic resonance imaging to achieve a diagnosis or narrow the diagnostic considerations. This article provides a comprehensive review of the imaging approach to jaw and maxillofacial bone tumors, including updates on the 2022 World Health Organization classification of these tumors. The relevant anatomy of the jaw and dental structures that is important for accurate imaging interpretation is discussed.

Familial clustering of dysbiotic oral and fecal microbiomes in juvenile dermatomyositis.

Juvenile dermatomyositis (JDM) is a rare immune-mediated disease of childhood with putative links to microbial exposures. In this multi-center, prospective, observational cohort study, we evaluated whether JDM is associated with discrete oral and gut microbiome signatures. We generated 16S rRNA sequencing data from fecal, saliva, supragingival, and subgingival plaque samples from JDM probands (n = 28). To control for genetic and environmental determinants of microbiome community structure, we also profiled microbiomes of unaffected family members (n = 27 siblings, n = 26 mothers, and n = 17 fathers). Sample type (oral-vs-fecal) and nuclear family unit were the predominant variables explaining variance in microbiome diversity, more so than having a diagnosis of JDM. The oral and gut microbiomes of JDM probands were more similar to their own unaffected siblings than they were to the microbiomes of other JDM probands. In a sibling-paired within-family analysis, several potentially immunomodulatory bacterial taxa were differentially abundant in the microbiomes of JDM probands compared to their unaffected siblings, including Faecalibacterium (gut) and Streptococcus (oral cavity). While microbiome features of JDM are often shared by unaffected family members, the loss or gain of specific fecal and oral bacteria may play a role in disease pathogenesis or be secondary to immune dysfunction in susceptible individuals.

Commitment, job satisfaction and personality: A cross sectional study of generational cohorts in nursing students.

BACKGROUND: The current domestic nursing workforce is the most generational diversity in history with a wide range of life experiences. PURPOSE: The purpose of this study was to investigate generational differences in organizational commitment, job satisfaction and personality traits in a sample of nursing students preparing for the workforce. METHODS: This cross-sectional study used data collected from pre-licensure final semester nursing students and degree completion students (n = 313) from three different schools about job satisfaction, personality traits and organizational commitment. RESULTS: Findings showed the scores between the generations were not significantly different for job satisfaction (p = 0.86) and organizational commitment (p = 0.40). Significant differences were found between the generations for the personality measures of agreeableness (p = 0.02), conscientiousness (p = 0.01), and emotional stability (p = 0.00). DISCUSSION/CONCLUSIONS: Understanding generational differences in nursing students entering the workforce can serve academia and practice partners to focus curriculum and resources appropriately to prepare the next generation of nurses for the challenges in a time of crisis.

Osteoblastoma and Osteoid Osteoma of the Mandible: Review of the Literature and Report of Two Cases.

Osteoblastoma and osteoid osteoma are rare benign neoplasms of the jaws. We reviewed current literature surrounding the ongoing debate over similarities and differences of osteoblastoma and osteoid osteoma and present two cases. Both cases are well-demarcated mixed radiodensity mandibular lesions with histological features of osteoblastoma. They exhibit, however, distinctly unique and contrasting clinical and imaging characteristics suggesting that the first case is osteoblastoma and the second is osteoid osteoma. The first case of a 37-year-old male presents with a large, expansile lesion at posterior mandible, surrounded by a thick sclerotic band. Unusual features include significant buccal/lingual expansion, extensive new bone apposition, and soft tissue edema in the masseter muscle. This is in contrast to the second case of a much smaller lesion in a 17-year-old male with history of recent third molar extraction in the left posterior mandible. In this case, CT imaging revealed a circular, nonexpansile lesion with a sclerotic border surrounded by a radiolucent rim. Both patients underwent surgical excision of the lesion with extraction of the adjacent tooth. We discuss herein the distinct clinical and imaging features.

Delayed diagnosis of palatal adenoid cystic carcinoma: Review of diagnostic workup and image features of perineural spread.

