Evidence-Based Medicine for Nonsurgical Facial Rejuvenation.

Options for nonsurgical facial rejuvenation treatment have increased significantly in both availability and popularity over the past two decades. However, there remains a paucity of clinical practice guidelines and evidence-based recommendations for these procedures. The purpose of this article is to assess the presence of current high-level research for various methods of nonsurgical facial rejuvenation using the Oxford Centre for Evidence-Based Medicine. Botulinum toxin injections remain the best-studied method, with several randomized controlled trials guiding recommendations for safety and efficacy. Several studies on injectable fillers document complications and recommendations to avoid these, but sample sizes are small and many are noncomparative. Deoxycholic acid has been well examined and Food and Drug Administration approved to address submental fat but has not been studied in other areas of the face. Although chemical peels, laser skin resurfacing, energy-based facial rejuvenation, microneedling, and platelet-rich plasma have a variety of facial rejuvenation applications with minimal side effect profiles, there is significant variability with treatment protocols, outcomes measures, and randomized controlled trials with extended follow-up to develop clinical practice guidelines.

United States emergency department visits for children with cerebrospinal fluid shunts.

OBJECTIVE: CSF shunt placement is the primary therapy for hydrocephalus; however, shunt malfunctions remain common and lead to neurological deficits if missed. There is a lack of literature characterizing the epidemiology of children with possible shunt malfunctions presenting to United States emergency departments (EDs). METHODS: A retrospective study was conducted of the 2006-2017 National Emergency Department Sample. The data were queried using an exhaustive list of Current Procedural Terminology and International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes representing children with hydrocephalus diagnoses, diagnostic imaging for shunt malfunctions, and shunt-related surgical revision procedures. RESULTS: In 2017, there were an estimated 16,376 ED visits for suspected shunt malfunction. Children were more commonly male (57.9%), ages 0-4 years (42.2%), and publicly insured (55.8%). Many did not undergo diagnostic imaging (37.2%), and of those who did, most underwent head CT scans (43.7%). Between 2006 and 2017, pediatric ED visits for suspected shunt malfunction increased 18% (95% CI 12.1-23.8). The use of MRI increased substantially (178.0%, 95% CI 176.9-179.2). Visits resulting in discharge home from the ED increased by 76.3% (95% CI 73.1-79.4), and those involving no surgical intervention increased by 32.9% (95% CI 29.2-36.6). CONCLUSIONS: Between 2006 and 2017, ED visits for children to rule out shunt malfunction increased, yet there was a decline in surgical intervention and an increase in discharges home from the ED. Possible contributing factors include improved clinical criteria for shunt evaluation, alternative CSF diversion techniques, changing indications for shunt placement, and increased use of advanced imaging in the ED. ABBREVIATIONS: CPT = Current Procedural Terminology; ED = emergency department; ETV = endoscopic third ventriculostomy; ICD-9 = International Classification of Diseases, Ninth Revision; ICD-10 = International Classification of Diseases, Tenth Revision; NEDS = National Emergency Department Sample.

Comparing cortical signatures of atrophy between late-onset and autosomal dominant Alzheimer disease.

Defining a signature of cortical regions of interest preferentially affected by Alzheimer disease (AD) pathology may offer improved sensitivity to early AD compared to hippocampal volume or mesial temporal lobe alone. Since late-onset Alzheimer disease (LOAD) participants tend to have age-related comorbidities, the younger-onset age in autosomal dominant AD (ADAD) may provide a more idealized model of cortical thinning in AD. To test this, the goals of this study were to compare the degree of overlap between the ADAD and LOAD cortical thinning maps and to evaluate the ability of the ADAD cortical signature regions to predict early pathological changes in cognitively normal individuals. We defined and analyzed the LOAD cortical maps of cortical thickness in 588 participants from the Knight Alzheimer Disease Research Center (Knight ADRC) and the ADAD cortical maps in 269 participants from the Dominantly Inherited Alzheimer Network (DIAN) observational study. Both cohorts were divided into three groups: cognitively normal controls (nADRC = 381; nDIAN = 145), preclinical (nADRC = 153; nDIAN = 76), and cognitively impaired (nADRC = 54; nDIAN = 48). Both cohorts underwent clinical assessments, 3T MRI, and amyloid PET imaging with either 11C-Pittsburgh compound B or 18F-florbetapir. To generate cortical signature maps of cortical thickness, we performed a vertex-wise analysis between the cognitively normal controls and impaired groups within each cohort using six increasingly conservative statistical thresholds to determine significance. The optimal cortical map among the six statistical thresholds was determined from a receiver operating characteristic analysis testing the performance of each map in discriminating between the cognitively normal controls and preclinical groups. We then performed within-cohort and cross-cohort (e.g. ADAD maps evaluated in the Knight ADRC cohort) analyses to examine the sensitivity of the optimal cortical signature maps to the amyloid levels using only the cognitively normal individuals (cognitively normal controls and preclinical groups) in comparison to hippocampal volume. We found the optimal cortical signature maps were sensitive to early increases in amyloid for the asymptomatic individuals within their respective cohorts and were significant beyond the inclusion of hippocampus volume, but the cortical signature maps performed poorly when analyzing across cohorts. These results suggest the cortical signature maps are a useful MRI biomarker of early AD-related neurodegeneration in preclinical individuals and the pattern of decline differs between LOAD and ADAD.

