Complications after minor salivary gland biopsy: a retrospective study of 630 patients from two Swedish centres.

OBJECTIVES: The aims of the study were to investigate the prevalence of impaired sensation after minor salivary gland biopsy (MSGB) in two Swedish centres [Karolinska University Hospital (KUH) and Skåne University Hospital (SUH)] and to assess its impact on quality of life (QoL) and associated risk factors. METHOD: A questionnaire including questions regarding the presence of impaired sensation, impact on QoL, and impact on everyday life was sent to patients who had undergone MSGB between 2007 and 2016, and their medical notes were scrutinized. RESULTS: The study included 630 patients (505 from KUH and 125 from SUH). In KUH the biopsies were performed by rheumatologists and in SUH by dentists or oral and maxillofacial surgeons (OMSs). Long-standing, probably permanent, impaired sensation after MSGB was reported by 21% of patients, and was associated with lower age and absence of anti-SSA antibodies. Patients with long-standing impaired sensation reported the inconvenience (1-10) of impaired sensation as 4.0 (2.0-7.0) [median (interquartile range)], and 32% reported an influence on their QoL, the reported influence (1-10) on everyday life being 3.0 (1.0-5.0). When comparing the outcomes from KUH and SUH, patients from SUH reported a significantly lower frequency of long-standing impaired sensation (14% vs 23%; p = 0.02). CONCLUSION: A high frequency of long-standing impaired sensation after MSGB was found among patients who had undergone MSGB, although it had a low impact on everyday life. The complication frequency was less pronounced when a dentist or an OMS had performed the biopsy.

Changes in the upper airway volume after orthognathic surgery: three-dimensional measurements in a supine body position.

The objectives of this study were to analyse the changes in airway cross-sectional areas and volumes due to surgical movements of the jaws and to identify any possible correlation with the direction of the movements. Fifty-seven participants, aged 18-28 years (mean 20.8 years) at surgery, were followed up for 12 months postoperatively. Pre- and postoperative measurements of the facial region obtained from computed tomography in a supine position were analysed according to the surgical movements and changes in the upper airways. Intra-rater reliability was assessed. Comparisons and correlations of jaw movements, changes in airway volume, and body mass index (BMI) were made. The cohort showed a significant change between the pre- and postoperative measurements for areas associated with the anterior nasal spine (P = 0.013), posterior nasal spine (P = 0.049), uvula (P = 0.006), and epiglottis (P = 0.046). Additionally, a correlation was found between the airway volume change and the change in mandible position (correlation coefficient 0.324, P = 0.014). All participants were non-smokers, and no correlation was observed between BMI and the upper airway volume. Changes in the upper airway can be expected following surgical movements of the jaws. A correlation was shown between a sagittal direction of the movements and the changes in the airways. Patients with obstructive sleep apnoea who are indicated for surgical movements of the jaws are expected to benefit from orthognathic surgery.

Mandibulotomy access to tumour sites: fewer complications for postoperative compared with preoperative radiotherapy.

The purpose of this study was to compare complication rates at the mandibulotomy site between patients receiving preoperative radiotherapy (RT) and those receiving postoperative RT during treatment for oral and oropharyngeal cancer where the surgical procedure required a mandibular osteotomy to gain access to the tumour. Sixty-four consecutive patients treated during the period 2000-2015 were available for analysis. Their medical records were reviewed retrospectively. All patients were followed for at least 1year postoperatively. A subgroup of patients received RT on several occasions or long before the mandibulotomy, therefore the statistical comparisons focused on the two groups of patients receiving RT on one occasion and within 6 months prior to or following surgery. Seventeen patients presented a total of 29 complications, yielding an overall complication rate of 27%. Orocutaneous fistula was the most common complication. Patients who received RT preoperatively presented a higher complication rate (9/15; 60%) when compared to those who received RT postoperatively (2/31; 6.5%) (odds ratio 21.8, P<0.001). This study demonstrated fewer complications in the mandibulotomy area exposed to postoperative RT compared with preoperative RT. It is therefore suggested that, when possible, RT should be given postoperatively if combination treatment with RT and surgery, including a mandibulotomy, is planned.

Is there a difference in judgement of facial appearance depending on ethnic background? Photographic evaluation of facial appearance in orthognathic surgery.

