3D Guided Dental Implant Placement: Impact on Surgical Accuracy and Collateral Damage to the Inferior Alveolar Nerve.

An increase in the number of implants placed has led to a corresponding increase in the number of complications reported. The complications can vary from restorative complications due to poor placement to damage to collateral structures such as nerves and adjacent teeth. A large majority of these complications can be avoided if the implant has been placed accurately in the optimal position. Therefore, the aim of this in vitro pilot study was to investigate the effect of freehand (FH) and fully guided (FG) surgery on the accuracy of implants placed in close proximity to vital structures such as the inferior alveolar nerve (IAN). Cone-beam computed tomography (CBCT) and intraoral scans of six patients who have had previous dental implants in the posterior mandible were used in this study. The ideal implant position was planned. FG surgical guides were manufactured for each case. In this study, the three-dimensional 3D printed resin models of each of the cases were produced and the implants placed using FG and FH methods on the respective models. The outcome variables of the study, angular deviations were calculated and the distance to the IAN was measured. The mean deviations for the planned position observed were 1.10 mm coronally, 1.88 mm apically with up to 6.3 degrees' angular deviation for FH surgery. For FG surgical technique the mean deviation was found to be at 0.35 mm coronally, 0.43 mm apically with 0.78 degrees angularly respectively. The maximum deviation from the planned position for the apex of the implant to the IAN was 2.55 mm using FH and 0.63 mm FG. This bench study, within its limitations, demonstrated surgically acceptable accuracy for both FH and FG techniques that would allow safe placement of implants to vital structures such as the IAN when a safety zone of 3 mm is allowed. Nevertheless, a better margin of error was observed for FG surgery with respect to the angular deviation and controlling the distance of the implant to the IAN using R2 Gate® system.

Introduction to collection: confronting the challenges of health research in humanitarian crises.

BACKGROUND: Humanitarian crises, such as armed conflict, forced displacement, natural disasters, and major disease outbreaks, take a staggering toll on human health, especially in low-resource settings. Yet there is a dearth of robust evidence to inform the governments, non-governmental organizations (NGOs), and other humanitarian organizations on how to best respond to them. The Fogarty International Center of the U.S. National Institutes of Health commissioned a collection of Research in Practice articles that highlights the experiences of scientists conducting research in the context of humanitarian crises. Unlike traditional research papers, the case analyses in this collection go beyond what research was completed and focus on why the research was important and how it was conducted in these extremely challenging settings. DISCUSSION: The papers selected for this collection span 27 countries, cover a broad range of humanitarian crises, and discuss a wide variety of disease and health risk factors. Of the 23 papers in the collection, 17 include an author from the affected country and five papers were authored by humanitarian NGOs. Throughout the collection, 43% of the authors were from low- and middle-income countries. Across the collection, some general themes emerged that are broadly applicable. Importantly, there is a clear need for more, high-quality research to address evidence gaps. Community engagement, already a key element to global health research, was highlighted as especially important for research involving populations dealing with severe trauma and disruption. Partnership with humanitarian actors, including local governments, local and international NGOs, and UN agencies, was found to be a critical strategy as well. CONCLUSION: A variety of audiences will find this collection useful. Global health educators can utilize papers to facilitate discussion around public health practice and equitable partnerships, among other topics. Humanitarian response organizations may use the collection to consider how research may inform and improve their work. Global health researchers, funders, and other stakeholders may use the collection to stimulate dialogue around key scientific research questions and better appreciate the importance of conducting research in humanitarian crises in the context of achieving broader global health goals.

A comparative meta-analysis of the prevalence of exercise addiction in adults with and without indicated eating disorders.

BACKGROUND: Exercise addiction is associated with multiple adverse outcomes and can be classified as co-occurring with an eating disorder, or a primary condition with no indication of eating disorders. We conducted a meta-analysis exploring the prevalence of exercise addiction in adults with and without indicated eating disorders. METHODS: A systematic review of major databases and grey literature was undertaken from inception to 30/04/2019. Studies reporting prevalence of exercise addiction with and without indicated eating disorders in adults were identified. A random effect meta-analysis was undertaken, calculating odds ratios for exercise addiction with versus without indicated eating disorders. RESULTS: Nine studies with a total sample of 2140 participants (mean age = 25.06; 70.6% female) were included. Within these, 1732 participants did not show indicated eating disorders (mean age = 26.4; 63.0% female) and 408 had indicated eating disorders (mean age = 23.46; 79.2% female). The odds ratio for exercise addiction in populations with versus without indicated eating disorders was 3.71 (95% CI 2.00-6.89; I2 = 81; p ≤ 0.001). Exercise addiction prevalence in both populations differed according to the measurement instrument used. DISCUSSION: Exercise addiction occurs more than three and a half times as often as a comorbidity to an eating disorder than in people without an indicated eating disorder. The creation of a measurement tool able to identify exercise addiction risk in both populations would benefit researchers and practitioners by easily classifying samples.

