Extraocular silicone oil migration to orbit and retrolaminar region: case report and systematic review.

BACKGROUND: Silicone oil insertion is a common modality in vitreoretinal surgeries. The purpose of this study is to conduct a systematic review to summarize the uncommon complication of extraocular silicone oil migration. METHODS: Following the PRISMA guidelines, a systematic review of the literature was performed on January 11, 2020, using PubMed and EMBASE with the following terms: "silicone oil," "eye," and "migrat*." RESULTS: A total of 69 patients-68 patients from 59 articles and one case from our institution-were included in the final analysis. The median age was 54 years (range, 9-92) and 40 patients (57.9%) were men. Orbital migration was reported in 34 patients, and retrolaminar migration (including optic nerve, optic chiasm, suprasellar, subarachnoid space, intraventricular spaces) was reported in 35 patients. Orbital migration group had more aphakics (p = 0.007), implanted glaucoma drainage device (p = 0.005), scleral buckle (p = 0.000), history of trauma-related indications for pars plana vitrectomy (p = 0.000), shorter silicone oil endotamponade time (p = 0.008), more symptomatic (p = 0.000), and requiring surgical intervention (p = 0.000). Retrolaminar migration group had older patients (p = 0.016) and more diabetics (p = 0.041). CONCLUSION: Systematic review sheds light on plausible risk factors on site of silicone oil migration. Majority of orbital cases are symptomatic and require intervention while retrolaminar cases are incidental and can be managed conservatively. Awareness of this complication can help guide clinicians predict which patients would likely need surgical intervention. Graphical abstract.

Exploring the potential of laser capture microdissection technology in integrated oral biosciences.

Laser capture microdissection (LCM) is a high-end research and diagnostic technology that helps in obtaining pure cell populations for the purpose of cell- or lesion-specific genomic and proteomic analysis. Literature search on the application of LCM in oral tissues was made through PubMed. There is ample evidence to substantiate the utility of LCM in understanding the underlying molecular mechanism involving an array of oral physiological and pathological processes, including odontogenesis, taste perception, eruptive tooth movement, oral microbes, and cancers of the mouth and jaw tumors. This review is aimed at exploring the potential application of LCM in oral tissues as a high-throughput tool for integrated oral sciences. The indispensable application of LCM in the construction of lesion-specific genomic libraries with emphasis on some of the novel molecular markers thus discovered is also highlighted.

Comparative Genomics and the Salivary Transcriptome of the Redbanded Stink Bug Shed Light on Its High Damage Potential to Soybean.

The redbanded stink bug, Piezodorus guildinii (Westwood) (Hemiptera: Pentatomidae), is a significant soybean pest in the Americas, which inflicts more physical damage on soybean than other native stink bugs. Studies suggest that its heightened impact is attributed to the aggressive digestive properties of its saliva. Despite its agricultural importance, the factors driving its greater ability to degrade plant tissues have remained unexplored in a genomic evolutionary context. In this study, we hypothesized that lineage-specific gene family expansions have increased the copy number of digestive genes expressed in the salivary glands. To investigate this, we annotated a previously published genome assembly of the redbanded stink bug, performed a comparative genomic analysis on 11 hemipteran species, and reconstructed patterns of gene duplication, gain, and loss in the redbanded stink bug. We also performed RNA-seq on the redbanded stink bug's salivary tissues, along with the rest of the body without salivary glands. We identified hundreds of differentially expressed salivary genes, including a subset lost in other stink bug lineages, but retained and expressed in the redbanded stink bug's salivary glands. These genes were significantly enriched with protein families involved in proteolysis, potentially explaining the redbanded stink bug's heightened damage to soybeans. Contrary to our hypothesis, we found no support for an enrichment of duplicated digestive genes that are also differentially expressed in the salivary glands of the redbanded stink bug. Nonetheless, these results provide insight into the evolution of this important crop pest, establishing a link between its genomic history and its agriculturally important physiology.

Antibody binding to native cytomegalovirus glycoprotein B predicts efficacy of the gB/MF59 vaccine in humans.

