Clinicoradiologic features of ameloblastomas: A single-centre study of 155 cases.

BACKGROUND: The purpose of the current study was to report on the clinical presentation and radiologic features of 155 cases of ameloblastoma (AB), representing a detailed, large, single-centre radiologic study. METHODS: Histologically confirmed cases were reviewed over 11 years. Demographic and clinical data were retrieved from the patient's records. Radiologic information was analysed from available radiographs. The radiologic features of ABs were assessed according to the mean age of presentation and the mean duration of the lesion. The distinguishing radiologic features between adults/children and sex were also evaluated. RESULTS: A statistically significant correlation existed between loss of border demarcation and advanced mean age. Multilocular lesions were markedly more common in adults compared to children. Multilocular ABs were associated with increased lesion duration and advanced mean age. Radiologic signs of reactive bony changes associated with the tumour presented at the highest mean duration of all bony effects. Bony expansion and cortical destruction were statistically correlated with lesion duration. Tooth impaction was more common in children. Some mandibular lesions reached a significant size, resulting in impingement of the maxillary sinus, zygoma, orbit and pterygoid plates. CONCLUSION: Due to unfortunate healthcare access constraints, ABs grow to significant sizes and exhibit features not often reported in the literature. The findings of this analysis highlighted the radiologic features of ABs expressed through the mean age and duration of the lesion. This emphasises the significance of timely management of these lesions.

The radiologic progression of ameloblastomas.

Background: In developing countries, many diagnosed cases of ameloblastoma (AB) have a significant delay in receiving treatment because of patient factors and healthcare facility constraints. Objectives: The radiologic progression of ABs with delayed treatment was analysed using panoramic radiographs and cone-beam computed tomography imaging. Method: Histopathologically confirmed cases of AB with follow-up radiographs indicating no treatment were retrospectively reviewed over a study period of 10 years. Fifty-seven cases with 57 initial and 107 follow-up radiographs were included. Each follow-up radiograph was analysed for changes in borders, locularity, effects on surrounding structures and lesion size. Results: There was a general increase in poorly-demarcated lesions, with seven cases transforming from an initial unilocular to a multilocular appearance. At follow-up, there was an increase in cortical thinning and cortical destruction. Ameloblastomas presented with a three-fold increase in average size from the initial to follow-up visits. Regression analysis showed a statistically significant relationship between lesion duration and length (p = 0.001). A statistically significant relationship existed between duration and overall lesion dimensions when only the first and last observations per patient were used (p = 0.044). Conclusion: Considering the aggressive nature and unlimited growth potential, ABs with delayed treatment may show extensive growth, complicating their eventual management. Contribution: This study aimed to raise awareness of the importance of the timeous management of patients with AB by highlighting the detrimental effects of delayed treatment.

The Creation of an Addiction Nursing Fellowship Program for Registered Nurses: A Unique Approach to Enhancing the Addiction-Treatment Workforce.

In 2020, Boston Medical Center and the Grayken Center for Addiction launched an addiction nursing fellowship to enhance registered nurses' knowledge and skills related to the care of patients with substance use disorders and to improve patient experience and outcomes. This paper describes the development and essential components of this innovative fellowship, to our knowledge the first of its kind in the United States, with the goal of facilitating replication in other hospital settings.

Part Deflection Measurements of AM-Bench IN718 3D Build Artifacts.

One of the primary barriers for adoption of additive manufacturing (AM) had been the uncertainty in the performance of AM parts due to residual stresses/strains. The rapid melting and solidification which occurs during AM processes result in high residual stresses/strains that produce significant part distortion. While efforts to mitigate residual stresses, such as post-process heat treatment, can reduce these effects, they nullify the benefits of the as-built component microstructure. Therefore, the ability to predict as-built component residual stresses and component deflection is crucial. AM-Bench seeks to provide modelers with high-fidelity data in well-characterized AM components to aid in model development and calibration. The measurements reported here are part of the 3D builds of nickel-based superalloy IN718 test objects for the CHAL-AMB2022-01-PD modeling challenges. The part deflection measurements were performed using a coordinate measurement machine after the part was partially separated from the build plate.

