Does the addition of cone-beam CT to panoral imaging reduce inferior dental nerve injuries resulting from third molar surgery? A systematic review.

OBJECTIVE: This systematic review aims to examine whether cone-beam CT (CBCT) assessment influences the incidence of nerve injury following high-risk mandibular third molar (MTM) surgery. STUDY DESIGN: Randomised controlled trials comparing two and three-dimensional imaging for assessing high-risk MTMs were included. MEDLINE, EMBASE, CENTRAL and the Dentistry and Oral Science Source (DOSS) were systematically searched along with extensive grey literature searches, hand searching of web sites, and detailed citation searching up to 3 September 2022. Risk of bias was assessed against the Cochrane Risk of Bias Tool (RoB 2.0). Certainty of the evidence was assessed using GRADE. RESULTS: Two authors independently screened 402 abstracts prior to full text screening of 27 articles, which culminated in seven RCTs for inclusion. Two studies were assessed as high risk of bias overall. The other five raised some concerns largely due to unblinded patients and lack of prior trial registration. Just one study reported significantly less nerve injuries following CBCT. The remaining six articles found no significant difference. CONCLUSION: The seven RCTs included in this systematic review offered moderate quality evidence that CBCT does not routinely translate to reduced incidence of nerve injury in MTM removal. A single study provided low quality evidence for a consequent change in the surgical approach. Low quality evidence from 3 studies suggested CBCT does not influence the duration of third molar surgery.

How do periodontal indices compare among non-smokers, tobacco and e-cigarette smokers?

Design Systematic review and network meta-analysis.Data sources Medline (PubMed), ISI Web of Science and Scopus. Additionally, the following journals were hand-searched between 2000 and December 2021: Journal of Periodontology, Journal of Clinical Periodontology, Clinical Oral Investigations, International Journal of Periodontics and Restorative Dentistry. Citations of included articles and relevant systematic reviews were also screened.Study selection Cross-sectional and observational studies were included which compared periodontal indices in non-smokers, tobacco and e-cigarette smokers. A minimum sample of 25 patients in each group was required, as was reporting of bleeding on probing (BOP), plaque indices (PI) and probing depth (PD) outcomes.Data extraction and synthesis Two independent authors examined titles, abstracts and full texts of relevant articles against the inclusion criteria, with any disagreements resolved by discussion, or a third reviewer. Data was collected using an Excel spreadsheet and risk of bias assessed via the NIH quality assessment tool for observational cohort and cross-sectional studies. Results were pooled and checked for suitability before network meta-analysis for each separate outcome.Results In total, 279 studies were screened from electronic and hand searching with 28 full text articles assessed for eligibility. Twenty-three were excluded at full text, with five included for quantitative synthesis and review. The included studies incorporated a total of 512 patients encompassing 170 non-smokers, 176 tobacco smokers (mean duration 10.7 years) and 166 e-cigarette smokers (mean duration 3.7 years). All studies were based in Saudi Arabia only and 99% of patients were male with mean ages 37.8 (non-smokers), 39.5 (tobacco) and 33.5 (e-cigarette). No studies adjusted for key confounding variables, which limited risk of bias to fair or good in all cases. Meta-analysis suggested PD and PI were significantly worse in tobacco smokers compared to both non-smokers and e-cigarette smokers. BOP was significantly reduced in both smoking groups versus non-smokers.Conclusions Notwithstanding the limitations of this review, there is some evidence that supports accepted understanding that tobacco smoking can compromise periodontal health. E-cigarette smoking in this cohort showed no significant difference to non-smokers in terms of probing depth or plaque index and may be a safer source of nicotine for patients in terms of periodontal health. Greater understanding may be drawn from analysis of randomised controlled trials in wider populations that account for important confounding variables.

Shipping in the north-east Atlantic: Identifying spatial and temporal patterns of change.

