Evaluating SWAG and Its Validity When Compared to 3D Imagery of Secondarily Grafted Cleft Sites.

OBJECTIVE: To test validity of 2D Standardized Way to Assess Grafts (SWAG) ratings to assess 3D outcomes of bone grafting (ABG). PATIENTS: 43 patients (34 UCLP, 9 BCLP) with non-syndromic complete clefts, bone-grafted at mean age 9yrs/3mos, with available post-graft occlusal radiographs and cone beam computed tomography (CBCT) (taken mean 4yrs/9mos post-ABG). MAIN OUTCOME MEASURES: 2D occlusal radiographs rated twice using SWAG by 6 calibrated raters. 12 scores were averaged and converted to a percentage reflecting bone-fill. Weighted Kappas were assessed for SWAG reliability. 3D cleft-site bone volume was calculated by 1 rater using ITK-SNAP. 13 cleft sites were re-measured by the 'one rater' for 3D reliability using Intraclass Correlation Coefficient (ICC). 2D versus 3D ratings were compared using paired t-test, independent samples t-test, Bland-Altman and Linear Regression. Significance level was P = .5. RESULTS: 2D reliability was 0.724 (intra-rater) and 0.546 (inter-rater). 3D reliability was 0.986. Bland-Altman plot comparing 2D vs 3D showed for 45 of 47 graft-sites were within 2 SD's. Mean % bone-fill was 64.11% with 2D and 69.06% with 3D (mean difference = 4.95%) that was a non-significant difference in both t-tests. Regression showed a statistically significant relation between the two methods (r2 = 0.46; P = .0001). CONCLUSION: 2D SWAG systematically and non-significantly underestimated bone-fill. There was a significant correlation between 2D/3D methods. Bland-Altman analysis illustrated the similarity of the two methods. For comparisons of group (cleft treatment Centers') bone grafting outcomes, the 2D method may suffice as a proxy for the 3D method. However, with individual variation up to 40% in 2D estimates of actual 3D volume, 2D SWAG method cannot be used in place of 3D images.

Current status of undergraduate orthodontic education in Canada.

PURPOSE: This study evaluated teaching hours and mode of instruction of undergraduate orthodontic education dental students in Canada receive, changes implemented by each educational dental institution (EDI) in response to the COVID-19 pandemic, and plans for mode of orthodontic education delivery post-COVID-19. METHODS: An electronic survey was administered to the program directors of undergraduate orthodontics at each EDI to reveal details regarding the (i) time and details of didactic, preclinical, and clinical experience provided to students and (ii) perceptions of undergraduate program directors about the adequacy of the current curricula. RESULTS: All 10 Canadian EDIs participated in the survey during the year 2021. Most EDIs deliver their orthodontic curricula beginning in the second year of the program (7, 70.0%), continuing through third (7, 70.0%) and fourth (6, 60.0%) years. The number of hours of didactic, preclinical, and clinical instruction varied by as much as 50 h per academic year across different EDIs. In response to the COVID-19 pandemic, almost all EDIs (9, 90.0%) maintained the same amount of didactic lecture time yet most switched to synchronous (5, 50.0%) or asynchronous (3, 30.0%) online delivery format. Most EDIs (8, 80.0%) indicated the quality of education was maintained during the pandemic. CONCLUSIONS: There exists significant variation in undergraduate orthodontic time allotment among Canadian EDIs. During the COVID-19 pandemic, most Canadian EDIs maintained a consistent amount of teaching hours while transitioning to some form of online course delivery. Most program directors indicated they believed students received the same quality of education after the change in mode of course delivery. The future of undergraduate orthodontic education will likely continue the accelerated trend toward online education.

Identification of a novel mortality-associated Helicobacter species in gopher tortoises (Gopherus polyphemus), qPCR test development and validation, and correlation with mortality in a wildlife rehabilitation population.

The genus Helicobacter includes spiral-shaped bacteria in the phylum Proteobacteria, class Epsilonproteobacteria, order Campylobacteriales, that have been associated with disease in animals, including reptiles. Three wild gopher tortoise (Gopherus polyphemus) index cases presented between 2012 and 2019 with nasal discharge, lethargy, and weight loss. Cytological examination of nasal discharge from all 3 tortoises identified marked heterophilic and mild histiocytic rhinitis with abundant extracellular and phagocytized spiral shaped bacteria that stained positive with Warthin-Starry stain. Polymerase chain reaction (PCR) and sequencing of the 16S rRNA gene revealed this to be a novel Helicobacter species. Two tortoises died despite treatment attempts, and the third was moribund and was euthanized. Histological examination of the nasal mucosa (n = 3) showed granulocytic to lymphocytic rhinitis with variable mucosal hyperplasia, erosion, and ulceration; Warthin-Starry staining highlighted the presence of spiral bacteria in the untreated tortoise. Genus-specific primers were designed, and the gyrA and groEL genes were amplified by PCR and sequenced. Phylogenetic analysis shows that this organism and other previously characterized Helicobacter from tortoises form a clade. Development and cross-validation of two qPCR diagnostic assays for the gyrA and groEL genes showed significant correlation of the results of two assays (P < 0.0001). These assays were used to survey nasal wash samples from 31 rehabilitating gopher tortoises. Mortality of tortoises significantly correlated with higher Helicobacter loads detected by qPCR (P = 0.028). Appropriate quarantine protocols for tortoises during rehabilitation should consider this organism. Upper respiratory disease in tortoises may involve complex microbial ecology; factors beyond Mycoplasmopsis (Mycoplasma) agassizii should be taken into account.