Radiological features of oral and maxillofacial plasmablastic lymphomas.

OBJECTIVE: The purpose of the current study was to report on the clinical presentation and radiological features of 72 cases of oral and maxillofacial plasmablastic lymphomas (PBL). METHODS: Histologically confirmed cases of PBL were retrospectively reviewed over a 10-year period. Demographic and clinical data were retrieved from the patient's records. Radiological information was obtained from the available radiographic examinations. RESULTS: The prevalence of PBL was 0.6% of diagnosed head and neck lesions. PBL presented at a mean age of 39 years, demonstrating a strong male predominance. All patients with a known retroviral disease (RVD) status were HIV-positive. PBL had a maxillary predilection (78%), with posterior regions of both jawbones most commonly affected (76%). Most cases had bony involvement (95%), with poorly demarcated bony borders seen in the majority of cases (93%). PBL had a tendency to cause a loss of cortical integrity (96%), either via cortical erosion or destruction, rather than cortical expansion (2%). CONCLUSION: Most of the current literature on PBL focuses on demographics, anatomical location, and histopathological profile, with radiological features only reported in isolated case reports. This study is the first of its kind to report on the clinicoradiological appearance of PBL in a large sample. These findings may assist clinicians in the clinical diagnostic work-up of patients, including the acquisition and assessment of appropriate advanced radiographic imaging.

Clinical and radiologic spectrum of glandular odontogenic cysts: A multicenter study of 92 cases.

OBJECTIVE: The purpose of this multicenter retrospective study was to report the clinical and radiologic features of 92 glandular odontogenic cysts (GOCs) diagnosed over a 20-year period. STUDY DESIGN: Histologically confirmed cases of GOC were retrospectively reviewed from 4 oral pathology laboratories in South Africa and Brazil to categorize the clinical and radiologic spectrum of GOCs. RESULTS: The mean age of patients was 46 years (range 17-87) with a male-to-female ratio of 1.2:1. GOCs had a mandibular predilection (68%), with 42% of all cases located anteriorly. Additionally, 42% of cases crossed the midline. Radiologically, most lesions were unilocular (53%) and uniformly radiolucent (97%), with well-demarcated borders (93%). Cortical expansion (62%), loss of cortical integrity (71%), and maxillary sinus (67%) and nasal cavity encroachment (72%) were common findings. Significant differences in lesions between the 2 countries were discovered in sex predilection, clinical signs and symptoms, and lesion locations within the mandible and maxilla. CONCLUSION: GOCs present with a wide spectrum of clinical and radiologic features, ranging from cysts with typical GOC-like presentations to more aggressive lesions. The need for advanced imaging in the surgical planning of GOCs exhibiting radiologic signs of aggression is justified based on the high recurrence rate.

Expression of Mucins in Salivary Gland Mucoepidermoid Carcinoma.

Mucoepidermoid carcinoma (MEC) is the most common malignant salivary gland tumour in both adults and children. Histological grading of MEC is subjective, but plays an important role in predicting patient prognosis. Epithelial mucin (MUC) status may aid in establishing a more accurate grade. This study aimed to investigate the expression of various mucins (MUC1, MUC2, MUC4 and MUC5AC) in MECs to determine a possible correlation with tumour grade. Fifteen cases of each tumour grade (low-, intermediate-, and high-grade) were retrieved from the pathology archives of the Department of Oral Pathology and Oral Biology at the University of Pretoria. The patients included 23 men and 22 women, and ranged from 13 to 85 years (mean 49.8 years). Sections from formalin-fixed paraffin-embedded (FFPE) tissue were used for fluorescence in situ hybridization (FISH) for MAML2 rearrangements and MUC immunohistochemical analysis. The percentage immunohistochemical expression of the neoplastic mucous cells was evaluated first, followed by the overall percentage expression of all tumour cells. The results indicated that MUC1 overexpression may be a reliable marker of high-grade MECs, whereas MUC4 overexpression may be more indicative of low-grade tumours. MUC5AC expression was considered an unreliable marker in determining grade. MUC2 was only expressed in a single case of MEC and may be considered a useful marker to exclude MEC as a diagnostic possibility. This study demonstrates that MECs show an altered MUC expression pattern that can be used for diagnostic purposes and to aid in establishing a more accurate tumour grade.