Extensive Verrucae over Healed Pemphigus Vulgaris Lesions in an Immunocompetent Female: A Rare Presentation of Wolf's Isotopic Response.

Wolf's isotopic response refers to the occurrence of a skin disorder at the site of another unrelated and already healed skin disease. The cases described so far in the literature include herpes (simplex or zoster) as the primary disease in most cases and a myriad of skin diseases as the secondary disease. Here, we report a case where extensive verrucae developed over the sites of healed lesions of pemphigus vulgaris, in an immunocompetent female. Pemphigus vulgaris being the primary disease and absence of verrucae over normal skin makes this case, a rare presentation.

Angiokeratoma Corporis Diffusum: An Uncommon Case with Suspected Anderson Fabry Disease.

Angiokeratomas are variable sized hyperkeratotic vascular papules that are characterized histologically by superficial dilated capillaries in papillary dermis with epidermal proliferation. They can occur as a single lesion to a generalized form (angiokeratoma corporis diffusum). Angiokeratoma corporis diffusum though initially synonymous with Anderson Fabry disease, is now known to occur in a variety of lysosomal enzyme deficiencies. We report a case of 22 year old male with angiokeratoma corporis diffusum associated with acroparesthesias, febrile episodes, sensorineural hearing loss and renal involvement. Histopathological evaluation showed characteristic ectatic blood vessels with vacuolated endothelial cells in papillary dermis. Based on the clinical evaluation and available investigations, we suspected him to be having to Anderson fabry disease. Resource constraints limited our ability to confirm our diagnosis with enzyme assay and electron microscopy. We report this unusual case in desire of re emphasizing the importance of clinical evaluation for reaching a diagnosis in a resource poor setting.

Exercise Addiction Prevalence and Correlates in the Absence of Eating Disorder Symptomology: A Systematic Review and Meta-analysis.

BACKGROUND: Exercise addiction (EA) can be debilitating and can be a symptom of an eating disorder. To date, the prevalence rates of EA without indicated eating disorders in the general population and associated correlates remain unreported. METHODS: Two authors searched major databases from inception to 31/12/2018 to identify studies investigating the prevalence of EA in any population without indicated eating disorders. We conducted a random effects meta-analysis to report (i) prevalence rates of EA using the exercise addiction inventory and exercise dependence scale and compare sub-populations, (ii) compare methods of EA measurement and explore heterogeneity, and (iii) report on correlates. RESULTS: A total of 13 studies including 3635 people were included. The prevalence of EA among general exercisers was 8.1% (95% CI 1.5%-34.2%), amateur competitive athletes was 5.0% (95% CI 1.3%-17.3%), and university students was 5.5% (95% CI 1.4-19.1%%). Overall prevalence rates varied depending on the EA measurement tool. EA subjects were more likely to have lower levels of overall wellbeing (only in amateur competitive athletes), higher anxiety levels, and have greater frontal brain activity. CONCLUSIONS: EA is prevalent in the absence of indicated eating disorders across populations but varies depending on measurement tool. Further research is needed to explore EA without indicated eating disorders in different populations using homogenous measurement tools, further determine psychological correlates, and examine which measures of EA without indicated eating disorders predict poor health outcomes.

Neuropsychological Outcomes of Exposure to Hurricane Katrina and Relocation.

OBJECTIVE: Survivors of natural disasters are at risk for mental health sequela, including deficits in neurocognitive functioning. This study explores links between hurricane exposure and resulting psychiatric symptoms and deficits in cognitive processing, attention, learning, and memory. METHODS: Relocated Katrina survivors and demographically matched controls completed neurocognitive tests assessing processing speed (Trail Making Test, Part A), mental flexibility (Trail Making Test, Part B), sustained attention (Conner's Continuous Performance Test), and learning and memory (Rey Auditory-Verbal Learning Test). PTSD (Clinician-Administered PTSD Scale) and depressive symptoms (BDI- II) were also measured. RESULTS: Survivors had more PTSD and depression symptoms and weaker performance in cognitive processing, mental flexibility, and sustained attention, but not memory and learning compared to controls. When controlling for depression and PTSD symptoms (analysis of covariances), only CPT-II response time remained significantly different for survivors, so that sustained attention deficits were independent of emotional symptoms. CONCLUSION: Survivors had more psychiatric symptoms and neurocognitive dysfunctions than controls in most assessed measures. Our study had mixed results in identifying cognitive deficits related to psychopathology. Results suggest that disaster survivors, even those without psychopathology, should be assessed for cognitive issues that may affect their ability to process post-disaster instructions and access assistance in recovery efforts.