Maritime traffic is increasing globally, with a four-fold increase in commercial vessel movements between 1992 and 2012. Vessels contribute to noise and air pollution, provide pathways for non-native species, and collide with marine wildlife. While knowledge of shipping trends and potential environmental impacts exists at both local and global levels, key information on vessel density for regional-scale management is lacking. This study presents the first in-depth spatio-temporal analysis of shipping in the north-east Atlantic region, over three years in a five-year period. Densities increased by 34%, including in 73% of Marine Protected Areas. Western Scotland and the Bay of Biscay experienced the largest increases in vessel density, predominantly from small and slow vessels. Given well-documented impacts that shipping can have on the marine environment, it is crucial that this situation continues to be monitored - particularly in areas designated to protect vulnerable species and ecosystems which may already be under pressure.

Altered sleep during spontaneous cannabinoid withdrawal in male mice.

Cessation of cannabinoid use in humans often leads to a withdrawal state that includes sleep disruption. Despite important health implications, little is known about how cannabinoid abstention affects sleep architecture, in part because spontaneous cannabinoid withdrawal is difficult to model in animals. In concurrent work we report that repeated administration of the high-efficacy cannabinoid 1 (CB1) receptor agonist AM2389 to mice for 5 days led to heightened locomotor activity and paw tremor following treatment discontinuation, potentially indicative of spontaneous cannabinoid withdrawal. Here, we performed parallel studies to examine effects on sleep. Using implantable electroencephalography (EEG) and electromyography (EMG) telemetry we examined sleep and neurophysiological measures before, during, and after 5 days of twice-daily AM2389 injections. We report that AM2389 produces decreases in locomotor activity that wane with repeated treatment, whereas discontinuation produces rebound increases in activity that persist for several days. Likewise, AM2389 initially produces profound increases in slow-wave sleep (SWS) and decreases in rapid eye movement (REM) sleep, as well as consolidation of sleep. By the third AM2389 treatment, this pattern transitions to decreases in SWS and total time sleeping. This pattern persists following AM2389 discontinuation and is accompanied by emergence of sleep fragmentation. Double-labeling immunohistochemistry for hypocretin/orexin (a sleep-regulating peptide) and c-Fos (a neuronal activity marker) in lateral hypothalamus revealed decreases in c-Fos/orexin+ cells following acute AM2389 and increases following discontinuation, aligning with the sleep changes. These findings indicate that AM2389 profoundly alters sleep in mice and suggest that sleep disruption following treatment cessation reflects spontaneous cannabinoid withdrawal.

What is the predictive value of OroGrams to estimate survival rates of HPV-positive oropharyngeal squamous cell carcinoma?

Design Retrospective cohort study.Cohort selection OroGrams is a nomogram designed to better predict survival patterns in patients with oropharyngeal squamous cell carcinoma (OPSCC) by incorporation of both HPV-DNA and p16 status. The aim of this study was to evaluate the external validity of OroGrams in a Scottish population. The study population was noted to have a higher smoking status than the four European cohorts among which Orograms was originally developed and established.Data analysis Retrospective analysis was undertaken of health records and death certificates of patients with OPSCC in Glasgow, Scotland between 2012 and 2017. Required baseline characteristics were compared to the original study cohorts to assess comparability. OroGrams was implemented to produce Kaplan Meier curves for overall and progression-free survival at one, three and five years. Brier scores were produced to compare these to the actual observed outcomes.Results Compared to the UK study group, significantly more of the Scottish cohort presented at a later stage (p <0.001), were smokers (p = 0.002), and were both HPV-DNA and p16-negative. More patients received surgery or radiotherapy alone and less received a combination of both with chemotherapy. Low Brier scores indicated good predictive ability of OroGrams in the Scottish group at one, three and five years that was most accurate for overall survival. This accuracy was similar to the UK cohort at one and three years, but less so at five-year follow-up. Outcome predictions were significantly better for HPV-positive versus negative cases at all time points.Conclusions OroGrams showed good prognostic accuracy for this Scottish cohort with significantly higher smoking, and HPV-DNA and p16-negative status, compared to the original UK study population. There were, however, limitations at longer follow-up periods and individual variation which limits its clinical application. Incorporation and weighting of smoking status and other comorbidities in future nomograms is recommended to enhance outcome understanding and better inform treatment planning.

