Infectious Spondylitis Caused by Streptococcus gordonii.

Infectious spondylitis is a rare but severe disease of the spine caused by bacteria or other pathogens. Particularly in immunocompromised patients, a definitive source of infection often remains uncertain. Among many pathogens, Streptococcus gordonii, a normal oral flora, is a very rare pathogen in infectious spondylitis. Only a few articles have reported infectious spondylitis caused by Streptococcus gordonii. To the best of our knowledge, there have been no reports of surgically treated infectious spondylitis caused by Streptococcus gordonii. Hence, in the current report, we present the case of a 76-year-old woman with known type 2 diabetes who was transferred to our medical center due to infectious spondylitis caused by Streptococcus gordonii following an L1 compression fracture and underwent an operation for treatment.

Incremental Model Fit Assessment in the Case of Categorical Data: Tucker-Lewis Index for Item Response Theory Modeling.

The Tucker-Lewis index (TLI; Tucker & Lewis, 1973), also known as the non-normed fit index (NNFI; Bentler & Bonett, 1980), is one of the numerous incremental fit indices widely used in linear mean and covariance structure modeling, particularly in exploratory factor analysis, tools popular in prevention research. It augments information provided by other indices such as the root-mean-square error of approximation (RMSEA). In this paper, we develop and examine an analogous index for categorical item level data modeled with item response theory (IRT). The proposed Tucker-Lewis index for IRT (TLIRT) is based on Maydeu-Olivares and Joe's (2005) [Formula: see text] family of limited-information overall model fit statistics. The limited-information fit statistics have significantly better Chi-square approximation and power than traditional full-information Pearson or likelihood ratio statistics under realistic situations. Building on the incremental fit assessment principle, the TLIRT compares the fit of model under consideration along a spectrum of worst to best possible model fit scenarios. We examine the performance of the new index using simulated and empirical data. Results from a simulation study suggest that the new index behaves as theoretically expected, and it can offer additional insights about model fit not available from other sources. In addition, a more stringent cutoff value is perhaps needed than Hu and Bentler's (1999) traditional cutoff criterion with continuous variables. In the empirical data analysis, we use a data set from a measurement development project in support of cigarette smoking cessation research to illustrate the usefulness of the TLIRT. We noticed that had we only utilized the RMSEA index, we could have arrived at qualitatively different conclusions about model fit, depending on the choice of test statistics, an issue to which the TLIRT is relatively more immune.

Hospital readmissions after stroke in patients with and without dementia and undergone gastrostomy tube placement.

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) in stroke patients is associated with high hospital readmission rates. The impact of dementia on hospital readmission rates in stroke patients who underwent PEG is unknown. We aimed to assess if stroke patients with dementia who undergo PEG are at risk for readmission. METHODS: We conducted a retrospective, observational study using the National Readmission Database from Healthcare Cost and Utilization Project (HCUP) from 2013 to 2014. Patients 65 years or older admitted with stroke and who had gastrostomy in the same hospital admission were included. We compared readmission rates at 30 and 60 days between patients with and without dementia and assessed the five most common readmission diagnosis. The association of dementia and hospital readmission was analyzed. RESULTS: Out of 492,727 patients over 65 who had stroke/PEG, 45,477 (9 %) had dementia. Patients with dementia underwent PEG placement more frequently than those without dementia (4.3% vs. 3.3%, respectively). There was no significant difference in the 30 and 60 days readmission rates between those with dementia and those without. Septicemia, aspiration pneumonitis and complications from the procedure were among top five readmission diagnosis. Dementia was not significantly associated with 30-day (odds ratio (OR) 0.99, 95% CI 0.87-1.13) or 60-day (OR 1, 95% CI 0.89-1.12) readmissions. CONCLUSIONS: Risks and benefits of gastrostomy in older adults with stroke and dementia should be honestly discussed with patients and their families since it exposes them to a higher risk of hospital readmission due to aspiration pneumonitis and complications from PEG.

Update on Flexible Sigmoidoscopy, Computed Tomographic Colonography, and Capsule Colonoscopy.

This article reviews alternative colorectal cancer (CRC) screening tests, including flexible sigmoidoscopy (FS), computed tomography (CT) colonography, and colon capsule endoscopy. FS has abundant and convincing evidence supporting its use for CRC screening and is a commonly used CRC test worldwide. CT colonography has demonstrated convincing results for CRC screening, but concerns regarding cost, accuracy for flat or sessile neoplasia, reproducibility, extracolonic findings, and lack of coverage have limited its use and development. Colon capsule endoscopy has demonstrated encouraging results for polyp detection in average-risk individuals, but is not approved for CRC screening at the current time.

Subcutaneous emphysema related to dental procedures.

