Mapping out the surgical anatomy of the lingual nerve: a systematic review and meta-analysis.

Objectives: Understanding the lingual nerve's precise location is crucial to prevent iatrogenic injury. This systematic review seeks to determine the lingual nerve's most probable topographical location in the posterior mandible. Materials and Methods: Two electronic databases were searched, identifying studies reporting the lingual nerve's position in the posterior mandible. Anatomical data in the vertical and horizontal dimensions at the retromolar and molar regions were collected for meta-analyses. Results: Of the 2,700 unique records identified, 18 studies were included in this review. In the vertical plane, 8.8% (95% confidence interval [CI], 1.0%-21.7%) and 6.3% (95% CI, 1.9%-12.5%) of the lingual nerves coursed above the alveolar crest at the retromolar and third molar regions. The mean vertical distance between the nerve and the alveolar crest ranged from 12.10 to 4.32 mm at the first to third molar regions. In the horizontal plane, 19.9% (95% CI, 0.0%-62.7%) and 35.2% (95% CI, 13.0%-61.1%) of the lingual nerves were in contact with the lingual plate at the retromolar and third molar regions. Conclusion: This systematic review mapped out the anatomical location of the lingual nerve in the posterior mandible, highlighting regions that warrant additional caution during surgeries to avoid iatrogenic lingual nerve injuries.

Maxillary Impaction Does Not Negatively Affect the Nasal Airway: A Systematic Review With Meta-Analysis.

PURPOSE: Le Fort I maxillary impaction is an orthognathic surgical procedure to reposition the maxillary complex superiorly. The objective of this study is to investigate if maxillary impaction negatively affects the nasal airway. METHODS: A systematic review with meta-analysis was performed to investigate the effects of maxillary impaction on the nasal cavity. PubMed, Embase, and Cochrane Library databases were accessed. Observational studies, nonrandomized, and randomized controlled trials were included if Le Fort 1 maxillary impaction and nasal airway outcomes assessments were performed. Studies were excluded if maxillary impaction or nasal airway outcome assessment was not performed or if the study included patients with cleft or craniofacial syndromes, previous nasal surgeries, or active respiratory tract. The demographic data, study methodology, magnitude of maxillary impaction, and outcomes related to the nasal airway were collected. These outcomes includes anatomical changes (evaluated by rhinoscopy, acoustic rhinometry, and computed tomography), changes to nasal airflow and resistance (evaluated by rhinomanometry) and changes to quality of life. RESULTS: The search yielded 7517 studies. Ten studies were included after the application of the selection criteria. A total of 126 patients underwent pure maxillary impaction, 97 underwent maxillary impaction and advancement, and 12 had impaction with setback. Despite that maxillary impactions decreased the nasal cavity volume by +21.7%, the cross-sectional area of the narrowest parts of the cavity was only reduced by -8.4%. Maxillary impactions generally increases the nasal airflow (+12.6%) while reducing nasal resistance (-20.2%). Rhinoscopies also showed a reduction in nasal obstruction. CONCLUSION: Maxillary impaction did not negatively affect the nasal airway. The surgeries did not lead to the reduction of the cross-sectional area at the strictures of the nasal cavities. The nasal airflow and resistance was not decreased and increased, respectively. The quality of life of the patients was also not shown to have worsened.

Healing complications and their detrimental effects on bone gain in vertical-guided bone regeneration: A systematic review and meta-analysis.

PURPOSE: Guided bone regeneration (GBR) utilizes a barrier membrane to allow osteogenic cells to populate a space by excluding epithelial and connective tissue cells. The purpose of this systematic review was to investigate the ratio of means (RoM) of vertical bone gained (Outcome) in vertical GBR procedures with healing complications (Intervention) and in vertical GBR procedures without healing complications (Comparison) in patients with vertically resorbed edentulous ridges that require dental implant placement (Population). A further aim was to investigate the incidence of complications after vertical GBR, and the influence of the timing of implant placement and regenerative devices on complications. MATERIALS AND METHODS: MEDLINE (through PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched in duplicate up to, and including, November 2020 for randomized and controlled clinical trials and prospective and retrospective case series. Outcomes included patient-level and site-level RoM of vertical bone gain between healing complications and uneventful healing, and incidences of complications that occurred after vertical GBR. Random-effects and fixed-effects meta-analyses were performed where appropriate. This study was registered on PROSPERO (CRD42021226432). RESULTS: A total of 31 publications were selected for the qualitative and quantitative analyses. The RoM of vertical bone gained was 0.65 [95% CI = 0.47, 0.91] and 0.62 [95% CI = 0.45, 0.85] when membrane exposure without suppuration and abscess formation without membrane exposure occurred respectively, in comparison to uneventful healing. The overall incidence proportion of healing complications occurring at the augmented site at a site- and patient-level was 11.0% [95% CI = 7.0, 15.6] and 10.8% [95% CI = 6.6, 15.7]. At a patient-level, there were no significant differences between a simultaneous or staged approach, or with the regenerative device used. The site-level incidence proportion of membrane exposure without suppuration, membrane exposure with suppuration, and with abscess formation without membrane exposure was 8.7% [95% CI = 4.2, 14.2], 0.7% [95% CI = 0.0, 2.9], and 0.5% [95% CI = 0.0, 1.7], respectively. The site-level weighted mean incidence proportion of neurologic complications occurring at the donor site was 0.8% [95% CI = 0.0, 5.3]. CONCLUSIONS: There is a significant reduction in bone gain when healing complications occur. However, healing complications are relatively uncommon surgical complications after vertical GBR.

