Bisphosphonate Osteonecrosis in a Case of Langerhans Cell Histiocytosis: Report of a Case and Review of Literature.

Langerhans Cell histiocytosis is a rare multisystem disease originating from dendritic cell lines primarily characterized by osteolytic lesion of the skeleton. Chemotherapy along with bisphosphonates have been used to control the progression of the disease and prevent the osteolysis associated with the disease. Bisphosphonate osteonecrosis of the jaws is a common finding following treatment with bisphosphonates for osteoporosis, metastatic tumors to the bone or the osteolytic lesions of multiple myeloma. The article highlights a rare case of bisphosphonate osteonecrosis of the mandible in a case of long-standing Langerhans cell histiocytosis.

Validity of IL-6 and Arthrocentesis in the Cause and Management of Internal Derangement of TMJ.

Purpose: The aim of this clinical study was to evaluate the level of Interleukine-6 (IL-6), pre and post arthrocentesis to validate it as a biomarker in the Internal Derangement (ID) of TMJ. Material and Methods: This study included 30 patients (20 females and 10 males) of Temporo-Mandibular Dysfunction (TMD) with Disc displacement without reduction (DDwoR) Wilkes stage III, who were refractory to conservative management. Arthrocentesis was performed as a therapeutic modality. Synovial fluid aspirates were obtained prior to arthrocentesis and post arthrocentesis with 300 ml of Ringer Lactate solution into the superior joint compartment for the assessment of level of IL-6. The clinical parameters used for correlating the level of IL-6 were degree of pain (VAS I), chewing ability (VAS II), Maximal Mouth Opening (MMO) in both pre and post op phase with the follow-up period of 01 day, 01 week, 01 month, 03 month and 06 month and the results were compared. ELISA was performed to analyze the levels of IL-6 in the aspirates. The clinical parameters and the level of IL-6 were recorded and analyzed statistically. Results: The study showed ID of TMJ (Wilkes stage III) s are more prevalent in females especially in the fourth decades of life with the mean age of 38.4 years. The post operative assessment in terms of pain, maximum mouth opening, lateral movements of the mandible and the levels of IL-6 were found to be statistically significant with a P value <0.01. Conclusion: This study validates the role of IL-6 as a definitive biomarker for the pathogenesis of ID of TMJ Wilkes stage III and arthrocentesis proved to be a minimally invasive therapeutic modality for its management.

Bony bridge resorption after secondary alveolar grafting and correlation with success of orthodontic treatment: A prospective volumetric cone beam computed tomography (CBCT) study.

BACKGROUND: Cleft lip/palate is the second most observed congenital defect which constitutes a serious dental-medical-social problem. Successful uptake and stability of alveolar graft is required to achieve closure of the oro-nasal fistula and continuity of the dental arches. Resorption of bone graft may compromise the results achieved. This study determined the bony bridge volume required for successful repair of alveolar cleft, evaluated the resorption after 3 months of grafting and correlated the success of orthodontic treatment. METHODS: 30 patients with unilateral cleft lip and palate requiring secondary alveolar bone grafting and orthodontic correction were included in the study. After arch expansion and before alveolar grafting using cone beam computed tomography (CBCT) of maxilla was recorded and was repeated after 3 months of alveolar bone grafting to estimate the volume of grafted bone in the cleft. RESULTS: The bridge bone volume resorption after 3 months post-operative ranged from 14% to 100% with a mean of 36.46%. The percentage of resorption of alveolar bone graft after 3 months of surgery was statistically significant. Success of orthodontic treatment was statistically significant when correlated with percentage of resorption. CONCLUSION: The accurate localization and estimation of the size and extent of alveolar cleft area is important for treatment planning. Post-operative it is important to analyze the outcome of transplanted bone as early as possible. Early evaluation can help to predict the outcome of transplanted bone and may guide to re-grafting of the site immediate or to restart any interrupted orthodontic procedure, if necessary.

Retromandibular transparotid approach compared with transmasseteric anterior parotid approach for the management of fractures of the mandibular condylar process: a prospective randomised study.

