Long-term cryopreservation of whole gingival tissue

Stem cells obtained from the body tissue, such as adipose tissue, dental pulp and gingival tissue. Fresh tissue is often used to isolate and culture for regenerative medicine. However, availability of tissue as and when required is one of the measure issue in regenerative medicine. Cryopreservation of tissue provides benefit over tissue availability, storage for significant amount of period and helps preserve the original cell structures. The effects of cryopreservation of gingival tissue for mesenchymal stem cell (MSC) are not well documented; however this process is of increasing importance for regenerative therapies. This study examined the effect of cryopreservation on the long term survival the whole gingival biopsy tissue. We studied cell outgrowth, cell morphology, MSC surface-markers and differentiation of mesenchymal stem cells derived from cryopreserved gingiva. In this study, gingival tissue was cryopreserved for 3, 6, 9 months. Cryopreserved tissue has been thawed and cells were isolated by using explant culture method. The fresh and cryopreserved gingival tissue cells were cultured and characterized for surface marker analysis, CFU-f, population doubling time, and osteogenic, chondrogenic and adipogenic differentiation. The fresh and cryopreserved tissue has similar stem cell properties. Results indicate that cryopreservation of the entire gingival tissue does not affect the properties of stem cells. This opens door for gingival tissue banking for future use in periodontology and regenerative medicine.

Efficacy of One Stage Full Mouth Disinfection on the Oral Health-Related Quality of Life in Patients with Generalised Chronic Periodontitis

Introduction: Intraoral translocation of periodontal pathogens from untreated intraoral niches can lead to recolonisation and reinfection of recently treated periodontal pockets. Poor oral health hampers the patient’s Quality of Life (QoL) as it causes social isolation, inferiority and the development of psychiatric conditions. Full Mouth Disinfection (FMD) performed within 24 hours using chlorhexidine has reported significant improvements in clinical, microbiological and psychological parameters when compared to conventional periodontal treatment. Aim: To investigate the long-term effect of FMD on Oral HealthRelated Quality of Life (OHRQoL) in patients with generalised chronic periodontitis. Materials and Methods: This study was a prospective clinical study conducted in the Department of Periodontology, Dr DY Patil Dental College and Hospital, Pune, Maharashtra, India, from October 2019 to December 2021. Study consisted of 60 participants who were allotted into two groups; 30 periodontally healthy volunteers (control group) and 30 patients (test group) diagnosed with generalised chronic periodontitis. The test group was asked to fill out the Oral Health Impact Profile-14 (OHIP-14) questionnaire to assess the OHRQoL at baseline followed by FMD protocol. All the patients were kept at periodic recall, and the OHRQoL was assessed again taken after one months three months, and six months. The control group was asked to fill out the questionnaire at the baseline. Repeated measure analysis of variance with post-hoc bonferroni test was used to compare differences in variation present from baseline to one month, three months and six months. For intergroup comparison at different time intervals, an unpaired t-test was applied. Results: The age group of participants ranged from 25- 55 years with a mean age of 41.3 years. Test group had 18 males and 12 females and, 20 males and 10 females were in the control group. The mean OHIP-14 score at baseline was 3.58±3.29 in the control group and 42.35±4.32 in the test group at baseline, showing a mean difference of -38.76±0.93, which was statistically significant. After one month there was a significant improvement in the OHIP-14 scores of the test group (26.35±2.60), which was further reduced to -13.58±0.81 and -9.0±0.88 by the end of three and six months. Therefore, a notable improvement in the QoL and periodontal conditions of the patients following FMD was appreciated. Conclusion: Periodontitis negatively impacts the OHRQoL. FMD provides an improvement in the perceived QoL among periodontitis patients.