OBJECTIVES: The objective of this study was to analyze 11 cases of subcutaneous emphysema associated with dental procedures from a single hospital and discuss approaches for accurate diagnosis and treatment of the condition. MATERIALS AND METHODS: The medical records of 11 patients who were treated for subcutaneous emphysema related to dental procedures between January 2009 and April 2017 were analyzed retrospectively. Patients with subcutaneous emphysema within the facial area or that spread to the neck and beyond, including the facial region, were assigned to two groups and compared in terms of age, sex, and durations of antibiotic use, hospitalization, and follow-up until improvement. The correlation between location of the origin tooth and range of emphysema spread was analyzed. RESULTS: The average durations of antibiotic use during conservative treatment and follow-up until improvement were 8.55 days (standard deviation [SD], 4.46 days) and 1.82 weeks (SD, 1.19 weeks), respectively. There was no intergroup difference in duration of antibiotic use (P=0.329) or follow-up (P=0.931). Subcutaneous emphysema was more common after dental procedures involving the maxilla or posterior region than after those involving the mandible or anterior region. There was no significant difference in air distribution according to location of the air orifice (maxilla, mandible, or both; P=0.106). CONCLUSION: Upon adequate conservative treatment accompanied by prophylactic antibiotic treatment considering the risk of infection, patients showed signs of improvement within a few days or weeks. There was no significant difference in treatment period between patients with subcutaneous emphysema localized to the facial region and those with subcutaneous emphysema spreading to the neck or beyond. These findings need to be confirmed by analysis of additional cases.

Prenatal ultrasonographic diagnosis of cleft lip with or without cleft palate; pitfalls and considerations.

Ultrasonographic examination is widely used for screening of abnormal findings on prenatal screening. Cleft lip with or without cleft palate of the fetus can also be screened by using ultrasonography. Presence of abnormal findings of the fetal lip or palate can be detected by the imaging professionals. However, such findings may not be familiar to oral and maxillofacial surgeons. Oral and maxillofacial surgeons can use ultrasonographic imaging of fetal cleft lip with or without cleft palate to provide information regarding treatment protocols and outcomes to the parent. Therefore, surgeons should also be able to identify the abnormal details from the images, in order to setup proper treatment planning after the birth of the fetus. We report two cases of cleft lip with or without cleft palate that the official readings of prenatal ultrasonography were inconsistent with the actual facial structure identified after birth. Also, critical and practical points in fetal ultrasonographic diagnosis are to be discussed.

Unilateral mandibular advancement with bilateral intraoral vertical ramus osteotomy.

Intraoral vertical ramus osteotomy (IVRO) is an effective surgical procedure that is used for the correction of mandibular prognathism. However, application of IVRO for mandibular advancement has been limited because of the instability of the proximal segments caused by the gap between the distal and proximal segments. We report a case of unilateral mandibular advancement with bilateral IVRO for the correction of facial asymmetry. This case shows possible application of bilateral IVRO for unilateral mandibular advancement without any means of fixation.

Role of caffeic Acid on collagen production in nasal polyp-derived fibroblasts.

OBJECTIVES: Caffeic acids are known to have anti-oxidant, anti-inflammatory, immunomodulatory, and tissue reparative effects. The purposes of this study were to determine the effect of caffeic acid on transforming growth factor (TGF) ß1-induced myofibroblast differentiation and collagen production, and to determine whether caffeic acid is involved in the antioxidant effect in nasal polyp-derived fibroblasts (NPDFs). METHODS: NPDFs were pretreated with caffeic acid (1-10 µM) for 2 hours and stimulated with TGF-ß1 (5 ng/mL) for 24 hours. The expression of α-smooth muscle actin (SMA), collagen types I and III, and Nox4 mRNA was determined by a reverse transcription-polymerase chain reaction, and the expression of α-SMA protein was determined by actin ned by immunofluorescence microscopy. The amount of total soluble collagen production was analyzed by the Sircol collagen dye-binding assay. The reactive oxygen species (ROS) generated by NPDFs were determined using 2',7'-dichlorfluorescein-diacetate. siNox4 was used to determine the effect of Nox4. RESULTS: The expression of α-SMA and production of collagen were significantly increased following TGF-ß1 treatment. In contrast, the level of expression of α-SMA and the level of production of collagen were decreased by pretreatment with caffeic acid. The activation of Nox4 and the subsequent production of ROS were also reduced by pretreatment with caffeic acid. The expression of α-SMA was prevented by inhibition of ROS generation with siNox4. CONCLUSION: Caffeic acid may inhibit TGF-ß1-induced differentiation of fibroblasts into myofibroblasts and collagen production by regulating ROS.

Comparative analysis of the amount of postoperative drainage after intraoral vertical ramus osteotomy and sagittal split ramus osteotomy.