Fractures of the mandibular condyle lead to displacement of the condyle and loss of the height of the ramus. A retromandibular approach is the most commonly used for open reduction and internal fixation (ORIF) of such fractures. We aimed to compare the complications associated with a retromandibular transparotid approach with a retromandibular transmasseteric anterior parotid (TMAP) approach for their management. Thirty patients were randomly selected into two groups (15 in each): Group A comprised the retromandibular transparotid approach and Group B the retromandibular TMAP. The variables evaluated were: operating time, facial nerve injury, occurrence of Frey syndrome, and sialocoele at one week, four weeks, three months, and six months. The mean (SD) age in group A and B was 33.93 (17.97) years and 33.53 (16.15) years, respectively, and there were 28 men and two women. Mean (SD) exposure time in the transparotid approach was 26.93 (5.19) minutes and 25.4 (8.35) minutes in the TMAP approach. The incidence of facial nerve injury was 2/15 patients in the transparotid group and 3/15 in the TMAP group, all of which resolved within six months. The incidence of sialocoele was 2/15 in the transparotid group. The results did not show any significant difference in complications between the two approaches, but the retromandibular transparotid approach provided straight-line access in fractures of the condylar neck, with fewer incidences of nerve injury. The anterior parotid approach, on the other hand, provided easier access for fractures that were medially dislocated or of the condylar base but had an increased incidence of facial nerve injuries.

Does methylprednisolone improve postoperative outcomes after mandibular third molar surgery? A systematic review and meta-analysis.

This systematic review and meta-analysis was performed to investigate whether methylprednisolone (MP) administered via any route improves postoperative outcomes (pain, trismus, and oedema) following mandibular third molar surgery. An electronic search of the PubMed, Scopus, Cochrane CENTRAL, and Google Scholar databases was performed to identify studies published in English up until January 2018. A total of 28 studies were included in the review: 25 randomized clinical trials (RCTs) and three controlled clinical trials. Studies were grouped according to the route of administration of MP for qualitative and quantitative analysis. Three studies were of 'high' quality and 22 were of 'medium' quality; three studies had a high risk of bias. Within the purview of the limitations of this review, the results showed that MP administered via any route significantly improves oedema in the early postoperative period, but has no effect on late postoperative oedema. Oral and intra-masseteric MP also seems to reduce pain and trismus in the early postoperative period. The results also indicate that oral MP may reduce late postoperative pain, while intra-masseteric MP may improve the late trismus outcome. More high quality RCTs are required to provide stronger evidence on the use of MP in third molar surgery.

A new multi-line cusp magnetic field plasma device (MPD) with variable magnetic field.

A new multi-line cusp magnetic field plasma device consisting of electromagnets with core material has been constructed with a capability to experimentally control the relative volume fractions of magnetized to unmagnetized plasma volume as well as accurate control on the gradient length scales of mean density and temperature profiles. Argon plasma has been produced using a hot tungsten cathode over a wide range of pressures 5 × 10-5 -1 × 10-3 mbar, achieving plasma densities ranging from 109 to 1011 cm-3 and the electron temperature in the range 1-8 eV. The radial profiles of plasma parameters measured along the non-cusp region (in between two consecutive magnets) show a finite region with uniform and quiescent plasma, where the magnetic field is very low such that the ions are unmagnetized. Beyond that region, both plasma species are magnetized and the profiles show gradients both in temperature and density. The electrostatic fluctuation measured using a Langmuir probe radially along the non-cusp region shows less than 1% (δIisat/Iisat < 1%). The plasma thus produced will be used to study new and hitherto unexplored physics parameter space relevant to both laboratory multi-scale plasmas and astrophysical plasmas.

Custom-made mouth prop for TMJ arthrocentesis: a technical note.

INTRODUCTION: TMJ arthrocentesis involves lavage of the upper joint space which forces the disc apart from the fossa and washes away the inflammatory components of the joint. To increase the joint space during arthrocentesis, the patient is usually asked to open the mouth and deviate it to the opposite side so as to distract the condyle from the glenoid fossa thereby increasing joint space. METHOD: The authors describe a simple and rapid technique of preparing a custom-made mouth prop to hold the mandible in eccentric position during arthrocentesis. FINDINGS: The custom-made mouth prop is an effective tool to help relax the patient in an eccentric position during the duration of arthrocentesis procedure.

A comparative study of sheath potential profile measurements with laser-heated and current-heated emissive probes.