Human cytomegalovirus (CMV) is the most common infectious cause of infant brain damage and posttransplant complications worldwide. Despite the high global burden of disease, vaccine development to prevent infection remains hampered by challenges in generating protective immunity. The most efficacious CMV vaccine candidate tested to date is a soluble glycoprotein B (gB) subunit vaccine with MF59 adjuvant (gB/MF59), which achieved 50% protection in multiple historical phase 2 clinical trials. The vaccine-elicited immune responses that conferred this protection have remained unclear. We investigated the humoral immune correlates of protection from CMV acquisition in populations of CMV-seronegative adolescent and postpartum women who received the gB/MF59 vaccine. We found that gB/MF59 immunization elicited distinct CMV-specific immunoglobulin G (IgG)-binding profiles and IgG-mediated functional responses in adolescent and postpartum vaccinees, with heterologous CMV strain neutralization observed primarily in adolescent vaccinees. Using penalized multiple logistic regression analysis, we determined that protection against primary CMV infection in both cohorts was associated with serum IgG binding to gB present on a cell surface but not binding to the soluble vaccine antigen, suggesting that IgG binding to cell-associated gB is an immune correlate of vaccine efficacy. Supporting this, we identified gB-specific monoclonal antibodies that differentially recognized soluble or cell-associated gB, revealing that there are structural differences in cell-associated and soluble gB are relevant to the generation of protective immunity. Our results highlight the importance of the native, cell-associated gB conformation in future CMV vaccine design.

Two phase II trials of temozolomide with interferon-alpha2b (pegylated and non-pegylated) in patients with recurrent glioblastoma multiforme.

BACKGROUND: Because of the poor outcomes for patients with recurrent glioblastoma multiforme (GBM), and some laboratory and clinical evidence of efficacy using interferon in GBM, we assessed the toxicity and efficacy of temozolomide (TMZ) combined with either short-acting (IFN) or long-acting (pegylated) interferon alpha2b (PEG) in two single-arm phase II studies, and compared the results to 6-month progression-free survival (PFS-6) data from historical controls. METHODS: Two single-arm phase II studies were carried out in adults with GBM. Patients were treated with the standard regimen of TMZ (150-200 mg m(-2) per day x 5 days every month) combined with either 4 million units per m(2) subcutaneously (SQ) three times weekly of IFN or 0.5 microg kg(-1) SQ weekly of PEG. Physical exams and imaging evaluations were carried out every 8 weeks. RESULTS: On the IFN study, 34 adults (74% men) were enrolled, and 29 adults (55% men) on the PEG study; median Karnofsky performance status was 80 and 90 for the IFN and PEG studies, respectively. Grade 3 or 4 toxicities were common, leucopoenia and thrombocytopoenia occurring in 35-38% and 18-21% of patients, respectively. Grade 3 or 4 fatigue occurred in 18% of patients on both studies. Lymphopoenia was infrequent. PFS-6 was 31% for 29 evaluable patients in the IFN study and 38% for 26 evaluable patients in the PEG study. CONCLUSION: In recurrent GBM patients, both studies of standard dose TMZ with either IFN or PEG showed improved efficacy when compared to historical controls, or reports using TMZ alone. Even though the TMZ+PEG study met criteria for further study, the results of both of these studies must be considered in light of the standard of care (TMZ plus radiotherapy) for newly diagnosed GBM, which has evolved since the inception of these studies. Despite the results of the current studies being eclipsed by the new GBM standard of care, these results can still inform the development of newer approaches for GBM, either in an earlier, upfront setting, or by extrapolation of the results and consideration of the use of PEG or IFN in conjunction with other antiglioma strategies.

Modifying the surface charge of pathogen-sized microspheres for studying pathogen transport in groundwater.

Consuming pathogen-contaminated groundwater has caused many waterborne disease worldwide. Microspheres are often used as pathogen surrogates because they can be made similar to pathogens in terms of their sizes, buoyant densities, and shapes. Laboratory studies have, however, shown that the surface charges of microspheres are very different from those of pathogens of comparable sizes, and that their attenuation and transport behaviors differ significantly to those of the pathogens mimicked. Thus, for microspheres to be better surrogates, their surface charges need to be modified. We have demonstrated that the surface charge of a microorganism can be closely mimicked by microspheres covalently coated with a protein that has a similar pHPZC to the microorganism. Using MS2 bacteriophage to test our concept, 20 nm carboxylated microspheres were covalently coated with casein. Zeta potentials as a function of pH were determined for purified MS2, casein, and uncoated and coated microspheres. The uncoated microspheres were significantly more negatively charged than MS2. The coated microspheres displayed zeta potentials and a pHPZC value similar to MS2. The modified surface charge on the microspheres was stable for at least 4 mo. Using the concept developed from this study, surrogates for many specific pathogens of concern can be developed, and the results can be corrected with pathogen die-off determined independently in the laboratory. Protein-coated microspheres could provide a new and alternative approach to investigate pathogen transport in groundwater. Future research is required to validate the surrogates' resemblances to pathogens in terms of their attenuation and transport behaviors in groundwater.