OBJECTIVES: Adenoid cystic carcinoma (ACC) is the malignancy most likely to spread perineurally. Delayed diagnosis often leads to undetected perineural spread (PNS). Better understanding of diagnostic processes, clinical and imaging features in ACC may allow earlier diagnoses. MATERIALS AND METHODS: A retrospective records search of the University of Washington Radiology archive identified patients with palatal ACC diagnosis and pre-treatment MDCT and/or MRI. Demographic data, clinical findings, diagnostic workup history and image features including the presence of PNS were recorded. RESULTS: 44 patients met inclusion and exclusion criteria. Symptoms included pain, mass, numbness, and sinonasal congestion. The most common finding on clinical examination was visible or palpable palatal mass. 55% of patients were evaluated by a dentist pre-diagnosis. Most common initial impressions were infection and/or dental disease. PNS was identified in 81.8% of patients, most commonly at pterygopalatine fossa, palatine foramina/canals, Vidian canal, or foramen rotundum. PNS was statistically significantly associated with paresthesia (p = 0.003) but not with tumor size, age, gender, or tobacco history. 44% of patients were diagnosed ≥1 year from initial symptoms, with a mean delay of 18.3 (range < 1-72) months. CONCLUSIONS: This study represents the first analysis of the nature of the diagnostic process of palatal ACC. Majorities of patients were evaluated by a general dentist pre-diagnosis. PNS was identified in a majority of patients and all the patients who presented with paresthesia had evidence of PNS. Despite patients presenting with paresthesia, palatal ACC is often initially misdiagnosed resulting in delayed diagnosis.

Osteoarthritis of the temporomandibular joint and increase of the horizontal condylar angle: a longitudinal study.

OBJECTIVE: Our previous study of patients with unilateral temporomandibular joint (TMJ) osteoarthritis (OA) showed that the affected joints had greater horizontal condylar angle (HCA) compared with the contralateral unaffected joints. However, it was unclear whether the HCA changes preceded or were the result of OA changes. The aim of this longitudinal study was to investigate the relationship between HCA and OA progression. STUDY DESIGN: In total, 127 patients (with or without TMJ disorders) completed baseline and follow-up examinations (average time to follow-up 7.9 years). Generalized estimating equation models were used to account for correlation of observations within the same patients. RESULTS: (1) HCA was greater in OA-affected joints than in unaffected joints (P = .04). (2) Increased HCA at follow-up was associated with change in joint status from no OA to OA. (P = .001). (3) Baseline HCA value alone did not predict future OA diagnosis. (4) All OA changes in fossa/articular eminence morphology, and some combinations of condylar changes, were associated with a greater HCA. (5) OA diagnosis was associated with pain during maximum opening (P = .005) and pain history (P = .002). (6) Aging alone was not correlated with increased HCA. CONCLUSIONS: Clinical progression of OA preceded increases in HCA. HCA alone did not predict OA development.

Oral health and plaque microbial profile in juvenile idiopathic arthritis.

BACKGROUND: The oral microbiota has been implicated in the pathogenesis of rheumatoid arthritis through activation of mucosal immunity. This study tested for associations between oral health, microbial communities and juvenile idiopathic arthritis (JIA). METHODS: A cross-sectional exploratory study of subjects aged 10-18 years with oligoarticular, extended oligoarticular and polyarticular JIA was conducted. Control groups included pediatric dental clinic patients and healthy volunteers. The primary aim was to test for an association between dental health indices and JIA; the secondary aim was to characterize the microbial profile of supragingival plaque using 16S rRNA gene sequencing. RESULTS: The study included 85 patients with JIA, 62 dental patients and 11 healthy child controls. JIA patients overall had significantly more gingival inflammation compared to dental patients, as evidenced by bleeding on probing of the gingiva, the most specific sign of active inflammation (p = 0.02). Overall, however, there was a trend towards better dental hygiene in the JIA patients compared to dental patients, based on indices for plaque, decay, and periodontitis. In the JIA patients, plaque microbiota analysis revealed bacteria belonging to genera Haemophilus or Kingella elevated, and Corynebacterium underrepresented. In poly JIA, bacteria belonging to the genus Porphyromonas was overrepresented and Prevotella was underrepresented. CONCLUSION: Increased gingival inflammation in JIA was independent of general oral health, and thus cannot be attributed to poor dental hygiene secondary to disability. The variation of microbial profile in JIA patients could indicate a possible link between gingivitis and synovial inflammation.

Cutaneous diphtheroid infection and review of other cutaneous Gram-positive Bacillus infections.

Cutaneous diphtheria is a rare infection in the United States. This article presents a case of genital ulcerations, which were likely secondary to cutaneous coryneform bacterial infection, and reviews the literature concerning the diagnosis and management of this entity. In addition, we briefly review other Gram-positive Bacillus bacterial infections of the skin.

Greater mandibular horizontal condylar angle is associated with temporomandibular joint osteoarthritis.