Postobturation Pain Associated with Tricalcium Silicate and Resin-based Sealer Techniques: A Randomized Clinical Trial.

INTRODUCTION: The incidence of immediate postobturation pain associated with 2 sealer techniques was compared and potential prognostic factors identified. METHODS: Patients referred for endodontic treatment were recruited with informed consent. Root canals were debrided and teeth rendered asymptomatic before random allocation to receive TotalFill BC (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) or AH Plus sealer (Dentsply Maillefer, Ballaigues, Switzerland). Patients blinded to the sealer reported their postobturation pain experience 1, 3, and 7 days after treatment. Blinded and calibrated assessors independently reviewed treatment quality, sealer extrusion, and radiographic data under standardized conditions. RESULTS: One hundred sixty eligible patients (163 teeth, 95.3%) returned their pain diary. No postobturation pain difference was found between the 2 sealers (P > .05), although the AH Plus sealer technique was significantly associated with extrusion beyond the apex (P < .05; odds ratio [OR] = 3.02; 95% confidence interval [CI], 1.39-6.57). Thirty-three (20.6%) patients reported pain on day 1 (median 1 = very mild pain), 16 (10.0%) on day 3 (median 1 = very mild pain), and 9 (5.6%) on day 7 (median 2 = mild pain). The prognostic factors were as follows: (1) moderate/severe preoperative pain (OR = 4.41; 95% CI, 1.42-13.76 on day 3 and OR = 5.16; 95% CI, 1.17-22.78 on day 7), (2) provoked preoperative pain (OR = 4.24; 95% CI, 1.40-12.78 on day 3 and OR = 5.35; 95% CI, 1.27-22.51 on day 7), (3) pulpless tooth (OR = 0.11; 95% CI, 0.02-0.57 on day 3), and (4) sonic activation during treatment (OR = 3.02; 95% CI, 1.39-6.57 on day 1 and OR = 3.01; 95% CI, 1.05-8.59 on day 3). CONCLUSIONS: There was no significant difference in pain experience between teeth filled using AH Plus or TotalFill BC Sealer 1, 3, and 7 days after obturation. Patient- and treatment-related factors could influence postobturation pain.

Clinical and histological sequelae of surgical complications in horizontal guided bone regeneration: a systematic review and proposal for management.

It is not uncommon to encounter post-surgical complications after horizontal guided bone regeneration (GBR). The primary aim of this review was to evaluate the incidence and types of complications that occur after horizontal GBR and propose management strategies to deal with these clinical situations. A secondary aim was to conduct a histomorphometric review of the wound healing process at sites that experienced post-surgical complications after GBR. A keyword search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for studies published in English from January 2015 to January 2020 was conducted for the primary aim and 23 studies were selected. A second search addressing the secondary aim was conducted, and five studies were included. Site-level analysis showed that the weighted mean incidence proportion of minor wound dehiscence and minor infections occurring at the augmented site was 9.9% [95% CI 6.4, 13.9, P < 0.01] and 1.5% [95% CI 0.4, 3.1, P = 0.21) respectively. Patient-level analysis showed minor and major complications occurring at a weighted mean incidence proportion of 16.1% [95% CI 11.9, 20.8, P = 0.01] and 1.6% [95% CI 0.0, 4.7, P < 0.01] respectively, while neurosensory alterations at the donor site was 7.0% [95% CI 1.3, 15.5, P < 0.01]. Subgroup analysis also revealed that the use of block grafts increased the incidence proportion of minor post-surgical complications, whereas a staged GBR procedure increased the incidence proportion of both minor and major post-surgical complications. Although exposure of the barrier membrane is often associated with less bone regeneration and graft resorption, the type of membrane used (resorbable or non-resorbable) had no statistically significant influence on any post-surgical complication. Histologically, a layer of fibrous connective tissue instead of bone is commonly observed at the interface between the native bone at the recipient site and the regenerated bone in cases with membrane exposure after GBR procedure. Minor wound dehiscence was the highest incidence proportion of post-surgical complications. Methods ranging from daily application of antiseptics, use of systemic antimicrobials, regular reviews, and total removal of the non-integrated biomaterials are commonly prescribed to manage these post-surgical complications in attempt to minimise the loss of tissue at the surgical site.