Data-driven characterization of thermal models for powder-bed-fusion additive manufacturing.

Computational modeling for additive manufacturing has proven to be a powerful tool to understand physical mechanisms, predict fabrication quality, and guide design and optimization. Varieties of models have been developed with different assumptions and purposes, and these models are sometimes difficult to choose from, especially for end-users, due to the lack of quantitative comparison and standardization. Thus, this study is focused on quantifying model uncertainty due to the modeling assumptions, and evaluating differences based on whether or not selected physical factors are incorporated. Multiple models with different assumptions, including a high-fidelity thermal-fluid flow model resolving individual powder particles, a low-fidelity heat transfer model simplifying the powder bed as a continuum material, and a semi-analytical thermal model using a point heat source model, were run with a variety of manufacturing process parameters. Experiments were performed on the National Institute of Standards and Technology (NIST) Additive Manufacturing Metrology Testbed (AMMT) to validate the models. A data analytics-based methodology was utilized to characterize the models to estimate the error distribution. The cross comparison of the simulation results reveals the remarkable influence of fluid flow, while the significance of the powder layer varies across different models. This study aims to provide guidance on model selection and corresponding accuracy, and more importantly facilitate the development of AM models.

A Pilot Project Using Pediatricians as Initial Diagnosticians in Multidisciplinary Autism Evaluations for Young Children.

OBJECTIVES: Wait times for autism spectrum disorder (ASD) evaluations are long, thereby delaying access to ASD-specific services. We asked how our traditional care model (requiring all patients to see psychologists for ASD diagnostic decisions) compared to an alternative model that better utilizes the available clinicians, including initial evaluation by speech, audiology, and pediatrics (trained in Level 2 autism screening tools). Pediatricians could diagnose immediately if certain about diagnosis but could refer uncertain cases to psychology. Accuracy and time to diagnosis, charges, and parent satisfaction were our main outcome measures. METHODS: Data were gathered through record extraction (n = 244) and parent questionnaire (n = 57). We compared time to diagnosis, charges, and parent satisfaction between traditional and alternative models. Agreement between pediatrician and psychologist diagnoses was examined for a subset (n = 18). RESULTS: The alternative model's time to diagnosis was 44% faster (85 vs 152 d) and 33% less costly overall. Diagnostic agreement was 93% for children with ASD diagnoses and 100% for children without ASD diagnoses. Pediatricians expressed higher diagnostic certainty about children with higher levels of ASD symptoms. Parents reported no differences in high satisfaction with experiences, family-centered care, and shared decision making. CONCLUSION: Efficient use of available clinicians with additional training in Level 2 autism screening resulted in improvements in time to diagnosis and reduced charges for families. Coordination of multidisciplinary teams makes this possible, with strategic sequencing of patients through workflow. Flexibility was key to not only allowing pediatricians to refer uncertain cases to psychology for diagnosis but also allowing for diagnosis by a pediatrician when symptomatic presentation clearly met diagnostic criteria.

Part geometry and conduction-based laser power control for powder bed fusion additive manufacturing.

