Evaluation of a novel algorithm for automating virtual surgical planning in mandibular reconstruction using fibula flaps

Virtual surgical planning plays an increasingly important role in jaw reconstruction. The aim of the present study was the evaluation of the clinical applicability of a novel algorithm for automating virtual mandibular reconstruction using fibula flaps.The software uses Computed-Tomography of the facial skeleton and the lower leg of 63 subjects, implemented in Python programming language. The developed algorithm is based on individual bone curvatures of the mandible and fibula. Ten different defects were generated for each mandible by virtually defined cutting planes. Three experienced surgeons reviewed all reconstruction proposals generated by the algorithm according to a visual analogue scale. The possible correlation between the ratings and the prioritization of the algorithm and the calculation time for the reconstructions were analyzed.Spearman analysis showed a strong correlation ?0.613 (p < 0.001) between the deviation of the reconstruction result from the target line and the average assessment of the surgeons as well as a moderate correlation ?0.448 (p = 0.013) between surgeons' assessments and the prioritization by the algorithm. The calculation time for twenty reconstructions per defect took between 4.99 s and 483.5 s depending on defect size and location.The evaluated algorithm automatically creates valid reconstruction results with acceptable computation time, which have received a high level of confirmation from experienced surgeons.     

Central Venous Disease in Hemodialysis Patients: An Update

Central venous occlusive disease (CVD) is a common concern among the hemodialysis patient population, with the potential to cause significant morbidity. Endovascular management of CVD, comprising percutaneous balloon angioplasty and bare-metal stenting, has been established as a safe alternative to open surgical treatment. However, these available treatments have poor long-term patency, requiring close surveillance and multiple repeat interventions. Recently, covered stents have been proposed and their efficacy assessed for the treatment of recalcitrant central venous stenosis and obstruction. Moreover, newly proposed algorithms for the surgical management of CVD warrant consideration. Here, we seek to provide an updated review of the current literature on the various treatment modalities for CVD.     

Immunochemotherapy for cutaneous leishmaniasis: a controlled trial using killed Leishmania (Leishmania) amazonensis vaccine plus antimonial

BACKGROUND: Leishmaniasis is endemic in 88 countries in the world, and 350 million individuals are at risk of acquiring the disease. Treatment for American cutaneous leishmaniasis (ACL) is long, expensive, and associated with important side-effects. METHODS: In this double-blind, placebo-controlled study, we treated 102 patients with ACL using either a combination of a single-strain Leishmania amazonensis killed promastigote vaccine plus a half dose of meglumine antimoniate, or placebo plus the same half dose regimen of meglumine antimoniate, in 10-day series followed by 10-day intervals. RESULTS: Of the 47 patients in the experimental arm, 47 (100%) were cured after four series of treatment, compared to four of 49 (8.2%) in the control group (P < 0.0001). Six patients were lost to follow-up. CONCLUSIONS: The combination of a single-strain Leishmania (Leishmania) amazonensis killed promastigote vaccine with a half dose regimen of antimonial is highly effective for the treatment of ACL.     

The role of BCG in human immune responses induced by multiple injections of autoclaved Leishmania major as a candidate vaccine against leishmaniasis

To determine if BCG was required in booster injections for autoclaved Leishmania major (ALM) vaccine, 75 volunteers with no response to leishmanin were injected double-blind and randomly with either ALM+BCG or BCG alone for the first injection and boosted either with ALM+BCG, ALM or BCG alone for the second and third. Addition of BCG to the boosters significantly increased the frequency and the magnitude of leishmanin skin tests (LSTs); however, there was no difference in proliferative and IFN-gamma responses (a month and a year later). Three injections of BCG produced no observable adverse reaction; hence BCG could be used in booster injections to increase the protective potential of this candidate vaccine.     

Experimental peri-implant mucositis around titanium and zirconia implants in comparison to a natural tooth: part 1—host-derived immunological parameters

The purpose of this study was to assess host-derived parameters around dental zirconia and titanium implants and natural teeth during the occurrence of mucositis. After 4 weeks of perfect oral hygiene, 16 clinically profiled patients were asked to refrain from oral hygiene for 2 weeks, resulting in experimental plaque accumulation. This was followed by 4 weeks of perfect oral hygiene to reverse the inflammation. Immunological samples were analyzed for interleukin 6 (IL-6), tumour necrosis factor alpha (TNF-α), and interleukin 1β (IL-1β). Immunological parameters were measured each week, starting at week 4 (session 2) and ending at week 10 (session 8). There were significant differences in IL-6 between the groups (zirconia vs. tooth and titanium vs. tooth), with unfavourable values for the tooth unit (P < 0.05). After reinstitution of oral hygiene, there was a significant increase in TNF-α values for the tooth but not for the zirconia and titanium implants. There were significant differences in IL-1β between the groups (zirconia vs. titanium and titanium vs. tooth), with higher IL-1β levels around titanium implants (P < 0.05). The soft tissue around titanium implants developed a stronger inflammatory response to experimental plaque accumulation in terms of IL-1β values, whereas the teeth presented an increase in IL-6 and TNF-α values.     

Efficacy of killed whole-parasite vaccines in the prevention of leishmaniasis—A meta-analysis

Despite decades of investigation in countries on three continents, an efficacious vaccine against Leishmania infections has not been developed. Although some indication of protection was observed in some of the controlled trials conducted with “first-generation” whole, inactivated Leishmania parasite vaccines, convincing evidence of protection was lacking. After reviewing all previously published or unpublished randomized, controlled field efficacy clinical trials of prophylactic candidate vaccines, a meta-analysis of qualified trials was conducted to evaluate whether there was some evidence of protection revealed by considering the results of all trials together. The findings indicate that the whole-parasite vaccine candidates tested do not confer significant protection against human leishmaniasis.