Genetic variability of wildlife-derived Sarcoptes scabiei determined by the ribosomal ITS-2 and mitochondrial 16S genes.

Infestation by the ectoparasitic mite Sarcoptes scabiei (Acari: Sarcoptidae) has important implications for global wildlife conservation and both animal and human health. Ribosomal and mitochondrial DNA sequences of parasites are useful to determine genetic diversity and to describe their likely dynamic evolution. In this study, we described the genetic diversity of S. scabiei individuals collected from wild animals in China by sequencing the ribosomal ITS-2 and mitochondrial 16S rRNA genes. A total of 13 Sarcoptes isolates of wildlife, coupled with one of rabbit origin, were subjected to genetic characteristics. After cloning and sequencing, 14 ITS-2 sequences and 12 16S rRNA sequences were obtained and analyzed. Further analysis of haplotype network and population genetic structure revealed that there were 79 haplotypes in ITS-2 (main haplotype H2) and 31 haplotypes in 16S rRNA (main haplotype C10). The phylogenetic trees showed some partial clustering by location and host, and the analysis of gene polymorphism may prompt that all isolates of S. scabiei have a similar origin. We speculate that the genetic evolution of S. scabiei may be related with that of the hosts, but more research is necessary to better understand the host-parasite co-evolutionary relationship in S. scabiei. These results provide new insights into understanding the population genetics and evolutionary biology of S. scabiei and therefore a better understanding of controlling its infestation pathways worldwide.

Genetic variation in mitochondrial cox2 of Heterakis gallinarum from poultry in Sichuan, China.

Heterakis gallinarum is one of the common parasitic nematodes found in the caecum of poultry. To investigate the genetic diversity and genetic structure of the H. gallinarum population in Sichuan, we amplified and sequenced the complete mitochondrial (mt) cytochrome c oxidase subunit II (cox2) gene of 59 H. gallinarum isolates from seven different geographical regions, then analyzed their genetic polymorphisms. All cox2 genes of the 59 H. gallinarum isolates were 696 bp in length, with an average A + T content of 67.1%. Fifty-nine sequences contained 34 variable sites, and were classified into 23 haplotypes (HS1-HS23). The values of haplotype diversity (Hd) and nucleotide diversity (π) were 0.688 and 0.00288, respectively. Based on values of FST and Nm (FST = 0.01929, Nm = 12.71), there was a frequent gene flow but no significant genetic differentiation observed among the populations. The network map showed that the most prominent haplotype was HS1, and the other haplotypes (HS2-HS23) were centered on HS1 with a star-like topology, indicating that H. gallinarum had previously experienced a population expansion. To our knowledge, this is the first research on the population genetics of H. gallinarum based on mitochondrial cox2.

Second primary tumors and myeloperoxidase expression in buccal mucosal squamous cell carcinoma.

OBJECTIVE: The present study investigated the relationship between the expression of manganese superoxide dismutase (MnSOD), catalase, glutathione peroxidase (GPx), and myeloperoxidase (MPO) in buccal mucosal squamous cell carcinoma (SCC), and the risk of second primary tumors (SPTs). STUDY DESIGN: Immunohistochemistry was performed to examine the expression of MnSOD, GPx, catalase, and MPO in tissue microarray slides of 173 male patients with buccal mucosal SCC who had undergone potentially curative resections. RESULTS: Forty-five (26.01%) patients developed SPTs. The prevalent subsites of SPTs were buccal mucosa (48.89%), tongue (13.33%), and lip (11.11%). High expression level of MPO was correlated with an increased risk of SPTs, even after adjustment for development of clinicopathologic parameters (high vs. low expression, adjusted hazard ratio = 3.89; 95% confidence interval, 1.33-11.41; P = .013). CONCLUSIONS: SPTs are common in male buccal mucosal SCC patients. Higher MPO expression in buccal mucosal SCC is a risk factor for SPTs.

