Dental implant tourism

Access and affordability of dental care can be problematic for some in the Australian community. Therefore, dental tourism is increasingly becoming more attractive to some patients due to decreased expense, increased convenience and immediacy of treatment. However, there are significant issues for both clinician and patient in regards to dental tourism. Lack of accountability and regulation are the main issues and this is particularly evident when complications occur. This paper presents five cases where complications have arisen in the setting of dental tourism.     

Chondrosarcoma of the bones of the feet

Twelve chondrosarcomas of the bones of the feet from 11 patients in the Scottish Bone Tumor Registry were reviewed. One patient with diaphyseal aclasis (osteochondromatosis) developed 2 chondrosarcomas. The mean age of patients was 52.3 years (range, 17 to 83 years). Men were predominantly affected. Four tumors affected the tarsal bones; the rest involved the short tubular bones. The usual clinical presentation was a painful, progressively enlarging swelling. Radiologically, most showed some bone expansion, cortical destruction with indistinct margins, and soft-tissue extension. Histologically, the majority were middle-grade tumors. Treatment included curettage or local excision for 4 tumors and amputation or ray resection for 8 tumors. Follow-up varied from 6 months to 18 years (average, 5.8 years). Local recurrence after surgery was seen in 3 patients. All 3 died because of metastases to the lungs or brain.     

The use of suture anchors in repair of the ruptured patellar tendon: a biomechanical study

BACKGROUND: Rupture of the patellar tendon is a disabling injury that usually requires surgical treatment. The standard method of repair involves placing suture loops through transpatellar tunnels. The use of suture anchors in patellar tendon repair has not been previously described. HYPOTHESIS: No difference exists in the amount of gap formation during cyclic loading or in ultimate load-to-failure strength between repairs performed with anchors and those performed with 2 types of transpatellar sutures. STUDY DESIGN: Controlled laboratory study. METHODS: Six matched pairs of cadaveric knees were tested in a custom biomechanical apparatus based on an established model. Repairs were performed using either suture anchors with No. 2 FiberWire or transpatellar suture tunnels using 2 different types of suture-No. 5 Ethibond and No. 2 FiberWire. Gap formation across the repair site during 250 cycles of extension as well as ramp-up load to failure were measured for each repair. RESULTS: The mean total gap formation across the repair site at 250 cycles was 4.1 +/- 1.9 mm for the suture anchor group, 6.7 +/- 1.8 mm for the FiberWire tunnel group, and 8.5 +/- 2.7 mm for the Ethibond tunnel group. Mean load to failure was 779 +/- 183 N, 730 +/- 83 N, and 763 +/- 231 N, respectively. CONCLUSION: Significantly less gap formation throughout 250 cycles (P = .009) and no difference in load to failure occurred with patellar tendon repairs performed with suture anchors as compared with repairs performed with transpatellar tunnels. CLINICAL RELEVANCE: The newly described method, using suture anchors for repair of patellar tendon ruptures, may be clinically equal or superior to the established method of using transpatellar tunnels.     

Effect of prior probability quality on biased time-delay estimation

When properly constructed, biased estimators are known to produce lower mean-square errors than unbiased estimators. A biased estimator for the problem of ultrasound time-delay estimation was recently proposed. The proposed estimator incorporates knowledge of adjacent displacement estimates into the final estimate of a displacement. This is accomplished by using adjacent estimates to create a prior probability on the current estimate. Theory and simulations are used to investigate how the prior probability impacts the final estimate. The results show that with estimation quality on the order of the Cramer-Rao lower bound at adjacent locations, the local estimate in question should generally exceed the Cramer-Rao lower-bound limitations on performance of an unbiased estimator. The results as a whole provide additional confidence for the proposed estimator.     

A method for direct localized sound speed estimates using registered virtual detectors

Accurate sound speed estimates are desirable in a number of fields. In an effort to increase the spatial resolution of sound speed estimates, a new method is proposed for direct measurement of sound speed between arbitrary spatial locations. The method uses the sound speed estimator developed by Anderson and Trahey. Their least squares fit of the received waveform's curvature provides an estimate of the wave's point of origin. The point of origin and the delay profile calculated from the fit are used to arrive at a spatially registered virtual detector. Between a pair of registered virtual detectors, a spherical wave is propagated. By beamforming the data, the time-of-flight between the two virtual sources can be calculated. From this information, the local sound speed can be estimated. Validation of the estimator is made using phantom and simulation data. The set of test phantoms consisted of both homogeneous and inhomogeneous media. Several different inhomogeneous phantom configurations were used for the physical validation. The simulation validation focused on the limits of target depth and signal-to-noise ratio on virtual detector registration. The simulations also compare the impact of two- and three-layer inhomogeneous media. The phantom results varied based on signal-to-noise ratio and geometry. The results for all cases were generally less than 1% mean error and standard deviation. The simulation results varied somewhat with depth and F/#, but primarily, they varied with signal-to-noise ratio and geometry. With two-layer geometries, the algorithm has a worst-case spatial registration bias of 0.02%. With three-layer geometries, the axial registration error gets worse with a bias magnitude up to 2.1% but is otherwise relatively stable over depth. The stability over depth of the bias in a given medium still allows for accurate sound speed estimates with a mean relative error less than 0.2%.     