A survey study examining the motivations, concerns, and perspectives of medical students engaging in neurosurgical research.

BACKGROUND: In a competitive landscape for neurosurgical residency admission, research productivity is increasingly important. Medical school applicants to neurosurgery report high numbers of "scholarly products" as published by the National Residency Match Program. Despite increased student involvement in research and productivity, to the best of our knowledge, no previous reported studies have examined student perspectives on their involvement in neurosurgical research. METHODS: For 2 consecutive years (February 2019 and February 2020), medical students (n = 55) from around the United States presented original research at the Student Neurosurgical Research Conference. Participants were administered a mixed-method survey designed to assess experiences and perspectives on engaging in neurosurgical research. Survey responses were analyzed independently by two researchers to assess for common themes and perspectives. RESULTS: Medical students engaged in all types of research work across nearly every neurosurgical subfield with "Basic/Bench Lab work" (38.5%) and "Chart Review" (23.1%) representing the majority of projects. Students commonly cited "curiosity/interest," and "residency application competitiveness" as main reasons for participation in research. About 66% of respondents reported experiencing anxiety/concern about research productivity "often" or "very often." Thematic analysis revealed that sources of research-related stress were (1) having enough publications to match into residency, and (2) having enough time in medical school to engage in research. CONCLUSION: Medical students engaging in neurosurgical research are highly motivated students driven by scientific curiosity and pressure to prepare for competitive residency applications. Students experience anxiety due to time constraints in medical curricula and increasing demands for scholarly productivity.

Complete Resolution of Traumatic Indirect Carotid-Cavernous Fistula Two Years After Inciting Event.

Indirect carotid cavernous fistulas (CCFs) are most often spontaneous, but can rarely be caused by trauma. With traumatic etiology, the timeline for the development of symptoms varies significantly and can be difficult to predict. In this report, we discuss the case of a patient found to have an indirect CCF who presented for acutely worsening ocular symptoms and a history of pulsatile tinnitus that began two years prior after a suspected inciting head injury. To our knowledge, no cases have described a traumatic indirect CCF with a similarly extensive indolent course who demonstrated full symptomatic recovery following treatment.

Convergent evolution of forelimb-propelled swimming in seals.

Modern pinnipeds (true and eared seals) employ two radically different swimming styles, with true seals (phocids) propelling themselves primarily with their hindlimbs, whereas eared seals (otariids) rely on their wing-like foreflippers.1,2 Current explanations of this functional dichotomy invoke either pinniped diphyly3-5 or independent colonizations of the ocean by related but still largely terrestrial ancestors.6-8 Here, we show that pinniped swimming styles form an anatomical, functional, and behavioral continuum, within which adaptations for forelimb swimming can arise directly from a hindlimb-propelled bauplan. Within phocids, southern seals (monachines) show a convergent trend toward wing-like, hydrodynamically efficient forelimbs used for propulsion during slow swimming, turning, bursts of speed, or when initiating movement. This condition is most evident in leopard seals, which have well-integrated foreflippers with little digit mobility, reduced claws, and hydrodynamic characteristics comparable to those of forelimb-propelled otariids. Using monachines as a model, we suggest that the last common ancestor of modern seals may have been hindlimb-propelled and aquatically adapted, thus resolving the apparent contradiction at the root of pinniped evolution.

The National Student Neurosurgical Research Conference: A Research Conference for Medical Students.