Emissive Langmuir probe is one of the most efficient diagnostic tools available for plasma potential measurements. Extensive studies have been carried out in designing different kinds of conventional (electrically heated) emissive probes (CEPs) to estimate the plasma potential. Laser heated emissive probe (LHEP) has been developed with certain advantages over the conventional probes such as low evaporation rate of the probe material, high lifetime, and high emission levels. Most importantly, the LHEP uses laser to heat the probe-tip and does not require electric current to heat the probe-tip like in CEP. The heating current in CEP substantially affects the plasma potential measurements, especially in the regions of plasma where high electric and magnetic field gradients are present. In this paper, we studied the plasma potential structures in sheath-presheath region using both LHEP and CEP in an unmagnetized dc-filament discharge plasma. Measurements of sheath spatial potential profile using laser heated emissive probe are compared with those obtained using conventional emissive probe.

The impact of HLA class I and EBV latency-II antigen-specific CD8(+) T cells on the pathogenesis of EBV(+) Hodgkin lymphoma.

In 40% of cases of classical Hodgkin lymphoma (cHL), Epstein-Barr virus (EBV) latency-II antigens [EBV nuclear antigen 1 (EBNA1)/latent membrane protein (LMP)1/LMP2A] are present (EBV(+) cHL) in the malignant cells and antigen presentation is intact. Previous studies have shown consistently that HLA-A*02 is protective in EBV(+) cHL, yet its role in disease pathogenesis is unknown. To explore the basis for this observation, gene expression was assessed in 33 cHL nodes. Interestingly, CD8 and LMP2A expression were correlated strongly and, for a given LMP2A level, CD8 was elevated markedly in HLA-A*02(-) versus HLA-A*02(+) EBV(+) cHL patients, suggesting that LMP2A-specific CD8(+) T cell anti-tumoral immunity may be relatively ineffective in HLA-A*02(-) EBV(+) cHL. To ascertain the impact of HLA class I on EBV latency antigen-specific immunodominance, we used a stepwise functional T cell approach. In newly diagnosed EBV(+) cHL, the magnitude of ex-vivo LMP1/2A-specific CD8(+) T cell responses was elevated in HLA-A*02(+) patients. Furthermore, in a controlled in-vitro assay, LMP2A-specific CD8(+) T cells from healthy HLA-A*02 heterozygotes expanded to a greater extent with HLA-A*02-restricted compared to non-HLA-A*02-restricted cell lines. In an extensive analysis of HLA class I-restricted immunity, immunodominant EBNA3A/3B/3C-specific CD8(+) T cell responses were stimulated by numerous HLA class I molecules, whereas the subdominant LMP1/2A-specific responses were confined largely to HLA-A*02. Our results demonstrate that HLA-A*02 mediates a modest, but none the less stronger, EBV-specific CD8(+) T cell response than non-HLA-A*02 alleles, an effect confined to EBV latency-II antigens. Thus, the protective effect of HLA-A*02 against EBV(+) cHL is not a surrogate association, but reflects the impact of HLA class I on EBV latency-II antigen-specific CD8(+) T cell hierarchies.

Design, development, and results from a charge-collector diagnostic for a toroidal electron plasma experiment.

A suitable charge-collector has been designed and developed to estimate charge-content of electron plasmas in a Small Aspect Ratio Toroidal Experiment in a C-shaped trap (SMARTEX-C). The electrons are periodically injected and held in the trap with the aid of electrostatic end-fields and a toroidal magnetic field. After a preset "hold" time, the trapped charges are dumped onto a grounded collector (by gating it). As the charges flow along the magnetic field lines onto the collector, the integrated current gives the charge-content of the plasma at the instant of dump. In designing such a charge collector, several challenges peculiar to the geometry of the trap and the nature of the plasma had to be addressed. Instantaneous charge measurements synchronised with the E × B drift of the plasma, along with fast transit times of electrons to the collector (few 100 ns or less) (due to the low aspect ratio of the trap) essentially require fast gating of the collector. The resulting large capacitive transients alongside low charge content (few nC) of such plasmas further lead to increasing demands on response and sensitivity of the collector. Complete cancellation of such transients is shown to be possible, in principle, by including the return path in our measurement circuit but the "non-neutrality" of the plasma acts as a further impediment. Ultimately, appropriate shielding and measurement circuits allow us to (re)distribute the capacitance and delineate the paths of these currents, leading to effective cancellation of transients and marked improvement in sensitivity. Improved charge-collector has thus been used to successfully estimate the time evolution of total charge of the confined electron plasma in SMARTEX-C.

