Histological incorporation of acellular dermal matrix in the failed superior capsule reconstruction of the shoulder.

BACKGROUND: Superior capsule reconstruction addresses massive rotator cuff tears using allografts and aims to restore the natural superior constraint of the shoulder and therefore shoulder biomechanics and function. There is no evidence relating to the histological incorporation of these grafts. METHODS: 27 superior capsule reconstructions were performed between June 2016 and November 2017. Follow-up was with clinical assessment and Magnetic Resonance Imaging, to identify graft failure. Reverse total shoulder replacement was offered for ruptured grafts and the graft was sent for histological analysis along with the footprint of graft attachment where possible. RESULTS: Five patients (18.5%) had evidence of graft failure, three of whom (11.1%) underwent revision procedures. Of the five ruptures, four failed at the glenoid insertion, and one was an intra-substance tear. Histological analysis showed extensive fibroblastic infiltration. The intra-substance tear showed some vascularity at the medial and lateral ends, and one of the glenoid pull-outs demonstrated micro-calcification and osteoid formation. There was no evidence of in-growth into the bone. DISCUSSION: An inflammatory response to the grafts was seen, with neo-vascularisation, and micro-calcification observed. These findings are from ruptured grafts, so may not represent the characteristics of those which have not ruptured. Further evidence from explanted intact grafts could be gained to improve our understanding of its incorporation. LEVEL OF EVIDENCE: Level IV evidence.

Dissemination of aerosol and splatter during ultrasonic scaling: a pilot study.

CONTEXT: Routine dental procedures produce aerosol and splatter, which pose a potential risk to the clinician and dental personnel, as well as the immunocompromised patient. Reports indicate that the ultrasonic scaler is the greatest producer of aerosol and splatter. AIMS: The study aimed to evaluate the contamination distance, contamination amount and contamination duration of aerosol produced during ultrasonic scaling. METHODS AND MATERIALS: The study was performed on a mannequin fitted with phantom jaws on a dental chair. Mock scaling was done for 15 min using an auto-tuned magnetostrictive ultrasonic scaler with the simultaneous use of a low volume saliva ejector. An ultrafiltrate-containing fluorescent dye was used in the reservoir supplying the scaler unit. Filter paper discs were placed in different positions and distances in the operatory. Immediately following scaling, the filter paper discs were replaced with new ones. This was done every 30 min for a total duration of 90 min. RESULTS: Maximum contamination was found on the right arm of the operator and left arm of the assistant. Contamination was also found on the head, chest and inner surface of the face mask of the operator and of the assistant. The aerosol was found to remain in the air up to 30 min after scaling. CONCLUSIONS: The occupational health hazards of dental aerosols can be minimized by following simple, inexpensive precautions.

Clinical quantitation of immune signature in follicular lymphoma by RT-PCR-based gene expression profiling.

Microarray gene expression profiling studies have demonstrated immune response gene signatures that appear predictive of outcome in follicular lymphoma (FL). However, measurement of these marker genes in routine practice remains difficult. We have therefore investigated the immune response in FL using real-time polymerase chain reaction (PCR) to measure expression levels of 35 candidate Indicator genes, selected from microarray studies, to polyA cDNAs prepared from 60 archived human frozen lymph nodes, in parallel with immunohistochemical analysis for CD3, CD4, CD7, CD8, CD10, CD20, CD21, and CD68. High levels of CCR1, a marker of monocyte activation, were associated with a shorter survival interval, and high levels of CD3 with better survival, while immunohistochemistry demonstrated association of high numbers of CD68(+) macrophages with a shorter survival interval and of high numbers of CD7(+) T cells with a longer survival interval. The results confirm the role of the host immune response in outcome in FL and identify CCR1 as a prognostic indicator and marker of an immune switch between macrophages and a T cell-dominant response. They demonstrate the utility of polyA DNA and real-time PCR for measurement of gene signatures and the applicability of using this type of "molecular block" in clinical practice.

Perchlorate accumulation in forage and edible vegetation.

The accumulation of perchlorate in vegetation is becoming a concern, with increasing numbers of sites reporting the presence of perchlorate in groundwater and surface water. This study investigated potential perchlorate uptake and distribution by a variety of forage and edible crops in both the laboratory and the field. Perchlorate concentrations in soybean leaves grown in the greenhouse were significantly higher than perchlorate concentrations in soybean seeds and pods. Perchlorate concentrations in alfalfa grown in sand were significantly lower than those in alfalfa grown in soil. The concentration of perchlorate in tomato was lower in the fruit than the leaves. Commercially grown wheat and alfalfa samples all contained perchlorate, 0.72-8.6 mg/kg of fresh weight (FW) in the wheat stems, 0.71-4.4 mg/kg of FW in the wheat heads, and 2.9 mg/kg of FW in alfalfa. All field garden samples tested (including cucumber, cantaloupe, and tomato) that were irrigated with perchlorate-tainted water contained perchlorate at various concentrations ranging from 0.040 to 1.65 mg/kg of FW. Bioconcentration factors (BCF), ratios of plant fresh weight concentrations to estimated or measured groundwater concentrations [(microg/kg of FW)/microg/L], were all in the same order of magnitude ranging from 215 +/- 126 for wheat stems to 233 +/- 264 for wheat heads and to 380 +/- 89 for alfalfa. BCF for garden fruit samples were much lower (0.5-20). Results from this study highlight the potential for perchlorate exposure by routes other than drinking water.