Human papillomavirus and oral and oropharyngeal carcinoma: the essentials.

There is a global increase in the prevalence of human papillomavirus (HPV)-driven oropharyngeal squamous cell carcinoma (OPSCC) in Australia and New Zealand. Risk factors for HPV-positive OPSCC are male gender, white race, age older than 40 but younger than 59 years old, having multiple lifetime sex partners, having oro-genital and oro-anal sex. High-risk HPV subtypes play a major role in the pathogenesis of OPSCC, however, they play a much lesser role in oral squamous cell carcinoma (OSCC). Among the laboratory tests used to detect oncogenic HPV infection, polymerase chain reaction is a sensitive method but does not reflect the role of HPV in oncogenesis. While widely used, p16 immunohistochemistry is both a sensitive and a specific surrogate marker for oncogenic HPV infection in OPSCC, but not in OSCC. However, it is a useful prognostic marker in OPSCC. The current gold standard to accurately detect oncogenic HPV infection is E6/E7 mRNAin situ hybridization. Because both HPV-positive and p16-positive OPSCC have better short-term prognoses there is current debate and trials on treatment de-escalation in HPV-positive OPSCC. Dental practitioners can play an important role in early diagnosis of HPV-positive OPSCC.

Using virtual microscopy to deliver an integrated oral pathology course for undergraduate dental students.

Dental students in the United Kingdom usually study histopathology as part of their undergraduate curriculum and this has traditionally been delivered using light microscopes in laboratory classes. Beginning in 2005, the oral pathology course in Sheffield was gradually modified by the introduction of virtual microscopy with a focus on creating a more integrated, clinically orientated and dynamic approach to student teaching and learning in histopathology. The purpose of this paper is to describe how virtual microscopy has been used to enhance dental students' learning of oral pathology, and its role in facilitating an integrated oral disease curriculum in Sheffield.

Effect of dietary cellulose on cell proliferation and progression of 1,2-dimethylhydrazine-induced colon carcinogenesis in rats.

The effects of different levels of dietary cellulose on colonic crypt mitotic activity and colon carcinogenesis were studied in 190 male Sprague-Dawley rats. Rats were divided into groups and fed a basal fiber-free diet supplemented with either 0, 5, or 15% pure cellulose (w/w), for periods of 10 weeks (initiation stage) or 32 weeks (promotional stage). Half of the rats in each group were given weekly s.c. injections of 9.5 mg 1,2-dimethylhydrazine (the base) (DMH) for 8 weeks. Some of the rats were killed at 10 weeks while most were killed 22 weeks later. In some groups the dietary cellulose level was changed to a different level at 10 weeks. Food intake and body weight data showed that the rats within each experiment were isocalorically fed. There was a direct correlation between crypt height and the percentage of cellulose in the diet. Addition of 5 or 15% dietary cellulose during the initiation stage of carcinogenesis resulted in a significant increase in crypt height. Increasing dietary cellulose after the initiation stage (0 to 5% and 5 to 15%) or maintaining a high dietary cellulose level throughout both the initiation and promotional stages (15%) resulted in a significant increase in crypt height. A DMH-induced increase in mitotic activity that was observed during the initiation stage was no longer evident after the 22-week promotional stage. The significant DMH-induced increases in proliferative zone height and crypt height that were initially observed during the initiation stage were also observed after the 22-week promotional stage. These data indicate that the initial DMH-induced increases observed in proliferative zone height and crypt height are irreversible. Addition of 5 or 15% cellulose was found to suppress DMH-enhanced mitotic activity in the crypts of the descending colon during the initiation stage of carcinogenesis. This finding was correlated with a significantly lower incidence of adenocarcinomas in rats maintained on 5 or 15% cellulose throughout both the initiation and promotional stages.

Suppression of a a carcinogen (1,2-dimethylhydrazine dihydrochloride)-induced increase in mitotic activity in the colonic crypts of rats by addition of dietary cellulose.

Serial injections of the colon carcinogen, 1,2-dimethylhydrazine (DMH), have been reported to increase the proliferative activity in the colonic crypts preceding development of tumors. Can addition of purified cellulose to a fiber-free AIN-76 rat diet be used to suppress this increase in proliferative activity? To answer this question rats were divided into two groups, and one group was given eight weekly injections of the DMH base at 9.5 mg/kg of body weight. Throughout this period and for 2 additional wk the rats were isocalorically fed a defined nutritionally complete diet both with and without different dietary levels of cellulose (0, 5, and 15%). The rats were given injections of colchicine 3 h prior to sacrifice to arrest and to collect dividing cells at metaphase. Analysis of variance was performed on various morphometric parameters obtained from histological sections of midaxial crypts from the descending colon. Our results confirm that DMH induced a significant increase in the mitotic activity as measured by the number of metaphase figures per crypt. The presence of dietary cellulose did cause a significant suppression of the DMH-induced increase in the crypt mitotic activity.