Assessment of hospital based prevalence of oral cancer among population of Kanpur, Uttar Pradesh.

BACKGROUND: Oral cancer incidence depends on both qualitative and quantitative factors wherein the incidence of oral cancer in patients with smoking and tobacco chewing habit is 8.4 times higher than that of patients with no habit. AIM: To understand about the prevalence of oral cancer in population of Kanpur reported to the hospital and analyse the association with age, gender and tobacco habit. MATERIAL AND METHOD: All 320 cases of Squamous cell carcinoma diagnosed histopathologically, since January 2007 to December 2016, were retrieved from the archives and a retrospective study was conducted along with association with the variables such as age, gender, site, habit and histopathological type. RESULTS: A total of 71 cases were reported in the age group of 30-39 (22.18%) and 60 cases (18.75%) were seen to be below 30yrs. Among individuals with habit, 135 (42.18%) were tobacco chewers and smoking was prevalent in about 48 (15%). The prevalence was more in males 37 (15.22%). Amongst both males (44.03%) and females (48.05%) gingivo-buccal sulcus was the most common site. The least common site was seen to be lip with only 10 (3.12%) patients. Well differentiated squamous cell carcinoma was common in both males and females with 155 (63.78%) and 47 (61.03%) respectively. Poorly differentiated squamous cell carcinoma was only reported in 4(1.64%) males. CONCLUSION: Early detection of these oral cancers will enable appropriate clinical management and monitoring. Moreover, improving the incidence, mortality, and survival rates of oral cancer requires a multi-tier structural approach that targets society, dentists, communities, and the individual.

Spatial patterns of neuroimaging biomarker change in individuals from families with autosomal dominant Alzheimer's disease: a longitudinal study.

BACKGROUND: Models of Alzheimer's disease propose a sequence of amyloid ß (Aß) accumulation, hypometabolism, and structural decline that precedes the onset of clinical dementia. These pathological features evolve both temporally and spatially in the brain. In this study, we aimed to characterise where in the brain and when in the course of the disease neuroimaging biomarkers become abnormal. METHODS: Between Jan 1, 2009, and Dec 31, 2015, we analysed data from mutation non-carriers, asymptomatic carriers, and symptomatic carriers from families carrying gene mutations in presenilin 1 (PSEN1), presenilin 2 (PSEN2), or amyloid precursor protein (APP) enrolled in the Dominantly Inherited Alzheimer's Network. We analysed 11C-Pittsburgh Compound B (11C-PiB) PET, 18F-Fluorodeoxyglucose (18F-FDG) PET, and structural MRI data using regions of interest to assess change throughout the brain. We estimated rates of biomarker change as a function of estimated years to symptom onset at baseline using linear mixed-effects models and determined the earliest point at which biomarker trajectories differed between mutation carriers and non-carriers. This study is registered at ClinicalTrials.gov (number NCT00869817) FINDINGS: 11C-PiB PET was available for 346 individuals (162 with longitudinal imaging), 18F-FDG PET was available for 352 individuals (175 with longitudinal imaging), and MRI data were available for 377 individuals (201 with longitudinal imaging). We found a sequence to pathological changes, with rates of Aß deposition in mutation carriers being significantly different from those in non-carriers first (across regions that showed a significant difference, at a mean of 18·9 years [SD 3·3] before expected onset), followed by hypometabolism (14·1 years [5·1] before expected onset), and lastly structural decline (4·7 years [4·2] before expected onset). This biomarker ordering was preserved in most, but not all, regions. The temporal emergence within a biomarker varied across the brain, with the precuneus being the first cortical region for each method to show divergence between groups (22·2 years before expected onset for Aß accumulation, 18·8 years before expected onset for hypometabolism, and 13·0 years before expected onset for cortical thinning). INTERPRETATION: Mutation carriers had elevations in Aß deposition, reduced glucose metabolism, and cortical thinning compared with non-carriers which preceded the expected onset of dementia. Accrual of these pathologies varied throughout the brain, suggesting differential regional and temporal vulnerabilities to Aß, metabolic decline, and structural atrophy, which should be taken into account when using biomarkers in a clinical setting as well as designing and evaluating clinical trials. FUNDING: US National Institutes of Health, the German Center for Neurodegenerative Diseases, and the Medical Research Council Dementias Platform UK.