Laser powder bed fusion (LPBF) uses a focused, high power laser to repeatedly scan geometric patterns on thin layers of metal powder, which build up to a final, solid three-dimensional (3D) part. This process is somewhat limited in that the parts tend to have poorer surface finish (compared to machining or grinding) and distortion due to residual stress, as well as multiple other deficiencies. Typical laser scan strategies are relatively simple and use constant laser power levels. This elicits local variations in the melt pool size, shape, or temperature, particularly near sharp geometric features or overhang structures due to the relatively higher thermal conductivity of solid metal compared to metal powder. In this paper, we present a new laser power control algorithm, which scales the laser power to a value called the geometric conductance factor (GCF). The GCF is calculated based on the amount of solid vs. powder material near the melt pool. The algorithm for calculating GCF is presented along with some basic examples for clarification. Then, we detail the hardware and software implementation on the National Institute of Standards and Technology (NIST) additive manufacturing metrology testbed (AMMT), which includes co-axial melt pool monitoring using a high-speed camera. Six parts were fabricated out of nickel superalloy 625 (IN625) with the same nominal laser power, but with varying GCF algorithm parameters. We demonstrate the effect of tailored laser power on reducing the variability of melt pool intensity measured throughout the 3D build. Finally, we contrast the difference between the 'optimized' part vs. the standard build parameters, including the deflection of the final part top surface near the overhang and the variation of surface finish on the down-facing surfaces. Ultimately, the improvements to the in-situ process monitoring and part qualities demonstrate the utility and future potential tuning and optimizing more complex laser scan strategies.

Incidental findings in the cervical spine at CT for trauma evaluation.

OBJECTIVE: CT is the standard of care for assessment of traumatic injuries. Because of the detail depicted with this technique, findings incidental to the injury are easily detected. We sought to determine the frequency and types of incidental findings in the cervical spines of trauma patients undergoing CT. MATERIALS AND METHODS: The trauma registry was accessed to identify the cases of patients evaluated with cervical spine CT at a level 1 trauma center from January to July 2007. Trauma registry data, including age, sex, injury severity score, mechanism of injury, length of stay, and diagnosis were recorded, and all CT scans of the cervical spine were reviewed for incidental findings. Clinically significant incidental findings were classified according to bodily location, and the association between various patient characteristics and the likelihood of an incidental finding was assessed. RESULTS: We identified incidental CT findings in 230 of 1,256 patients (18.3%) who underwent CT of the cervical spine during an initial trauma evaluation. We stratified the incidental findings as trauma-related and not trauma-related. The likelihood of non-trauma-related incidental findings was associated with age (p < 0.0001). The likelihood of trauma-related incidental findings was associated with injury severity score (p < 0.0001). CONCLUSION: Incidental findings in the cervical spine were associated with age, injury severity score, and mechanism of injury. Awareness of the prevalence of incidental findings is important to assuring that both traumatic and nontraumatic pathologic findings are detected and appropriately managed.

Eccentric plantar-flexor torque deficits in participants with functional ankle instability.

CONTEXT: Inversion ankle sprains can lead to a chronic condition called functional ankle instability (FAI). Limited research has been reported regarding isokinetic measures for the plantar flexors and dorsiflexors of the ankle. OBJECTIVE: To examine the isokinetic eccentric torque measures of the ankle musculature in participants with stable ankles and participants with functionally unstable ankles during inversion, eversion, plantar flexion, and dorsiflexion. DESIGN: Case-control study. SETTING: Athletic training research laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty participants with a history of "giving way" were included in the FAI group. Inclusion criteria for the FAI group included a history of at least 1 ankle sprain and repeated episodes of giving way. Twenty participants with no prior history of ankle injury were included in the control group. INTERVENTION(S): Isokinetic eccentric torque was assessed in each participant. MAIN OUTCOME MEASURE(S): Isokinetic eccentric testing was conducted for inversion-eversion and plantar-flexion-dorsiflexion movements. Peak torque values were standardized to each participant's body weight. The average of the 3 trials for each direction was used for statistical analysis. RESULTS: A significant side-by-group interaction was noted for eccentric plantar flexion torque (P < .01). Follow-up t tests revealed a significant difference between the FAI limb in the FAI group and the matched limb in the control group. Additionally, a significant difference was seen between the sides of the control group (P = .03). No significant interactions were identified for eccentric inversion, eversion, or dorsiflexion torques (P > .05). CONCLUSIONS: A deficit in plantar flexion torque was identified in the functionally unstable ankles. No deficits were identified for inversion, eversion, or dorsiflexion torque. Therefore, eccentric plantar flexion strength may be an important contributing factor to functional ankle instability.