Prophylaxis for infective endocarditis: antibiotic sensitivity of dental plaque.

The antibiotic sensitivity pattern of bacteria isolated from bacteraemia after dental extraction was compared with that of bacteria isolated from dental plaque samples from the same patient. The results supported the current practice of using penicillin and erythromycin empirically for prophylaxis. The prediction of the most appropriate antibiotic for prophylaxis using dental plaque samples was most accurate when the minimum inhibitory concentration (MIC) of plaque isolates were used. It appears that a predictive test using dental plaque may be of some value in patients with recent or long-term antibiotic therapy.

The influence of macromolecular polymerization of spin-lattice relaxation of aqueous solutions.

The docking or polymerization of globular proteins is demonstrated to cause changes in proton NMR spin-lattice (T1) relaxation times. Studies on solutions of lysozyme, bovine serum albumin, actin, and tubulin are used to demonstrate that two mechanisms account for the observed changes in T1. Polymerization displaces the hydration water sheath surrounding globular proteins in solution that causes an increase in T1. Polymerization also slows the average tumbling rate of the proteins, which typically causes a contrary decrease in T1. The crystallization reaction of lysozyme in sodium chloride solution further demonstrates that the "effective" molecular weight can either decrease or increase T1 depending on how much the protein is slowed. The displacement of hydration water increases T1 because it speeds up the mean motional state of water in the solution. Macromolecular docking typically decreases T1 because it slows the mean motional state of the solute molecules. Cross-relaxation between the proteins and bound water provides the mechanism that allows macromolecular motion to influence the relaxation rate of the solvent. Fast chemical exchange between bound, structured, and bulk water accounts for monoexponential spin-lattice relaxation. Thus the spin-lattice relaxation rate of water in protein solutions is a complex reflection of the motional properties of all the molecules present containing proton magnetic dipoles. It is expected, as a result, that the characteristic relaxation times of tissues will reflect the influence of polymerization changes related to cellular activities.

Halothane and eucalyptol as alternatives to chloroform for softening gutta-percha.

Because chloroform was identified as a potential carcinogen by the Food and Drug Administration, interest has been revived to identify an alternative solvent to soften gutta-percha for removal from obturated root canals. This study compared the effectiveness of halothane, eucalyptol, and chloroform in softening gutta-percha in simulated root canals. One milliliter of a solvent was placed into a small glass funnel whose stem was obturated with a 30-mm column of gutta-percha. After 30 s, softening was evaluated for each solvent by recording the time required to reach a depth of 10 mm by hand filing with a #100 Hedstrom file. The depth of penetration of a #40 finger plugger under constant weight for 15 min was also determined for each solvent. By using a one-way analysis of variance and Scheffe's test, all comparisons were not significant except for the depth of penetration with constant weight between chloroform and halothane (p less than 0.05). The results indicate that halothane and eucalyptol are suitable alternatives to chloroform as gutta-percha softening solvents.

The effects of antidepressant drugs on salivary flow and content of sodium and potassium ions in human parotid saliva.

Stimulated parotid saliva was collected, using the Carlson-Crittenden cup, from normal controls and patients on antidepressant drugs. The saliva from patients using amitriptyline, dothiepin (tricyclics), fluoxetine and paroxetine (selective serotonin re-uptake inhibitors; SSRI) was analysed for flow rate, [Na+] and [K+], and was compared with that from unmedicated, non-depressed volunteers for all variables. The tricyclic antidepressants produced a significant reduction in flow (amitriptyline, p < 0.01; dothiepin, p < 0.05), and consequent decrease in [Na+] and increase in [K+]. These effects were presumably due to muscarinic receptor blockade. The SSRIs produced no significant change in these variables. A prospective study of dothiepin in non-depressed patients confirmed that it decreases stimulated parotid flow. This finding also suggested that depression itself contributed little to the oral dryness observed in and reported by the depressed patients. The patients' subjective rating of oral dryness related well to a reduction in stimulated flow. This applied to those taking either tricyclics or SSRI, both showing a reduced flow rate relative to control (p < 0.001 and p < 0.05, respectively). This amounted to a 58% reduction in flow rate in the tricyclic group. The data suggest that measurement of stimulated parotid salivary flow is a reliable indicator of drug-induced oral dryness.