Is there a variation in facial ideals depending on ethnic background that affects judgements of outcome in orthognathic surgery? How does the evaluation correlate with patient-reported outcome measures? Two evaluation panels, Singaporean and Swedish, judged photographs of patients undergoing orthognathic surgery taken before and after operation. Improvement in facial aesthetics was calculated between the two ratings. The result was compared between the panels and correlated with health-related quality of life (QoL) measures. Thirty male and 27 female patients aged between 18 and 28 years (mean 21) were included, and 52 subjects were eligible for comparison of health-related QoL. The photographic evaluation showed that both panels judged there to be significant improvement in facial aesthetics after treatment (p<0.001). The Singaporean panel rated the overall facial appearance higher than the Swedish panel when evaluating photographs both before (p=0.025) and after (p=0.032) operation. Improvement of the overall facial appearance showed no significant difference between the panels (p>0.30). No correlation between health-related QoL and improvement of facial appearance was found by either panel. Subjective evaluation of facial aesthetics in orthognathic surgery is unaffected by the observer's ethnic origin. Independently of their ethnicity, the evaluation juries found that facial aesthetics improved after orthognathic surgery. Improvement reported by the juries corresponded to that reported by patients.

A comparison of cost-effectiveness of computer-assisted 2-and 3-dimensional planning techniques in orthognathic surgery.

The aim of this randomised controlled trial was to compare the costs and benefits of computer-based 2-dimensional and 3-dimensional predictions in orthognathic surgery. Subjects aged 18-30 years with severe class III malocclusion had their treatment planned with both 2- and 3-dimensional techniques. They were randomised in a 1:1 ratio for one or other planning technique. Costs (financial, time, and dose of radiation) were compared with benefits (accuracy and health-related quality of life (HRQoL)). In total, 57 subjects (27 women and 30 men, mean (range) age 21 (18-28) years) completed the study. Comparisons showed no significant difference in total time spent, but a large advantage for the 2-dimensional technique in financial costs (p < 0.001); it also required a significantly lower dose of radiation (p < 0.001). The cost-effectiveness analysis showed a reduction in time of 0.53 minutes/HRQoL-point gained, and an increased economic cost of US$15/HRQoL point gained for the 3-dimensional technique. It also showed that the two techniques consumed an equal amount of time, but that the 2-dimensional technique had lower financial costs, and the 3-dimensional technique a larger dose of radiation.

Lower extremity function in patients with early rheumatoid arthritis during the first five years, and relation to other disease parameters.

Objective: The objective of this study was to investigate lower extremity function in early rheumatoid arthritis (RA) and assess its relation to other disease parameters. Methods: An inception cohort (recruited in 1995-2005) of patients with early RA was followed according to a structured protocol. Lower extremity function was investigated at inclusion and after 1, 2, and 5 years using the Index of Muscle Function (IMF; total score 0-40). Self-reported disability was estimated using the Health Assessment Questionnaire (HAQ). The same rheumatologist assessed patients for swollen joints and joint tenderness. Results: In total, 106 patients were included. Lower extremity function improved from baseline to the 1 year visit [IMF total median 10, interquartile range (IQR) 4-16 vs 7, IQR 3-12; p = 0.01]. This was followed by a decline in lower extremity function. Throughout the study, there were significant correlations between IMF and HAQ scores (r = 0.38-0.58; p < 0.001 at all time-points). Patients with knee and/or ankle synovitis at inclusion had significantly higher IMF scores than those without such joint involvement, with similar associations for joint tenderness. In multivariate linear regression analysis, ankle synovitis was significantly associated with higher IMF scores (ß = 2.91, 95% confidence interval 0.28-5.54), whereas there was no such association for metatarsophalangeal (MTP) arthritis. Conclusion: Lower extremity function in early RA improved during the first year, followed by a gradual decline. Ankle involvement had a greater impact than MTP involvement on lower extremity function. This highlights the importance of treating large-joint disease in RA.

Outcome of photographic evaluation of facial appearance in orthognathic surgery: how does it correlate with planning of treatment and patient-reported outcome?

The outcome of treatment in orthognathic surgery is dependent on preoperative surgical planning. The main purpose of the present study was to evaluate from photographs the improvement in facial appearance after orthognathic surgery. In addition, the outcomes of two different planning techniques, 2-dimensional and 3-dimensional, were compared and the correlation between the outcome and health-related quality of life (HRQoL) assessed. The study was a randomised controlled trial with the intervention being either 2-dimensional or 3-dimensional treatment planning. An evaluation panel compared photographs taken before and after operation on patients with severe class III malocclusion. The change in facial appearance was rated, the two planning techniques compared, and the result correlated with previously published findings on cephalometric accuracy and HRQoL in the same group. Completed 12-month follow-up resulted in the inclusion of 57 subjects aged between 18 and 28 years at the time of operation (mean 21 years). We found significant differences between the two evaluations (p = 4.4E-9) but no significant difference in facial improvement between the planning techniques (p = 0.54). However, there was a correlation between cephalometric measurement of accuracy in the anterior maxilla and evaluation of improvement of facial appearance (p = 0.024, r = 0.30), but we found no correlation +between HRQoL and the evaluation of facial appearance (p = 0.31, r = -0.14). We conclude that there was an improvement in facial aesthetics after orthognathic surgery that was independent of the planning technique used.