OBJECTIVE: Medical students interested in neurosurgery are increasingly involved in research, and research conferences have proven valuable for developing medical research experience and exposure. A research conference was designed for medical students interested in neurosurgery to present research. METHODS: Our team designed an annual research conference at the Warren Alpert Medical School of Brown University in conjunction with the Neurosurgery and Neurology Departments. In February 2019, we hosted the first Student Neurosurgical and Neurological Research Conference (SNRC), the first national research conference, to our knowledge, designed for medical students to present neurosurgical research in the United States. The conference consisted of student poster/oral presentations, keynote speeches from clinical faculty, and surgical skills workstations. In February 2020, we hosted the second SNRC. After each conference, participants (n = 55) completed a survey to assess student perspectives of the conference. RESULTS: Fifty-five medical students from around the nation attended the conferences to present their research. One hundred percent of participants affirmed that the conference fulfilled their primary reason for attending, which for most (54.5%) was the opportunity to present research. Thematic analysis revealed that students especially appreciated the "lower stress environment" and "opportunity to get feedback on their research." Notably, 97.6% of students felt the conference strengthened or increased their interest in neurosurgery. CONCLUSIONS: Participants felt that the SNRC was a valuable opportunity to present research in an environment conducive for practice and improvement. Research conferences primarily for medical students may support the development of young researchers while increasing and strengthening interest in the field of neurosurgery.

Dysregulation of Insulin-Linked Metabolic Pathways in Alzheimer's Disease: Co-Factor Role of Apolipoprotein E ɛ4.

BACKGROUND: Brain insulin resistance and deficiency are well-recognized abnormalities in Alzheimer's disease (AD) and likely mediators of impaired energy metabolism. Since apolipoprotein E (APOE) is a major risk factor for late-onset AD, it was of interest to examine its potential contribution to altered insulin-linked signaling networks in the brain. OBJECTIVE: The main goal was to evaluate the independent and interactive contributions of AD severity and APOE ɛ4 dose on brain expression of insulin-related polypeptides and inflammatory mediators of metabolic dysfunction. METHODS: Postmortem fresh frozen frontal lobe tissue from banked cases with known APOE genotypes and different AD Braak stages were used to measure insulin network polypeptide immunoreactivity with a commercial multiplex enzyme-linked immunosorbent assay (ELISA). RESULTS: Significant AD Braak stage and APOE genotype-related abnormalities in insulin, C-peptide, gastric inhibitory polypeptide (GIP), glucaton-like peptide-1 (GLP-1), leptin, ghrelin, glucagon, resistin, and plasminogen activator inhibitor-1 (PAI-1) were detected. The main factors inhibiting polypeptide expression and promoting neuro-inflammatory responses included AD Braak stage and APOE ɛ4/ɛ4 rather than ɛ3/ɛ4. CONCLUSION: This study demonstrates an expanded role for impaired expression of insulin-related network polypeptides as well as neuroinflammatory mediators of brain insulin resistance in AD pathogenesis and progression. In addition, the findings show that APOE has independent and additive effects on these aberrations in brain polypeptide expression, but the impact is decidedly greater for APOE ɛ4/ɛ4 than ɛ3/ɛ4.

Citizen science in the marine environment: estimating common dolphin densities in the north-east Atlantic.

BACKGROUND: Citizen science is increasingly popular and has the potential to collect extensive datasets at lower costs than traditional surveys conducted by professional scientists. Ferries have been used to collect data on cetacean populations for decades, providing long-term time series for monitoring of cetacean populations. One cetacean species of concern is the common dolphin, which has been found stranded around the north-east Atlantic in recent years, with high numbers on French coasts being attributed to fisheries bycatch. We estimate common dolphin densities in the north-east Atlantic and investigate the ability of citizen science data to identify changes in marine mammal densities and areas of importance. MATERIALS AND METHODS: Data were collected by citizen scientists on ferries between April and October in 2006-2017. Common dolphin sightings data from two ferry routes across three regions, Bay of Biscay (n = 569); south-west United Kingdom to the Isles of Scilly in the Celtic Sea (n = 260); and English Channel (n = 75), were used to estimate density across ferry routes. Two-stage Density Surface Models accounted for imperfect detection, and tested the influence of environmental (chlorophyll a, sea surface temperature, depth, and slope), spatial (latitude and longitude) and temporal terms (year and Julian day) on occurrence. RESULTS: Overall detection probability was highest in the areas sampled within the English Channel (0.384) and Bay of Biscay (0.348), and lowest on the Scilly's route (0.158). Common dolphins were estimated to occur in higher densities on the Scilly's route (0.400 per km2) and the Bay of Biscay (0.319 per km2), with low densities in the English Channel (0.025 per km2). Densities on the Scilly's route appear to have been relatively stable since 2006 with a slight decrease in 2017. Densities peaked in the Bay of Biscay in 2013 with lower numbers since. Densities in the English Channel appear to have increased over time since 2009. DISCUSSION: This study highlights the effectiveness of citizen science data to investigate the distribution and density of cetaceans. The densities and temporal changes shown by this study are representative of those from wider-ranging robust estimates. We highlight the ability of citizen science to collect data over extensive periods of time which complements dedicated, designed surveys. Such long-term data are important to identify changes within a population; however, citizen science data may, in some situations, present challenges. We provide recommendations to ensure high-quality data which can be used to inform management and conservation of cetacean populations.