Burden of Care of Various Infant Orthopedic Protocols for Improvement of Nasolabial Esthetics in Patients With CUCLP.

OBJECTIVES: 1. To evaluate the orthodontic burden of care of nasoalveolar molding (NAM) and modified McNeil for the treatment of patients with complete unilateral cleft lip and palate (CUCLP). 2. To compare the esthetic outcomes of each with those of centers not utilizing infant orthopedics (IO). DESIGN: Retrospective cohort study. SETTING: Institutional. PARTICIPANTS: Four cohorts with repaired CUCLP (n = 149) from 3 centers. INTERVENTIONS: Two cohorts were treated in the same center and had either traditional infant orthopedics (TIO) or NAM and 2 were treated in centers not employing IO. MAIN OUTCOME MEASURES: Burden of care data for the IO groups were compared using t tests. Frontal and profile photographs at approximately age 5 were collected for ratings of nasolabial esthetics, using a modification of the Asher-McDade method. Intrarater and interrater reliabilities were determined using weighted κ statistics. Median ratings were compared using a Kruskal-Wallis test. RESULTS: The burden of care of NAM was significantly greater than TIO for both the number of visits (9.9 vs 6.6, [ P < .001]); and treatment duration (127 vs 112 days, [ P < .05]). Significant differences in nasolabial esthetic ratings were noted among the 3 centers. No significant differences were observed in the nasolabial esthetic outcomes between the NAM and TIO groups. CONCLUSIONS: 1. NAM required more visits and longer overall duration compared with TIO. 2. The center employing IO showed favorable nasolabial esthetics compared to those not utilizing IO. 3. No significant differences were found in the nasolabial esthetics of patients who have received NAM compared with TIO.

The Americleft Project: Comparison of Ratings Using Two-Dimensional Versus Three-Dimensional Images for Evaluation of Nasolabial Appearance in Patients With Unilateral Cleft Lip and Palate.

This study was conducted to determine if nasolabial appearance is rated with comparable results and reliability on 3-dimensional stereophotogrammetric facial images versus standard clinical photographs (2-dimensional). Twenty-seven consecutively treated patients with repaired complete unilateral cleft lip and palate were selected. Six trained and calibrated raters assessed cropped 2- and 3-dimensional facial images. Nasolabial profile, nasolabial frontal, and vermillion border esthetics were rated with the 5-point scale described by Asher-McDade using the modified Q-sort method. Cropped 3-dimensional images were available for viewing by each rater, allowing for complete rotational control for viewing the images from all aspects. Two- and three-dimensional ratings were done separately and repeated the next day.Interrater reliability scores were good for 2-dimensional (κ = 0.607-0.710) and fair to good for 3-dimensional imaging (κ = 0.374-0.769). Intrarater reliability was good to very good for 2-dimensional (κ = 0.749-0.836) and moderate to good for 3-dimensional imaging (κ = 0.554-0.855). Bland-Altman analysis showed satisfactory agreement of 2- and 3-dimensional scores for nasolabial profile and nasolabial frontal, but more systematic error occurred in the assessment of vermillion border.Although 3-dimensional images may be perceived as more representative of a direct clinical facial evaluation, their use for subjective rating of nasolabial aesthetics was not more reliable than 2-dimensional images in this study. Conventional 2-dimensional images provide acceptable reliability while being readily accessible for most cleft palate centers.

Adjustment in parents of children undergoing stem cell transplantation.

Pediatric stem cell transplantation (SCT) is a demanding procedure for children and parents. Interventions to promote positive adjustment of parents in this setting are needed. A total of 171 patient-parent dyads from 4 sites received 1 of 3 interventions to reduce SCT-related distress: a child intervention with massage and humor therapy, an identical child intervention plus a parent intervention with massage and relaxation/imagery, or standard care. Parents completed weekly self-report measures of distress and positive affect during the acute phase of treatment (weeks -1 through +6); and measures of depression, posttraumatic stress (PTSD), and benefit finding at baseline and week +24. No significant differences across treatment arms were observed on repeated measures of parental distress. There was a marginally significant effect of the child intervention on parental positive affect. Over time, parental distress decreased significantly and positive affect increased significantly in all groups. Similarly, there were no significant intervention effects on the global adjustment outcomes of depression, PTSD, and benefit finding. However, reports of depression and PTSD decreased significantly and reports of benefit finding increased significantly from baseline to week +24 for all groups. Across all study arms, parent adjustment improved over time, suggesting that parents demonstrate a transient period of moderately elevated distress at the time of their child's admission for transplantation, followed by rapid improved to normative levels of adjustment. Similar to results previously reported for their children, these parents appear resilient to the challenges of transplantation.

