Diagnostic accuracy of fused CBCT images in the evaluation of temporomandibular joint condylar bone resorption.

OBJECTIVES: To evaluate the diagnostic accuracy of fused CBCT images for patients with condylar bone resorption of temporomandibular joint (TMJ) osteoarthrosis. MATERIALS AND METHODS: Forty-two TMJs from twenty-one patients were included. Bone resorption of condyles evaluated by three experts was used as the reference standard. Three oral and maxillofacial radiology residents evaluated the resorption of condyles with a five-point scale for the four sets of images (two consecutive CBCT images without fusion, fused 2D cross-sectional images, fused 3D images, and combining fused 2D cross-sectional images and fused 3D images) randomly and independently. Each set of images was evaluated at least 1 week apart, and a second evaluation was performed 4 weeks later. Intraclass correlation coefficients were calculated to assess the intra- and inter-observer agreement. The areas under the ROC curves (AUCs) were compared among the four image sets using the Z test. RESULTS: Twenty-four TMJs were determined as condylar bone resorption, and eighteen were determined as no obvious change. The average AUC values from the three observers for the three fused image sets (0.94, 0.93, 0.93) were significantly higher than the image set without fusion (p < 0.01). The intra- and inter-observer agreement on the three fused image sets (0.70-0.89, 0.91-0.92) was higher than the image set without fusion (0.37-0.63, 0.75). CONCLUSIONS: Fused CBCT images of TMJ osteoarthrosis patients can intuitively display the condylar bone resorption and significantly improve the diagnostic accuracy. CLINICAL RELEVANCE: Fused CBCT images can help clinicians intuitively observe bone changes of the condyle in TMJ osteoarthrosis patients.

Efficacy, safety, and immunology of an inactivated alum-adjuvant enterovirus 71 vaccine in children in China: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial.

BACKGROUND: A vaccine for enterovirus 71 (EV71) is needed to address the high burden of disease associated with infection. We assessed the efficacy, safety, immunogenicity, antibody persistence, and immunological correlates of an inactivated alum-adjuvant EV71 vaccine. METHODS: We did a randomised, double-blind, placebo-controlled, phase 3 trial. Healthy children aged 6-35 months from four centres in China were randomly assigned (1:1) to receive vaccine or alum-adjuvant placebo at day 0 and 28, according to a randomisation list (block size 30) generated by an independent statistician. Investigators and participants and their guardians were masked to the assignment. Primary endpoints were EV71-associated hand, foot, and mouth disease (HFMD) and EV71-associated disease during the surveillance period from day 56 to month 14, analysed in the per-protocol population. This study is registered with ClinicalTrials.gov, number NCT01508247. FINDINGS: 10,245 participants were enrolled and assigned: 5120 to vaccine versus 5125 to placebo. 4907 (with three cases of EV71-associated HFMD and eight cases of EV71-associated disease) versus 4939 (with 30 cases of EV71-associated HFMD and 41 cases of EV71-associated disease) were included in the primary efficacy analysis. Vaccine efficacy was 90·0% (95% CI 67·1-96·9) against EV71-associated HFMD (p=0·0001) and 80·4% (95% CI 58·2-90·8) against EV71-associated disease (p<0·0001). Serious adverse events were reported by 62 of 5117 (1·2%) participants in the vaccine group versus 75 of 5123 (1·5%) in the placebo group (p=0·27). Adverse events occurred in 3644 (71·2%) versus 3603 (70·3%; p=0·33). INTERPRETATION: EV71 vaccine provides high efficacy, satisfactory safety, and sustained immunogenicity. FUNDING: China's 12-5 National Major Infectious Disease Program, Beijing Vigoo Biological.

Transient receptor potential melastatin 4 channel controls calcium signals and dental follicle stem cell differentiation.

