Tzu Chi Medical Journal

Female genital mutilation; culture, religion, and medicalization, where do we direct our searchlights for it eradication: Nigeria as a case study Olalekan Olugbenga Awolola, NA Ilupeju Tzu Chi Medical Journal 2019 31(1):1-4 Female genital mutilation (FGM) is a form of violence against the girls and the women and also an infringement into the rights of the women in the society. It is practiced mostly in Africa, but migration has revolutionized its spread to almost all parts of the world. The government and the constituted authorities, our traditional rulers, the legislative, the judiciary, and the law enforcement agents have the machineries to stop this inhuman behavior, but they lack the will and the necessary information about the incidence and consequences of FGM. The review involved Internet and literature search mostly those written on the African continent and some that were specific to Nigeria from 1999 to 2018. This article reviewed the spread, the obstetrics and the gynecological complications, the roles of the traditional circumcisers, and the negative and the positive roles of the caregivers, especially its medicalization in the abandonment of FGM in Nigeria. The article also looked critically at the best ways to achieve zero tolerance to FGM. To achieve the targeted zero tolerance to FGM, the identified factors have to be tackled holistically.

The roles of anti-citrullinated protein antibodies in the immunopathogenesis of rheumatoid arthritis Hui-Chun Yu, Ming-Chi Lu Tzu Chi Medical Journal 2019 31(1):5-10 Rheumatoid arthritis (RA) is a common systemic autoimmune disease. Its major manifestation is persistent joint inflammation, which can lead to bone destruction and severe disability. The immunopathogenesis of RA is very complex, involving both innate and adaptive immune systems. Recently, the discovery of anti-citrullinated protein antibodies (ACPAs) has revolutionized the diagnosis and our understanding of the immunopathogenesis of RA. The presence of ACPAs is also closely linked to the disease activity of RA. Therefore, it is reasonable to believe that ACPAs and protein citrullination are key issues for the development of RA. We have summarized the recent study results in this review. The first theory concerning the pathogenesis of RA proposed that ACPAs link the well-known genetic and environmental risk factors for developing RA. However, due to the close association between joint inflammation and ACPAs, a more direct role of ACPAs in the immunopathogenesis of RA is anticipated. Within the past 10 years, many studies, including some of our own, have shown that ACPAs can promote an inflammatory response through complement activation, formation of neutrophil extracellular traps, and direct binding to key players, including monocytes, osteoclasts, and osteoblasts, in the mediation of bone destruction in the joints of RA patients. We also present some new perspectives and issues that need to be further investigated.

Transplanting human umbilical cord mesenchymal stem cells and hyaluronate hydrogel repairs cartilage of osteoarthritis in the minipig model Kun-Chi Wu, Yu-Hsun Chang, Hwan-Wun Liu, Dah-Ching Ding Tzu Chi Medical Journal 2019 31(1):11-19 Objectives: Osteoarthritis (OA) is a chronic disease of degenerative joints. Mesenchymal stem cells (MSCs) have been used for cartilage regeneration in OA. We investigated the therapeutic potential of human umbilical cord-derived MSCs (HUCMSCs) with hyaluronic acid (HA) hydrogel transplanted into a porcine OA preclinical model. Materials and Methods: The HUCMSCs were characterized with respect to morphology, surface markers, and differentiation capabilities. Quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) was used to examine gene expressions in a HUCMSC–HA coculture. Two healthy female minipigs weighing 30–40 kg and aged approximately 4 months were used in this large animal study. A full-thickness chondral injury was created in the trochlear groove of each of the pig's rear knees. After 3 weeks, a second osteochondral defect was created. Then, 1.5 mL of a HUCMSC (5 × 106 cells) and HA composite (4%) was transplanted into the chondral-injured area in the right knee of each pig. Using the same surgical process, an osteochondral defect (untreated) was created in the left knee as a control. The pigs were sacrificed 12 weeks after transplantation. Macroscopic and microscopic histologies, qRT-PCR, and immunostaining evaluated the degree of chondral degradation. Results: The HUCMSCs exhibited typical MSC characteristics, including spindle morphology, expression of surface markers (positive for CD29, CD4, CD73, CD90, and human leukocyte antigen [HLA]-ABC; negative for CD34, CD45, and HLA-DR), and multipotent differentiation (adipogenesis, osteogenesis, and chondrogenesis). More extensive proliferation of HUCMSCs was noted with 4% and 25% of HA than without HA. Expression of COL2A1 and aggrecan in the HUCMSC-derived chondrocytes was increased when HA was included. The treated knees showed significant gross and histological improvements in hyaline cartilage regeneration when compared to the control knees. The International Cartilage Repair Society histological score was higher for the treated knees than the control knees. Conclusion: Our findings suggest that cartilage regeneration using a mixture of HUCMSCs and HA in a large animal model may be an effective treatment for OA, and this study is a stepping stone toward the future clinical trials.

