Risk of corneal epithelial defects with and without postoperative erythromycin ointment after laser photocoagulation for retinopathy of prematurity.

Purpose: We aim to compare the incidence of corneal epithelial defects after laser for retinopathy of prematurity (ROP) with and without the use of postoperative erythromycin ointment. Methods: In this retrospective observational cohort study, a total of 100 infants (200 eyes) consecutively treated with laser for ROP between 2012 and 2018. The primary outcome was presence or absence of corneal epithelial defect using fluorescein on bedside examination within the first week following laser for ROP. Additional data assessed included: the use of postoperative prophylactic erythromycin ointment for 1 week, postoperative day on which examination using fluorescein occurred, presence of corneal opacity, gender, birth weight, and gestation age. The presence or absence of postoperative corneal epithelial defects was compared between eyes receiving postoperative erythromycin ointment or not using a Fisher's exact test. Results: Postoperative corneal epithelial defects were more common in eyes which did not receive postoperative erythromycin (7 of 40 eyes; 17.5%), compared to eyes which did receive erythromycin (1 of 160 eyes; 0.6%; P < 0.0001). Postoperative bedside examinations with fluorescein were performed within 2 days of surgery on 136 of 200 of eyes (68%). Corneal opacities were noted in 3 of 200 eyes (1.5%). Conclusion: We observed less corneal epithelial defects in eyes which received postoperative erythromycin ointment for 1 week after laser for ROP than in those which did not. While multiple variables may influence the presence or absence of postoperative corneal epithelial defects following laser for ROP, consideration for postoperative lubricating ointment following laser for ROP seems reasonable.

Fluoride in Saliva and Oral Mucosa after Brushing with 1,450 or 5,000 ppm Fluoride Toothpaste.

The aim was to measure and compare fluoride concentrations in oral mucosa and saliva following a single brushing with either 1,450 or 5,000 ppm fluoride toothpaste. Fourteen healthy participants provided saliva and oral mucosa samples in the morning before tooth brushing. Then participants brushed their teeth with 1,450 ppm fluoride toothpaste, and saliva and mucosa samples were collected after 1, 2, 4, and 6 h. The experiment was repeated 3-7 days later with 5,000 ppm fluoride toothpaste. All samples were analyzed for fluoride using an ion-selective electrode adapted for microanalysis. Pre-brushing fluoride concentrations were higher in mucosa (mean1,450 0.26 ppm and mean5,000 0.20 ppm) than in saliva (mean1,450 0.08 ppm and mean5,000 0.07 ppm). The mean fluoride concentrations increased in both mucosa and saliva following a single brushing with both 1,450 ppm (meanmuc1,450 (1 h) 1.15 ppm, meansal1,450 (1 h) 0.33 ppm) and 5,000 ppm fluoride toothpaste (meanmuc5,000 (1 h) 3.21 ppm and meansal5,000 (1 h) 0.90 ppm). At 6 h, the fluoride concentrations had returned to pre-brushing levels. Across the 6-h sampling period the fluoride concentration in saliva was statistically significantly 1.4 times higher following brushing with 5,000 ppm compared with 1,450 ppm fluoride toothpaste. For mucosa, this ratio was only 1.1 and not statistically significant. In conclusion, the fluoride level in oral buccal mucosa is higher than in saliva and follows the same fluoride clearance pattern as in saliva. Over the initial 6-h period following a single tooth brushing, the ratio of the fluoride concentration in mucosa to that in saliva is independent of the fluoride concentrations in the toothpastes used.

Case Report of Proliferative Peripheral Retinopathy in Two Familial Lissencephaly Infants with Miller-Dieker Syndrome.

A complete ophthalmic examination is not routinely performed on infants with Miller-Dieker syndrome (MDS, chromosome 17p13.3 microdeletion). The authors present the cases of four cousins with MDS who also carried a 16p13.3 microduplication (not associated with Rubinstein-Taybi syndrome). Retinopathy of prematurity-like proliferative peripheral retinopathy (PPR) was detected in two male first cousins, but was not detected in the female half-cousins. PPR in the first infant resolved by 4 months, but the second infant's PPR progressed, requiring photocoagulation followed by lens-sparing vitrectomy. While ocular abnormalities are more prevalent and severe in other lissencephalopathies, the PPR in these MDS infants underscores the sight-saving potential of performing an ophthalmologic exam with early molecular testing for all lissencephaly infants.