Cutaneous B-cell lymphoma in a Perdido Key Beach mouse (Peromyscus poliontus trissyllepsis).

The Perdido Key beach mouse (Peromyscus poliontus trissyllepsis) is an endangered mammal indigenous to the panhandle beaches of Northwest Florida. A captive 3.5-y-old female mouse was evaluated because of severe pruritus, diffuse alopecia, skin reddening, and ulcerations over the dorsum of her body. Initial skin biopsy of the affected area suggested bacterial dermatitis but was inconclusive. Despite empiric antibiotic, anthelmintic, and antihistamine treatments, she continued to decline and developed severe ulcerations over the majority of her body. Postmortem histopathologic evaluation led to a tentative diagnosis of epitheliotropic lymphoma, suggestive of a mycosis fungoides T-cell-type cutaneous lymphoma. However, immunohistochemistry results challenged this diagnosis, indicating that the lesion was actually an epidermotropic B-cell lymphoma. Spontaneous cutaneous B-cell lymphomas are rare in rodents and had not previously been reported to occur in Perdido Key beach mice. This case report provides initial evidence that the Perdido Key beach mouse is susceptible to cutaneous B-cell lymphoma.

Anterior uveitis as an atypical presentation of large granular lymphoma in a caracal (Caracal caracal).

An 11-year-old, female, spayed caracal (Caracal caracal) presented with a 3-month history of intermittent anorexia, vomiting, and weight loss. At examination, bilateral anterior uveitis with anisocoria was present. Further examination under general anesthesia revealed the anterior chamber of the right eye contained copious amounts of thick fibrin, hypopyon, and hyphema obscuring the ventral pupil margin and ventral iris. Aqueous paracentesis revealed a cytologic diagnosis of large granular lymphoma. Additional antemortem diagnostics (computed tomography, ultrasound with fine needle aspiration, and cytology) confirmed the diagnosis of multicentric large granular lymphoma with associated intestinal perforation. Necropsy and histopathology confirmed multicentric large granular lymphoma in the right eye, jejunum, mesenteric lymph nodes, and right kidney. Large granular lymphoma in nondomestic felids is likely rare since it has not been previously reported, but should be considered as a differential in any felid species with anterior uveitis or when lymphoma is considered. In the case of this caracal, the use of aqueous paracentesis with cytology was a powerful diagnostic.

Three-dimensional morphologic nasal surface characteristics that predict the extremes of esthetics in patients with repaired cleft lip and palate.

OBJECTIVE: The purposes of this study were (1) to develop imaging methods and objective numeric parameters to describe nose morphology, and (2) to correlate those parameters with nasal esthetics for patients with clefts. METHODS: A total of 28 patients with repaired complete unilateral cleft lip and palate (CUCLP) and 20 age- and gender-matched individuals without clefts were identified. A panel of orthodontists rated and ranked nasal esthetics from nose casts for the cleft group. Best and worst esthetic cleft groups were established from the cast assessments. Three-dimensional surface coordinates of the casts were digitally mapped with an electromagnetic tracking device. Digitized nasal images were oriented, voxelated, sliced, and mathematically curve-fitted. Maximum difference, percent area difference, and maximum and minimum derivative differences between cleft and noncleft and between right and left nose sides were calculated. Differences in parameters between groups were assessed with the use of analysis of variance (ANOVA) and t tests, and correlations with esthetics were assessed with the Spearman rank correlation test. RESULTS: Differences were seen between cleft and noncleft and best and worst esthetic groups for all four parameters (p < .05). The best esthetic cleft group had (1) lower percent area difference (p < .0001), (2) lower maximum difference (p < .001), and (3) smaller differences in slope of the nose in the coronal plane (p < .0001) than the worst esthetic cleft group. CONCLUSIONS: Maximum difference and maximum derivative difference and, to a lesser degree, percent area difference can be used to identify differences between cleft and noncleft nasal morphology and to assess levels of nasal esthetics for patients with CUCLP.

Medical management of Toxoplasma meningitis in a white-throated capuchin (Cebus capucinus).

A 32-yr-old white-throated capuchin monkey (Cebus capucinus) was presented for paraparesis. A diagnosis of protozoal meningitis was made on the basis of a lymphocytic pleocytosis with elevated protein in cerebrospinal fluid and a positive serum titer to Toxoplasma gondii of 131,072 using an indirect hemagglutination test. Treatment with clindamycin and trimethaprim-sulfamethoxazole resulted in improvement within 3 days and complete clinical resolution within 2 wk.