Cloning and characterization of the fatty acid-binding protein gene from the protoscolex of Taenia multiceps.

Taenia multiceps (Cestoda: Taeniidae), a worldwide cestode parasite, is emerging as an important helminthic zoonosis due to serious or fatal central nervous system disease commonly known as coenurosis in domestic and wild ruminants including humans. Herein, a fatty acid-binding protein (FABP) gene was identified from transcriptomic data in T. multiceps. This gene, which contains a complete coding sequence, was amplified by reverse-transcriptase polymerase chain reaction. The corresponding protein, which was named TmFABP, had a molecular weight of 14 kDa, and subsequently was recombinantly expressed in Escherichia coli. The fusion protein was purified on Ni-NTA beads (Bio-Rad). Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blot analyses showed that the purified recombinant protein caused immunogenicity. Immunohistochemical studies showed that TmFABP was expressed at the tegumental level in the protoscolices and in the cells between the body wall and parenchyma layer of the cestode. In sections from gravid proglottids, intense staining was detected in the uterus and eggs. Based on this, TmFABP could be switched on during differentiation of germinative layers to protoscoleces and from metacestodes to adult worms. Taken together, our results already reported for T. multiceps suggest the possibility of TmFABP developing a vaccine to control and prevent coenurosis.

Myelodysplasia followed by Good's Syndrome: a unique manifestation associated with thymoma.

Good's syndrome, also known as thymoma with combined immunodeficiency, is rare. The immunodeficiency may precede, arise concurrently with or follow the diagnosis of thymoma. In addition to myasthenia gravis and Good's syndrome, paraneoplastic syndromes associated with thymoma can also be manifested with hematological disorders, such as pure red cell aplasia, aplastic anemia, agranulocytosis, hemolytic anemia, pernicious anemia, and paroxysmal nocturnal hemoglobinuria. Myelodysplastic syndrome is a group of clonal hematopoietic stem cell diseases characterized by cytopenia(s), dysplasia in one or more lineages, ineffective hematopoiesis, and potential precursors of acute leukemia. One proposed pathogenesis of myelodysplasia is autoantibodies that directly reject against hematopoietic cells, but this situation is rare in thymoma. Herein, we report a thymoma patient with unique paraneoplastic syndromes who developed myelodysplasia prior to Good's syndrome. Early and accurate diagnosis of myelodysplastic syndrome is important for disease management, especially in patients whose myelodysplastic syndrome is possibly derived from autoimmunity. For thymoma patients with recurrent infections, comprehensive immunologic studies to exclude the possibility of Good's syndrome and prophylactic intravenous immunoglobulin infusion in suitable candidates are warranted.

Pterostilbene inhibits colorectal aberrant crypt foci (ACF) and colon carcinogenesis via suppression of multiple signal transduction pathways in azoxymethane-treated mice.

Pterostilbene (PS), a natural dimethylated analogue of resveratrol, is known to have diverse pharmacologic activities including anticancer, anti-inflammation, antioxidant, apoptosis, antiproliferation, and analgesic potential. This paper reports the inhibitory effect of dietary administration of pterostilbene against the formation of azoxymethane (AOM)-induced colonic aberrant crypt foci (ACF) preneoplastic lesions and adenomas in male ICR mice and delineates its possible molecular mechanisms. ICR mice were given two AOM injections intraperitoneal and continuously fed a 50 or 250 ppm pterostilbene diet for 6 or 23 weeks. It was found that the dietary administration of pterostilbene effectively reduced AOM-induced formation of ACF and adenomas and inhibited the transcriptional activation of iNOS and COX-2 mRNA and proteins in mouse colon stimulated by AOM. Treatment with pterostilbene resulted in the induction of apoptosis in mouse colon. Moreover, administration of pterostilbene for 23 weeks significantly suppressed AOM-induced GSK3beta phosphorylation and Wnt/beta-catenin signaling. It was also found that pterostilbene significantly inhibited AOM-induced expression of VEGF, cyclin D1, and MMPs in mouse colon. Furthermore, pterostilbene markedly inhibited AOM-induced activation of Ras, phosphatidylinositol 3 kinase/Akt, and EGFR signaling pathways. All of these results revealed that pterostilbene is an effective antitumor agent as well as its inhibitory effect through the down-regulation of inflammatory iNOS and COX-2 gene expression and up-regulation of apoptosis in mouse colon, suggesting that pterostilbene is a novel functional agent capable of preventing inflammation-associated colon tumorigenesis.