Elevations in the intracellular Ca(2+) concentration are a phenomena commonly observed during stem cell differentiation but cease after the process is complete. The transient receptor potential melastatin 4 (TRPM4) is an ion channel that controls Ca(2+) signals in excitable and nonexcitable cells. However, its role in stem cells remains unknown. The aim of this study was to characterize TRPM4 in rat dental follicle stem cells (DFSCs) and to determine its impact on Ca(2+) signaling and the differentiation process. We identified TRPM4 gene expression in DFSCs, but not TRPM5, a closely related channel with similar function. Perfusion of cells with increasing buffered Ca(2+) resulted in a concentration-dependent activation of currents typical for TRPM4, which were also voltage-dependent and had Na(+) conductivity. Molecular suppression with shRNA decreased channel activity and cell proliferation during osteogenesis but not adipogenesis. As a result, enhanced mineralization and phosphatase enzyme activity were observed during osteoblast formation, although DFSCs failed to differentiate into adipocytes. Furthermore, the normal agonist-induced first and secondary phases of Ca(2+) signals were transformed into a gradual and sustained increase which confirmed the channels' ability to control Ca(2+) signaling. Using whole genome microarray analysis, we identified several genes impacted by TRPM4 during DFSC differentiation. These findings suggest an inhibitory role for TRPM4 on osteogenesis while it appears to be required for adipogenesis. The data also provide a potential link between the Ca(2+) signaling pattern and gene expression during stem cell differentiation.

Relationship between development of the condylar cortex and the changes in condyle morphology: a cone-beam computed tomography (CBCT) observational study.

Background: A correct understanding of the mandibular condyle morphology may help clinicians judge the normal range of morphological variations of asymptomatic patients or the pathological conditions correctly. Hence, the aim of the present study was to evaluate the status of condyle cortication and condyle morphology, and to investigate the relationship between the development of the condylar cortex and the changes of condyle morphology. Methods: The present study was an observational study. A total of 1,010 temporomandibular joint (TMJ) cone-beam computed tomography (CBCT) images were collected retrospectively. The mandibular condyle morphology was observed in axial (concave, convex, plane and others for anterior and posterior facets), coronal (plane, convex, angled and round for superior facet) and sagittal (round and plane for superior facet) views, and the condylar cortication was grouped into three types (undeveloped, developing and developed). Analytical statistics were performed to detect a relationship between the cortication status and morphology of the condyles. Results: For males and females, the mean age was 15.11±2.71 and 14.25±2.60 years (for condylar bone without cortication), 19.45±3.92 and 18.65±3.45 years (with developing cortical bone), 23.63±3.36 and 23.86±3.73 years (with developed cortical bone), respectively. The condyle morphology with a plane form in the anterior aspect, a convex form in the posterior aspect, a convex form in the coronal view and a round form in the sagittal view was the most often recorded condyle morphologies (13.2%). After the cortical bone of condyle completely forms, the plane form was significantly increased in the superior surface in both sagittal and coronal views. Conclusions: The condylar shape gradually changes with growth and development of the condyle bone cortex. The more mature the bone cortex is, the higher the probability that the condyle will have an uneven shape, which may mean that the condyle morphology may change due to remodeling during growth and development.

Quantitative assessment of condylar bone resorption using fused CBCT images: differentiating and diagnosing three distinct groups based on volume and thickness decrease.

OBJECTIVES: To investigate the accuracy of fused CBCT images in diagnosing three distinct groups of bone changes characterized by volume and thickness decrease in patients with temporomandibular joint osteoarthrosis (TMJ OA) during follow-up. METHODS: In this retrospective study, 109 patients (176 TMJs) with TMJ OA were included. Two consecutive CBCT images for the same patient were registered and fused. Then, three image sets were established: without fusion, fused 2D image, and fused 3D image. Three residents randomly and independently evaluated whether there was condylar resorption with the three image sets respectively. The samples diagnosed as condylar resorption by the expert panel were divided into three subgroups according to the volume and thickness decrease calculated after segmentation. The inter- and intraobserver agreement, receiver operating characteristic (ROC), and area under the curve (AUC) evaluated the diagnostic capability for different subgroups. RESULTS: For the volume decrease more than 50 mm3 and thickness decrease more than 1 mm groups, the AUC values for fused image sets were higher than those without fusion (p < 0.01). For the volume decrease within 50 mm3 and thickness decrease within 1 mm groups, the AUC values for fused 2D image sets were higher than the image sets without fusion (p < 0.05), but there was no significant difference between the fused 3D image sets and the image sets without fusion (p = 0.48 for volume decrease, p = 0.37 for thickness decrease). CONCLUSIONS: The fused images can improve the diagnostic accuracy and repeatability for the samples with at least 50 mm3 volume decrease or 1 mm thickness decrease compared with the image groups without fusion.