N,N-Ru(II)-p-cymene-poly(N-vinylpyrrolidone) surface functionalized gold nanoparticles: from organoruthenium complex to nanomaterial for antiproliferative activity

Organometallic Ru-arene complexes are promising as anticancer agents, but the lack of tumor uptake and poor solubility in the physiological medium impede their development. In order to deal with these challenges, we developed gold nanoparticles coated with Ru(arene)-functionalized PNVP-Py, where PNVP-Py is pyridine end-functionalized poly(N-vinylpyrrolidone). It is demonstrated that these particles exhibit higher anti-proliferative activity than the individual organometallic ruthenium(ii) complex of the type [Ru(η6-p-cymene)(NN)Cl]PF6, where NN is bis(4-methoxyphenylimino)acenaphthene, against colorectal adenocarcinoma cell lines. More specifically, a RuII(η6-p-cymene) complex containing a NN bidentate ligand has been prepared and characterized by spectral studies and X-ray crystallography. To tether the isolated complex onto the surface of the AuNPs, PNVP-Py, which contains a pyridine group at one end to coordinate to the Ru-complex and a suitable functional group at the other end to bind on the surface of the AuNPs, has been prepared and utilized to obtain the macromolecular complex [Ru(η6-p-cymene)(NN)(PNVP-Py)]Cl2. Next, stable Ru(p-cym)(NN)(PNVP-Py)@AuNPs were obtained via a ligand exchange reaction of citrate-stabilized AuNPs with a macromolecular complex by a direct 'grafting to' approach and characterized well. Despite the lower DNA cleavage activity, the nanoconjugate exhibits better cytotoxicity than the individual complex against HT-29 colorectal adenocarcinoma cells on account of its enhanced permeability across the cell membrane. The AO/EB staining assay revealed that the nanoconjugate is able to induce an apoptotic mode of cell death, which was further quantitatively evaluated by Annexin V-FITC/PI double assay. An immunofluorescence assay indicated the higher potency of the nanoconjugate to inhibit cyclin D1 gene expression that is required for cancer cell growth. To the best of our knowledge, this is the first report of the modification of an organometallic Ru(arene) complex into a Ru(arene)metallopolymer-gold nanoconjugate for the development of ruthenium-based nanomedicine for cancer treatment.

GCF and serum levels of omentin in periodontal health and disease of diabetic and non-diabetic individuals: A comparative study

Background

Omentin is an adipocytokine secreted by visceral adipose tissue cells associated with the action of insulin-increasing, insulin-facilitated glucose uptake.

Aim

The aim of this study was to compare and evaluate the levels of omentin in gingival crevicular fluid (GCF) and serum of periodontally healthy individuals and chronic periodontitis (CP) patients with and without type 2 diabetes mellitus (T2DM).

Settings and Design

A hospital-based comparative study was conducted amongst 40 subjects of age group 30-50 years.

Methods

Subjects were divided into four groups, group I (10 healthy individuals), group II (10 T2DM), group III (10 CP only) and group IV (10 patients with CP and T2DM). Clinical and systemic parameters assessed were gingival index (GI), plaque index (PI), probing pocket depth (PPD), periodontal attachment level (PAL) and glycated haemoglobin (HbA_1c). Serum and GCF samples were collected and analysed for omentin levels using the enzyme-linked immunosorbent assay (ELISA).

Results

Although the mean GCF omentin levels were highest in group I and lowest in group IV, it was not statistically significant. However, the serum omentin levels were statistically significant, showing the highest mean level in group I and lowest in group IV and serum levels were statistically significant. Also, the serum omentin levels had a negative correlation with HbA_1c.

Conclusion

The levels of omentin reflect the diabetic status of an individual, which suggests that omentin can be a potential anti-inflammatory marker and a therapeutic agent for conditions like CP and T2DM.

Encapsulation of a Ru(η6-p-cymene) complex of the antibacterial drug trimethoprim into a polydiacetylene-phospholipid assembly to enhance its in vitro anticancer and antibacterial activities

The first report of a Ru(arene)–liposome nanoaggregate to enhance the in vitro anticancer activity of a Ru–arene complex in liver cancer cells.

Efficacy of green tea-based mouthwashes on dental plaque and gingival inflammation: A systematic review and meta-analysis

Objectives

The purpose of this study was to conduct a systematic review and if appropriate a meta-analysis of the efficacy of daily rinsing with green tea-based mouthwashes in terms of plaque index (PI) and/or gingival index (GI) as compared to other mouthwashes in plaque-induced gingivitis patients.

Materials and Methods

MEDLINE, Cochrane Central Register of Controlled Trials, IndMed, Google Scholar, and major journals were searched for studies up to December 2016. A comprehensive search strategy was designed, and the eligible articles were independently screened for eligibility by two reviewers. Randomized controlled trials in which individuals were intervened with oral mouthwashes of interest were included. Where appropriate, a meta-analysis was performed and standardized mean differences (SMDs) for GI and PI were calculated.