Awareness on cytology procedure in oral cancer detection among undergraduates: An institutional study.

BACKGROUND: The screening and the early detection of the premalignant and malignant lesions are the only means for controlling the oral cancer which is known to be one of the leading causes for mortality worldwide. Oral exfoliative cytology though not a substitute for biopsy can be a powerful tool for its early detection. Dental Surgeons can play a great role in this direction. AIMS AND OBJECTIVES: The present study was undertaken to assess the self-reported knowledge and attitude regarding the early detection of oral cancer and exfoliative cytology among the undergraduates of Rama Dental College, Kanpur. MATERIAL AND METHODS: A pretested questionnaire based cross sectional study consisting of twenty four questions was conducted among hundred randomly selected students from third year, final year and intern's batch. RESULTS: According to 73% of students biopsy was the special test done in oral cancer detection and only 59% had heard regarding oral cytology technique. Formalin was the fixative known for cytology smears among 61%. Significance of toluidine blue staining was not known by 62%. Seventy seven percent of students were not aware about classes of cytology reporting. Eighty six percent of students felt that the adequacy of training in cytology was lagging. CONCLUSION: This survey identified an existing gap in the knowledge among the dental students regarding cytology as a diagnostic aid in oral cancer detection. This emphasizes the need to provide training for undergraduates at clinical level on regular basis and also through CDE and oral can-cer detection workshops.

Assessment of relationship of ABO blood groups among tobacco induced oral cancer patients of Kanpur Population, Uttar Pradesh.

BACKGROUND: The possibility of association between ABO blood groups and malignancy was first discussed by Anderson DE & Haas C. The association between blood group and oral cancer is least explored and hence this study was undertaken to evaluate relationship of ABO blood groups with an increased risk for oral cancer. MATERIALS AND METHOD: The present study was conducted at various cancer hospitals in Kanpur. The study samples comprised 100 oral cancer patients and 50 controls with tobacco chewing habit. The information regarding the socio demographic profile, history on tobacco habits, type of oral cancer and ABO blood group profile was obtained from the case sheets of the patients. RESULTS: The frequency of squamous cell carcinoma was significantly higher in men (78%) than women (22%) and mostly found in the age range of 45-65 years and also consuming chewing type of tobacco. It was found that out of 100 patients, 53 were of blood group B+ve, 28 of O +ve, 16 of A+ve and 3 had the blood group AB+ve. The high potential risk of developing OSCC was more in B+ve blood group (1.96 times), and relative frequency (%) in blood group O+ve (1.64 times) than in the control group Among locations of oral cancers, squamous cell carcinoma of tongue (25%) and buccal mucosa (15%) was more common in B+ve and Carcinoma of floor of mouth (11%) was more common in O+ve blood group cases. It was found that people with blood group B+ve, followed by O+ve had increased risk of developing OSCC with most prevalent being Well Differentiated OSCC as compared to people of other blood groups. CONCLUSION: The present study reveals that there is an inherited element in the susceptibility against different types of oral cancers. The people with blood group B+ve and O+ve having tobacco chewing habits can be appraised that they are more at risk to develop oral cancer than people with other blood groups.

Micronuclei assay in exfoliated buccal cells of radiation treated oral cancer patients.