Sex-dependent neurobiological features of prenatal immune activation via TLR7.

Immune activation during pregnancy via infection or autoimmune disease is a risk factor for neuropsychiatric illness. Mouse models of prenatal immune activation often involve maternal administration of agents that activate toll-like receptors (TLRs), a class of pattern recognition receptors that initiate innate immune responses. Such studies have focused primarily on activating the TLR3 or TLR4 subtypes, to mimic immune responses to viral or bacterial infections, respectively. Here, we characterize the effects of prenatal activation of TLR7, which is implicated in the pathogenesis of autoimmune disease. Prenatal TLR7 activation via administration of the selective agonist imiquimod (5.0 mg/kg) induces a phenotype in offspring characterized by reduced anxiety-like behavior, fragmented social behavior, and altered ultrasonic vocalization patterns at 6-12 weeks of age. The characteristics of this phenotype are readily distinguishable from-and in some ways opposite to-those seen following prenatal activation of TLR3 and/or TLR4. Prenatal TLR7-activated mice have normal baseline locomotor activity, but are hyperresponsive to stimuli including social partners, circadian cues, and gonadal hormone fluctuations. These alterations are accompanied by decreases in microglia density but increases in ramifications. RNA-sequencing of dorsal striatum, a region showing profound changes in microglial markers, indicates that prenatal TLR7 activation induces differential expression of hundreds of genes at 13 weeks of age, with virtually no overlap in differentially expressed genes between males and females. Our findings demonstrate that prenatal immune activation can promote a wide range of developmental trajectories, depending on the type and/or pattern of TLR activation and the sex of the offspring.

Management of Croup in the Emergency Department: The Role of Multidose Nebulized Epinephrine.

OBJECTIVES: Croup occasionally requires medical intervention for respiratory distress. Mainstays of treatment are corticosteroids and nebulized epinephrine. Diagnosis and assessment of severity remain clinical. Safety of discharge from an emergency department (ED) after treatment with corticosteroids and 1 nebulized epinephrine has been established. No evidence exists regarding risk associated with discharge after multidose nebulized epinephrine. Many patients requiring multidose nebulized epinephrine are reflexively admitted. The purpose of this study was to provide a descriptive analysis of the current management of croup, specifically patients requiring multidose nebulized epinephrine. METHODS: The Pediatric Health Information System was used to extract information on patients diagnosed with croup age 0 to 11 years, evaluated in pediatric EDs from 2004 to 2014, who received corticosteroids and at least 1 nebulized epinephrine. We retrospectively assessed patients requiring multidose nebulized epinephrine, evaluating risk of return for additional care associated with discharges and reviewing admissions for markers of disease severity. RESULTS: A total of 95,403 patients were identified. Those requiring corticosteroids and multidose nebulized epinephrine (N = 8084) were less likely to return for further care if discharged from the ED (5.4% return single dose, 0.8% return multidose: P < 0.0001) and were admitted at a higher rate (10.7% admission single dose, 70.5% admission multidose: P < 0.0001). Of those admitted, only 31.7% received more than 2 treatments. CONCLUSIONS: Patients requiring single-dose nebulized epinephrine are managed differently than those requiring multidose nebulized epinephrine. There is likely a role for multidose nebulized epinephrine in the outpatient management of croup. A prospective study is needed.