Fluoride in saliva and dental biofilm after 1500 and 5000 ppm fluoride exposure.

OBJECTIVES: The aim of this randomized, double-blind, crossover study was to measure fluoride in saliva and 7-day-old biofilm fluid and biofilm solids after rinsing three times per day for 3 weeks with 0, 1500, or 5000 ppm fluoride (NaF). MATERIALS AND METHODS: Following the 3-week wash-in/wash-out period, including 1 week of biofilm accumulation, saliva and biofilm samples were collected from 12 participants immediately before (background fluoride), and 10, 30, and 60 min after a single rinse. Biofilm samples were separated into fluid and solids, and samples were analyzed using a fluoride electrode (microanalysis). RESULTS: The background fluoride concentration was statistically significantly higher in the 5000 compared to the 1500 ppm F rinse group in all three compartments (22.3 and 8.1 µM in saliva, 126.8 and 58.5 µM in biofilm fluid, and 10,940 and 4837 µmol/kg in biofilm solids). The 1-h fluoride accumulation for the 5000 ppm F rinse was higher than for the 1500 ppm F rinse in all three compartments, although not statistically significant for saliva and biofilm solids. CONCLUSION: Regular exposure to 5000 ppm fluoride elevates background fluoride concentrations in saliva, biofilm fluid, and biofilm solids compared to 1500 ppm fluoride. Increasing the fluoride concentration almost 3.5 times (from 1500 to 5000 ppm) only elevates the background fluoride concentrations in saliva, biofilm fluid, and biofilm solids twofold. CLINICAL RELEVANCE: Even though fluoride toothpaste may be diluted by saliva, the results of the present study indicate that use of 5000 ppm fluoride toothpaste might lead to improved caries control.

Fluoride in Dental Biofilm Varies across Intra-Oral Regions.

Information on differences in biofilm fluoride concentration across intra-oral regions may help explain the distribution of caries within the dentition. The aim of this cross-sectional study was to describe the fluoride concentration in saliva and in biofilm fluid and biofilm solids across 6 intra-oral regions. Unstimulated whole saliva was collected from 42 participants and biofilm harvested from the buccal sites in the 4 molar and 2 anterior regions. Samples were collected at least 1 h after use of fluoride dentifrice. No attempt was made to control the participants' food consumption or use of other topical agents. Centrifuged saliva, biofilm fluid, and biofilm solids were analysed for fluoride using a fluoride ion-selective electrode, adapted for microanalysis. Fluoride in biofilm varied across intra-oral regions. The mean biofilm fluid fluoride concentrations across the oral cavity ranged from 11.6 to 16.8 µM, being statistically significantly higher in the upper anterior region than in any other region. In all regions the fluoride concentration in biofilm fluid was higher than in saliva. For biofilm solids the fluoride concentration was highest in the lower anterior region (2,461 µmol/kg) and lowest in the lower molar regions (388 and 406 µmol/kg, respectively). Within biofilm, the solids contained most of the fluoride (81 to >99%). The biofilm fluid fluoride concentration was significantly positively associated with salivary fluoride and only marginally associated with that of biofilm solids. In conclusion, this study has shown pronounced differences in fluoride distribution across intra-oral regions and compartments. This shows that the sampling site is a crucial factor for studies of biofilm fluoride.

Vascularized tissue transfer in head and neck surgery: Is intensive care unit-based management necessary?