OBJECTIVES: The purpose of this retrospective study was to compare the amount of postoperative drainage via closed suction drainage system after intraoral vertical ramus osteotomy (IVRO) and sagittal split ramus osteotomy (SSRO). MATERIALS AND METHODS: We planned a retrospective cohort study of 40 patients selected from a larger group who underwent orthognathic surgery from 2007 to 2013. Mean age (range) was 23.95 (16 to 35) years. Patients who underwent bilateral IVRO or SSRO were categorized into group I or group II, respectively, and each group consisted of 20 patients. Closed suction drainage system was inserted in mandibular osteotomy sites to decrease swelling and dead space, and records of drainage amount were collected. The data were compared and analyzed with independent t-test. RESULTS: The closed suction drainage system was removed at 32 hours postoperatively, and the amount of drainage was recorded every 8 hours. In group I, the mean amount of drainage was 79.42 mL in total, with 31.20 mL, 19.90 mL, 13.90 mL, 9.47 mL, and 4.95 mL measured at 0, 8, 16, 24, and 32 hours postoperatively, respectively. In group II, the mean total amount of drainage was 90.11 mL, with 30.25 mL, 25.75 mL, 19.70 mL, 8.50 mL, and 5.91 mL measured at 0, 8, 16, 24, and 32 hours postoperatively, respectively. Total amount of drainage from group I was less than group II, but there was no statistically significant difference between the two groups (P=0.338). There was a significant difference in drainage between group I and group II only at 16 hours postoperatively (P=0.029). CONCLUSION: IVRO and SSRO have different osteotomy design and different extent of medullary exposure; however, our results reveal that there is no remarkable difference in postoperative drainage of blood and exudate.

Fracture of the clivus as an unusual complication of LeFort I osteotomy: case report.

LeFort I osteotomy is a standard technique for the surgical correction of dentofacial deformities. Despite its low morbidity, it can lead to various complications at the base of the skull. We report the case of a fractured clivus as an unusual complication.

Full thickness skin grafts from the groin: donor site morbidity and graft survival rate from 50 cases.

OBJECTIVES: Full thickness skin grafts (FTSG) offer several advantages; they are esthetically superb, have less postoperative shrinkage, and offer minimal postoperative pain and scar formation at the donor site. As a donor site of FTSG, the groin offers a relatively large area of skin with high elasticity. The aim of this study was to evaluate FTSG from the groin for reconstruction in oral and maxillofacial surgery. MATERIALS AND METHODS: In a retrospective study, 50 patients (27 males, 23 females) who received FTSG from the groin were evaluated for their operation records, clinical photography, and medical records. RESULTS: The width of skin from the groin was distributed from 2-8 cm (mean: 5.1 cm) at the donor site, while the long axis length was distributed from 3-13 cm (mean: 7.4 cm). A high number of patients, 47 patients (94%) out of 50, showed good healing at the donor site. Wound impairment was seen in 3 patients (6%), minor wound dehiscence in 2 patients, and severe wound dehiscence in 1 patient. In the recipient site, delayed healing was observed in 2 patients (4%). CONCLUSION: FTSG from the groin to repair soft tissue defects in reconstruction surgery is a good method due to the relatively big size of the graft, decreasing morbidity at the donor site, and higher graft survival rates.

Heterocyclic methylsulfone hydroxamic acid LpxC inhibitors as Gram-negative antibacterial agents.

The synthesis and antibacterial activity of heterocyclic methylsulfone hydroxamates is presented. Compounds in this series are potent inhibitors of the LpxC enzyme, a key enzyme involved in the production of lipopolysaccharide (LPS) found in the outer membrane of Gram-negative bacteria. SAR evaluation of compounds in this series revealed analogs with potent antibacterial activity against challenging Gram-negative species such as Pseudomonas aeruginosa and Klebsiella pneumoniae.

Pyridone methylsulfone hydroxamate LpxC inhibitors for the treatment of serious gram-negative infections.

The synthesis and biological activity of a new series of LpxC inhibitors represented by pyridone methylsulfone hydroxamate 2a is presented. Members of this series have improved solubility and free fraction when compared to compounds in the previously described biphenyl methylsulfone hydroxamate series, and they maintain superior Gram-negative antibacterial activity to comparator agents.

Potent inhibitors of LpxC for the treatment of Gram-negative infections.

In this paper, we present the synthesis and SAR as well as selectivity, pharmacokinetic, and infection model data for representative analogues of a novel series of potent antibacterial LpxC inhibitors represented by hydroxamic acid.

One-pot (1-ethoxycarbonylcyclopropyl)triphenylphosphonium tetrafluoroborate ring-opening and Wittig reaction.