Results

A total of 9 articles out of the 311 titles met the eligibility criteria. A meta-analysis was performed for five studies that compared green tea-based mouthwashes with chlorhexidine (CHX). The SMD for PI was -0.14 (95% CI: -1.70, 1.43; P = 0.86 and I² = 94%), while that for GI was 0.43 ((95% CI: -0.63, 1.49; P = 0.43, I² = 89%). Both these estimates suffered from significant heterogeneity. For both PI and GI, two studies were in favor of green tea while three studies were in favor of CHX.

Conclusions

Green tea-based mouthwashes can be considered an alternative to CHX mouthwashes in sustaining oral hygiene, especially because of the added advantages provided by such herbal preparations.

Next-generation sequencing (NGS) of cell-free circulating tumor DNA and tumor tissue in patients with advanced urothelial cancer: a pilot assessment of concordance

Background

Advances in cancer genome sequencing have led to the development of various next-generation sequencing (NGS) platforms. There is paucity of data regarding concordance of different NGS tests carried out in the same patient.

Methods

Here, we report a pilot analysis of 22 patients with metastatic urinary tract cancer and available NGS data from paired tumor tissue [FoundationOne (F1)] and cell-free circulating tumor DNA (ctDNA) [Guardant360 (G360)].

Results

The median time between the diagnosis of stage IV disease and the first genomic test was 23.5 days (0-767), after a median number of 0 (0-3) prior systemic lines of treatment of advanced disease. Most frequent genomic alterations (GA) were found in the genes TP53 (50.0%), TERT promoter (36.3%); ARID1 (29.5%); FGFR2/3 (20.5%), PIK3CA (20.5%) and ERBB2 (18.2%). While we identified GA in both tests, the overall concordance between the two platforms was only 16.4% (0%-50%), and 17.1% (0%-50%) for those patients (n = 6) with both tests conducted around the same time (median difference = 36 days). On the contrary, in the subgroup of patients (n = 5) with repeated NGS in ctDNA after a median of 1 systemic therapy between the two tests, average concordance was 55.5% (12.1%-100.0%). Tumor tissue mutational burden was significantly associated with number of GA in G360 report (P < 0.001), number of known GA (P = 0.009) and number of variants of unknown significance (VUS) in F1 report (P < 0.001), and with total number of GA (non-VUS and VUS) in F1 report (P < 0.001).

Conclusions

This study suggests a significant discordance between clinically available NGS panels in advanced urothelial cancer, even when collected around the same time. There is a need for better understanding of these two possibly complementary NGS platforms for better integration into clinical practice.

Abstract P4-06-04: Germline alterations in African-American versus Caucasian patients with triple-negative breast cancer in the era of multi-gene panel testing

Background. Triple negative breast cancer (TNBC) has been associated with a relatively high rate of germline BRCA1/2 deleterious mutations (11-20%). With use of panel testing, additional predisposition genes are being identified. Among Caucasian (CC) patients (pts), pathogenic germline variants in BRCA1/2 are mainly associated with TNBC. However, these may not fully explain the higher incidence of TNBC among African Americans (AA). Additionally, partly due to under-testing among AA, the distribution of predisposition genes for AA TNBC pts is unknown, and a greater proportion of germline alterations may be classified as a variant of uncertain significance (VUS). We hypothesized that additional clinically significant germline mutations in genes, other than in BRCA1/2, may explain the increased incidence of TNBC among AA, which may be better elucidated by panel testing.

Methods. A retrospective chart review was completed of all self-identified CC and AA TNBC pts who presented to two institutions from 10/2013 to 12/2016. A total of 596 pts were analyzed. 434 (73%) were CC and 162 (27%) were AA. Clinicopathologic features including histologic subtype, age, gender, bilateral disease and stage were examined. Patients were assessed for meeting the National Comprehensive Cancer Network (NCCN) criteria for genetic testing in TNBC, type of testing performed, and the results. The distribution of mutations in higher penetrance genes (BRCA1, BRCA2, and PALB2), pathogenic variants in other genes, and VUS in AA vs. CC were analyzed. Significance was determined using a two-tailed Fisher exact test with significance of p&lt;0.05.