BACKGROUND: Research using magnetic resonance imaging analysis has shown that internal temporomandibular joint derangement is associated with significantly greater horizontal condylar angle. However, the association between osteoarthritic (OA) bony changes as shown on computed tomography and horizontal condylar angle has never been evaluated. OBJECTIVE: To investigate the relationship between mandibular condylar angle and OA degenerative changes. STUDY DESIGN: This is a retrospective study using cone beam computed tomography images and reports from 60 patients with unilateral OA degenerative changes and 43 control patients with no OA-affected joints. RESULTS: Condylar angles in the joints of control patients and the unaffected joints in OA patients were not significantly different. The mean horizontal condylar angle in the unilaterally OA-affected joints (29.5° ± 10.5°) was larger than in the contralateral unaffected joints (22.5° ± 7.7°) (P < .001). In the OA-affected joints, flattening and erosion of the articular eminence was associated with a greater condylar angle (P < .05). CONCLUSIONS: Moderate to severe degenerative temporomandibular joint change is associated with greater horizontal condylar angle.

College nursing faculty job satisfaction and retention: A national perspective.

The need for registered nurses in the United States continues to grow. To meet this need for increased numbers of nurses, recruitment and retention of qualified nurse educators has become a priority. In addition, the factors associated with nursing faculties' intent to stay have emerged as important considerations for administrators. The concepts of job satisfaction and intent to stay become vital to recruiting and retaining nursing faculty. In the past decade few empirical studies have been conducted on a national scale to address job satisfaction and intent to stay in academia. The purpose of this retrospective study is to analyze variables of relationships with nurse faculty job satisfaction and intent to stay from data collected throughout the United States. The Collaborative on Academic Careers in Higher Education (COACHE) survey was employed for the purposes of this study. Over 1350 nurse educators were included in the survey. The findings support a variety of modifiable variables that are viewed as important by nursing faculty. The strongest relationship was found to be institutional leadership. The implications can inform academic administrators seeking to retain nursing faculty.

Metabolic Requirement of Septic Shock Patients Before and After Liberation From Mechanical Ventilation.

OBJECTIVES: This study identified the difference in energy expenditure and substrate utilization of patients during and upon liberation from mechanical ventilation. METHODS: Patients under intensive care who were diagnosed with septic shock and dependent on mechanical ventilation were recruited. Indirect calorimetry measurements were performed during and upon liberation from mechanical ventilation. RESULTS: Thirty-five patients were recruited (20 men and 15 women; mean age, 69 ± 10 years). Measured energy expenditures during ventilation and upon liberation were 2090 ± 489 kcal·d-1 and 1910 ± 579 kcal·d-1, respectively ( P < .05). Energy intake was provided at 1148 ± 495 kcal·d-1 and differed significantly from all measured energy expenditures ( P < .05). Mean carbohydrate utilization was 0.19 ± 0.1 g·min-1 when patients were on mechanical ventilation compared with 0.15 ± 0.09 g·min-1 upon liberation ( P < .05). Mean lipid oxidation was 0.08 ± 0.05 g·min-1 during and 0.09 ± 0.07 g·min-1 upon liberation from mechanical ventilation ( P > .05). CONCLUSIONS: Measured energy expenditure was higher during than upon liberation from mechanical ventilation. This could be the increase in work of breathing from the continuous positive pressure support, repeated weaning cycles from mechanical ventilation, and/or the asynchronization between patients' respiration and ventilator support. Future studies should examine whether more appropriately matching energy expenditure with energy intake would promote positive health outcomes.

Hereditary basaloid follicular hamartoma syndrome.

Basaloid follicular hamartoma syndrome (BFHS) is a rare adnexal tumor genodermatosis. We present a case of hereditary BFHS and review the literature concerning the clinical and histologic features of this entity.

Mandibular inferior cortical bone thickness on panoramic radiographs in patients using bisphosphonates.

OBJECTIVE: The goal of this study was to detect dimensional changes in the mandibular cortical bone associated with bisphosphonate (BP) use and to correlate measurements of the cortical bone with the cumulative dose of BPs. STUDY DESIGN: Mandibular inferior cortical bone thickness (MICBT) was measured under the mental foramen on panoramic radiographs of patients with and without bisphosphonate-related osteonecrosis of the jaws (BRONJ) taking BPs and controls. RESULTS: Patients with BRONJ had the highest mean MICBT (6.81 ± 1.35 mm), compared with patients without BRONJ taking BPs (5.44 ± 1.09 mm) and controls (4.79 ± 0.85 mm) (P < .01). Mean MICBT of patients with BRONJ was significantly higher than that of patients without BRONJ taking BPs. There was a correlation between MICBT and cumulative dose of zolendronate. CONCLUSIONS: Measurement of MICBT on panoramic radiographs is a potentially useful tool for the detection of dimensional changes associated with BP therapy.

