The effect of SLActive surface in guided bone formation in osteoporotic-like conditions

Objectives: The aim of the study was to evaluate new bone formation under etched titanium (SLA) and modified‐etched hydrophilic titanium (modSLA) domes placed on the calvarium of healthy, osteoporotic and osteoporotic treated with bisphosphonates rabbits. Methods: Experimental osteoporosis was induced by ovariectomy (OV) and calcium‐deficient diet in 24 New Zealand female rabbits. Twelve OV rabbits were treated with weekly dozes of alendronate (Fosamax^®) (B) while 12 OV rabbits received no treatment (O). Another 12 rabbits were sham operated and used as healthy controls (C). At 6 weeks following OV, one modSLA and one SLA titanium dome were placed in the parietal bones of each rabbit. The animals were sacrificed at 30 and 120 days following the dome placement. Various histomorphometric measurements were performed in the most central of the undecalcified sections produced. Results: After 30 days of healing, in the C group, the total bone (TB) area was 37.6% and 37.0% under the modSLA and SLA domes, respectively. In the O group, the TB was 35.7% and 24.8%. In the B group, TB was 37.0% and 32.1%, respectively. After 120 days of healing, in the C group TB was 40.1% and 36.4%, respectively. In the O group, TB was 29.6% and 27.9%, respectively. In the B group, TB was 49.7% and 42.5%, respectively. Hierarchical analysis of variance showed that the type of titanium dome significantly influenced new bone and the amount of new bone being in contact with inner surface of the dome (BIC) independently of the observation period and group (P<0.05). The administration of bisphosphonates influenced the BIC (P<0.05). Conclusion: The use of modSLA surface may promote bone healing and osseointegration in osteoporotic rabbits, whereas administration of bisphosphonates may compromise the osseointegration of the newly formed bone at the early healing period. To cite this article:
Mardas N, Schwarz F, Petrie A, Hakimi A‐R, Donos N. The effect of SLActive surface in guided bone formation in osteoporotic‐like conditions.
Clin. Oral Impl. Res. 22 , 2011; 406–415.
doi: 10.1111/j.1600‐0501.2010.02094.x     

Determinants of aesthetic satisfaction following TRAM and implant breast reconstruction

INTRODUCTION: Several studies have evaluated patient satisfaction following breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap and tissue expander/implant. However, the specific aesthetic determinants of patient satisfaction have not been determined. METHODS: Patients who had undergone tissue expander/implant or TRAM flap reconstruction were retrospectively polled on their age, type and timing of reconstruction, mastectomy type, laterality of reconstruction, adjuvant therapy, and symmetrizing and nipple-areolar procedures. Aesthetic satisfaction based on breast shape, symmetry of breast shape, breast size, symmetry of breast size, breast scarring, and breast sensation was assessed using a 5-point scale. RESULTS: Two hundred eleven patients with 105 TRAM flaps and 160 expander/implants responded. Unilateral TRAM recipients rated their breast shape, symmetry of breast shape, and symmetry of breast volume significantly higher than did implant patients. When bilateral reconstruction patients were evaluated, no significant differences were seen. The presence of nipple-areolar reconstruction positively influenced every parameter except breast sensation. Immediate reconstruction, skin-sparing mastectomy, and age >60 years at the time of reconstruction were also associated with higher scores, while postoperative radiation therapy resulted in lower satisfaction. Free flap reconstruction produced higher satisfaction in breast shape and breast scarring when compared with pedicle flap reconstruction. CONCLUSIONS: Aesthetic satisfaction after breast reconstruction is highly influenced by the presence of nipple-areolar reconstruction and less so by age, timing of reconstruction, adjuvant therapy, or free flap procedures. The type of reconstructive procedure is a significant variable only in unilateral reconstruction.     

Immediate functional loading of single-tooth TiO2 grit-blasted implant restoration. A controlled prospective study in a porcine model. Part II: Histology and histomorphometry

Background: Evidently, there is a fast‐moving shift from delayed to immediate implant loading. The hypothesis to be tested was that bone reactions adjacent to single TiO₂‐microthreaded implants exposed to immediate masticatory loading for 10 weeks after placement would modulate osseointegration. Materials and Methods: Cylindrical‐ and tapered‐designed implants (Astra Tech AB, Mölndal, Sweden) replaced first and third mandibular premolars respectively in 12 pigs. The animals were allocated into two groups based on soft and hard diet feeding. Each animal received, at random positions, four different masticatory loading conditions: implant with either (1) a cover screw only, (2) a healing abutment, (3) an implant with a crown without occlusal contact, or (4) an implant with a crown in contact with the antagonistic teeth. Results: Histomorphometry showed that there were no statistically significant differences in bone‐implant contact (BIC), bone mass inside/outside of the threads and soft tissue ingrowth ratio for all the implants at 10 weeks after placement irrespective of masticatory loading condition. Bone loss showed a trend of progressive increase for implants with a healing abutment toward implants with occlusal contact. Conclusions: The results of this study rejected the hypothesis and could be explained by the fact that grit‐blasted acid‐etched implants were already placed in dense bone.     