Vesicular Stomatitis Virus as a Novel Cancer Vaccine Vector to Prime Antitumor Immunity Amenable to Rapid Boosting With Adenovirus

Vesicular stomatitis virus (VSV) has proven to be an effective vaccine vector for immunization against viral infection, but its potential to induce an immune response to a self-tumor antigen has not been investigated. We constructed a recombinant VSV expressing human dopachrome tautomerase (hDCT) and evaluated its immunogenicity in a murine melanoma model. Intranasal delivery of VSV-hDCT activated both CD4⁺ and CD8⁺ DCT-specific T-cell responses. The magnitude of these responses could be significantly increased by booster immunization with recombinant adenovirus (Ad)-hDCT, which led to enhanced efficacy against B16-F10 melanoma in both prophylactic and therapeutic settings. Notably, the interval of VSV/Ad heterologous vaccination could be shortened to as few as 4 days, making it a potential regimen to rapidly expand antigen-specific effector cells. Furthermore, VSV-hDCT could increase DCT-specific T-cell responses primed by Ad-hDCT, suggesting VSV is efficient for both priming and boosting of the immune response against a self-tumor antigen.     

Macrophage Depletion via Clodronate Pretreatment Reduces Transgene Expression from AAV Vectors In Vivo

Adeno-associated virus is a popular gene delivery vehicle for gene therapy studies. A potential roadblock to widespread clinical adoption is the high vector doses required for efficient transduction in vivo, and the potential for subsequent immune responses that may limit prolonged transgene expression. We hypothesized that the depletion of macrophages via systemic delivery of liposome-encapsulated clodronate would improve transgene expression if given prior to systemic AAV vector administration, as has been shown to be the case with adenoviral vectors. Contrary to our expectations, clodronate liposome pretreatment resulted in significantly reduced transgene expression in the liver and heart, but permitted moderate transduction of the white pulp of the spleen. There was a remarkable localization of transgene expression from the red pulp to the center of the white pulp in clodronate-treated mice compared to untreated mice. Similarly, a greater proportion of transgene expression could be observed in the medulla located in the center of the lymph node in mice treated with clodronate-containing liposomes as compared to untreated mice where transgene expression was localized primarily to the cortex. These results underscore the highly significant role that the immune system plays in influencing the distribution and relative numbers of transduced cells in the context of AAV-mediated gene delivery.     

In vivo liver tracking with a high volume rate 4D ultrasound scanner and a 2D matrix array probe

The effectiveness of intensity-modulated radiation therapy (IMRT) is compromised by involuntary motion (e.g. respiration, cardiac activity). The feasibility of processing ultrasound echo data to automatically estimate 3D liver motion for real-time IMRT guidance was previously demonstrated, but performance was limited by an acquisition speed of 2 volumes per second due to hardware restrictions of a mechanical linear array probe. Utilizing a 2D matrix array probe with parallel receive beamforming offered increased acquisition speeds and an opportunity to investigate the benefits of higher volume rates. In?vivo livers of three volunteers were scanned with and without respiratory motion at volume rates of 24 and 48 Hz, respectively. Respiration was suspended via voluntary breath hold. Correlation-based, phase-sensitive 3D speckle tracking was applied to consecutively acquired volumes of echo data. Volumes were omitted at fixed intervals and 3D speckle tracking was re-applied to study the effect of lower scan rates. Results revealed periodic motion that corresponded with the heart rate or breathing cycle in the absence or presence of respiration, respectively. For cardiac-induced motion, volume rates for adequate tracking ranged from 8 to 12 Hz and was limited by frequency discrepancies between tracking estimates from higher and lower frequency scan rates. Thus, the scan rate of volume data acquired without respiration was limited by the need to sample the frequency induced by the beating heart. In respiratory-dominated motion, volume rate limits ranged from 4 to 12 Hz, interpretable from the root-mean-squared deviation (RMSD) from tracking estimates at 24 Hz. While higher volume rates yielded RMSD values less than 1 mm in most cases, lower volume rates yielded RMSD values of 2-6 mm.