Health research in humanitarian crises: an urgent global imperative.

Globally, humanitarian crises-such as armed conflict, forced displacement, natural disasters and major disease outbreaks-affect more people today than at any point in recorded history. These crises have immense acute and long-term health impacts on hundreds of millions of people, predominantly in low and middle-income countries (LMIC), yet the evidence base that informs how humanitarian organisations respond to them is weak. Humanitarian crises are often treated as an outlier in global health. However, they are an increasingly common and widespread driver of health that should be integrated into comprehensive approaches and strategies, especially if we hope to achieve ambitious global health targets such as the Sustainable Development Goals. The academic research community can play an important role in addressing the evidence gap in humanitarian health. There are important scientific questions of high public health relevance that can only be addressed by conducting research in humanitarian settings. While working in these settings is uniquely challenging, there are effective strategies that can be employed, such as using flexible and adaptive research methodologies, partnering with non-governmental organisations and other humanitarian actors, and devoting greater attention to issues of research ethics, community engagement, local LMIC-based partners, building humanitarian research capacity and collaborating across disciplines.

Weekday and seasonal patterns in psychiatric referrals in three major London A&E departments, 2012-2014.

Aims and method To identify temporal and demographic trends in referrals made to psychiatric liaison services. Routine clinical data from 16 105 individual referrals from three central London accident and emergency (A&E) departments to psychiatric liaison services from 2012 to 2014 were obtained and analysed using the Clinical Record Interactive Search (CRIS). RESULTS: Referrals from A&E to psychiatric liaison services increased 16% over the 3-year study period. There were fewer referrals to psychiatric liaison services in winter months compared with other seasons. There were fewer referrals to psychiatric liaison services over the weekend compared with weekdays (average 15.4 daily weekday referrals v. 13.2 weekend, z = 5.1, P < 0.001), and weekend referrals were slightly less likely to result in admission to psychiatric hospital (11.3% v. 12.8%, respectively, χ2 = 6.33, P = 0.01). Clinical implications Psychiatric staffing in A&E and inpatient psychiatric wards requires planning to meet temporal and regional variations in the pattern of demand. Declaration of interest None.

Associations of biological stress markers in hurricane survivors: Heartrate variability, Interleukin-2 and Interleukin-6 in depression and PTSD.

OBJECTIVE: Inflammatory and immunologic cytokines and vagal activity have important roles in health and mental health, and may influence each other. The authors assessed relationships of representative biomarkers linked to disaster exposure-heart rate variability (HRV) with Interleukin-2 (IL-2, cell-medicated immunity) and Interleukin-6 (IL-6, pro-inflammatory and pro-immunologic), stratified by psychiatric diagnosis. DESIGN: Participants were assessed for psychiatric diagnosis, IL-2, IL-6, HRV, and HR reactivity to trauma reminders. SETTING: Outpatient university psychiatry clinics in Oklahoma City and Tulsa. PARTICIPANTS: Relocated Katrina survivors and demographically matched controls, not on psychiatric, cardiovascular, or inflammatory medications. MAIN OUTCOME MEASURES: SCID-IV, baseline serum IL-2 and IL-6, HRV through power spectral analysis. RESULTS: Survivors had higher sympathetic and lower parasympathetic activity at baseline and lower parasympathetic HR reactivity than controls, with flattened parasympathetic reactivity in the presence of depression and of post-traumatic stress disorder (PTSD). Survivors' IL-2 and IL-6 did not differ from controls and did not differ in PTSD or depression. Depressed survivors' sympathetic reactivity correlated negatively with IL-2 and parasympathetic reactivity correlated positively with IL-2. CONCLUSIONS: HRV differed after hurricane exposure and with survivors& depression and/or PTSD, more sensitively capturing somatic sequelae than assessed cytokines. Higher sympathetic HR reactivity associated with lower immuno-logic IL-2 may indicate a double biological "hit" in depressed disaster survivors, possibly rendering them more vulnerable to cardiovascular and immunologic illness as well as depression. Associations of HRV with IL-2 may support reciprocal influences of cytokines and vagal activity. Lack of significant correlations of IL-6 with HRV measures is consistent with its pleiotropic role.

A Clinico-Etiological Study of Dermatoses in Pediatric Age Group in Tertiary Health Care Center in South Gujarat Region.