Public Health Implications of Recommendations to Individualize Glycemic Targets in Adults With Diabetes

OBJECTIVE

To estimate how many U.S. adults with diabetes would be eligible for individualized A1C targets based on 1) the 2012 American Diabetes Association (ADA) guideline and 2) a published approach for individualized target ranges.

RESEARCH DESIGN AND METHODS

We studied adults with diabetes ≥20 years of age from the National Health and Nutrition Examination Survey 2007–2008 (n = 757). We assigned A1C targets based on duration, age, diabetes-related complications, and comorbid conditions according to 1) the ADA guideline and 2) a strategy by Ismail-Beigi focused on setting target ranges. We estimated the number and proportion of adults with each A1C target and compared individualized targets to measured levels.

RESULTS

Using ADA guideline recommendations, 31% (95% CI 27–34%) of the U.S. adult diabetes population would have recommended A1C targets of <7.0%, and 69% (95% CI 66–73%) would have A1C targets less stringent than <7.0%. Using the Ismail-Beigi strategy, 56% (51–61%) would have an A1C target of ≤7.0%, and 44% (39–49%) would have A1C targets less stringent than <7.0%. If a universal A1C <7.0% target were applied, 47% (41–54%) of adults with diabetes would have inadequate glycemic control; this proportion declined to 30% (26–36%) with the ADA guideline and 31% (27–36%) with the Ismail-Beigi strategy.

CONCLUSIONS

Using individualized glycemic targets, about half of U.S. adults with diabetes would have recommended A1C targets of ≥7.0% but one-third would still be considered inadequately controlled. Diabetes research and performance measurement goals will need to be revised in order to encourage the individualization of glycemic targets.For nearly a decade, diabetes care guidelines from the American Diabetes Association (ADA) have recommended that the goal of glycemic control should be to lower the A1C to <7.0% for adults living with diabetes (1). This recommendation currently motivates diabetes public health programs and diabetes care translational research. All of these efforts have the overall intention of shifting the national distribution of A1C levels downward in order to improve diabetes outcomes and may lead to overtreatment of A1C levels in certain diabetes populations.Although the standard A1C target of <7.0% is probably the best-known feature of the ADA guidelines, the ADA guidelines also recommend that A1C targets should be based on individual clinical circumstances. Similar recommendations for individualized targets have been supported by the Veterans Health Administration-Department of Defense (VA-DoD), American Geriatric Society, American College of Physicians (ACP), and American Association of Clinical Endocrinologists (AACE) (2–5). Recommendations to individualize targets are based on major type 2 diabetes trials that found different levels of benefit, and even harm, from lower A1C levels depending on diabetes population characteristics (e.g., duration of diabetes, age, and comorbidity) (6–10). According to the ADA, lower A1C targets are recommended for patients with a short duration of diabetes, long life expectancy, and no significant cardiovascular disease (1). Conversely, higher A1C targets are recommended for patients with longstanding diabetes, advanced age, limited life expectancy, a history of macrovascular or advanced microvascular complications, extensive comorbidities, or a high risk for severe hypoglycemia (1–5). Although guidelines have identified these special populations, recommendations on how to set individualized A1C targets have been open to interpretation.Recently, a formal strategy for individualizing targets was published by Ismail-Beigi et al. (11). Similar to diabetes care guidelines, this strategy was based on expert interpretation of outcomes from prominent diabetes trials, including the U.K. Prospective Diabetes Study (UKPDS), Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Control Evaluation (ADVANCE), and Veterans Affairs Diabetes Trial (VADT) (6–10). The Ismail-Beigi strategy used the same clinical characteristics proposed in previous guidelines from the VA-DoD, American Geriatric Society, and ACP (e.g., age, duration of diabetes, history of macrovascular and microvascular complications, comorbidity, and psychosocioeconomic context). Based on their strategy, only adults 20–44 years of age with no history of diabetes-related complications would be recommended an A1C target of ≤6.5%, and several populations are recommended individualized A1C targets above the conventional ADA threshold of <7.0%, including adults 45–65 years of age with established macrovascular or advanced microvascular complications, adults >65 years of age with longstanding diabetes or established macrovascular or advanced microvascular complications, and all adults with advanced age. Additionally, because the Ismail-Beigi strategy suggested ranges of glycemic targets (i.e., ∼7, 7.0–8.0, or ∼8.0%), there exists the potential that some patients who could safely tolerate lower glycemic targets may be undertreated in order to stay within range.These recent calls for greater individualization of A1C targets raise fundamental public health questions. The degree to which the individualization of diabetes care is regarded as important depends on how many U.S. adults with diabetes may be candidates for A1C targets more or less stringent than the conventional target of <7.0%. Previous assessments of diabetes care quality have used population-level A1C thresholds to judge the quality of care (12–14); however, the diabetes care quality may differ from previous reports using these newer standards of individualization (15). In order to understand the potential impact of the individualization of glycemic targets on diabetes care quality, we characterized the U.S. adult diabetes population by clinical variables that have been proposed as reasons to individualize A1C targets. We then operationalized the ADA and Ismail-Beigi strategies for individualization to estimate 1) the distribution of the U.S. adult diabetes population across each individualized A1C target and 2) the size of the population who have measured A1C levels that are at or below their recommended individualized A1C target.     