Inverse mirror plasma experimental device­A new magnetized linear plasma device with wide operating range.

Inverse mirror plasma experimental device has been designed and fabricated for detailed experimental investigation of phase mixing and wave breaking of plasma oscillation/wave. The device produces quiescent magnetized plasma over a wide operating range using multifilamentary source with low filament spacing in cusp geometry along with a flexible transition magnetic field region between the plasma source chamber and the main chamber. Argon plasma has been produced in the device over a wide pressure range from 1.7 × 10(-5) mbar to 9 × 10(-4) mbar, achieving plasma densities in the range of ∼10(9) cm(-3)-10(12) cm(-3) and temperatures in the range of ∼1.7 eV-5 eV. To fulfill a desired prerequisite of having quiescent plasma (δn/n ≤ 1%) for realizing phase mixing of nonlinear plasma oscillation and other wave experiments, a quiescent magnetized plasma is obtained: typical quiescence, δn/n ∼ 0.5% at 10(-4) mbar and B(main) ∼ 1 kG. The potential of the multifilamentary plasma source has been experimentally explored using a flexible transition magnetic field and the usual control features of a filament discharge. Probe measurements reveal that the plasma to be axially and radially uniform, an excellent scenario for wave launching and studying its propagating and phase mixing characteristics.

Efficacy of Autogenous Split Thickness Calvarial Graft in the Management of Residual Cranial Defect.

INTRODUCTION: The patients with cranial deformity suffer from headache, dizziness, irritability, loss of concentration, depression, anxiety, intolerance to noise and vibration and neuromotor weakness. It is therefore essential to restore the calvarium. MATERIAL AND METHOD: This study was conducted in the Department of Oral and Maxillofacial Surgery, Armed Forces Medical College, Pune between Oct 2010 and Mar 2012. The study population was selected from the outpatient department and from the referred cases. The aim was to study the uptake of split thickness calvarial graft in the management of residual cranial defect. After applying the inclusion and exclusion criterions, ten cases were selected with residual cranial deformity, operated for cranioplasty using split thickness calvarial graft and evaluated. CONCLUSION: It was concluded that cranioplasty using autogenous split thickness calvarial graft for restoring cranial defects is a useful technique and this procedure allows the surgeon to reconstruct a moderate-to-large cranial defect, without breaching the inner cortical plate.

A mine is a terrible thing to waste: high content, single cell technologies for comprehensive immune analysis.

In recent years, an incredible variety of single cell technologies have become available to analyze immune responses. These technologies include polychromatic flow cytometry, mass cytometry, highly multiplexed single cell qPCR, RNA sequencing, microtools, and high-resolution imaging. In this article, we review these platforms, describing their power and limitations for comprehensive analysis of the immune system. We relate the properties of these technologies to the various cellular states relevant to an immune response, in order to address which technologies are most appropriate for which settings.

Measurement of spatial and temporal behavior of H(α) emission from Aditya tokamak using a diagnostic based on a photomultiplier tube array.

A photo multiplier tube (PMT) array based spectroscopic diagnostic with fast time response of 10 µs and spatial resolution ∼3 cm has been developed and installed on Aditya tokamak to study the spatial and temporal behavior of Hα emissions from typical discharges. Collimated light has been collected from the plasma along 16 lines of sight passing through entire plasma poloidal cross section of Aditya and detected by two 8 channels PMT arrays after selecting Hα emission using interference filter. The studies are carried out during plasma formation phase of Aditya by changing vertical field and its delay with respect to loop voltage. It is observed that plasma initiated in the high field side in typical discharges of Aditya. The plasma formation position is matched with null field location estimated through simulation.

Comparative evaluation of the mandibular distraction zone using ultrasonography and conventional radiography.