Human leukocyte antigen-A*33:03-B*58:01-DRB1*15:140, a deduced probable human leukocyte antigen haplotype in association with a human leukocyte antigen low-incidence allele DRB1*15:140 in Taiwanese individuals: A case analysis Kuo-Liang Yang, Zheng-Zhong Zheng Tzu Chi Medical Journal 2019 31(1):20-22 Objective: Human leukocyte antigen (HLA)-DRB1*15:140 is a low-frequency allele in the HLA-DRB1 locus. The aim of this study is to confirm the ethnicity of DRB1*15:140 and to deduce a probable HLA-DRB1*15:140-associated HLA haplotype in Taiwanese individuals. Materials and Methods: A total of 1815 healthy unrelated Taiwanese individuals and 14,562 unrelated mainland Chinese individuals were tested for HLA using a sequence-based typing method. Polymerase chain reaction was performed to amplify exons 2 and 3 of the HLA-A and HLA-B loci and exons 1 and 2 of the HLA-DRB1 locus using group-specific primer sets. The amplicons were sequenced in both directions with the BigDye Terminator Cycle Sequencing Ready Reaction Kit according to the manufacturer's protocols. Results: The DNA sequence of HLA-DRB1*15:140 is identical to DRB1*15:02:01:01 in exons 1 and 2, except at residue 91 of DRB1*15:02:01:01 where a G in DRB1*15:02:01:01 is replaced by an A in DRB1*15:140 (codon 2; GAC->AAC). The nucleotide substitution in exon 1 introduces a one amino acid substitution at residue 2 where an aspartic acid (D) in DRB1*15:02:01:01 is replaced by an asparagine (N) in DRB1*15:140. We deduced the probable HLA haplotype associated with DRB1*15:140 in Taiwanese to be HLA-A*33:03-B*58:01-DRB1*15:140. Conclusion: Information on the ethnicity and distribution of DRB1*15:140 and its deduced probable HLA haplotype in association with the low-incidence allele is of value for HLA-testing laboratories for reference purposes and can help bone marrow donor registries find compatible donors for patients with this uncommon HLA allele.

Osteocalcin and carotid–femoral pulse wave velocity in patients on peritoneal dialysis Po-Jui Chi, Yu-Li Lin, Jen-Pi Tasi, Chih-Hsien Wang, Jia-Sian Hou, Chung-Jen Lee, Bang-Gee Hsu Tzu Chi Medical Journal 2019 31(1):23-28 Objective: Vascular calcification is a cardiovascular risk factor in dialysis patients. Vascular calcification involves a complex process of biomineralization resembling osteogenesis, which leads to arterial stiffness. Osteocalcin is the most abundant noncollagenous protein in the bone matrix. It is synthesized in the bone by osteoblasts and reflects the rate of bone formation. The aim of this study was to evaluate the relationship between serum osteocalcin levels and the carotid–femoral pulse wave velocity (cfPWV) in peritoneal dialysis (PD) patients. Materials and Methods: Serum intact osteocalcin and cfPWV were measured in 62 PD patients. Those with CfPWV values >10 m/s were defined as the high central arterial stiffness group, while those with values ≤10 m/s were regarded as the low central arterial stiffness group, according to the European Society of Hypertension and of the European Society of Cardiology guidelines. Results: Seventeen of the 62 PD patients (27.4%) were in the high central arterial stiffness group. The high central arterial stiffness group were older (P = 0.002), had a longer PD vintage (P = 0.018), and had higher serum osteocalcin levels (P = 0.001) than those in the low group. Multivariate logistic regression analysis showed that the osteocalcin level (odds ratio: 1.069, 95% confidence interval (CI): 1.005–1.137, P = 0.035), PD vintage (odds ratio: 1.028, 95% CI: 1.010–1.048, P = 0.003), and age (odds ratio: 1.081, 95% CI: 1.005–1.162, P = 0.035) were independently associated with central arterial stiffness in PD patients. Among these patients, cfPWV (ρ: 0.216, P = 0.001) values and log-transformed intact parathyroid hormone (ρ: −'0.447, P < 0.001) levels were independently associated with the osteocalcin level in PD patients after multivariate forward stepwise linear regression analysis. Conclusion: Older PD patients with a longer PD vintage and higher serum osteocalcin levels had higher central arterial stiffness as measured by cfPWV. The serum osteocalcin level is an independent marker of central arterial stiffness in PD patients.

Ovo-lactovegetarian diet as a possible protective factor against gallbladder polyps in Taiwan: A cross-sectional study Hao-Wen Liu, Cheng-Yu Chen Tzu Chi Medical Journal 2019 31(1):29-34 Objective: Gallbladder polyps (GBPs) are an increasingly common incidental finding and 3% to 8% of GBPs become malignant. A poor prognosis is expected in patients with gallbladder cancer. No studies have considered the relationship between diet and the development of GBPs in the Taiwanese population. The objective of this study was to investigate whether a vegetarian diet protects against GBP development. Materials and Methods: This cross-sectional study included 11,717 individuals who received a health checkup at Taipei Tzu Chi Hospital (New Taipei City, Taiwan) between October 2011 and October 2016. All individuals completed questionnaires that collected data about their characteristics, dietary patterns, and lifestyle. Physical examinations were conducted, and blood chemistry tests were performed. The presence of GBPs was determined using ultrasonography. We subsequently evaluated the association between diet and GBP prevalence using multivariate analysis. Results: The prevalence of GBPs for the entire group was 8.3%. GBPs were significantly less common in the vegetarian groups (vegans 9.0%, ovo-lacto vegetarians 7.5%, and semi-vegetarians 7.2%) compared with the omnivore group (9.6%) (P = 0.002). Step-wise logistic regression revealed that an ovo-lacto vegetarian diet was a possible protective factor (odds ratio = 0.83, P = 0.015). Conclusions: The study findings showed a strong negative association between an ovo-lacto vegetarian diet and GBP occurrence.