An efficient method was developed for the synthesis of 2-methylene-4-substituted ethyl butyrates via cyclopropyl opening followed by a Wittig reaction. The desired products were formed in a two-step, one-pot reaction sequence. Alternatively, the key intermediate ylide 2 was isolable and could be stored under oxygen-free conditions and subsequently utilized. A variety of nucleophiles were found to open the commercially available cyclopropane 1. The resulting ylide reacted with aldehydes to provide E-olefinic products.

Association of T cells and eosinophils with Staphylococcus aureus exotoxin A and toxic shock syndrome toxin 1 in nasal polyps.

BACKGROUND: Staphylococcus aureus exotoxins (SEs) have been implicated in the pathogenesis of nasal polyps (NPs) in patients with chronic rhinosinusitis (CRS). The aim of this study was to identify the correlation between SEs and T cells in NPs. METHODS: After a nasal smear culture, the nasal lavage fluid and NP tissue were obtained from 30 CRS with NP (CRSwNP) patients. The control samples were taken from 10 normal individuals. The presence of S. aureus exotoxin A (SEA) and toxic shock syndrome toxin 1 (TSST-1) was verified through a polymerase chain reaction (PCR) analysis and immunohistochemical staining. Immunohistochemical staining for CD4(+) and CD8(+) T cells was performed, followed by hematoxylin and eosin (H&E) staining for eosinophils. RESULTS: The PCR analysis and immunohistochemical staining for SEA and TSST-1 showed a significantly higher expression in the NP group when compared with that in the control group. Furthermore, the number of T cells and eosinophils were notably increased in the NP group when compared with that in the control group. Significant correlation was observed between the results of the culture, PCR, and immunohistochemical staining in the NP group. Moreover, the number of T cells and eosinophils was significantly increased in the positive experimental groups, when compared with that in the control group. CONCLUSION: Our results indicate that there was, indeed, some correlation between the expression of SE in the nasal cavity and the increased number of T cells and eosinophils in NPs.

Expression of extracellular matrix metalloproteinase inducer in nasal polyps.

BACKGROUND: Extracellular matrix metalloproteinase inducer (EMMPRIN) is a transmembrane glycoprotein that belongs to the immunoglobulin superfamily. The presence of EMMPRIN in nontumoral tissues suggests a role in other physiological and pathological situations, which may be associated with increased matrix metalloproteinase expression. The purpose of this study was to investigate the expression of EMMPRIN mRNA (OMIM *606080) and to localize the EMMPRIN protein in nasal polyps and healthy nasal mucosa. METHODS: The expression of EMMPRIN was investigated in the nasal polyps of 10 patients undergoing endonasal sinus surgery and compared with nasal mucosal samples obtained from 10 healthy controls. EMMPRIN mRNA was extracted from the tissues, and then a reverse transcription-polymerase chain reaction was performed. Western blot analysis was used to analyze differences in the levels of expression of EMMPRIN protein between patients with nasal polyps and healthy controls, and the EMMPRIN protein was localized in immunohistochemical staining and quantitative analysis of immunopositivity. RESULTS: The levels of expression of EMMPRIN mRNA and protein were significantly increased in patients with nasal polyps compared with healthy controls. EMMPRIN protein was expressed in the epithelium and infiltrating inflammatory cells of nasal polyps and the healthy nasal mucosa. The percentages of the immune-stained area and the number of EMMPRIN-immunopositive inflammatory cells per millimeter were significantly elevated in nasal polyps compared with controls. CONCLUSION: EMMPRIN is expressed in nasal mucosa and in nasal polyps, and the level of EMMPRIN expression is increased in nasal polyps. These results suggest that the increased expression of EMMPRIN may play a role in the pathogenesis of nasal polyps.

Synchronous double primary cancers of the unilateral parotid gland.

Synchronous parotid neoplasms, especially synchronous neoplasms of two separate and histologically different types, are extremely uncommon. A review of the literature revealed that most reported cases were either a combination of two distinct benign neoplasms or a benign neoplasm and another malignant tumor. To the best of our knowledge, there has been no report of synchronous unilateral double primary carcinomas of the parotid gland. Here we report a 39-year-old woman who exhibited basal cell adenocarcinoma and mucoepidermoid carcinoma simultaneously in the left parotid gland.

Endoscopic treatment of nasolacrimal sac obstruction secondary to fibrous dysplasia of paranasal sinuses.

Fibrous dysplasia involving paranasal sinuses mostly has asymptomatic features, but sometimes may cause signs and symptoms which relate to the location and extent of bony abnormalities. The use of endoscopic nasal surgery for debulking ethmoidal fibrous dysplasia, blocking the left nasolacrimal sac and simultaneous intranasal endoscopic dacryocystorhinostomy with silicone intubation is presented. The procedure and advantages of endoscopic approach over the external approach are outlined in this paper.