The purpose of this study was to determine the efficacy of ultrasonography (USG) for the evaluation of bone formation in the mandibular distraction wound and to compare this with radiographic evaluation, which is currently the standard modality. Twenty-two patients underwent mandibular distraction (30 sides) with a variety of distraction devices. The wounds were assessed with plain radiographs and USG at established time intervals. Estimates of bone formation using a semiquantitative bone fill score were made for radiographs and USG. USG bone fill scores were correlated with radiography scores. At week 4 the difference between the scores was statistically significant (P=0.01); at all other time points, USG and radiography scores were comparable. At week 4, USG scores were significantly higher than the corresponding radiography scores, indicating that USG is an earlier indicator of calcification in the distraction zone as compared to radiography. USG evaluation of the distraction osteogenesis (DO) zone has many inherent advantages over conventional methods. The results of this study indicate that USG is an accurate non-invasive technique that may prove to be useful in assessing the mandibular DO regenerate in patients.

A linear helicon plasma device with controllable magnetic field gradient.

Current free double layers (CFDLs) are localized potential structures having spatial dimensions - Debye lengths and potential drops of more than local electron temperature across them. CFDLs do not need a current for them to be sustained and hence they differ from the current driven double layers. Helicon antenna produced plasmas in an expanded chamber along with an expanding magnetic field have shown the existence of CFDL near the expansion region. A helicon plasma device has been designed, fabricated, and installed in the Institute for Plasma Research, India to study the role of maximum magnetic field gradient as well as its location with respect to the geometrical expansion region of the chamber in CFDL formation. The special feature of this machine consisting of two chambers of different radii is its capability of producing different magnetic field gradients near the physical boundary between the two chambers either by changing current in one particular coil in the direction opposite to that in other coils and/or by varying the position of this particular coil. Although, the machine is primarily designed for CFDL experiments, it is also capable of carrying out many basic plasma physics experiments such as wave propagation, wave coupling, and plasma instabilities in a varying magnetic field topology. In this paper, we will present the details of the machine construction, its specialties, and some preliminary results about the production and characterization of helicon plasma in this machine.

Optimization of HTST process parameters for production of ready-to-eat potato-soy snack.

Ready-to-eat (RTE) potato-soy snacks were developed using high temperature short time (HTST) air puffing process and the process was found to be very useful for production of highly porous and light texture snack. The process parameters considered viz. puffing temperature (185-255 °C) and puffing time (20-60 s) with constant initial moisture content of 36.74% and air velocity of 3.99 m.s(-1) for potato-soy blend with varying soy flour content from 5% to 25% were investigated using response surface methodology following central composite rotatable design (CCRD). The optimum product in terms of minimum moisture content (11.03% db), maximum expansion ratio (3.71), minimum hardness (2,749.4 g), minimum ascorbic acid loss (9.24% db) and maximum overall acceptability (7.35) were obtained with 10.0% soy flour blend in potato flour at the process conditions of puffing temperature (231.0 °C) and puffing time (25.0 s).

Hemimasticatory spasm: a case report with a new management strategy.

Hemimasticatory spasm is a rare neuromuscular disorder where the patient experiences involuntary, painful spasm of muscles of mastication. Only 15 cases have been reported in literature. We present a case which was treated unconventionally with satisfactory outcome.

Low-grade osteosarcoma of the mandible.

Osteosarcoma (OS), a rare malignant bone tumour arising from primitive bone forming mesenchyme, most often arises in the metaphyses of long bones of the extremities. Bone or osteoid formation within the tumour is characteristic of an osteosarcoma. Craniofacial osteosarcoma (CFOS), most often located in the mandible or maxilla, accounts for only 5-13% of all osteosarcomas. In general, OS of the jaw is a high-grade lesion. Low-grade lesions are rare and represent less than 2% of all osteosarcomas reported in the literature. Because of its rarity and well differentiation, Low-grade OS is usually misdiagnosed as a benign lesion. The clinical and radiographic presentation does not correlate well with the subtle histology picture of a low-grade osteosarcoma which makes the diagnosis difficult.

Ameloblastic Carcinoma of the mandible.

Odontogenic carcinomas are rare lesions arising from dental embryogenic residues and have been designated by a variety of terms like malignant ameloblastoma, ameloblastic carcinoma, metastatic ameloblastoma or primary intra-alveolar epidermoid carcinoma. Ameloblastic carcinoma combines the histological features of ameloblastoma with cytological atypia, even in the absence of metastasis. The lesion has been reported to arise either from the odontogenic cyst or the ameloblastoma. Majority originate de novo and the remaining are malignant transformation of an ameloblastoma.