Scandiatransplant acceptable mismatch program (STAMP) a bridge to transplanting highly immunized patients.

BACKGROUND: Highly immunized patients are a challenge for organ transplantation programs. One way of increasing the likelihood of transplantation in this group of patients is to expand the possible donations by defining acceptable HLA mismatches. In the Scandiatransplant Acceptable Mismatch Program (STAMP), a de-centralized approach has been implemented in 2009. AIMS: The program has been improved during the years from utilizing HLA-A, -B, -DR matching only to include typing of all deceased donors for HLA-A, -B, -C, -DRB1 and -DQB1. The calculation of a transplantability score (TS) has been introduced in order to take both HLA and AB0 into consideration resulting in a more realistic picture of the transplantability chance. MATERIALS AND METHODS: Patients were selected for eligibility and results of immunisation status were prepared in each of the 9 tissue typing laboratories, while access to the program is finally governed by a common steering group of immunologists and clinicians. RESULTS: In the period from March 2009 until February 2015, 96 patients were transplanted within this program. The mean recipient age was 49 years and 57% were females, 30% of the patients were first transplants and of these 93% were females. The majority of the patients had 2-5 HLA-A, -B. -DR mismatches. The allograft survival at 60 months was 79.1%. Applying the TS to the cohort confirmed that patients with a low TS score had longer waiting times. CONCLUSION: The program has matured during the years and now proves to be a valid approach for transplanting highly immunized patients.

Donor or recipient origin of posttransplant lymphoproliferative disorders following solid organ transplantation.

Previous studies of donor or recipient origin of posttransplant lymphoproliferative disorders (PTLDs) following solid organ transplantation (SOT) have either been small or with selected patient groups. We studied tumor origin in a population-based cohort of 93 patients with PTLD following SOT. Tumor origin of PTLD tissue was analyzed by fluorescence in situ hybridization of the sex chromosomes in cases of sex mismatch between donor and recipient (n = 41), or HLA genotyping in cases of identical sex but different HLA type (n = 52). Tumor origin of PTLD could be determined in 67 of the 93 cases. All 67 PTLDs were of recipient origin. They were found in recipients of kidney (n = 38), liver (n = 12), heart (n = 10) and lung (n = 7). The most common recipient-derived lymphomas were monomorphic B-cell PTLDs (n = 45), monomorphic T cell PTLDs (n = 9), indolent lymphomas (n = 6), and polymorphic PTLD (n = 4). Half of the recipient-derived PTLDs were Epstein-Barr virus-positive. Twelve of the recipient-derived PTLDs were located in the grafts: in four cases exclusively and in eight cases in combination with disseminated disease outside the graft. Tumor origin was indeterminable in 26 cases, probably due to low DNA quality. We conclude that the vast majority of PTLDs after SOT was of recipient origin.

Unrelated adult stem cell donor medical suitability: recommendations from the World Marrow Donor Association Clinical Working Group Committee.

The World Marrow Donor Association (WMDA) fosters collaboration between international registries to facilitate the exchange of hematopoietic stem cell products for unrelated stem cell donor transplantation. As indications for hematopoietic SCT grow, the movement of products across the world will increase. Although competent authorities may regulate products within their country, there is a need to protect the best interests of donors and recipients by identifying universal donor medical suitability criteria. Within this report the WMDA provides a background to unrelated adult donor and recipient safety, recommends a common framework for assessing the health of unrelated adult donors at each stage of the donation pathway and presents a novel mechanism for sharing international consensus criteria for individual medical and lifestyle conditions. Wherever possible, these criteria are evidence-based. By establishing a donor medical suitability working group, the WMDA has developed a process through which donor centers and registries may request a consensus opinion on conditions not already listed, as well as challenge existing criteria. Guidance from the WMDA is intended to complement, not supersede, guidance from national competent authorities and international regulatory bodies.

