Imaging-Based 3-Dimensional Printing for Improved Maxillofacial Presurgical Planning: A Single Center Case Series

Purpose3-D printing is an increasingly widespread technology that allows physical models to be constructed based on cross-sectional medical imaging data. We sought to develop a pipeline for production of 3-dimensional (3-D) models for presurgical planning and assess the value of these models for surgeons and patients.MethodsIn this institutional review board–approved, single-center case series, participating surgeons identified cases for 3-D model printing, and after obtaining patient consent, a 3-D model was produced for each of the 7 participating patients based on preoperative cross-sectional imaging. Each model was given to the surgeon to use during the surgical consent discussion and preoperative planning. Patients and surgeons completed questionnaires evaluating the quality and usefulness of the models.ResultsThe 3-D models improved surgeon confidence in their operative approach, influencing the choice of operative approach in the majority of cases. Patients and surgeons reported that the model improved patient comprehension of the surgery during the consent discussion, including risks and benefits of the surgery. Model production time was as little as 4 days, and the average per-model cost was $350.Conclusions3-D printed models are useful presurgical tools from both surgeon and patient perspectives. Development of local hospital-based 3-D printing capabilities enables model production with rapid turnaround and modest cost, representing a value-added service for radiologists to offer their surgical colleagues.     

Molecular identification of coxsackievirus A24 variant,isolated from an outbreak of acute hemorrhagic conjunctivitis in Singapore in 2005

Summary An outbreak of acute hemorrhagic conjunctivitis (AHC) was reported in Singapore military camps in the year 2005. A total of 103 conjunctival swab specimens were collected from military personnel diagnosed clinically with AHC. PCR testing on these conjunctival specimens revealed the presence of an enterovirus, and this was confirmed by virus isolation. Molecular typing using a partial VP1 gene confirmed a variant of coxsackievirus A24 (CA24v) as the most likely etiological agent for the outbreak. Full-length genome sequencing was carried out on 2 selected virus strains, DSO-26SIN05 and DSO-52SIN05. Sequence comparison and phylogenetic analyses of the VP4, VP1 and 3Cpro gene regions were performed, clustering the Singapore CA24v strains with viruses originating from Asia in the post-2000 era. In addition, we report evolution rates of 4.2 × 10⁻³ and 1.0 × 10⁻³ nucleotide/year, respectively, for the VP4 capsid and 3Cpro gene regions. Our result shows a focal evolutionary point around 1965–1966, suggesting that the CA24v virus has been evolving constantly since its emergence in Singapore, nearly 40 years ago.     

Myxoma virus M063R is a host range gene essential for virus replication in rabbit cells

The myxoma virus M063R gene product exhibits some sequence similarity to the poxvirus host range gene, C7L, of vaccinia virus. To address the potential host range function of the M063R gene product in rabbits, a deletion mutant of myxoma virus (vMyx63KO) was generated and characterized. vMyx63KO replicated to normal titre levels and produced foci that were indistinguishable from those produced by MV in vitro in a monkey kidney cell line (BGMK) that are permissive for wild type MV. However, vMyx63KO failed to replicate in all rabbit cell lines tested, including both primary and established cells lines, as well as cells derived from a variety of tissues. M063R expression was not required for myxoma virus binding, entry or early gene expression, whereas DNA replication was aborted and late genes were not expressed in vMyx63KO infected rabbit cells. Thus, the replication block for vMyx63KO in rabbit cells preceded the stage of late gene expression and DNA replication. Finally, an in vivo pathogenesis study indicated that vMyx63KO failed to cause any signs of classic myxomatosis in infected rabbits, but functioned as a non-replicating vaccine and provided protection for subsequent challenge by wild type myxoma virus. Altogether, these observations demonstrate that M063R plays a critical role in determining the host specificity of myxoma virus in rabbit cells.     

Women with neurofibromatosis 1 are at a moderately increased risk of developing breast cancer and should be considered for early screening

Background

Malignancy risks in patients with neurofibromatosis 1 (NF1) are increased, but those occurring outside of the nervous system have not been clearly defined.

Aim

To evaluate the risk of breast cancer in women with NF1 in a population‐based study.

Methods

The risk of breast cancer in a cohort of 304 women with NF1 aged ⩾20 years was assessed and compared with population risks over the period 1975–2005 using a person‐years‐at‐risk analysis.

Results

There were 14 cases of breast cancers in the follow‐up period, yielding a standardised incidence ratio (SIR) of 3.5 (95% CI 1.9 to 5.9). However, six breast cancers occurred in women in their 40s, and the SIR of breast cancer in women aged <50 years was 4.9 (95% CI 2.4 to 8.8).

Interpretation

Women with NF1 aged <50 years have a fivefold risk of breast cancer, are in the moderate risk category and should be considered for mammography from 40 years of age.Neurofibromatosis 1 (NF1; MIM 162200) is a common autosomal dominant genetic disorder with an estimated birth incidence of 1 in 2500 and a prevalence of 1 in 5000.¹ NF1 is a fully penetrant condition, with all patients manifesting signs of the disease by the age of 5 years. However, many de novo cases remain undiagnosed well into adult life. All affected individuals will develop at least some of the neurocutaneous features, none of which are life threatening; these include the pigmentary changes (café au lait spots, skin fold freckling and Lisch nodules) and neurofibromas (although these may not be numerous). It is the occurrence of disease complications that causes most of the associated morbidity and mortality. A third of affected individuals will develop at least one of the more severe disease complications in their lifetime; the occurrence of complications cannot be predicted even within families.² The disease is extremely variable, and the individual gene fault is unlikely to determine the total course of the condition.The NF1 gene is a tumour suppressor gene and those with the mutation are at a fourfold increased risk of cancer compared with the general population.^3,4,5 The gene product neurofibromin is thought to deliver much of its function through downregulating the oncogene ras. Patients with NF1 have a greatly increased relative risk of developing gliomas, malignant peripheral nerve sheath tumours, juvenile chronic myelomonocytic leukaemia, rhabdomyosarcoma and phaeochromocytoma; such tumours may have a different natural history from those occurring sporadically, and require a specific approach to their detection and management.Until now no one has reported an overall significantly increased risk of any commonly occurring cancers in patients with NF1, although a recent paper did find a significantly increased risk in women aged <50 years—this was not significant overall.⁶ The fact that several patients develop breast cancer before 50 years of age prompted us to look systematically for an increased risk of breast cancer.     

REPIMPACT - a prospective longitudinal multisite study on the effects of repetitive head impacts in youth soccer

Brain Imaging and Behavior - Repetitive head impacts (RHI) are common in youth athletes participating in contact sports. RHI differ from concussions; they are considered hits to the head that...     

A case report and review of the locked metacarpophalangeal joint

A 59-year-old female with metacarpal joint locking is presented. The successful closed manipulation is described with a review of the literature.