Treatment outcomes for multidrug-resistant tuberculosis in Eastern Taiwan Chih-Bin Lin, Hung-Chieh Sun, Chen-Yuan Chiang, Che-Wei Wu, Hsu-Wen Chou, Tao-Qian Tang, Jen-Jyh Lee Tzu Chi Medical Journal 2019 31(1):35-39 Objectives: The objective of this study is to evaluate the treatment outcomes of patients with multidrug-resistant tuberculosis (MDR-TB) under special programmatic management in Eastern Taiwan over the past 10 years. Materials and Methods: All newly diagnosed MDR-TB patients and MDR-TB patients enrolled previously with persistent positive cultures were included in this study, from May 2007 to April 2017, in Eastern Taiwan. A panel of pulmonologists designed the initial MDR-TB regimens. Subsequently, regimens were adjusted according to drug susceptibility test results for second-line drugs. Mobile teams were organized for treatment support, and several measures were adapted to safeguard effective treatment support. Results: A total of 178 patients with bacteriological confirmed pulmonary MDR-TB were identified, of whom 167 had treatment outcomes when the study was conducted. Of these 167 patients, 120 (71.9%) were cured, 11 (6.5%) completed therapy (78.4% had successful treatment), 25 (15.0%) died, 9 (5.4%) had treatment failure, none were transferred out, and 2 (1.2%) were lost to follow-up. Surgery was performed on 8 (4.8%). Conclusions: This is an analysis of the treatment outcomes after adopting the Directly Observed Treatment, Short-course Plus program to treat MDR-TB patients in Eastern Taiwan. We had a low proportion of loss-to-follow-up, resulting in a high treatment success rate. This program serves as an effective model in providing quality care to patients with MDR-TB.

Prognosticators of hepatocellular carcinoma with intrahepatic vascular invasion Yuan-Chen Lo, Feng-Chun Hsu, Shih-Kai Hung, Kuo-Chih Tseng, Yu-His Hsieh, Moon-Sing Lee, Chih-Wei Tseng, Hon-Yi Lin, Liang-Cheng Chen, Wen-Yen Chiou Tzu Chi Medical Journal 2019 31(1):40-46 Objective: The prognosis of intrahepatic vascular invasion, including unilateral or main portal vein tumor thrombosis (PVTT) and hepatic vein thrombosis, is still poor. Many patients with intrahepatic vascular invasions never receive radiotherapy (RT). In recent years, more conformal RT techniques such as intensity-modulated RT (IMRT) have been developed and applied to treat other cancers and have significantly improved treatment results and decreased side effects. The purpose of this study is to evaluate the treatment results in patients with intrahepatic vascular invasion and explore the role of IMRT in these treatments. Materials and Methods: There were a total of 73 patients with newly diagnosed AJCC stage IIIB hepatocellular carcinoma (HCC), with either PVTT or hepatic vein tumor thrombosis between 2007 and 2015 in our hospital. IMRT was used for all patients who received RT. Prognostic factors, including treatment modalities, liver function, and comorbidities, were analyzed using univariate and multivariate analysis with the Cox model. Survival time was analyzed using the Kaplan–Meier method. Results: The longest follow-up time was 45.3 months. The median age was 67 years. Univariate analyses indicated that IMRT, transarterial chemoembolization (TACE), target therapy (sorafenib), tumor size, Child-Pugh class, and ascites were significantly associated with overall survival (OS). In multivariate analysis, IMRT (hazard ratio [HR], 0.495; P = 0.019), sorafenib (HR, 0.340; P = 0.013), tumor size (HR, 2.085; P = 0.020), and Child-Pugh class (P = 0.004), were independent prognostic predictors for patients with intrahepatic vessel invasion, but TACE and ascites were not. The outcomes of patients who had different treatment modalities were significantly different (P < 0.001). Patients who received IMRT with TACE had the best outcomes. Patients who received an RT dose above 5400 cGy had better outcomes than those who with a dose below 5400 cGy, although the results were not significantly different (P = 0.248). Conclusion: IMRT is an important treatment component for patients with intrahepatic vascular invasion. Combined treatment modalities, such as IMRT with TACE, could improve the outcomes of HCC patients with intrahepatic vessel invasion.

