Evaluation of electromagnetic navigational bronchoscopic biopsy of lung lesions performed by a thoracic surgical service.

BACKGROUND: With the increasing use of computed tomography scans for lung cancer screening and surveillance of other cancers, thoracic surgeons are being referred patients with lung lesions for biopsies. Electromagnetic navigational bronchoscopy-guided lung biopsy is a relatively new technique for bronchoscopic biopsy. Our objective was to evaluate the diagnostic yields and safety of electromagnetic navigational bronchoscopy-guided lung biopsy. METHODS: We conducted a retrospective review of patients who underwent an electromagnetic navigational bronchoscopy biopsy, performed by a thoracic surgical service, and evaluated its safety and diagnostic accuracy. RESULTS: In total, 110 patients (men 46, women 64) underwent electromagnetic navigational bronchoscopy sampling of pulmonary lesions (n = 121; median size 27 mm; interquartile range 17-37 mm). There was no procedure-related mortality. Pneumothorax requiring pigtail drainage occurred in 4 patients (3.5%). Ninety-three (76.9%) of the lesions were malignant. Eighty-seven (71.9%) of the 121 lesions had an accurate diagnosis. Accuracy increased with increased lesion size (P = .0578) with a yield of 50% for lesions <2 cm, increasing to 81% for lesions ≥2 cm. The lesions that demonstrated a positive "bronchus sign" had a yield of 87% (45/52) compared with 61% (42/69) in lesions with a negative "bronchus sign" (P = .0359). CONCLUSION: Thoracic surgeons can perform electromagnetic navigational bronchoscopy safely, with minimal morbidity and with good diagnostic yields. Accuracy increases with the presence of a bronchus sign and increasing lesion size. Patients with larger tumors and the bronchus sign may be candidates for this approach to biopsy. Further work is required to define the role of electromagnetic navigational bronchoscopy in the diagnosis of pulmonary lesions.

Minimally Invasive Single-Implant Treatment in the Esthetic Zone.

Clinicians face significant challenges when placing single-tooth, implant-supported restorations in the esthetic zone. Understanding myriad factors, such as smile design, patient expectations, and hard- and soft-tissue responses, plays a vital role in achieving a predicable outcome. This article presents a case report demonstrating a minimally invasive approach, which combined immediate implant placement, hard- and softtissue augmentation, and immediate provisionalization in 1 visit.

Dental implant uncovering techniques with emphasis on increasing keratinized mucosa.

The focus in implantology today is on the need to achieve results that are not only functional but also long-lasting and highly esthetic. Increased width and thickness of keratinized mucosa (KM) around dental implants, which is now widely recognized to be associated with better long-term success than implants without KM, addresses these goals. This is especially important in the esthetic zone, where marginal recession can be of concern. The author describes the following methods of implant uncovering that emphasize enhancement of the keratinized mucosa: the punch technique; buccally advanced flap; roll flap; tissue preservation technique; free connective tissue graft; and pedicle flap.

Prosthetic resolution of peri-implant mucositis: promoting soft-tissue health through proper restorative design.

As the use of dental implants has become more prevalent in restorative dentistry, a need has emerged for developing proper therapeutic approaches and modalities to treat peri-implant disease. While much attention has focused on tissue-centric treatment modalities, this article will examine another causative factor in peri-implant disease: improper restorative design. It will discuss the therapeutic benefits of modifying the morphology of existing restorative components in a case of chronic peri-implant mucositis, as well as review some basic concepts of current implant management.

Serum methylmalonic acid and holotranscobalamin-II as markers for vitamin B12 deficiency in end-stage renal disease patients.

BACKGROUND: Vitamin replacement, particularly B vitamins, remains an important concern in end-stage renal disease (ESRD) patients undergoing chronic hemodialysis. Serum markers such as methylmalonic acid (MMA) and holoTranscobalamin (holoTC) used to detect vitamin B12 deficiency are affected by impaired renal function which makes the interpretation of these biomarkers difficult in ESRD patients. We investigated the role renal failure has on MMA and holoTC concentrations and evaluated using MMA and/or holoTC to identify B12 deficient patients. MATERIALS AND METHODS: We evaluated the utility of serum MMA and holoTC for its role in the detection of vitamin B12 deficiency in dialysis patients (n=17) by using the reduction of MMA concentrations as a marker of the response to vitamin B12 treatment (1 mg, intramuscular injections once per month for 3 months). Nerve conduction studies (NCS) were done before and after vitamin B12 treatments to evaluate for any alteration in peripheral sensorimotor nerve function within a subset of the cohort. RESULTS: Receiver operating characteristic curves for detection of vitamin B12 deficiency in dialysis patients showed that serum MMA concentrations had the greatest predictive potential (area under the curve = 0.792, p = 0.043) with an optimal cutoff of 750 nmol/L. Dialysis patients (n=10) with pre-MMA > 750 nmol/L and pre-HoloTC < 260 pmol/L showed a significant response to the vitamin B12 treatment (a mean MMA reduction of 461 nmol/L after B12 supplementation; p = 0.006). CONCLUSION: MMA is viable marker of B12 deficiency in ESRD patients. Holo TC has potential as a supplementary marker with MMA to predict the response of vitamin B12 supplementation. Future studies on MMA and B12 should be done to confirm these findings in larger cohorts and to identify individuals who may benefit from vitamin B12 supplementation.