BACKGROUND: Dermatologic conditions have different presentation and management in pediatric age group from that in adult; this to be studied separately for statistical and population based analysis. OBJECTIVE: To study the pattern of various dermatoses in infants and children in tertiary health care center in South Gujarat region. MATERIALS AND METHODS: This is a prospective study; various dermatoses were studied in pediatric patients up to 14 years of age attending the Dermatology OPD of New Civil Hospital, Surat, Gujarat over a period of 12 months from June 2009 to June 2010. All patients were divided into four different study groups: <1 month (neonates), 1 month to 1 year, >1 to 6 years and 7 to 14 years. RESULTS: There were 596 boys and 425 girls in total 1021 study populations. Majority of the skin conditions in neonates were erythema toxicum neonatorum (12.97%), scabies (9.92%), mongolian spot (9.16%), and seborrheic dermatitis (7.63%). In > 1 month to 14 years age group of children among infectious disorder, children were found to be affected most by scabies (24.49%), impetigo (5.96%), pyoderma (5.62%), molluscum contagiosum (5.39%), tinea capitis (4.49%), leprosy (2.02%), and viral warts (1.35%) while among non-infectious disorders, they were affected by atopic dermatitis (4.27%), pityriasis alba (4.16%), seborrheic dermatitis (3.60%), pityriasis rosea (3.15%), others (3.01%), phrynoderma (2.70%), lichen planus (2.58%), contact dermatitis (1.57%) and ichthyosis (1.45%). CONCLUSION: There is a need to emphasize on training the management of common pediatric dermatoses to dermatologists, general practitioners and pediatricians for early treatment.

In vivo bone biocompatibility and degradation of porous fumarate-based polymer/alumoxane nanocomposites for bone tissue engineering.

The objective of this study was to determine how the incorporation of surface-modified alumoxane nanoparticles into a biodegradable fumarate-based polymer affects in vivo bone biocompatibility (characterized by direct bone contact and bone ingrowth) and in vivo degradability. Porous scaffolds were fabricated from four materials: poly(propylene fumarate)/propylene fumarate-diacrylate (PPF/PF-DA) polymer alone; a macrocomposite consisting of PPF/PF-DA polymer with boehmite microparticles; a nanocomposite composed of PPF/PF-DA polymer and mechanically reinforcing surface-modified alumoxane nanoparticles; and a low-molecular weight PPF polymer alone (tested as a degradation control). Scaffolds were implanted in the lateral femoral condyle of adult goats for 12 weeks and evaluated by micro-computed tomography and histological analysis. For all material groups, small amounts of bone, some soft tissue, and a few inflammatory elements were observed within the pores of scaffolds, though many pores remained empty or filled with fluid only. Direct contact between scaffolds and surrounding bone tissue was also observed in all scaffold types, though less commonly. Minimal in vivo degradation occurred during the 12 weeks of implantation in all materials except the degradation control. These results demonstrate that the incorporation of alumoxane nanoparticles into porous PPF/PF-DA scaffolds does not significantly alter in vivo bone biocompatibility or degradation.

Analysis of the osteoinductive capacity and angiogenicity of an in vitro generated extracellular matrix.

In this study, the osteoinductive potential of an in vitro generated extracellular matrix (ECM) deposited by marrow stromal cells seeded onto titanium fiber mesh scaffolds and cultured in a flow perfusion bioreactor was investigated. Culture periods of 8, 12, and 16 days were selected to allow for different amounts of ECM deposition by the cells as well as ECM with varying degrees of maturity (Ti/ECM/d8, Ti/ECM/d12, and Ti/ECM/d16, respectively). These ECM-containing constructs were implanted intramuscularly in a rat animal model. After 56 days, histologic analysis of retrieved constructs revealed no bone formation in any of the implants. Surrounding many of the implants was a fibrous capsule, which was often interspersed with fat cells. Within the pore spaces, the predominant tissue response was the presence of blood vessels and young fibroblasts or fat cells. The number of blood vessels on a per area basis calculated from a histomorphometric analysis increased as a function of the amount of ECM within the implanted constructs, with a significant difference between Ti/ECM/d16 and plain Ti constructs. These results indicate that although an in vitro generated ECM alone may not induce bone formation at an ectopic site, its use may enhance the vascularization of implanted constructs.

Fabrication and in vitro degradation of porous fumarate-based polymer/alumoxane nanocomposite scaffolds for bone tissue engineering.