BACKGROUND: Micronuclei are suitable internal dosimeters for revealing tissue-specific genotoxic damage in individuals exposed to carcinogenic mixtures. Evaluation of radiation-induced cellular changes to predict radiosensitivity has invested many investigators since such changes were first found in biopsy material. AIM: The aim of the present study was to assess the relationship of with histopathological grade and number of radiation therapy sittings with the frequency of micronuclei and nuclear anomalies among oral cancer patients. MATERIAL & METHOD: Thirty male patients with histologically proven cases of oral cancer undergoing radiation therapy and age and sex matched 20 healthy controls were included in the study. Scrape cytology smears of exfoliated buccal cells were prepared and stained using Feulgen stain and frequency of micronuclei and other nuclear anomalies counts were evaluated with the help of light microscope expressed as per 1000 buccal cells. RESULTS: The mean values of the micronuclei and nuclear anomalies were 14.03 and 21.30 respectively. There was a significant association and strong positive correlation of Radiation exposure and grades of squamous cell carcinoma with micronuclei and nuclear anomalies. There was no statistically significant association and correlation between nuclear anomalies in well differentiated and moderately differentiated carcinomas. CONCLUSION: With increase number of radiation therapy sittings, there was increase in number of micronuclei and nuclear anomalies. Hence the result of this study highlights that increased number of micronuclei and nuclear anomalies provides information regarding radiosensitivity of epithelial cells.

Basal cell adenoma of palatal glands.

OBJECTIVE: Salivary gland neoplasms represent less than 3% of all tumors in the general population of which benign adenomas account for 65.5%. Basal cell adenoma which is classified as a subtype of monomorphic adenomas accounts for 1-2% of all salivary gland epithelial tumors, and more than 80% of them arise in the major salivary glands, mostly the parotid gland and has female predominance reporting mostly in the elderly age groups. We here report a case of basal cell adenoma of trabecular type in a male patient of age 45 years in the minor salivary glands of left posterior palatal region.

Prevalence of odontogenic lesions among the Kanpur population: an institutional study.

BACKGROUND: The frequency and incidence of odontogenic cysts and tumors are controversial and depends in the geographic location. These lesions have great clinical and histopathological diversity, and reflect a need for epidemiological profile to be considered when these lesions are studied. AIM: The purpose of this study was to determine the prevalence of odontogenic cysts and tumors over a period of 10 years and to compare with other data reported around the world. MATERIALS AND METHODS: Data for the study were obtained from the archives of the Department of Oral and Maxillofacial Pathology, diagnosed as the cases of Odontogenic cysts and tumors histopathologically, reported from January 2007 to March 2016. Case records of the patients that fit the histological classification of the World Health Organization (2005) were included in the study and the variables analyzed were: Age, sex, anatomical location, and histological type. RESULTS: In a total of 1319 biopsies reported, 112 were odontogenic in nature. Of these 112 odontogenic lesions reported, Odontogenic Cysts accounted for 54.4% and odontogenic tumors of 45.53%. Of them 61.60% of the patients were males. Common age of occurrence was 21-50 years and mandibular posterior was the most common site of occurrence. Most common odontogenic cyst and tumor reported was dentigerous cyst and ameloblastoma respectively. CONCLUSION: This study provides epidemiological information on odontogenic cyst and tumors at an institutional level. The relative frequency of these cysts and tumors can be analyzed at a global level to understand their prevalence, incidence, biological behaviour, and distribution.

Detection of microorganisms on formalin-fixed and stored pathology tissues: A microbiological study.

BACKGROUND: Formalin is widely used to fix histological preparations and as preservatives in embalming solutions and is an age-long practice in medical laboratories. It is generally accepted that the risk of contracting infections is relatively high among medical laboratory workers and pathologists. Recent studies have, however, suggested that formalin does not effectively inactivate all kinds of microbes in formalin-fixed tissue (FFT). Long time preserved tissues in formalin may develop growth of microbes on the surface of the formalin. AIMS AND OBJECTIVES: The purpose of the study is to determine the growth of microorganisms on the surface of FFTs. MATERIALS AND METHODS: Fifty-one containers of 10% formalin with fixed tissues and undiscarded formalin solution not containing tissues of years 2013-2015 (17 in each year) were selected, and samples for inoculation onto the cysteine lactose electrolyte deficient agar plates were taken from the surface of the FFT using sterile cotton tips. The growth of the colonies was checked for after 48 h. RESULTS: Out of 51 samples from 2013 to 2015, 17 had shown growth of microbial colonies. Six out of 17 samples of 2013, 7 out of 17 of 2014 and 4 out of 17 samples of 2015 had colonies of microbes on agar plates. Gram-negative bacilli, Bacillus subtilis and micrococci were mostly found. CONCLUSION: There were viable microbes on the surfaces of formalin solution containing pathology tissue. Since cross-contamination by microbes may occur during regrossing or processing, protocols to decrease cross-contamination should be instituted.

Evaluation of (89)Zr-pertuzumab in Breast cancer xenografts.