Efficacy and safety of a novel submucosal injection solution for endoscopic resection in porcine models.

OBJECTIVE: A submucosal injection is usually required to improve the efficacy and safety of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR). This study aimed to evaluate the performance of 3.3% sodium carboxymethyl starch (Na-CMS) solution, a novel submucosal injection solution, for ESD and EMR. METHODS: Na-CMS, normal saline (NS) and two commercially available agents (sigMAVisc and Eleview) were injected into the esophageal submucosa of randomly grouped pigs. The level of submucosal elevation was examined. Subsequently, ESD or EMR procedures using 3.3% Na-CMS or NS as submucosal injections were performed in the gastrointestinal tract of the pigs. RESULTS: Submucosal elevation was significantly higher and more sustained in the 3.3% Na-CMS group than in the controls (P < 0.05). The volume required for ESD or EMR was significantly lower in the 3.3% Na-CMS group than in the NS group (ESD: 12.21 ± 4.09 mL vs 28.25 ± 8.02 mL, P < 0.001; EMR: 3.99 ± 1.98 mL vs 7.15 ± 3.67 mL, P = 0.001). The ESD resection time was significantly shorter in the 3.3% Na-CMS group than in the NS group (16.58 ± 7.30 min vs 25.29 ± 11.89 min, P = 0.004). Hemorrhage after ESD in the 3.3% Na-CMS group was less severe than that in the NS group (P = 0.006). CONCLUSION: 3.3% Na-CMS is an effective, safe and low-cost submucosal injection solution and holds promise as preferable agent for submucosal injection in ESD and EMR procedures.

New identification of the moray eel Gymnothorax minor (Temminck & Schlegel, 1846) in China (Anguilliformes, Muraenidae).

A new identification of Gymnothorax minor (Temminck & Schlegel, 1846) is documented based on morphological characteristics and DNA barcoding. Sixty-one individuals of G. minor were collected from the East China Sea and the South China Sea. This species was previously reported as Gymnothorax reticularis Bloch, 1795 in China because of the similarity in external shape and color. Gymnothorax minor can be easily distinguished from G. reticularis by its color pattern of 18-20 irregular dark brown vertical bars and the body having scattered small brown spots. Additionally, the teeth are uniserial on both jaws, and the vertebrae number 137-139. By combining congener sequences of the cytochrome oxidase I (COI) gene from GenBank, two groups were detected among all the COI sequences of the currently named G. minor, which further indicated that two valid species were present based on genetic distance. A divergence also occurred on the number of vertebrae between the northern and southern populations. The phylogenetic and morphological analysis strongly supports that the northern and southern populations of G. minor are two different species. Furthermore, the distribution area of the northern G. minor has expanded southward to 5°15'N in the South China Sea. More specimens of G. minor and G. reticularis are crucial in order to define their geographical distribution boundaries and provide the correct DNA barcoding.

Fabrication and Characterization of Stable Soy ß-Conglycinin-Dextran Core-Shell Nanogels Prepared via a Self-Assembly Approach at the Isoelectric Point.