Sleep-wake patterns in children with intrauterine growth retardation

The purpose of this study was to characterize the sleep patterns of children with intrauterine growth retardation, known to be at risk for neurodevelopmental disorders, and seek a possible correlation with behavior, concentration, and attention problems. The sleep patterns of 26 children with intrauterine growth retardation aged 4 to 7 years were compared with those of 47 control children using activity monitors (actigraphs). In addition, data were collected from the parents regarding sleep habits, behavior, concentration, and attention. Children with intrauterine growth retardation aged 4 to 7 years were found to have a tendency toward poorer quality of sleep than their matched controls. This inclination was statistically significant only for one sleep measure, the true sleep time. A tendency toward increased fragmentation of sleep, prolonged waking, and decreased sleep efficiency, although not statistically significant in this study, was demonstrated. Our results showed that 58% of the children with intrauterine growth retardation, compared with 40% of the children in the control group, could be defined as "poor sleepers" (sleep efficiency lower than 90% or three or more waking episodes per night). This disturbed sleep profile is probably an integral part of the neurodevelopmental profile typical of these at-risk children. No significant correlations were found between sleep quality and behavior, concentration, and attention problems.     

An emerging 1q21.1 deletion-associated neurodevelopmental phenotype

In this study, we describe the neurodevelopmental and epileptic phenotypes in a family with an inherited 1q21.1 deletion. During the pregnancy with the proband, increased nuchal translucency and oligohydramnion were detected. The proband showed mild global developmental delay and ataxic gait. Seizures started in the proband at the age of 2 years and manifested as generalized tonic-clonic seizures, atypical absence seizures, head drops, and drop attacks with no abnormal findings on interictal electroencephalogram. We performed an Agilent Human Genome CGH (comparative genomic hybridization) Microarray 105A, and a microdeletion on chromosome 1q21.1 was identified in both the patient and his asymptomatic father. This deletion encompasses 1.65 Mb and is larger than the reported recurrent class I deletions in this region. Cryptic cytogenetic abnormalities should be considered in patients with neurodevelopmental problems and atypical presentation of epilepsy with a normal electroencephalography (EEG).     

Regional differences in the severity of Lewy body pathology across the olfactory cortex

We studied α-synuclein pathology in the rhinencephalon of ten cases of Parkinson's disease (PD) and twelve neurologically normal controls, of which seven had incidental Lewy bodies in the substantia nigra at autopsy and five had no pathological evidence of neurological disease. In all PD and incidental Lewy bodies cases, α-synuclein pathology was found in all five subregions of the primary olfactory cortex that were sampled, and amongst them the pathology was significantly more severe in the temporal division of the piriform cortex than in the frontal division of the piriform cortex, olfactory tubercle or anterior portions of the entorhinal cortex. The orbitofrontal cortex, which is an area of projection from the primary olfactory cortex, was affected in some cases but overall the α-synuclein pathology was less severe in this area than in the primary olfactory cortex. Because different areas of the rhinencephalon are likely to play different roles in olfaction and our data indicate a differential involvement by α-synuclein deposition of structures implicated in smell, future prospective studies investigating the pathophysiological basis of hyposmia in PD should consider to examine the areas of primary olfactory cortex separately.     

Inhibition of ras by farnesylthiosalicylate significantly reduces the levels of autoantibodies in two animal models of the antiphospholipid syndrome

BACKGROUND: Stimulation and proliferation of lymphocytes require activation of Ras. S-farnesylthiosalicylic acid (FTS) is a synthetic substance that detaches Ras from the inner cell membrane and induces its rapid degradation. Antiphospholipid antibodies (aPL) are a heterogeneous group of antibodies detected in patients with antiphospholipid syndrome (APS), which is associated with thrombosis, pregnancy losses, and thrombocytopenia. OBJECTIVE: To examine the effect of FTS treatment on aPL levels in a genetic autoimmune model (the MRL/lpr mice) and in an induced model of APS. METHODS: Female Balb/C mice immunized once with beta2-glycoprotein I (beta2-GPI) in complete Freund's adjuvant (CFA) and female MRL/lpr mice were treated intraperitoneally with either FTS (5 mg/Kg/day) or saline 3-5 times a week. aPL and anti-beta2-GPI antibodies were measured by ELISA. RESULTS: FTS treatment 3 times a week resulted in significant decreases of aPL and anti-beta2-GPI antibodies in both animal models. In contrast, more frequent treatment (5 times a week) had no significant effect on autantibody levels in both animal models. We further compared 2 protocols in the induced APS model, one for alternate day treatment and the other for daily treatment on the first 3 days each week, and found a decrease in autoantibody levels only in the alternate day protocol. CONCLUSIONS: Inhibition of Ras activation by FTS is effective in decreasing autoantibody levels in models of APS. The differential modulation of immune function by alternate day compared to daily treatment may provide better understanding of the role of Ras activation in this system.