OBJECTIVES/HYPOTHESIS: To study the impact of a non-intensive care unit (ICU)-based postoperative management strategy on patient outcomes following vascularized free tissue transfer for head and neck surgical defects. STUDY DESIGN: Retrospective cohort study. METHODS: The patients consisted of two groups of adults who underwent vascularized free tissue transfer for head and neck reconstruction between July 2007 and June 2012, at an academic and a community-based hospital. By protocol, the first group of patients had a planned admission to the intensive care unit. After creation of a designated head and neck surgical unit, the second group was cared for in a protocol driven, non-ICU setting. Outcomes and costs were compared between the two patient groups. RESULTS: There was no adverse impact on flap survival, inpatient morbidity, or mortality with the implementation of postoperative care outside of an ICU. The patients who stayed in the ICU in the immediate postoperative period had a longer median length of hospital stay (ICU vs. non-ICU, 8 days [interquartile range {IQR}= 7-11 days] vs. 7 days [IQR = 6-9.5 days], P = .001). Median hospital charges and cost of care for patients who received ICU-based care (US$109,367 [IQR = US$88,112-US$130,833] and US$33,642 [IQR = US$28,143-US$43,196], respectively) were significantly higher than those for non-ICU-based care (US$86,195 [IQR = US$71,208-US$101,199] and US$28,524 [IQR = US$22,611-US$33,226], P < .0001). CONCLUSIONS: We demonstrate that care in a non-intensive care setting following vascularized free tissue transfer is safe, less costly, and decreases length of hospital stay compared to routine intensive care-based management.

Characterization of enamel incremental markings and crown growth parameters in minipig molars.

We studied the structure and periodicity of regular incremental markings in third molar enamel of minipigs. Light microscopy of ground sections revealed the presence of incremental markings matching the description of laminations. Their number within the section planes closely paralleled crown formation time (CFT) in days reported for minipig third molars, thereby indicating the daily nature of laminations. Spacing of consecutive laminations increased from lowest values in the inner to highest values in the outer enamel, where mean daily secretion rates of about 20 µm were recorded. Mean enamel extension rates determined for deciles along the enamel-dentin junction varied between highest values (155 µm/day) in the most cuspally located and lowest values (19 µm/day) in cervical enamel. Backscattered electron imaging in the SEM revealed the presence of thin, regularly spaced hypermineralized incremental lines in the outer enamel portion. These lines exhibited the same spacing as the laminations and were, thus, likewise regarded as daily incremental markings. Between two successive daily incremental markings, subdaily growth marks were discernible in light microscopic and in BSE-SEM images. These subdaily growth marks closely resembled the (daily) prism-cross striations of human enamel. Supra-daily growth marks were not identified in the minipig enamel. The results of this study parallels previous findings in sheep enamel. It is cautioned that CFT of ungulate teeth may be considerably overestimated if the periodicity established for growth marks in human enamel is uncritically transferred to the analysis of morphologically similar growth marks in ungulate enamel.

No benefit in staging fluorodeoxyglucose-positron emission tomography in clinically node-negative head and neck cutaneous melanoma.

BACKGROUND: Fluorodeoxyglucose-positron emission tomography (FDG-PET) has a high sensitivity for detecting metastasis from melanoma, but its application in early-stage melanomas is questionable. The purpose of this study was to determine if positron emission tomography (PET) is beneficial in staging of clinically node negative (cN0) head and neck melanoma. METHODS: After institutional review board approval, patients with head and neck melanoma treated at 2 cancer centers (between 2000 and 2010) were identified using International Classification of Disease (ICD)-9 codes. A retrospective medical chart review of cN0 patients was performed for the treatment course and outcomes. RESULTS: A total of 165 patients were treated; of these, 106 were node negative. FDG-PET was included in initial staging of 47 cN0 patients. None had true distant metastasis detected on PET. The imaging also failed to detect nodal metastasis in 2 patients who had disease on lymphatic sampling. CONCLUSION: FDG-PET did not alter the initial staging or treatment in patients with cN0 head and neck melanoma. Therefore, its routine use for staging is not warranted.

Activated charcoal composite biomaterial promotes human embryonic stem cell differentiation toward neuronal lineage.

Transplantation of biomaterial scaffolds encasing human embryonic stem cells (hESCs) has been proposed as a clinical therapy for various neurological lesions and disorders. In light of recent developments, artificially synthesized carbon-based biomaterials such as carbon nanotubes and graphene have demonstrated feasibility in supporting stem cell attachment and differentiation. However, the applicability is significantly hampered by evidence of nanotoxic effects on multiple cell types. Thus, an emergent drive for an innovative carbonaceous biomaterial calls for a safer platform with comparable advantageous characteristics. Here, we showed for the first time, a natural coal-based activated charcoal (AC) composite biosubstrate can support and promote neuronal differentiation in hESCs. The bio-friendly AC composite biomatrices resulted in more matured neuron-like cells. Both of axonal length and density were at least twice as long and abundant, respectively, when compared with control groups. A functional assay demonstrated that the derived neuron-like cells responded to depolarization-dependent synaptic recycling and may contain active synapses. In addition, the AC composite substrate can serve to concentrate growth factors and cell adhesion proteins, further encouraging attachment and hESC differentiation. Moreover, the AC composite biomaterial can potentially be economically manufactured as implantable three-dimensional bioscaffolds, facilitating the regeneration of damaged neural and other tissues.