Fluconazole-resistant Candida species in the oral flora of fluconazole-exposed HIV-positive patients.

The purpose of this study was to examine the effect of preceding fluconazole treatment on the oral mycologic flora and on the sensitivity of oral Candida albicans isolates to fluconazole. Saline oral rinses were collected from 89 HIV-positive patients, of whom 48 had been exposed to fluconazole and 41 were fluconazole-naive. The rinses were cultured on Sabouraud's and Pagano Levin agars, and yeasts were identified by standard methods. Fluconazole sensitivity of C. albicans isolates was measured by disk diffusion assay. C. albicans was isolated from 69% of patients who had received fluconazole and from 93% of the patients who were fluconazole-naive (p < 0.05). Nine other species of yeasts were also isolated, most commonly C. glabrata. Five patients previously exposed to fluconazole harbored fluconazole-resistant C. albicans, whereas no resistance was detected among the patients who were fluconazole-naive (p < 0.01). Sixteen of the patients who were fluconazole-exposed carried yeasts other than C. albicans, compared with only five patients in the fluconazole-naive group (p < 0.01). All of the fluconazole-resistant strains were isolated from patients with low CD4 counts (less than 100 cells/ml) and after lengthy fluconazole exposures. Nevertheless, patients in Charlotte, N.C., who had a greater mean fluconazole exposure time (10.25 +/- 1.41 months) than patients in Glasgow, UK, (0.65 +/- 0.18 months; p < 0.005), did not develop significantly more in vitro resistance or species diversity. This study indicates that long-term fluconazole treatment can have significant effects on the yeast flora of the mouth, particularly in a patient with a CD4 count of less than 100 cells/ml.

Bacteraemia and tissue damage resulting from air polishing.

This study investigates the production of bacteraemia in dental prophylaxis by use of a commercially available air polishing device. Prophylaxis by means of the conventional rubber cup and paste method was used as a control. The study showed that air polishing can result in loss of epithelium at the gingival margin. The likelihood of a bacteraemia resulting from air polishing, in the absence of gingivitis, was less than in the group undergoing conventional prophylaxis. Although a higher number of bacteraemias was seen in the control group, the difference between the two groups was not statistically significant. Results indicate that patients who are at risk continue to require antibiotic cover.

A clinical evaluation of benzydamine hydrochloride.

A double-blind clinical trial of the effects of the use of benzydamine hydrochloride for patients undergoing the surgical removal of impacted lower third molar teeth showed no significant effects on swelling and trismus between control and experimental groups, although a significant reduction in the post-operative consumption of analgesics was noted.

Patient-controlled sedation using midazolam.

Midazolam was given for sedation as an initial bolus, followed by either a continuous infusion or a patient controlled infusion during third molar extractions. The results showed that there were no significant changes in blood pressure, pulse rate or oxygen saturation during the procedure. Both methods gave good amnesia to events at the start, (100%), as well as to events during, (70% and 75%), and at the end, (61% and 70%), of surgery. There was high acceptance of both methods of sedation (93% and 98% respectively). There was no patient preference for either method of sedation, nor was the operator able to distinguish between the two methods. Hence it is concluded that patient controlled infusion and continuous infusion of midazolam are both satisfactory methods of sedation for patients undergoing surgery under local anaesthesia.

Implant-based treatment for the loss of a single tooth.

This article describes the authors' experience in the provision of single-tooth replacement by means of Brånemark implant treatments. Over a 5-year period, 45 treatments have been undertaken with a current fixture retention rate of 100 percent. Careful planning and attention to detail in surgical, prosthodontic, and technical aspects have resulted in an excellent functional and aesthetic treatment with high acceptance by patients.

Primary reconstruction of the mandible with iliac bone and titanium implants following resection of a recurrent odontogenic keratocyst.

An aggressive surgical management of a mandibular odontogenic keratocyst in a young female patient is described. This management stratagem was followed in view of a histological finding of epithelial dysplasia and the possible, although unlikely, chance of squamous cell carcinoma developing in the cyst lining. Primary bone grafting and immediate fixture placement of implants were used to make good the mandibular resection site. This was thought to be the best option for management, minimising the number of surgical interventions and providing a framework for fixed bridgework in an area of the mouth that is difficult to reconstruct adequately. A successful outcome to the treatment has been observed, with graft survival, osseointegration of fixtures, the provision of functional and aesthetically pleasing implant-borne bridgework and, to date, the absence of clinical or radiographic evidence of recurrence of the cyst.