Revision temporomandibular joint arthroplasty for the treatment of acquired metal allergy and review of the literature.

The purpose of this study was to examine the outcomes of patients who received revision temporomandibular joint (TMJ) arthroplasty for the treatment of acquired metal allergy. It was hypothesized that subjects would have significant improvements in pain, swelling, and function. Patients who underwent TMJ revision due to nickel allergy were identified retrospectively. Outcomes documented included the presence or absence of facial erythema and facial swelling. Maximum incisal opening was also measured. Additional outcomes collected included age at initial surgery, initial TMJ device type, presenting symptoms, and TMJ device used for surgical revision. Four patients were identified with a nickel allergy to their TMJ prosthesis (containing nickel). All subjects experienced pain and swelling as their primary symptoms prior to the revision, with two subjects showing dermatological symptoms of overlying erythema. The four female subjects underwent exchange of their previously implanted prosthesis with a titanium alloy prosthesis. Postoperatively, all subjects showed improvements in pain score, resolution of swelling and erythema, and improvements in maximum incisal opening. This small case series suggests that revision TMJ arthroplasty with a titanium alloy prosthesis is a potential treatment for acquired metal allergy from traditional TMJ prosthesis implantation.

The prevalence of obstructive sleep apnea in symptomatic patients with syndromic craniosynostosis.

The reported prevalence of obstructive sleep apnea (OSA) in patients with syndromic craniosynostosis (SCS) varies due to inconsistent definitions of OSA, lack of uniform diagnostic testing, and different mixes of syndromic diagnoses. The purpose of this study was to determine the prevalence of OSA in symptomatic patients with SCS, and to determine whether this differs by phenotypic diagnosis. A retrospective cohort study of children with SCS was conducted. The primary outcome was presence of OSA diagnosed by polysomnography. The prevalence of OSA was calculated and stratified by diagnosis to compare differences in prevalence and severity (mild, moderate, or severe). The prevalence of OSA in symptomatic patients was 74.2%. Patients with Apert syndrome had the highest prevalence (80.6%), followed by Pfeiffer, Crouzon with acanthosis nigricans, and Crouzon syndromes (72.7%, 66.7%, and 64.7%, respectively). Severe OSA was most common in patients with Pfeiffer syndrome (45.5%), while patients with Apert and Crouzon syndromes were more likely to have moderate OSA (29.0% and 23.5%, respectively). Given that 56.4% of patients with SCS are symptomatic and that 74.2% of these symptomatic patients have OSA, it is recommended that a screening level I polysomnography be part of the clinical care for all patients with SCS.

Incidence and determinants of 1-month mortality after cancer-directed surgery.

BACKGROUND: Death within 1 month of surgery is considered treatment related and serves as an important health care quality metric. We sought to identify the incidence of and factors associated with 1-month mortality after cancer-directed surgery. PATIENTS AND METHODS: We used the Surveillance, Epidemiology and End Results Program to study a cohort of 1 110 236 patients diagnosed from 2004 to 2011 with cancers that are among the 10 most common or most fatal who received cancer-directed surgery. Multivariable logistic regression analyses were used to identify factors associated with 1-month mortality after cancer-directed surgery. RESULTS: A total of 53 498 patients (4.8%) died within 1 month of cancer-directed surgery. Patients who were married, insured, or who had a top 50th percentile income or educational status had lower odds of 1-month mortality from cancer-directed surgery {[adjusted odds ratio (AOR) 0.80; 95% confidence interval (CI) 0.79-0.82; P < 0.001], (AOR 0.88; 95% CI 0.82-0.94; P < 0.001), (AOR 0.95; 95% CI 0.93-0.97; P < 0.001), and (AOR 0.98; 95% CI 0.96-0.99; P = 0.043), respectively}. Patients who were non-white minority, male, or older (per year increase), or who had advanced tumor stage 4 disease all had a higher risk of 1-month mortality after cancer-directed surgery, with AORs of 1.13 (95% CI 1.11-1.15), P < 0.001; 1.11 (95% CI 1.08-1.13), P < 0.001; 1.02 (95% 1.02-1.03), P < 0.001; and 1.89 (95% CI 1.82-1.95), P < 0.001 respectively. CONCLUSIONS: Unmarried, uninsured, non-white, male, older, less educated, and poorer patients were all at a significantly higher risk for death within 1 month of cancer-directed surgery. Efforts to reduce 1-month surgical mortality and eliminate sociodemographic disparities in this adverse outcome could significantly improve survival among patients with cancer.

Evidence for a family of SO8 gauged supergravity theories.

In this note we discuss the classification of duality orbits of N=8 gauged supergravity models. Using tensor classifiers, we show that there is a one-parameter family of inequivalent SO(8) gauged supergravity theories. We briefly discuss the couplings of such models and show that, although the maximally symmetric vacuum has the same quadratic spectrum, the supersymmetry transformations, the couplings, and the scalar potential are parameter dependent. We also comment on the possible M theory uplift and on the meaning of the parameter for the dual gauge theories.

Blood pressure control has distinct effects on executive function, attention, memory and markers of cerebrovascular damage.

Hypertension causes cognitive impairment, involving mainly executive functions, but the effect of blood pressure (BP) control on the different cognitive domains is still debated. We correlated executive function, attention and memory with BP control and cerebrovascular damage in 60 undemented middle-aged hypertensives at baseline and after 6-year follow-up. At first evaluation, the patients with poor BP control had higher score of white matter lesions, reduced cerebrovascular reserve capacity and greater carotid intima-media thickness (IMT) than those with good BP control. Performance on executive tests correlated with IMT and with performance on attention tests, which was impaired by low diastolic BP. At long-term follow-up, performance in attention and executive tests improved in spite of the minor improvement of BP control, increased IMT and worse memory. Low diastolic BP has a negative effect on attention, which affects executive performance at first cross-sectional examination. This confounding effect has to be taken into consideration when planning studies on cognitive function. Longitudinal studies are required to unravel the effect of BP control on cognitive function, as only long-term antihypertensive treatment improves both attention and executive performance.