Results. 306/434 (71%) CC and 98/162 (60%) AA TNBC pts met criteria for genetic testing (p=0.023). For those who met NCCN criteria for testing, 216/306 (71%) CC and 66/98 (67%) AA TNBC pts underwent testing (p=0.61). For all pts, the average age of first diagnosis was 59.5 (SD 14) for CC vs. 62.4 (SD 12.9) for AA pts. For pts who underwent testing, regardless of meeting NCCN criteria, 18% (40/221) of CC vs.12% (8/68) of AA patients had a mutation in a higher penetrance gene (p=0.27), 1% (3/221) of CC vs. 3% (2/68) of AA had a mutation in other genes (BRIP1, Lynch genes; p=0.34), and 16% (36/221) of CC vs. 18% (12/68) of AA had a VUS (p=0.982). Of VUS, 42% (5/12) in AA vs. 19% (7/36) in CC were in higher penetrance breast cancer genes (p=0.14).

Conclusion. More CC than AA TNBC pts met criteria for genetic testing. This difference may in part be explained by the later age at diagnosis for AA given that age is a major factor in determining genetic testing. Broadening eligibility for testing in AA may help to identify more patients with an underlying genetic predisposition to TNBC. No difference was seen in the frequency of higher penetrance genes, other genes, and VUS between AA and CC pts. However, important non-BRCA genes were identified with panel testing in both AA and CC pts. In addition to broadening testing criteria for existing multi-gene panels, further genetic analysis may be necessary to explain the predisposition to TNBC in AA pts. To our knowledge, this is the first report of evaluation of predisposition genes among AA TNBC pts using germline panel testing.

Citation Format: Nizialek EA, Gopalakrishnan D, Yanda C, Abbas H, Kline M, Stephens M, Grobmyer SR, Eng C, Mitchell A, Pederson H, Vinayak S. Germline alterations in African-American versus Caucasian patients with triple-negative breast cancer in the era of multi-gene panel testing [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-06-04.

Abstract P4-10-13: Analyses of racial disparities in genetic testing and surgical management of patients with triple-negative breast cancer in the era of multigene panel testing

Background

Under-utilization of genetic counseling and testing among African-American (AA) women with breast cancer (BC) has been reported in previous studies, and there are concerns that disparities may widen with further genomic advances. Our objective was to compare AA and Caucasian (CC) patients with triple-negative breast cancer (TNBC) with regards to referral for genetic counseling, patterns of genetic testing, and patient-compliance with genetic counseling recommendations. We chose TNBC since a majority of these patients would qualify for genetic counseling ± testing. We also analyzed for differences between the two races in prevalence of deleterious BC-associated mutations, stage of BC on presentation, and surgical choices.

Methods

In this retrospective medical records-based observational study, we included all patients in our tumor registry with TNBC diagnosed between 09/01/2013 and 02/28/2017. Race, clinical characteristics and details pertaining to genetic counseling and testing were recorded. X2 test was used to compare categorical variables. A p-value &lt; 0.05 was considered significant.

Results

477 patients -358 CC and 96 AA- with TNBC were included. Mean age was 60.3 years. 331 patients met National Comprehensive Cancer Network (NCCN) criteria for genetic counseling - of these, 85.5% had genetic consult order placed, 72.8% attended counseling, and 71.9% underwent genetic testing (multigene panel testing 55.0%, BRCA 1/2 testing 39.9%, single-site testing 2.5%, and multisite-3 testing 2.5%). Between CC and AA, no significant differences were found in the proportion of qualifying patients who had referral for genetic counseling (84.7 vs 87.7%, p=0.562), attended counseling (72.2% vs 73.7%, p=0.816), or underwent genetic testing (72.1% vs 70.1%, p=0.764). The choices of type of genetic tests were also not significantly different between the two groups (p=0.349). Though the prevalence of highly penetrant mutations in breast cancer-associated genes trended to be higher among CC than AA (14.1% vs 9.5%), this difference did not reach statistical significance (p=0.429). In our population, stage of TNBC at presentation was comparable between the two races – 80.4% of CC presented with stage I or II disease compared to 80.2% of AA (p=0.931). The two groups were also comparable with regards to the choices of breast surgery and reconstruction, as shown in the table.