In this work, the fabrication and in vitro degradation of porous fumarate-based/alumoxane nanocomposites were evaluated for their potential as bone tissue engineering scaffolds. The biodegradable polymer poly (propylene fumarate)/propylene fumarate-diacrylate (PPF/PF-DA), a macrocomposite composed of PPF/PF-DA and boehmite microparticles, and a nanocomposite composed of PPF/PF-DA and surface-modified alumoxane nanoparticles were used to fabricate porous scaffolds by photo-crosslinking and salt-leaching. Scaffolds then underwent 12 weeks of in vitro degradation in phosphate buffered saline at 37 degrees C. The presence of boehmite microparticles and alumoxane nanoparticles in the polymer inhibited scaffold shrinkage during crosslinking. Furthermore, the incorporation of alumoxane nanoparticles into the polymer limited salt-leaching, perhaps due to tighter crosslinking within the nanocomposite. Analysis of crosslinking revealed that the acrylate and overall double bond conversions in the nanocomposite were higher than in the PPF/PF-DA polymer alone, though these differences were not significant. During 12 weeks of in vitro degradation, the nanocomposite lost 5.3% +/- 2.4% of its mass but maintained its compressive mechanical properties and porous architecture. The addition of alumoxane nanoparticles into the fumarate-based polymer did not significantly affect the degradation of the nanocomposite compared with the other materials in terms of mass loss, compressive properties, and porous structure. These results demonstrate the feasibility of fabricating degradable nanocomposite scaffolds for bone tissue engineering by photo-crosslinking and salt-leaching mixtures of fumarate-based polymers, alumoxane nanoparticles, and salt microparticles.

Functional bone engineering using ex vivo gene therapy and topology-optimized, biodegradable polymer composite scaffolds.

Bone tissue engineering could provide an alternative to conventional treatments for fracture nonunion, spinal fusion, joint replacement, and pathological loss of bone. However, this approach will require a biocompatible matrix to allow progenitor cell delivery and support tissue invasion. The construct must also support physiological loads as it degrades to allow the regenerated tissue to bear an increasing load. To meet these complex requirements, we have employed topology-optimized design and solid free-form fabrication to manufacture biodegradable poly(propylene fumarate)/beta-tricalcium phosphate composites. These scaffolds were seeded with primary human fibroblasts transduced with an adenovirus expressing bone morphogenetic protein-7 and implanted subcutaneously in mice. Specimens were evaluated by microcomputed tomography, compressive testing, and histological staining. New bone was localized on the scaffold surface and closely followed its designed contours. Furthermore, the total stiffness of the constructs was retained for up to 12 weeks after implantation, as scaffold degradation and tissue invasion took place.

Tissue engineering strategies for bone regeneration.

Bone loss due to trauma or disease is an increasingly serious health problem. Current clinical treatments for critical-sized defects are problematic and often yield poor healing due to the complicated anatomy and physiology of bone tissue, as well as the limitations of medical technology. Bone tissue engineering offers a promising alternative strategy of healing severe bone injuries by utilizing the body's natural biological response to tissue damage in conjunction with engineering principles. Osteogenic cells, growth factors, and biomaterial scaffolds form the foundation of the many bone tissue engineering strategies employed to achieve repair and restoration of damaged tissue. An ideal biomaterial scaffold will provide mechanical support to an injured site and also deliver growth factors and cells into a defect to encourage tissue growth. Additionally, this biomaterial should degrade in a controlled manner without causing a significant inflammatory response. The following chapter highlights multiple strategies and the most recent advances in various areas of research for bone tissue regeneration.

Nanoreinforcement of poly(propylene fumarate)-based networks with surface modified alumoxane nanoparticles for bone tissue engineering.

A novel composite material has been fabricated for bone tissue engineering scaffolds utilizing the biodegradable polymer poly(propylene fumarate)/poly(propylene fumarate)-diacrylate (PPF/PPF-DA) and surface-modified carboxylate alumoxane nanoparticles. Various surface-modified nanoparticles were added to the polymer including a surfactant alumoxane, an activated alumoxane, a mixed alumoxane containing both activated and surfactant groups, and a hybrid alumoxane containing both groups within the same substituent. These nanocomposites, as well as polymer resin and unmodified boehmite composites, underwent flexural and compressive mechanical testing and were examined using electron microscopy. Hybrid alumoxane nanoparticles dispersed in PPF/PPF-DA exhibited over a 3-fold increase in flexural modulus at 1 wt % loading compared to polymer resin alone. No significant loss of flexural or compressive strength was observed with increased loading of hybrid alumoxane nanoparticles. These dramatic improvements in flexural properties may be attributed to the fine dispersion of nanoparticles into the polymer and increased covalent interaction between polymer chains and surface modifications of nanoparticles.