Bony tumour in an unusual location on the mandible

Osteomas are benign osteogenic tumors that are seen in the facial bones, but uncommonly in the mandible. In the facial bones, both central and peripheral osteomas have been described. Peripheral osteomas have been described to occur in the frontal, ethmoid, and maxillary sinuses but are not common in jawbones. When in the mandible, they are usually found over the angle and inferior border of the mandible. We report on a solitary peripheral osteoma located unusually in the sigmoid notch of the left mandible causing facial asymmetry.KEY WORDS: Mandible, mandibular notch, osteoma, sigmoid notch, tumor     

Impacts of the COVID-19 Pandemic on Cardiac Rehabilitation Delivery around the World

Background:We investigated impacts of COVID-19 on cardiac rehabilitation (CR) delivery around the globe, including virtual delivery, as well as effects on providers and patients.Methods:In this cross-sectional study, a piloted survey was administered to CR programs globally via REDCap from April to June 2020. The 50 members of the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) and personal contacts facilitated program identification.Results:Overall, 1062 (18.3% program response rate) responses were received from 70/111 (63.1% country response rate) countries in the world with existent CR programs. Of these, 367 (49.1%) programs reported they had stopped CR delivery, and 203 (27.1%) stopped temporarily (mean = 8.3 ± 2.8 weeks). Alternative models were delivered in 322 (39.7%) programs, primarily through low-tech modes (n = 226,19.3%). Furthermore, 353 (30.2%) respondents were re-deployed, and 276 (37.3%) felt the need to work due to fear of losing their job, despite the perceived risk of contracting COVID-19 (mean = 30.0% ± 27.4/100). Also, 266 (22.5%) reported anxiety, 241(20.4%) were concerned about exposing their family, 113 (9.7%) reported increased workload to transition to remote delivery, and 105 (9.0%) were juggling caregiving responsibilities during business hours. Patients were often contacting staff regarding grocery shopping for heart-healthy foods (n = 333, 28.4%), how to use technology to interact with the program (n = 329, 27.9%), having to stop their exercise because they have no place to exercise (n = 303, 25.7%), and their risk of death from COVID-19 due to pre-existing cardiovascular disease (n = 249, 21.2%). Respondents perceived staff (n = 488, 41.3%) and patient (n = 453, 38.6%) personal protective equipment, as well as COVID-19 screening (n = 414, 35.2%), and testing (n = 411, 35.0%) as paramount to in-person service resumption.Conclusion:Given the estimated number of CR programs globally, these results suggest approximately 4400 CR programs globally have ceased or temporarily stopped service delivery. Those that remain open are implementing new technologies to ensure their patients receive CR safely, despite the challenges.Highlights:

• – COVID-19 has impacted cardiac rehabilitation (CR) delivery around the globe.
• – In this cross-sectional study, a survey was completed by 1062 (18.3%) CR programs from 70 (63.1%) countries.
• – The pandemic has resulted in at least temporary cessation of ~75% of CR programs, with others ceasing initiation of new patients, reducing components delivered, and/or changing of mode delivery with little opportunity for planning and training.
• – There is also significant psychosocial and economic impact on CR providers.
• – Alternative CR model (e.g., home-based, virtual) reimbursement advocacy is needed, to ensure safe, accessible secondary prevention delivery.

     

Transcaval aortic valve implantation in a patient with Larsen syndrome: technical and anesthetic challenges

Transcatheter aortic valve implantation has emerged as a therapeutic option for patients with symptomatic severe aortic stenosis who are inoperable, or at very high risk of open-heart surgery. Recently, we encountered a patient with aortic stenosis and Larsen syndrome, who had short stature, obesity, kyphoscoliosis, multiple musculoskeletal deformities, and severe restrictive lung disease. An open-heart surgery in such a patient involves substantial peri-operative risk. A successful transcaval aortic valve implantation was done under general anesthesia.     