  CaucasiansAfrican-Americansp-valueSurgery TypePartial Mastectomy154(47.4%)38(44.7%)0.317 Unilateral Mastectomy101(31.1%)35(41.2%) Bilateral Mastectomy70(21.5%)12(14.1%)ReconstructionYes96(56.1%)24(51.1%)0.535 No75(43.9%)23(48.9%)Reconstruction TypeImplant87(90.6%)19(79.2%)0.118 Tissue Flap9(9.4%)5(20.8%)

Conclusions

Contrary to previous reports, in this cohort of TNBC patients, we did not identify significant disparities between AA and CC in patterns of referral for genetic counseling, in patient compliance with testing or in type of testing performed. Also, no significant differences were found between the two races in choices of breast surgery or reconstruction. As a caveat, with an overall insured rate of ˜97% across our network, the uninsured population may have been under-represented by our cohort.

Citation Format: Gopalakrishnan D, Yanda C, Abbas H, Kline M, Stephens M, Grobmyer SR, Pederson HJ. Analyses of racial disparities in genetic testing and surgical management of patients with triple-negative breast cancer in the era of multigene panel testing [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-13.

Comparative Evaluation of Bioactive Glass Putty and Platelet Rich Fibrin in the Treatment of Human Periodontal Intrabony Defects: A Randomized Control Trial

INTRODUCTION

Platelet-Rich Fibrin (PRF) and bioactive glass putty have been shown to be effective in promoting reduction in probing depth, gain in clinical attachment, and defect fill in intrabony periodontal defects. The individual role played by bioactive glass putty in combination with PRF is yet to be elucidated.

AIM

To compare the clinical effectiveness of the combination of PRF and bioactive glass putty and bioactive glass putty alone as regenerative techniques for intrabony defects in humans.

MATERIALS AND METHODS

Ten pairs of intrabony defects were surgically treated with PRF and bioactive glass putty (Test group) on one side or bioactive glass putty alone (Control group) on other side. The primary outcomes of the study included changes in probing depth; attachment level and bone fill of osseous defect. The clinical parameters were recorded at baseline, 3, 6, and 9 months. Radiographic assessment was done using standardized intraoral periapical radiographs. Differences between baseline and postoperative measurementsbetween the control and test groups were calculated using independent t-test. Comparisons were made within each group between baseline, 3 months, 6 months and 9 months using the ANOVA test followed by Bonferroni test.

RESULTS

The mean probing depth reduction was greater in the test group (bioactive glass putty and PRF) i.e., (3.2±2.3 mm) than in the control group (bioactive glass putty alone) i.e., (3.15±1.06 mm). The mean CAL gain was also greater in the test group (4.1±1.73 mm) as compared to the control group (3.15±1.06 mm), (p-value<0.95). Furthermore significantly greater mean bone fill was found in the test group (7.1±1.37 mm) as compared to the control group (5.7 ± 1.64 mm), (p-value<0.043).

CONCLUSION

The results of this study showed both the groups bioactive glass putty alone (Control Group) and the combination of PRF and bioactive glass putty (Test Group) are effective in the treatment of intrabony defects. The bioactive glass putty appears to be a suitable vehicle to administer biologic substances like PRF and growth factors to induce the new bone regeneration.

Salivary microbiome of an urban Indian cohort and patterns linked to subclinical inflammation

OBJECTIVE

To profile salivary microbiomes of an urban-living, healthy Indian cohort and explore associations with proinflammatory status.

METHODS

Fifty-one clinically healthy Indian subjects' salivary microbiomes were analyzed using 16S rRNA Illumina MiSeq sequencing. Community distribution was compared with salivary data from the Human Microbiome Project (HMP). Indian subjects were clustered using microbiome-based "partitioning along medoids" (PAM), and relationships of interleukin-1 beta levels with community composition were analyzed.