The preparation of soy ß-conglycinin-dextran nanogels (∼90 nm) went through two stages, which are safe, facile, and green. First, amphiphilic graft copolymers were formed by dextran covalently attaching to ß-conglycinin via Maillard dry-heating reaction. Second, the synthesized conjugates were heated above the denaturation temperature at the isoelectric point (pH4.8) so as to assemble nanogels. The effects of pH, concentration, heating temperature, and time on the fabrication of nanogels were examined. The morphology study displayed that the nanogels exhibited spherical shape with core-shell structures, which was reconfirmed by zeta-potential investigation. Both circular dichroism spectra and surface hydrophobicity analyses indicated that the conformations of ß-conglycinin in the core of nanogels were changed, and the latter experiment further revealed that the hydrophobic groups of ß-conglycinin were exposed to the surface of protein. The nanogels were stable against various conditions and might be useful to deliver hydrophobic bioactive compounds.

A helical zinc(II) coordination polymer assembled from 1,3-bis[(pyridin-3-yl)methoxy]benzene and benzene-1,4-dicarboxylic acid.

In catena-poly[[aqua[1,3-bis(pyridine-3-ylmethoxy)benzene-κN]zinc(II)]-µ2-benzene-1,4-dicarboxylato-κ(2)O(1):O(4)], [Zn(C8H4O4)(C18H16N2O2)(H2O)]n, each Zn(II) centre is tetrahedrally coordinated by two O atoms of bridging carboxylate groups from two benzene-1,4-dicarboxylate anions (denoted L(2-)), one O atom from a water molecule and one N atom from a 1,3-bis[(pyridin-3-yl)methoxy]benzene ligand (denoted bpmb). (Aqua)O-H···N hydrogen-bonding interactions induce the formation of one-dimensional helical [Zn(L)(bpmb)(H2O)]n chains which are interlinked through (aqua)O-H···O hydrogen-bonding interactions, producing two-dimensional corrugated sheets.

[Percutaneous vertebroplasty and kyphoplasty for the treatment of thoracolumbar fractures in the elderly].

OBJECTIVE: To study the clinical effects of percutaneous vertebroplasty and kyphoplasty in the treatment of fresh thoracolumbar fractures in the elderly. METHODS: From May 2004 to March 2009, among 29 patients (32 vertebras) with thoracolumbar fractures, 18 patients (21 vertebras) were treated with percutaneous vertebroplasty (PVP) and 11 patients (11 vertebras) were treated with percutaneous kyphoplasty (PKP). The visual analogue scale (VAS) and mobility were evaluated 3 days before and after operation. During follow-up period, patients were observed and evaluated in terms of relief of back pain and regaining of living ability. Complications such as bone cement leakage were analyzed. RESULTS: All the patients got successful operation. The average operation time was 38.6 minutes for the 18 patients (21 vertebras) with PVP performed, and 3.2 ml (2-5 ml) bone cement was injected. For the 11 patients (11 vertebras) with PKP performed, the average operation time was 43 minutes, and an average of 3.8 ml (2-6 ml) bone cement was injected. The VAS decreased from preoperative (7.5 +/- 0.7) to (2.2 +/- 0.5) at the 3rd day after operation; the mobility scores of the patients decreased from preoperative (2.4 +/- 0.6) to (1.2 +/- 0.3) at the 3rd day after operation; the vertebral height increased from an average of (52.4 +/- 9.7)% pre-operation to (85.2 +/- 10.6)% after operation; and the average kyphosis correction of Cobb angle was 11.2 degrees. During an average of 12.6 months follow-up, no patients reported vertebral pain. Review of X-ray films showed no significant loss of vertebral height. One patient died from complications of heart disease 5 months being discharged from hospital. Another patient died from the same cause at 6 months after opertaion. Paravertebral leakage of bone cement was also found in 2 patients. No serious complications occurred and patients were satisfied with the treatment. CONCLUSION: PVP, PKP can be used to instantly reinforce vertebral injury, relieve pain, and improve the patient's mobility. For elder people with fresh thoracolumbar fractures, when health conditions are allowed, PVP or PKP surgery is the right treatment.