Tumors metastatic to thyroid neoplasms: a case report and review of the literature.

Metastasis into a thyroid neoplasm-tumor-to-tumor metastasis-is exceedingly rare. We describe the 28th documented case of a tumor metastatic to a thyroid neoplasm and review the literature on tumor-to-tumor metastasis involving a thyroid neoplasm as recipient. All cases showed a recipient thyroid neoplasm with an abrupt transition to a morphologically distinct neoplasm. Metastasis into primary thyroid neoplasm was synchronous in 33% of cases and metachronous in 67%. Follicular adenoma was the most common recipient thyroid neoplasm overall (16/28), and papillary thyroid carcinoma was the most common malignant recipient neoplasm (9/28). Of the 9 recipient papillary carcinomas, 6 were follicular variants. Renal cell carcinoma was the most common neoplasm to metastasize to a primary thyroid neoplasm (9/28), followed by lung (6/28), breast (5/28), and colon (3/28) carcinoma. Tumor-to-tumor metastasis should be considered whenever a dimorphic pattern is encountered in a thyroid tumor.

Fluoride concentration in dentine as a biomarker of fluoride intake in European roe deer (Capreolus capreolus) - an electron-microprobe study.

OBJECTIVE: Fluoride concentration in dentine has been recommended as the best marker for the level of chronic fluoride intake and the most suitable indicator of an individual's total body burden of fluoride. We analysed fluoride concentrations in the dentine of cheek teeth of European roe deer from fluoride-polluted habitats to retrospectively assess the level of fluoride uptake into the tissue. Thereby, we tested the hypothesis of the existence of mechanisms that limit fluoride intake of individuals and fluoride exposure of forming dental hard tissues during the late foetal and early postnatal periods in the species. DESIGN: Using electron-microprobe analysis, fluoride profiles were obtained on sectioned P(4)s, M(1)s, and M(3)s from individuals exhibiting pronounced dental fluorosis. Fluoride concentrations were compared between early formed (peripheral) and late-formed (juxtapulpal) dentine both within single teeth and amongst the three different teeth studied. RESULTS: Peripheral dentine of the M(1), which is formed during the late foetal and early postnatal periods, exhibited markedly lower fluoride concentrations than juxtapulpal dentine of the same tooth and both, peripheral and juxtapulpal dentine of P(4) and M(3) that are formed post-weaning. CONCLUSIONS: Our study provides strong support for the hypothesis that in the European roe deer the prenatal and early postnatal (pre-weaning) stages of dental development are (largely) protected against exposure to excess fluoride. This is attributed to the operation of certain protective mechanisms during these periods.

Dentin abnormalities in cheek teeth of wild red deer and roe deer from a fluoride-polluted area in Central Europe.

This study analyses the severity and distribution of mineralization defects in the dentin of red and roe deer teeth (mandibular fourth premolars, first and third molars) obtained from individuals that had lived in a fluoride-polluted area along the Czech-German border. Mineralization defects presented as hypomineralized or interglobular dentin. In the P(4)s and M(3)s the entire dentin exhibited areas of defective mineralization, whereas in the M(1)s only the central and inner dentin portions were affected. This suggests that the early periods of dentin formation in the first molar, occurring during the late fetal and early postnatal (milk-feeding) periods of life, are protected against exposure to excess fluoride levels. Our findings are consistent with the hypothesis that certain protective mechanisms (partial placental diffusion barrier and blood-milk barrier to fluoride, clearance of fluoride from plasma by the rapidly growing skeleton) operate during these ontogenetic periods. Studying fluoride-induced dentin abnormalities in addition to enamel fluorosis broadens the time window during which fluoride effects on the developing dental hard tissues can be recorded. Including dentin in the analysis of dental fluorosis allows a more detailed reconstruction of lifetime fluoride exposure than would be possible by studying enamel fluorosis only, thereby adding to the significance of free-ranging deer as bioindicators of fluoride pollution.