RESULTS

Indian subjects presented higher phylogenetic diversity than HMP. Several taxa associated with traditional societies gut microbiomes (Bacteroidales, Paraprevotellaceae, and Spirochaetaceae) were raised. Bifidobacteriaceae and Lactobacillaceae were approximately fourfold greater. A PAM cluster enriched in several Proteobacteria, Actinobacteria, and Bacilli taxa and having almost twofold higher Prevotella to Bacteroides ratio showed significant overrepresentation of subjects within the highest quartile of salivary interleukin-1 beta levels. Abiotrophia, Anaerobacillus, Micrococcus, Aggregatibacter, Halomonas, Propionivivrio, Paracoccus, Mannhemia, unclassified Bradyrhizobiaceae, and Caulobacteraceae were each significant indicators of presence in the highest interleukin-1 beta quartile. 2 OTUs representing Lactobacillus fermentum and Cardiobacterium hominis significantly correlated with interleukin-1 beta levels.

CONCLUSION

The salivary microbiome of this urban-dwelling Indian cohort differed significantly from that of a well-studied Western cohort. Specific community patterns were putatively associated with subclinical inflammation levels.

Water soluble Ru(ii)–arene complexes of the antidiabetic drug metformin: DNA and protein binding, molecular docking, cytotoxicity and apoptosis-inducing activity

The incorporation of antidiabetic drug metformin with organometallic Ru(arene) pharmacophore is a promising approach to develop new anticancer agents.

Association of Postmenopausal Osteoporosis and Periodontal Disease: A Double-Blind Case-Control Study

BACKGROUND

Both osteoporosis (OP) and periodontitis are chronic inflammatory diseases associated with bone loss mediated by local and systemic factors. The two diseases share common risk factors. Previous studies have suggested that OP in itself is a predisposing factor for periodontal tissue destruction in postmenopausal women. However, only a moderate correlation has been shown between the two conditions. In this study, we compared the severity of periodontal disease in postmenopausal osteoporotic women and postmenopausal women without OP.

MATERIALS AND METHODS

The study group consisted of 100 postmenopausal women in the age group of 50-65 years: Group 1 (50 osteoporotic) and Group 2 (50 non-osteoporotic women). Periodontal parameters included sulcus bleeding index, oral hygiene index simplified, probing pocket depth (PPD), and clinical attachment loss (CAL), interproximal alveolar bone loss (ABL), and number of missing teeth. The correlation of periodontal disease status with systemic bone mineral density (BMD) was evaluated by dual-energy X-ray absorptiometry.

RESULTS

The results indicated that osteoporotic (Group 1) women had a significantly greater PPD, CAL, and ABL when compared with the non-osteoporotic Group 2 (P < 0.0001). There was no significant correlation between BMD and various parameters between the groups.

CONCLUSIONS

Within the limitations of the present study it was noted that postmenopausal OP is associated with an increased incidence and severity of periodontal disease. Educating postmenopausal osteoporotic women regarding the importance of good oral care should be part of their management regime. Hence, it could be inferred a possibility of a probable relationship between OP and periodontal disease, but long-term prospective studies are warranted in the future in order to provide definitive evidence.

Diffuse pulmonary hemorrhage complicating thrombolytic therapy for acute myocardial infarction

Diffuse pulmonary hemorrhage has rarely been reported as a complication of thrombolytic therapy. Recently, two patients who developed this complication were observed at our institution. This diagnosis should be considered in any post-thrombolytic patient with respiratory distress, diffuse pulmonary infiltrates, and an otherwise unexplained fall in hemoglobin.

Cervico thoracic junction spinal tuberculosis presenting as radiculopathy

A case of cervico thoracic junctional area spinal tuberculosis presenting as painful radiculitis of the upper extremity is reported. The predominant symptom of radicular pain and muscle weakness in the hand, along with a claw deformity, led to considerable delay in diagnosis. The presence of advanced bone destruction with severe instability was demonstrated on the MRI scan done later. Surgical management by radical anterior debridement and fusion, along with chemotherapy, led to resolution of the upper extremity symptoms. The brachial plexus radiculopathy secondary to tuberculosis has not been reported. The absence of myelopathic signs even in the presence of advanced bone destruction, thecal compression and instability is uncommon in adults.