Beta7 integrin deficiency suppresses B cell homing and attenuates chronic ileitis in SAMP1/YitFc mice.

Lymphocyte recruitment to intestinal tissues depends on ß(7) integrins. In this study, we studied disease severity and lymphocyte recruitment into the small intestine in SAMP1/YitFc mice, which develop chronic ileitis with similarity to human Crohn's disease. To assess the role of ß(7) integrins in chronic ileitis, we generated SAMP1/YitFc lacking ß(7) integrins (SAMP1/YitFc Itgb7(-/-)) using a congenic strain developed via marker-assisted selection. We analyzed ileal inflammation in SAMP1/YitFc and SAMP1/YitFc Itgb7(-/-) mice by histopathology and the distribution of T and B lymphocytes in the mesenteric lymph nodes (MLNs) by flow cytometry. Short-term (18 h) adoptive transfer experiments were used to study the in vivo homing capacity of T and B lymphocytes. In both young (<20 wk) and old (20-50 wk) SAMP1/YitFc Itgb7(-/-) mice, ileitis was reduced by 30-50% compared with SAMP1/YitFc mice. SAMP1/YitFc Itgb7(-/-) mice showed a dramatic 67% reduction in the size of their MLNs, which was caused by a 85% reduction in lymphocyte numbers and reduced short-term B cell homing. Flow cytometric analysis revealed a highly significant decrease in the percentage of B cells in MLNs of SAMP1/YitFc Itgb7(-/-) mice. Cotransfer of SAMP1/YitFc MLN B cells but not SAMP1/YitFc Itgb7(-/-) MLN B cells along with CD4(+) T cells resulted in exacerbated ileitis severity in SCID mice. Our findings suggest that ß(7) integrins play an essential role in spontaneous chronic ileitis in vivo by promoting homing of disease-exacerbating B cells to MLNs and other intestinal tissues.

Defective regulation of CXCR2 facilitates neutrophil release from bone marrow causing spontaneous inflammation in severely NF-kappa B-deficient mice.

NF-kappaB is a major regulator of innate and adaptive immunity. Neutrophilic granulocytes (neutrophils) constitutively express RelA/p65 (Rela), c-Rel (Crel), and p50 (Nfkappab1) but not p52 (Nfkappab2) subunits. In this paper, we describe Crel(-/-)Nfkappab1(-/-)Rela(+/-) mice that have the most severe genetic neutrophil NF-kappaB deficiency compatible with life, Rela(-/-) mice being embryonic lethal. Crel(-/-)Nfkappab1(-/-)Rela(+/-) mice developed spontaneous dermal and intestinal inflammation associated with chronic neutrophilia, elevated CXCL1, and G-CSF. The bone marrow contained fewer nucleated cells and was enriched in myeloid progenitor cells. Neutrophilia was preserved when Crel(-/-)Nfkappab1(-/-)Rela(+/-) bone marrow was transferred into wild-type mice, but mixed bone marrow chimeras receiving wild-type and Crel(-/-)Nfkappab1(-/-)Rela(+/-) bone marrow showed normal circulating neutrophil numbers, excluding an intrinsic proliferation advantage. In mixed bone marrow chimeras, Crel(-/-)Nfkappab1(-/-)Rela(+/-) neutrophils were preferentially mobilized from the bone marrow in response to CXCL1 injection, LPS-induced lung inflammation, and thioglycollate-induced peritonitis. Crel(-/-)Nfkappab1(-/-)Rela(+/-) neutrophils expressed higher levels of the CXCL1 receptor CXCR2 both under resting and stimulated conditions and failed to downregulate CXCR2 during inflammation. Treatment with an anti-CXCR2 Ab abolished preferential mobilization of Crel(-/-)Nfkappab1(-/-)Rela(+/-) neutrophils in peritonitis in mixed chimeric mice and neutrophilia in Crel(-/-)Nfkappab1(-/-)Rela(+/-) mice. We conclude that severe NF-kappaB deficiency facilitates neutrophil mobilization, which causes elevated numbers of preactivated neutrophils in blood and tissues, leading to spontaneous inflammation. These neutrophil effects may limit the usefulness of global NF-kappaB inhibitors for the treatment of inflammatory diseases.