Pertuzumab is a monoclonal antibody that binds to HER2 and is used in combination with another HER2-specific monoclonal antibody, trastuzumab, for the treatment of HER2+ metastatic breast cancer. Pertuzumab binds to an HER2 binding site distinct from that of trastuzumab, and its affinity is enhanced when trastuzumab is present. We aim to exploit this enhanced affinity of pertuzumab for its HER2 binding epitope and adapt this antibody as a PET imaging agent by radiolabeling with (89)Zr to increase the sensitivity of HER2 detection in vivo. Here, we investigate the biodistribution of (89)Zr-pertuzumab in HER2-expressing BT-474 and HER2-nonexpressing MDA-MB-231 xenografts to quantitatively assess HER2 expression in vivo. In vitro cell binding studies were performed resulting in retained immunoreactivity and specificity for HER2-expressing cells. In vivo evaluation of (89)Zr-pertuzumab was conducted in severely combined immunodeficient mice, subcutaneously inoculated with BT-474 and MDA-MB-231 cells. (89)Zr-pertuzumab was systemically administered and imaged at 7 days postinjection (p.i.) followed by terminal biodistribution studies. Higher tumor uptake was observed in BT-474 compared to MDA-MB-231 xenografts with 47.5 ± 32.9 and 9.5 ± 1.7% ID/g, respectively at 7 days p.i (P = 0.0009) and blocking studies with excess unlabeled pertuzumab showed a 5-fold decrease in BT-474 tumor uptake (P = 0.0006), confirming the in vivo specificity of this radiotracer. Importantly, we observed that the tumor accumulation of (89)Zr-pertuzumab was increased in the presence of unlabeled trastuzumab, at 173 ± 74.5% ID/g (P = 0.01). Biodistribution studies correlate with PET imaging quantification using max SUV (r = 0.98, P = 0.01). Collectively, these results illustrate that (89)Zr-pertuzumab as a PET imaging agent may be beneficial for the quantitative and noninvasive assessment of HER2 expression in vivo especially for patients undergoing trastuzumab therapy.

Short-term malaria reduction by single-dose azithromycin during mass drug administration for trachoma, Tanzania.

Single-dose mass drug administration of azithromycin (AZT) is underway to eliminate trachoma worldwide. Studies in Ethiopia showed a reduction in all-cause childhood deaths after administration. To examine the effect of single-dose AZ MDA on prevalent malaria infections in a large prospective cohort of children and parents in Dodoma Province, Tanzania, we quantified the temporal prevalence of malaria parasitemia by real-time PCR for 6 months after single-dose AZT. In the first month after treatment but not in subsequent months, Plasmodium falciparum infections were reduced by 73% (95% CI 43%-89%) in treatment versus control villages and differences remained significant (p = 0.00497) in multivariate models with village-level random effects. Genetic sequencing of P. falciparum ribosomal L4 protein showed no mutations associated with AZT resistance. AZT mass drug administration caused a transient, 1-month antimalarial effect without selecting for P. falciparum ribosomal L4 resistance mutations in a region with a 10-year history of treating trachoma with this drug.

Enhancement of protease production by Pseudomonas aeruginosa isolated from dairy effluent sludge and determination of its fibrinolytic potential

Objective: The present study aimed at isolating proteolytic bacteria from dairy effluent sludge, designing the process parameters for the enhanced production of protease and determination of its fibrinolytic potential. Methods: The dairy sludge was processed according to the microbiological criteria for the isolation of proteolytic bacteria. All the isolates were screened for their protease production ability and the isolate showing highest proteolysis was selected for further studies. Effects of various media components and process parameters like carbon and nitrogen supplementation, temperature, pH and incubation period were investigated. Partial purification of the protease was done using ammonium sulphate fractionation, following which its molecular weight and fibrinolytic activity were determined. Results: Based on the biochemical studies, the selected isolate was identified as Pseudomonas aeruginosa. The highest protease yield was obtained with maltose and yeast extract as supplements. The optimum pH, temperature and incubation period for protease production by the isolate was found to be 7.0, 37℃ and 48 h respectively. The partially purified enzyme preparation showed a single protein band in sodium dodecyl sulphate polyacrylamide gel electrophoresis, revealing the apparent molecular weight of the enzyme to be 35 kDa. The efficient removal of the blood stain emphasized its fibrinolytic potential. Conclusions: From the present study it is envisaged that cultural parameters significantly affect the protease production. Based upon the fibrinolytic activity, this protease may find broad applications in detergent and pharmaceutical industries.