Maternal and early postnatal immune activation produce sex-specific effects on autism-like behaviors and neuroimmune function in mice.

Increasing evidence suggests a role for inflammation in neuropsychiatric conditions including autism spectrum disorder (ASD), a neurodevelopmental syndrome with higher prevalence in males than females. Here we examined the effects of early-life immune system activation (EIA)-comprising regimens of prenatal, early postnatal, or combined ("two-hit") immune activation-on the core behavioral features of ASD (decreased social interaction, increased repetitive behavior, and aberrant communication) in C57BL/6J mice. We treated timed-pregnant mice with polyinosinic:polycytidylic acid (Poly I:C) on gestational day 12.5 to produce maternal immune activation (MIA). Some offspring also received lipopolysaccharide (LPS) on postnatal day 9 to produce postnatal immune activation (PIA). EIA produced disruptions in social behavior and increases in repetitive behaviors that were larger in males than in females. Ultrasonic vocalizations (USVs) were altered in both sexes. Molecular studies revealed that EIA also produced prominent sex-specific changes in inflammation-related gene expression in the brain. Whereas both sexes showed increases in pro-inflammatory factors, as reflected by levels of mRNA and protein, expression of anti-inflammatory factors was decreased in males but increased in females. Our findings demonstrate that EIA can produce sex-specific behavioral effects and immune responses in the brain, and identify molecular processes that may contribute to resilience in females.

Supernumerary teeth observed in a live True's beaked whale in the Bay of Biscay.

Mesoplodont beaked whales are one of the most enigmatic mammalian genera. We document a pod of four beaked whales in the Bay of Biscay breaching and tail slapping alongside a large passenger ferry. Photographs of the animals were independently reviewed by experts, and identified as True's beaked whales (Mesoplodon mirus). This is the first conclusive live sighting of these animals in the north-east Atlantic, and adds information to previous sightings that are likely to have been M. mirus. Photographs of an adult male appears to show two supernumerary teeth posterior to the apical mandibular tusks. Whilst analysed museum specimens (n = 8) did not show evidence of alveoli in this location, there is evidence of vestigial teeth and variable dentition in many beaked whale species. This is the first such record of supernumerary teeth in True's beaked whales.

Nuclear radiation and prevalence of structural birth defects among infants born to women from the Marshall Islands.

BACKGROUND: With their unique history of exposure to extensive nuclear testing between 1946 and 1958, descendants of Marshall Island residents may have underappreciated genetic abnormalities, increasing their risk of birth defects. METHODS: We conducted a retrospective cohort study of resident women with at least one singleton live birth between 1997 and 2013 in northwest Arkansas using state birth certificate data linked to data from the Arkansas Reproductive Health Monitoring System, a statewide birth defects registry. We calculated unadjusted and adjusted prevalence ratios (PR) and 95% confidence intervals (CI) from modified Poisson regression analyses for non-Hispanic (NH) whites, NH-blacks, Hispanics and Marshallese, using NH-whites as the reference group. RESULTS: Of the 91,662 singleton births during the study period, 2,488 were to Marshallese women. Due to the relatively small number of Marshallese births, we could not calculate prevalence estimates for some defects. Marshallese infants had higher rates of congenital cataracts (PR = 9.3; 95% CI: 3.1, 27.9). Although the number of defects was low, Marshallese infants also had higher rates of truncus arteriosus (PR = 44.0; 95% CI: 2.2, 896.1). CONCLUSIONS: Marshallese infants may have increased risk of specific birth defects, but estimates are unstable because of small sample size so results are inconclusive. Larger population-based studies would allow for further investigation of this potential risk among Marshallese infants.