A new HLA-A*03 null allele - A*03:162N caused by an exon 4 insertion and discovered during an external quality assessment exercise.

HLA-A*03:162N differs from A*03:01:01:01 by an exon 4, 664-665insCATG causing E198A and A199X.

Prevalence and risk factors for udder cleft dermatitis in dairy cattle.

Udder cleft dermatitis (UCD) is a skin lesion in dairy cattle mostly located at the anterior junction between the udder and the abdominal wall or between the front quarters. Relatively little is known about causative factors for UCD, and few studies have investigated prevalence and risk factors of UCD. Therefore, the aim of this study was to investigate the prevalence of UCD in a random sample of dairy herds with freestalls and milking parlors in a county of Sweden. Thirty dairy herds participated in the study. Each herd was visited once at milking, when every third cow was investigated for presence of UCD. Associations between UCD and milk production, breed, parity, days in milk, claw health, and udder health on the herd and cow levels were also investigated. In addition, a case-control study was performed in 6 herds with a high prevalence of UCD to investigate associations between udder conformation or mange and UCD. Udder cleft dermatitis was found in 18.4% of the 1,084 cows included in the study. The within-herd cow prevalence varied between zero and 39%, with an average of 18.5%. Risk factors for UCD at the herd level were a high proportion of Swedish Red cows and a high production level. At the cow level, breed, parity, and production level were identified as risk factors. The highest risk of having UCD was found in high-producing Swedish Red cows that had calved at least 3 times. Veterinary-treated clinical mastitis was associated with UCD, but cow composite somatic cell count was not. A strong anterior udder attachment was a protective factor, but signs of mange had no association with UCD. The primary cause of UCD is still unclear, and more research is needed to identify the best ways to prevent the development of this animal welfare problem.

HLA-B*27:05:25 - a further HLA-B*27:05 allele with a synonymous nucleotide substitution.

HLA-B*27:05:25 differs from B*27:05:02 by a single synonymous nucleotide substitution (192C>T) at codon 40 in exon 2.

Potential adult sibling stem cell donors' perceptions and opinions regarding an information and care model.

The first international recommendations and guidelines for the care of sibling stem cell donors were established in 2010, and have not yet been evaluated. However, a model for information and care of adult potential sibling stem cell donors (the IC model) developed and introduced at the Skåne University Hospital, Lund, Sweden, in 2005 conforms closely to them. The IC model aims to protect the privacy of potential donors, support and respect their free choice, and identify quickly those unwilling or unable to donate and thus minimize delay in seeking alternative donors. To evaluate the IC model a questionnaire survey in 2010 gathered the perceptions and views on information provision; influences over decision making; and care provision under the IC model of 148 adult siblings informed about SCT donation, and asked to undergo HLA-typing since September 2005 at the hospital. The results suggest the IC model works well but highlights areas for improvement, such as in delivery of HLA typing results to non-matched siblings, and a need to further prevent complicating influence from health professionals and relatives on the decision to undergo HLA typing. Thus improved, the IC model could provide the groundwork for other SCT units seeking to implement the recommendations and guidelines.

Allogeneic hematopoietic stem cell donation-standardized assessment of donor outcome data: a consensus statement from the Worldwide Network for Blood and Marrow Transplantation (WBMT).

The number of allogeneic hematopoietic SCTs performed globally each year continues to increase, paralleled by an increased demand for donors of therapeutic cells. Donor characteristics and collection procedures have undergone major changes during recent decades, and further changes are foreseen. Information on short- and long-term donor outcomes is of crucial importance to ensure maximal donor safety and availability. Current data, predominantly from unrelated donors, give reliable information on the frequent early events associated with donation-most of them of mild-to-moderate intensity. Information on the type and relative risk of serious adverse reactions is more limited. Moreover, only few data exist on long-term donor outcome. On the basis of this need, recommendations for a minimum data set for prospective donor follow-up were developed in a workshop with the participation of an international group of investigators actively involved in allogeneic stem cell donation under the auspices of and approved by the Worldwide Network for Blood and Marrow Transplantation. Establishment of a standardized global follow-up for both, related and unrelated, donors will enable monitoring of the short- and long-term safety profiles of hematopoietic cell donation and form a solid basis for future donor selection and counseling.

A new HLA-DQB1 sequence, DQB1*02:01:04, discovered during an external quality assessment exercise.

HLA-DQB1*02:01:04 differs from DQB1*02:01:01 by one nucleotide (G>A) at position 303 in exon 2 resulting in a silent substitution (codon 69 - GAG >GAA), conserved glutamate.