A three‐dimensional measurement approach for the morphology of the femoral head

The hip joint is one of the most frequent sites of osteoarthritis. Advances in diagnosis and clinical treatment have progressed dramatically in the last few decades; however, there are limitations associated with the lack of reliable measures for quantifying hip joint morphology. Current diagnostic measures of the hip are performed with pre-determined measures, typically lengths and angles, on 2D radiographic planes. The current measurement techniques do not utilize the inherent 3D nature of CT and MR imaging and do not necessarily quantify the relevant clinical pathologies. A valid and reliable measurement modality that measures the surface geometry of the femoral head is necessary for early diagnosis and treatment of hip disease. The purpose of this study was to establish a method to quantify femoral head morphology using a three-dimensional model. A novel measurement approach was applied to 45 cadaveric femurs (23 right; 22 left; nine female, 17 male) and their digitally reconstructed 3D CT models. The mean difference between the cadaveric and digital measures was −2.04 mm with 95% confidence limits (CI) of 13.67 mm and −17.75 mm, respectively. The digital measurement approach was found to have excellent intraobserver reliability (ICC = 0.99, CI 0.98–0.99) and interobserver reliability (ICC = 0.98, CI 0.93–0.99). This valid and reliable novel digital measurement approach enables quantification of the 3D surface geometry of the femoral head and is able to measure individual variations and potentially detect abnormalities. This method may be used to assist future studies to establish valid diagnostic measurements for femoral head and head–neck junction pathologies.     

A single injection of a novel kappa opioid receptor agonist salvinorin A attenuates the expression of cocaine-induced behavioral sensitization in rats

Kappa opioid receptor (KOPr) activation antagonizes many cocaine-related behaviors but adverse side-effects such as sedation, dysphoria, and depression limit their therapeutic use. Recently, salvinorin A (Sal A), a naturally occurring KOPr agonist, has been shown to attenuate cocaine-induced drug seeking in a model of relapse in rats. The present study evaluated the effects of acute Sal A exposure on cocaine-induced hyperactivity and cocaine sensitization in rats. Acute treatment with a dose of Sal A that decreased drug seeking in a previous study (0.3 mg/kg) significantly attenuated the expression of cocaine sensitization. This dose of Sal A failed to affect spontaneous locomotion or to produce a conditioned taste aversion to a novel-tasting saccharin solution. However, Sal A decreased climbing and swimming time and increased time spent immobile in the forced swim test. These findings indicate that Sal A, just like traditional KOPr agonists, attenuates cocaine-induced behavioral sensitization but does not produce the adverse effect of conditioned aversion, suggesting improved potential compliance. However, prodepressive effects were also produced and these effects may limit the therapeutic potential.     

Interleukin‐10‐secreting T cells define a suppressive subset within the HIV‐1‐specific T‐cell population

Recent studies have indicated that Treg contribute to the HIV type 1 (HIV‐1)‐related immune pathogenesis. However, it is not clear whether T cells with suppressive properties reside within the HIV‐1‐specific T‐cell population. Here, PBMC from HIV‐1‐infected individuals were stimulated with a 15‐mer Gag peptide pool, and HIV‐1‐specific T cells were enriched by virtue of their secretion of IL‐10 or IFN‐γ using immunomagnetic cell‐sorting. Neither the IL‐10‐secreting cells nor the IFN‐γ‐secreting cells expressed the Treg marker FOXP3, yet the IL‐10‐secreting cells potently suppressed anti‐CD3/CD28‐induced CD4⁺ as well as CD8⁺ T‐cell proliferative responses. As shown by intracellular cytokine staining, IL‐10‐ and IFN‐γ‐producing T cells represent distinct subsets of the HIV‐1‐specific T cells. Our data collectively suggest that functionally defined HIV‐1‐specific T‐cell subsets harbor potent immunoregulatory properties that may contribute to HIV‐1‐associated T‐cell dysfunction.     

Annular pigment band on the posterior capsule following blunt ocular trauma: a case report

Background  

To report an unusual case of annular pigment band on the posterior capsule following blunt ocular trauma.