Vascularised rib graft defects of the diaphysis of the humerus in children. A report of two cases

In our practice sequestration of the shafts of long bones in children because of acute osteomyelitis continues to be a problem. Conventional procedures for bone grafting are likely to fail. Vascularised grafts with microvascular anastomosis are technically demanding with a high rate of failure. Transfer of the rib on its vascular pedicle to achieve anterior fusion in the thoracic spine is now well established and the length of the pedicle available is adequate to allow grafting of a diaphyseal defect in the humerus. We describe the successful use of this procedure in two patients.

Molecular heterogeneity in very-long-chain acyl-CoA dehydrogenase deficiency causing pediatric cardiomyopathy and sudden death

BACKGROUND

Genetic defects are being increasingly recognized in the etiology of primary cardiomyopathy (CM). Very-long-chain acyl-CoA dehydrogenase (VLCAD) catalyzes the first step in the beta-oxidation spiral of fatty acid metabolism, the crucial pathway for cardiac energy production.

METHODS AND RESULTS

We studied 37 patients with CM, nonketotic hypoglycemia and hepatic dysfunction, skeletal myopathy, or sudden death in infancy with hepatic steatosis, features suggestive of fatty acid oxidation disorders. Single-stranded conformational variance was used to screen genomic DNA. DNA sequencing and mutational analysis revealed 21 different mutations on the VLCAD gene in 18 patients. Of the mutations, 80% were associated with CM. Severe CM in infancy was recognized in most patients (67%) at presentation. Hepatic dysfunction was common (33%). RNA blot analysis and VLCAD enzyme assays showed a severe reduction in VLCAD mRNA in patients with frame-shift or splice-site mutations and absent or severe reduction in enzyme activity in all.

CONCLUSIONS

Infantile CM is the most common clinical phenotype of VLCAD deficiency. Mutations in the human VLCAD gene are heterogeneous. Although mortality at presentation is high, both the metabolic disorder and cardiomyopathy are reversible.

Asymmetry of the calves in the assessment of patients with suspected acute pulmonary embolism

PURPOSE

The purpose of this investigation was to evaluate measured asymmetry of the calves in the assessment of patients with suspected pulmonary embolism (PE).

METHODS

Patients randomized for pulmonary angiography in the collaborative study of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) were evaluated. Only patients in whom the circumference of the calves was measured were included in this evaluation of PIOPED data. Among these, 232 had angiographically diagnosed PE and 446 had no PE by angiography. For purposes of comparison, measurements of the calves also were made in a nonrandomized current cohort of 101 healthy subjects. All calf measurements were made 10 cm below the tibial tuberosity.

RESULTS

Asymmetry in the circumference of the calves of 1 cm or more was measured in 101 of 232 or 44% (95% confidence interval [CI], 37 to 51%) with PE, 176 of 446 or 39% (95% CI, 34 to 44%) without PE, and in 6 of 101 or 6% (95% CI, 1 to 11%) control subjects (PE vs control subjects, p < 0.001; subjects without PE vs control subjects, p < 0.001; PE vs no PE, p = NS). Among patients with PE, the addition of calf asymmetry of 1 cm or more to qualitative signs of deep venous thrombosis increased the prevalence of a detectable abnormality of the lower extremities from 62 of 232 or 27% (95% CI, 21 to 33%) to 129 of 232 or 56% (95% CI, 49 to 63% [p < 0.001]).

CONCLUSION

Asymmetry of the calves of 1 cm or more is abnormal. Such asymmetry of the calves did not distinguish between patients with PE and those with no PE. When considered in proper perspective with other nonspecific signs and symptoms in patients with suspected acute PE, however, subtle calf asymmetry may call attention to the possibility of thromboembolic disease. The observation of subtle asymmetry may indicate a need for noninvasive diagnostic tests of the lower extremities to determine whether deep venous thrombosis is present.

Microstructural organization of carbon induced neotendon

Experiments have been conducted in guinea pigs to replace the calcaneal tendon with carbon fibers. The new tendon formed has been studied macroscopically, histologically and by scanning electron microscopy, and shows a close resemblance to the normal tendinous structure but is adherent to the surrounding tissues. It is suggested that the surface characteristics of carbon fibers play an important role in that these attract and allow fibrinous exudate to spread on their surface, into which fibroblasts grow. This, together with the large surface area available, is probably responsible for the orderly longitudinal arrangement of collagen fibers parallel to the carbon fiber implant.