Cholangitis after coil embolization of an iatrogenic hepatic artery pseudoaneurysm: an unusual case report.

Pseudoaneurysm involving the hepatic arterial system is a recognized complication of biliary surgery. The standard nonsurgical treatment is coil embolization. We present a case of a patient who underwent coil embolization of a pseudoaneurysm and subsequently presented with ascending cholangitis due to migration of coils into the common bile duct.

Surgical anatomy of the parotid duct with emphasis on the major tributaries forming the duct and the relationship of the facial nerve to the duct.

Although there is a great amount in the literature to describe the anatomy of the parotid gland as a whole, little attention is given to the parotid duct. The purpose of this study is to examine the surgical anatomy of the parotid duct with special emphasis placed on the major tributaries forming the parotid duct and the relationship of the facial nerve to the duct. Twenty-nine fresh cadaver halves were dissected and the branching pattern of the ducts, position within the parotid, and their relationship to the facial nerve were studied. Of the complete heads studied, the parotid duct had the same pattern in 78.6% on the right and left sides. The parotid ducts in 31.0% of the half heads presented as a single discernible duct from parotid papilla to within the gland. In 62.1% of the half heads, the ducts were formed by a branching pattern within the gland. In the ducts with a branching pattern, 48.3% displayed a bifurcated pattern, 6.9% were trifurcated, and 6.9% had multiple branches. In 6.9% of the half heads studied, the parotid ducts bifurcated distal to the parotid gland. In all cases, the deep lobe of the parotid enveloped the parotid duct; only small ductules connected the superficial lobe with the duct. The facial nerve and its branches were always observed lateral to the parotid duct. Because one dissects lateral to the facial nerve during a superficial parotidectomy, generally the parotid duct remains intact and potential complications such as facial paralysis, sialoceles, and fistulizations are thereby minimized.

Application of survival analysis to carious lesion transitions in intervention trials.

OBJECTIVE: To demonstrate the usefulness of a survival-time regression model for the analysis of data from two 3-year trials of the caries-preventive effect of sugar-substituted chewing gums and fluoride toothpaste, carried out among 892 Lithuanian children. METHODS: A caries onset was defined as a transition from sound to carious and a caries recovery was defined as a transition from carious to sound. The time at risk for each type of transition was calculated. Using an exponential survival-time regression model, the hazard ratios for the covariates experimental group (control, sugar substitute, fluoride), age, gender, surface type and posteruptive surface age was estimated. This analysis was repeated using two alternative definitions of the caries transitions. RESULTS: The analyses confirmed that caries rates are higher in occlusal surfaces, and that posteruptive surface age influences caries rates. Moreover, it also confirmed that fluoride affects the outcome of ongoing caries activity more than the initiation of caries. CONCLUSIONS: Survival-time analysis of caries transitions allows for the extraction of much more information from caries trials than does the traditional DMF-based analysis, and traditional DMF incremental values may easily be derived from the models.

Taking away the fear: a grounded theory study of cooperative care in the treatment of head and neck cancer.

Cooperative care is a relatively new treatment model that seeks to improve quality, conserve resources, and manage chronic conditions by providing patient and carepartner education in a homelike setting. Support from health care professionals is immediately available as patients and carepartners learn the skills needed to manage a disease and its treatment. This study sought to describe the effect of cooperative care on the treatment of head and neck cancer. Grounded theory methodology and focused interviews of 21 participants were used to answer three research questions: (1) Do the patients, carepartners, and providers involved in cooperative care perceive the potential psychosocial and self-care benefits? (2) How does the cooperative care treatment model affect the achievement of self-care for patients with surgical treatment of head and neck cancer? (3) What are appropriate theories regarding the benefits of cooperative care in the treatment of head and neck cancer that can be tested with quantitative methods? Results indicate that providers perceived cooperative care as a time-consuming process that resulted in less anxious, more communicative patients who required fewer post-discharge resources. Patients and carepartners perceived cooperative care as an experience that took away their fear by providing self-care education within a caring community.