Donor safety: the role of the WMDA in ensuring the safety of volunteer unrelated donors: clinical and ethical considerations.

Since the beginning of hematopoietic stem cell harvesting from volunteer unrelated donors, ensuring donor safety has been a necessary goal of all parties involved in the process. As donation of BM or PBSCs is not in the interest of the donor's own physical health, donor registries and transplantation centers must take into account both medical and ethical aspects involved in the donation procedure. One of the principal goals leading to the formation of the World Marrow Donor Association (WMDA) was to establish internationally acceptable standards for all aspects of unrelated donor care.

Pheromone communication channels in tortricid moths: lower specificity of alcohol vs. acetate geometric isomer blends.

Discrimination of conspecific and heterospecific signals is a key element in the evolution of specific mate recognition systems. Lepidopteran pheromone signals are typically composed of several compounds that synergize attraction of conspecific and inhibit attraction of heterospecific males. Blends convey specificity, but not their single components, that are typically shared by several species. Many sex pheromones are blends of geometric or positional isomers of straight-chain acetates, while species-specific blends of analogous alcohols have not been described. We have, therefore, studied the attraction of tortricid moths to the geometric isomers (E,E)-, (E,Z)-, (Z,E)- and (Z,Z)-8,10-dodecadien-1-ol. Only one species responding to these alcohols seemed to be attracted to a blend of two isomers, while most species are attracted to only one alcohol isomer. Lack of a pronounced synergist or antagonist effect of the other geometric isomers explains the lack of specific attraction to isomer blends and reduces accordingly the number of specific communication signals composed of these alcohols. In comparison, many more species respond to the analogous (E,E)-, (E,Z)-, (Z,E)- and (Z,Z)-8,10-dodecadienyl acetates and their binary blends. The acetate isomers all play a behavioural role, either as attractants, attraction synergists or antagonists, and thus promote specific communication with acetate blends. Male moths seem to discriminate the acetate isomers with greater precision than the analogous alcohols. It is proposed that discrimination is facilitated by steric differences between the four acetate isomers, as compared to the more uniform steric properties of the alcohols.

Effects of short-term food deprivation on orexin-A-induced intestinal bicarbonate secretion in comparison with related secretagogues.

Studies of gastrointestinal physiology in humans and intact animals are usually conducted after overnight fast. We compared the effects of orexin-A, vasoactive intestinal polypeptide (VIP), melatonin, serotonin, uroguanylin, ghrelin and prostaglandin E(2) (PGE(2)) on duodenal bicarbonate secretion in fed and overnight fasted animals. This review is a summary of our findings. Secretagogues were administered by intra-arterial infusion or luminally (PGE(2)). Enterocyte intracellular calcium ([Ca(2+)](i)) signalling was studied by fluorescence imaging. Total RNA was extracted, reverse transcripted to cDNA and expression of orexin receptors measured by quantitative real-time PCR. Orexin-A stimulates the duodenal secretion in continuously fed animals but not in food-deprived animals. Similarly, short-term fasting causes a 100-fold decrease in the amount of the muscarinic agonist bethanechol required for stimulation of secretion. In contrast, fasting does not affect secretory responses to intra-arterial VIP, melatonin, serotonin, uroguanylin and ghrelin, or that to luminal PGE(2). Orexin-A induces [Ca(2+)](i) signalling in enterocytes from fed rats but no significant [Ca(2+)](i) responses occur in enterocytes from fasted animals. In addition, overnight fasting decreases the expression of mucosal orexin receptors. Short-term food deprivation thus decreases duodenal expression of orexin receptors and abolishes the secretory response to orexin-A as well as orexin-A-induced [Ca(2+)](i) signalling. Fasting, furthermore, decreases mucosal sensitivity to bethanechol. The absence of declines in secretory responses to other secretagogues tested strongly suggests that short-term fasting does not affect the secretory capacity of the duodenal mucosa in general. Studies of intestinal secretion require particular evaluation with respect to feeding status.

Flexible multi electrode brain-machine interface for recording in the cerebellum.

A new type of chip based microelectrode for acute electrophysiological recordings in the CNS has been developed. It's designed to be adaptable to a multitude of specific neuronal environments, in this study the cerebellar cortex of rat and cat. Photolithographically patternened SU-8 is used to yield flexible and biocompatible penetrating shanks with gold leads. Electrodes with an impedance of about 300 kOmega at 1kHz have excellent signal to noise ratio in acute recordings in cat cerebellum.