Evidence analysis library review of best practices for performing indirect calorimetry in healthy and non-critically ill individuals.

When measurement of resting metabolic rate (RMR) by indirect calorimetry is necessary, following evidence-based protocols will ensure the individual has achieved a resting state. The purpose of this project was to update the best practices for measuring RMR by indirect calorimetry in healthy and non-critically ill adults and children found the Evidence Analysis Library of the Academy of Nutrition and Dietetics. The Evidence Analysis process described by the Academy of Nutrition and Dietetics was followed. The Ovid database was searched for papers published between 2003 and 2012 using key words identified by the work group and research consultants, studies used in the previous project were also considered (1980 to 2003), and references were hand searched. The work group worked in pairs to assign papers to specific questions; however, the work group developed evidence summaries, conclusion statements, and recommendations as a group. Only 43 papers were included to answer 21 questions about the best practices to ensure an individual is at rest when measuring RMR in the non-critically ill population. In summary, subjects should be fasted for at least 7 hours and rest for 30 minutes in a thermoneutral, quiet, and dimly lit room in the supine position before the test, without doing any activities, including fidgeting, reading, or listening to music. RMR can be measured at any time of the day as long as resting conditions are met. The duration of the effects of nicotine and caffeine and other stimulants is unknown, but lasts longer than 140 minutes and 240 minutes, respectively. The duration of the effects of various types of exercise on RMR is unknown. Recommendations for achieving steady state, preferred gas-collection devices, and use of respiratory quotient to detect measurement errors are also given. Of the 21 conclusions statements developed in this systemic review, only 5 received a grade I or II. One limitation is the low number of studies available to address the questions and most of the included studies had small sample sizes and were conducted in healthy adults. More research on how to conduct an indirect calorimetry measurement in healthy adults and children and in sick, but not critically ill, individuals is needed.

Massive interstitial copy-neutral loss-of-heterozygosity as evidence for cancer being a disease of the DNA-damage response.

BACKGROUND: The presence of loss-of-heterozygosity (LOH) mutations in cancer cell genomes is commonly encountered. Moreover, the occurrences of LOHs in tumor suppressor genes play important roles in oncogenesis. However, because the causative mechanisms underlying LOH mutations in cancer cells yet remain to be elucidated, enquiry into the nature of these mechanisms based on a comprehensive examination of the characteristics of LOHs in multiple types of cancers has become a necessity. METHODS: We performed next-generation sequencing on inter-Alu sequences of five different types of solid tumors and acute myeloid leukemias, employing the AluScan platform which entailed amplification of such sequences using multiple PCR primers based on the consensus sequences of Alu elements; as well as the whole genome sequences of a lung-to-liver metastatic cancer and a primary liver cancer. Paired-end sequencing reads were aligned to the reference human genome to identify major and minor alleles so that the partition of LOH products between homozygous-major vs. homozygous-minor alleles could be determined at single-base resolution. Strict filtering conditions were employed to avoid false positives. Measurements of LOH occurrences in copy number variation (CNV)-neutral regions were obtained through removal of CNV-associated LOHs. RESULTS: We found: (a) average occurrence of copy-neutral LOHs amounting to 6.9% of heterologous loci in the various cancers; (b) the mainly interstitial nature of the LOHs; and (c) preference for formation of homozygous-major over homozygous-minor, and transitional over transversional, LOHs. CONCLUSIONS: The characteristics of the cancer LOHs, observed in both AluScan and whole genome sequencings, point to the formation of LOHs through repair of double-strand breaks by interhomolog recombination, or gene conversion, as the consequence of a defective DNA-damage response, leading to a unified mechanism for generating the mutations required for oncogenesis as well as the progression of cancer cells.

De novo synthesis of PCR templates for the development of SARS diagnostic assay.

A novel coronavirus was identified as the cause for severe acute respiratory syndrome (SARS). The complete sequence of SARS genome has provided an opportunity for the development of molecular diagnostic assays. To restrain further outbreak of SARS, the World Health Organization has posted several pairs of polymerase chain reaction (PCR) primers for early diagnosis and urged more research to be done on PCR protocols. Here we report a strategy for the de novo synthesis of PCR templates complimentary to the SARS virus genome, which has the advantage of working on PCR templates without concern about viral infection and also has the advantage that it can be used by those who do not have access to the SARS virus. This highly efficient and safe strategy for obtaining SARS gene fragments is useful for the development of PCR assays, as well as for the preparation of reliable positive controls for PCR testing kits.