Medium-term clinical outcomes of laminoplasty with adjunct short anterior fusion in multilevel cervical myelopathy Tsung-Chiao Wu, Kuang-Ting Yeh, Ru-Ping Lee, Tzai-Chiu Yu, Ing-Ho Chen, Cheng-Huan Peng, Kuan-Lin Liu, Jen-Hung Wang, Wen-Tien Wu Tzu Chi Medical Journal 2019 31(1):47-51 Objectives: Expansive open-door laminoplasty (EOLP) is effective for multilevel cervical spondylotic myelopathy (MCSM). When MCSM is combined with one- or two-level segmental kyphosis, instability, or major anterior foci, EOLP with short-segment anterior cervical fusion (ACF) results in good short-term neurological recovery and can preserve postoperative range of motion (ROM). The objective of this study was to evaluate the medium-term clinical outcomes of this procedure and to analyze the risk factors affecting the neurological function at the last follow-up. Materials and Methods: A total of 87 patients were enrolled in this retrospective study conducted from January 2007 to May 2011. These patients exhibited MCSM with combined short segmental kyphosis, instability, or major anterior pathology, and received EOLP and short-segment anterior fusion. The follow-up period lasted at least 60 months. The radiographic outcomes were collected from plain radiographs with dynamic views checked preoperatively and at the last follow-up. Neurological status and visual analog scale scores for neck pain were evaluated. Logistic regression analysis was then applied to determine the correlation between radiographic parameters and rates of neurological recovery. Results: The mean Japanese Orthopedics Association recovery rate at the last follow-up was 77.8%. The improvement in functional scores and reduction in neck pain were statistically significant. The most influential risk factor affecting neurologic recovery was preoperative functional status. Conclusions: EOLP followed by short-segment ACF is a favorable treatment for patients with MCSM with concomitant short-segment kyphosis, instability, or major anterior pathology.

Magnetic resonance angiography determined variations in the circle of Willis: Analysis of a large series from a single center Reddy Ravikanth, Babu Philip Tzu Chi Medical Journal 2019 31(1):52-59 Objective: The purpose of this study is to evaluate and describe the prevalence and patterns of arterial variants in the circle of Willis (CW) seen in noncontrast three-dimensional time-of-flight magnetic resonance angiography in a series of patients with cerebral vascular accidents (CVAs). Materials and Methods: A descriptive study was undertaken in 200 patients who presented for screening for CVA in the Department of Radiodiagnosis and Imaging, St. John&#39;s Medical College Hospital, Bengaluru, from September 2014 to September 2016. Results: The most common types of CW in a single subject were anterior variant Type A and posterior variant Type E. Type A in the anterior circulation is the normal adult pattern. There is a single anterior communicating artery. The internal carotid artery bifurcates into the precommunicating segment of the anterior cerebral artery and middle cerebral artery. Type E in the posterior circulation is hypoplasia or absence of both posterior communicating arteries and isolation of the anterior and posterior parts of the circle at this level. Overall, CW variants were slightly more common in women than in men. Conclusion: Our findings show that the configuration of the CW may vary greatly in the general population. The wide range in the morphology of CW warrants further research on various races and larger populations to confirm the influence of genetic, regional, environmental, and hemodynamic factors or their combination.  REVIEW ARTICLES - CLINICAL   Female genital mutilation; culture, religion, and medicalization, where do we direct our searchlights for it eradication: Nigeria as a case study p. 1 Olalekan Olugbenga Awolola, NA Ilupeju DOI:10.4103/tcmj.tcmj_127_18   Female genital mutilation (FGM) is a form of violence against the girls and the women and also an infringement into the rights of the women in the society. It is practiced mostly in Africa, but migration has revolutionized its spread to almost all parts of the world. The government and the constituted authorities, our traditional rulers, the legislative, the judiciary, and the law enforcement agents have the machineries to stop this inhuman behavior, but they lack the will and the necessary information about the incidence and consequences of FGM. The review involved Internet and literature search mostly those written on the African continent and some that were specific to Nigeria from 1999 to 2018. This article reviewed the spread, the obstetrics and the gynecological complications, the roles of the traditional circumcisers, and the negative and the positive roles of the caregivers, especially its medicalization in the abandonment of FGM in Nigeria. The article also looked critically at the best ways to achieve zero tolerance to FGM. To achieve the targeted zero tolerance to FGM, the identified factors have to be tackled holistically. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta The roles of anti-citrullinated protein antibodies in the immunopathogenesis of rheumatoid arthritis p. 5 Hui-Chun Yu, Ming-Chi Lu DOI:10.4103/tcmj.tcmj_116_18   Rheumatoid arthritis (RA) is a common systemic autoimmune disease. Its major manifestation is persistent joint inflammation, which can lead to bone destruction and severe disability. The immunopathogenesis of RA is very complex, involving both innate and adaptive immune systems. Recently, the discovery of anti-citrullinated protein antibodies (ACPAs) has revolutionized the diagnosis and our understanding of the immunopathogenesis of RA. The presence of ACPAs is also closely linked to the disease activity of RA. Therefore, it is reasonable to believe that ACPAs and protein citrullination are key issues for the development of RA. We have summarized the recent study results in this review. The first theory concerning the pathogenesis of RA proposed that ACPAs link the well-known genetic and environmental risk factors for developing RA. However, due to the close association between joint inflammation and ACPAs, a more direct role of ACPAs in the immunopathogenesis of RA is anticipated. Within the past 10 years, many studies, including some of our own, have shown that ACPAs can promote an inflammatory response through complement activation, formation of neutrophil extracellular traps, and direct binding to key players, including monocytes, osteoclasts, and osteoblasts, in the mediation of bone destruction in the joints of RA patients. We also present some new perspectives and issues that need to be further investigated. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta ORIGINAL ARTICLES - BASIC Transplanting human umbilical cord mesenchymal stem cells and hyaluronate hydrogel repairs cartilage of osteoarthritis in the minipig model p. 11 Kun-Chi Wu, Yu-Hsun Chang, Hwan-Wun Liu, Dah-Ching Ding DOI:10.4103/tcmj.tcmj_87_18   Objectives: Osteoarthritis (OA) is a chronic disease of degenerative joints. Mesenchymal stem cells (MSCs) have been used for cartilage regeneration in OA. We investigated the therapeutic potential of human umbilical cord-derived MSCs (HUCMSCs) with hyaluronic acid (HA) hydrogel transplanted into a porcine OA preclinical model. Materials and Methods: The HUCMSCs were characterized with respect to morphology, surface markers, and differentiation capabilities. Quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) was used to examine gene expressions in a HUCMSC–HA coculture. Two healthy female minipigs weighing 30–40 kg and aged approximately 4 months were used in this large animal study. A full-thickness chondral injury was created in the trochlear groove of each of the pig's rear knees. After 3 weeks, a second osteochondral defect was created. Then, 1.5 mL of a HUCMSC (5 × 106 cells) and HA composite (4%) was transplanted into the chondral-injured area in the right knee of each pig. Using the same surgical process, an osteochondral defect (untreated) was created in the left knee as a control. The pigs were sacrificed 12 weeks after transplantation. Macroscopic and microscopic histologies, qRT-PCR, and immunostaining evaluated the degree of chondral degradation. Results: The HUCMSCs exhibited typical MSC characteristics, including spindle morphology, expression of surface markers (positive for CD29, CD4, CD73, CD90, and human leukocyte antigen [HLA]-ABC; negative for CD34, CD45, and HLA-DR), and multipotent differentiation (adipogenesis, osteogenesis, and chondrogenesis). More extensive proliferation of HUCMSCs was noted with 4% and 25% of HA than without HA. Expression of COL2A1 and aggrecan in the HUCMSC-derived chondrocytes was increased when HA was included. The treated knees showed significant gross and histological improvements in hyaline cartilage regeneration when compared to the control knees. The International Cartilage Repair Society histological score was higher for the treated knees than the control knees. Conclusion: Our findings suggest that cartilage regeneration using a mixture of HUCMSCs and HA in a large animal model may be an effective treatment for OA, and this study is a stepping stone toward the future clinical trials. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Human leukocyte antigen-A*33:03-B*58:01-DRB1*15:140, a deduced probable human leukocyte antigen haplotype in association with a human leukocyte antigen low-incidence allele DRB1*15:140 in Taiwanese individuals: A case analysis p. 20 Kuo-Liang Yang, Zheng-Zhong Zheng DOI:10.4103/tcmj.tcmj_72_18   Objective: Human leukocyte antigen (HLA)-DRB1*15:140 is a low-frequency allele in the HLA-DRB1 locus. The aim of this study is to confirm the ethnicity of DRB1*15:140 and to deduce a probable HLA-DRB1*15:140-associated HLA haplotype in Taiwanese individuals. Materials and Methods: A total of 1815 healthy unrelated Taiwanese individuals and 14,562 unrelated mainland Chinese individuals were tested for HLA using a sequence-based typing method. Polymerase chain reaction was performed to amplify exons 2 and 3 of the HLA-A and HLA-B loci and exons 1 and 2 of the HLA-DRB1 locus using group-specific primer sets. The amplicons were sequenced in both directions with the BigDye Terminator Cycle Sequencing Ready Reaction Kit according to the manufacturer's protocols. Results: The DNA sequence of HLA-DRB1*15:140 is identical to DRB1*15:02:01:01 in exons 1 and 2, except at residue 91 of DRB1*15:02:01:01 where a G in DRB1*15:02:01:01 is replaced by an A in DRB1*15:140 (codon 2; GAC->AAC). The nucleotide substitution in exon 1 introduces a one amino acid substitution at residue 2 where an aspartic acid (D) in DRB1*15:02:01:01 is replaced by an asparagine (N) in DRB1*15:140. We deduced the probable HLA haplotype associated with DRB1*15:140 in Taiwanese to be HLA-A*33:03-B*58:01-DRB1*15:140. Conclusion: Information on the ethnicity and distribution of DRB1*15:140 and its deduced probable HLA haplotype in association with the low-incidence allele is of value for HLA-testing laboratories for reference purposes and can help bone marrow donor registries find compatible donors for patients with this uncommon HLA allele. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta ORIGINAL ARTICLES - CLINICAL RESEARCH Osteocalcin and carotid–femoral pulse wave velocity in patients on peritoneal dialysis p. 23 Po-Jui Chi, Yu-Li Lin, Jen-Pi Tasi, Chih-Hsien Wang, Jia-Sian Hou, Chung-Jen Lee, Bang-Gee Hsu DOI:10.4103/tcmj.tcmj_12_18   Objective: Vascular calcification is a cardiovascular risk factor in dialysis patients. Vascular calcification involves a complex process of biomineralization resembling osteogenesis, which leads to arterial stiffness. Osteocalcin is the most abundant noncollagenous protein in the bone matrix. It is synthesized in the bone by osteoblasts and reflects the rate of bone formation. The aim of this study was to evaluate the relationship between serum osteocalcin levels and the carotid–femoral pulse wave velocity (cfPWV) in peritoneal dialysis (PD) patients. Materials and Methods: Serum intact osteocalcin and cfPWV were measured in 62 PD patients. Those with CfPWV values >10 m/s were defined as the high central arterial stiffness group, while those with values ≤10 m/s were regarded as the low central arterial stiffness group, according to the European Society of Hypertension and of the European Society of Cardiology guidelines. Results: Seventeen of the 62 PD patients (27.4%) were in the high central arterial stiffness group. The high central arterial stiffness group were older (P = 0.002), had a longer PD vintage (P = 0.018), and had higher serum osteocalcin levels (P = 0.001) than those in the low group. Multivariate logistic regression analysis showed that the osteocalcin level (odds ratio: 1.069, 95% confidence interval (CI): 1.005–1.137, P = 0.035), PD vintage (odds ratio: 1.028, 95% CI: 1.010–1.048, P = 0.003), and age (odds ratio: 1.081, 95% CI: 1.005–1.162, P = 0.035) were independently associated with central arterial stiffness in PD patients. Among these patients, cfPWV (ρ: 0.216, P = 0.001) values and log-transformed intact parathyroid hormone (ρ: −'0.447, P < 0.001) levels were independently associated with the osteocalcin level in PD patients after multivariate forward stepwise linear regression analysis. Conclusion: Older PD patients with a longer PD vintage and higher serum osteocalcin levels had higher central arterial stiffness as measured by cfPWV. The serum osteocalcin level is an independent marker of central arterial stiffness in PD patients. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Ovo-lactovegetarian diet as a possible protective factor against gallbladder polyps in Taiwan: A cross-sectional study p. 29 Hao-Wen Liu, Cheng-Yu Chen DOI:10.4103/tcmj.tcmj_16_18   Objective: Gallbladder polyps (GBPs) are an increasingly common incidental finding and 3% to 8% of GBPs become malignant. A poor prognosis is expected in patients with gallbladder cancer. No studies have considered the relationship between diet and the development of GBPs in the Taiwanese population. The objective of this study was to investigate whether a vegetarian diet protects against GBP development. Materials and Methods:This cross-sectional study included 11,717 individuals who received a health checkup at Taipei Tzu Chi Hospital (New Taipei City, Taiwan) between October 2011 and October 2016. All individuals completed questionnaires that collected data about their characteristics, dietary patterns, and lifestyle. Physical examinations were conducted, and blood chemistry tests were performed. The presence of GBPs was determined using ultrasonography. We subsequently evaluated the association between diet and GBP prevalence using multivariate analysis. Results:The prevalence of GBPs for the entire group was 8.3%. GBPs were significantly less common in the vegetarian groups (vegans 9.0%, ovo-lacto vegetarians 7.5%, and semi-vegetarians 7.2%) compared with the omnivore group (9.6%) (P = 0.002). Step-wise logistic regression revealed that an ovo-lacto vegetarian diet was a possible protective factor (odds ratio = 0.83, P = 0.015). Conclusions: The study findings showed a strong negative association between an ovo-lacto vegetarian diet and GBP occurrence. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Treatment outcomes for multidrug-resistant tuberculosis in Eastern Taiwan p. 35 Chih-Bin Lin, Hung-Chieh Sun, Chen-Yuan Chiang, Che-Wei Wu, Hsu-Wen Chou, Tao-Qian Tang, Jen-Jyh Lee DOI:10.4103/tcmj.tcmj_18_18   Objectives: The objective of this study is to evaluate the treatment outcomes of patients with multidrug-resistant tuberculosis (MDR-TB) under special programmatic management in Eastern Taiwan over the past 10 years. Materials and Methods: All newly diagnosed MDR-TB patients and MDR-TB patients enrolled previously with persistent positive cultures were included in this study, from May 2007 to April 2017, in Eastern Taiwan. A panel of pulmonologists designed the initial MDR-TB regimens. Subsequently, regimens were adjusted according to drug susceptibility test results for second-line drugs. Mobile teams were organized for treatment support, and several measures were adapted to safeguard effective treatment support. Results: A total of 178 patients with bacteriological confirmed pulmonary MDR-TB were identified, of whom 167 had treatment outcomes when the study was conducted. Of these 167 patients, 120 (71.9%) were cured, 11 (6.5%) completed therapy (78.4% had successful treatment), 25 (15.0%) died, 9 (5.4%) had treatment failure, none were transferred out, and 2 (1.2%) were lost to follow-up. Surgery was performed on 8 (4.8%). Conclusions: This is an analysis of the treatment outcomes after adopting the Directly Observed Treatment, Short-course Plus program to treat MDR-TB patients in Eastern Taiwan. We had a low proportion of loss-to-follow-up, resulting in a high treatment success rate. This program serves as an effective model in providing quality care to patients with MDR-TB. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Prognosticators of hepatocellular carcinoma with intrahepatic vascular invasion p. 40 Yuan-Chen Lo, Feng-Chun Hsu, Shih-Kai Hung, Kuo-Chih Tseng, Yu-His Hsieh, Moon-Sing Lee, Chih-Wei Tseng, Hon-Yi Lin, Liang-Cheng Chen, Wen-Yen Chiou DOI:10.4103/tcmj.tcmj_14_18   Objective: The prognosis of intrahepatic vascular invasion, including unilateral or main portal vein tumor thrombosis (PVTT) and hepatic vein thrombosis, is still poor. Many patients with intrahepatic vascular invasions never receive radiotherapy (RT). In recent years, more conformal RT techniques such as intensity-modulated RT (IMRT) have been developed and applied to treat other cancers and have significantly improved treatment results and decreased side effects. The purpose of this study is to evaluate the treatment results in patients with intrahepatic vascular invasion and explore the role of IMRT in these treatments. Materials and Methods: There were a total of 73 patients with newly diagnosed AJCC stage IIIB hepatocellular carcinoma (HCC), with either PVTT or hepatic vein tumor thrombosis between 2007 and 2015 in our hospital. IMRT was used for all patients who received RT. Prognostic factors, including treatment modalities, liver function, and comorbidities, were analyzed using univariate and multivariate analysis with the Cox model. Survival time was analyzed using the Kaplan–Meier method. Results: The longest follow-up time was 45.3 months. The median age was 67 years. Univariate analyses indicated that IMRT, transarterial chemoembolization (TACE), target therapy (sorafenib), tumor size, Child-Pugh class, and ascites were significantly associated with overall survival (OS). In multivariate analysis, IMRT (hazard ratio [HR], 0.495; P = 0.019), sorafenib (HR, 0.340; P = 0.013), tumor size (HR, 2.085; P= 0.020), and Child-Pugh class (P = 0.004), were independent prognostic predictors for patients with intrahepatic vessel invasion, but TACE and ascites were not. The outcomes of patients who had different treatment modalities were significantly different (P < 0.001). Patients who received IMRT with TACE had the best outcomes. Patients who received an RT dose above 5400 cGy had better outcomes than those who with a dose below 5400 cGy, although the results were not significantly different (P = 0.248). Conclusion: IMRT is an important treatment component for patients with intrahepatic vascular invasion. Combined treatment modalities, such as IMRT with TACE, could improve the outcomes of HCC patients with intrahepatic vessel invasion. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Medium-term clinical outcomes of laminoplasty with adjunct short anterior fusion in multilevel cervical myelopathy p. 47 Tsung-Chiao Wu, Kuang-Ting Yeh, Ru-Ping Lee, Tzai-Chiu Yu, Ing-Ho Chen, Cheng-Huan Peng, Kuan-Lin Liu, Jen-Hung Wang, Wen-Tien Wu DOI:10.4103/tcmj.tcmj_22_18   Objectives: Expansive open-door laminoplasty (EOLP) is effective for multilevel cervical spondylotic myelopathy (MCSM). When MCSM is combined with one- or two-level segmental kyphosis, instability, or major anterior foci, EOLP with short-segment anterior cervical fusion (ACF) results in good short-term neurological recovery and can preserve postoperative range of motion (ROM). The objective of this study was to evaluate the medium-term clinical outcomes of this procedure and to analyze the risk factors affecting the neurological function at the last follow-up. Materials and Methods: A total of 87 patients were enrolled in this retrospective study conducted from January 2007 to May 2011. These patients exhibited MCSM with combined short segmental kyphosis, instability, or major anterior pathology, and received EOLP and short-segment anterior fusion. The follow-up period lasted at least 60 months. The radiographic outcomes were collected from plain radiographs with dynamic views checked preoperatively and at the last follow-up. Neurological status and visual analog scale scores for neck pain were evaluated. Logistic regression analysis was then applied to determine the correlation between radiographic parameters and rates of neurological recovery. Results: The mean Japanese Orthopedics Association recovery rate at the last follow-up was 77.8%. The improvement in functional scores and reduction in neck pain were statistically significant. The most influential risk factor affecting neurologic recovery was preoperative functional status. Conclusions: EOLP followed by short-segment ACF is a favorable treatment for patients with MCSM with concomitant short-segment kyphosis, instability, or major anterior pathology. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Magnetic resonance angiography determined variations in the circle of Willis: Analysis of a large series from a single center p. 52 Reddy Ravikanth, Babu Philip DOI:10.4103/tcmj.tcmj_167_17   Objective: The purpose of this study is to evaluate and describe the prevalence and patterns of arterial variants in the circle of Willis (CW) seen in noncontrast three-dimensional time-of-flight magnetic resonance angiography in a series of patients with cerebral vascular accidents (CVAs). Materials and Methods: A descriptive study was undertaken in 200 patients who presented for screening for CVA in the Department of Radiodiagnosis and Imaging, St. John's Medical College Hospital, Bengaluru, from September 2014 to September 2016. Results:The most common types of CW in a single subject were anterior variant Type A and posterior variant Type E. Type A in the anterior circulation is the normal adult pattern. There is a single anterior communicating artery. The internal carotid artery bifurcates into the precommunicating segment of the anterior cerebral artery and middle cerebral artery. Type E in the posterior circulation is hypoplasia or absence of both posterior communicating arteries and isolation of the anterior and posterior parts of the circle at this level. Overall, CW variants were slightly more common in women than in men. Conclusion: Our findings show that the configuration of the CW may vary greatly in the general population. The wide range in the morphology of CW warrants further research on various races and larger populations to confirm the influence of genetic, regional, environmental, and hemodynamic factors or their combination. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta CASE REPORTS Janus kinase 2 V617F mutation in an unrelated peripheral blood stem cell donor p. 60 Shang-Hsien Yang, Hsiang-Lin Wan, Ming-Hui Gu, Tso-Fu Wang DOI:10.4103/tcmj.tcmj_189_17   Polycythemia vera (PV) is relatively uncommon in early adulthood, and evidence about the prevalence of the Janus kinase 2 (JAK2) V617F mutation in the general population is limited. Here, we report a previously healthy volunteer peripheral blood stem cell (PBSC) donor who developed symptomatic PV with the JAK2 V617F mutation 2 years after PBSC mobilization and harvest. The characteristic mutation was identified retrospectively in the blood sample of the donor at the confirmation typing stage, which was before granulocyte colony-stimulating factor injection. This report presents a safety issue for both donor and recipient of hematopoietic stem cell transplantation. Clinicians should be aware of this during health workup and postdonation follow-up of unrelated PBSC donors. Any abnormal and/or equivocal laboratory data, especially during the donor workup stage, should not be overlooked. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta A rare case of septic cavernous sinus thrombosis as a complication of sphenoid sinusitis p. 63 Ming-Chun Chen, Yu-Huai Ho, Pau-Nyen Chong, Jui-Hsia Chen DOI:10.4103/tcmj.tcmj_1_18   Isolated sphenoid sinusitis is a rare disorder and may present with severe complications due to its proximity to the orbital and intracranial areas. We report a 13-year-old boy hospitalized for septic shock with fever of unknown origin. Facial palsy was later noted. Brain magnetic resonance imaging showed a sphenoid mass and right cavernous sinus and internal jugular vein thrombosis. Biopsy revealed chronic rhinosinusitis. Complete recovery followed by an incision/drainage procedure and antibiotic treatment. Acute sphenoid sinusitis should be included in the differential diagnosis of septic manifestations mimicking central nervous system infection or cranial nerve palsy. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta LETTER TO THE EDITOR Dengue fever with chikungunya concurrent infection p. 66 Pathum Sookaromdee, Viroj Wiwanitkit DOI:10.4103/tcmj.tcmj_121_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Orofacial Sciences

Dentists as Vanguard of Oral Health Rooban Thavarajah Journal of Orofacial Sciences 2018 10(2):57-58

Clinical Complications in Procedures for Horizontal Bone Augmentation Through Autologous Onlay Grafts Obtained From the Mandibular Ramus: An Observational Study Daniel R.B de Resende, Aline Siqueira, Eduardo Rosas, Eduardo Borie Echevarría Journal of Orofacial Sciences 2018 10(2):59-62 Aim and Objective : The aim of this study was to describe clinically the prevalence of postsurgical complications in a group of patients treated with autologous bone grafts obtained from the mandibular ramus. Materials and Methods: Data were obtained from a sample of 76 adults, who were subjected to a surgical procedure of horizontal bone augmentation through autologous onlay bone grafts obtained from the oblique line of mandible. A total of 113 onlay grafts were removed and placed in 152 recipients’ area, previously fitted to the receptor site and stabilized through two fixation screws. All complications were recorded in relation to the recipient and donor sites, and the follow-up time of the sample was of 2 years. Results: Of the entire sample studied, 69.7% did not show any type of postsurgical complication; however, 30.3% of them exhibited a type of complication, with temporary paresthesia being the most prevalent (7.9%). Conclusion: More than 30% of the patients that received horizontal bone augmentation through autologous onlay bone grafts obtained from the oblique line according to the conventional technique showed some type of postsurgical complication.

Age Estimation by Modified Demirjian's Method in Children and Adolescents of Hyderabad Population—A Panoramic Study M. Priyanka, G. Kiran, R. Poornima, R. Shravani, K. C. Shobhita, P. Preethi Journal of Orofacial Sciences 2018 10(2):63-68 Introduction: Human identification is one of the most important tasks of forensic practitioner. Estimation of age is one of the essential factors which play a significant role in each aspect of life, including forensic medicine and dentistry, wherein race, age, and sex determination are used in person identification. Aims and Objectives: To correlate the relationship between chronological age (CA) with dental age (DA) using modified Demirjian’s method and to establish the applicability of modified Demirjian’s method in Hyderabad population. Materials and Methods: Our study samples consist of 113 randomly selected samples (39 males and 74 females) of age ranging from 8 to 20 years of Hyderabad population for children and adolescents. Panoramic radiographs of these patients were evaluated based on the modified Demirjian’s method. The obtained data were tabulated and analyzed using SPSS version 20.0. Results: The present study showed a significant correlation between CA and DA in both females (r = 0.84) and males (r = 0.882). The overall mean difference between the DA and CA for females and males was +1.14 and +0.86, respectively. In the whole sample, DA was found to be over estimated by +1.04 with CA. Conclusion: DA overestimated the CA by +1.04 years. According to the present study, there was a difference and overestimation of DA in comparison with CA in Hyderabad population and hence population specific formula for each area is necessary.

Comparison of the Shear Bond Strength of Treated and Untreated Brackets on Treated and Untreated Enamel Surfaces in Rebonding Delal Dara Kilinc, Gülşilay Sayar Journal of Orofacial Sciences 2018 10(2):69-74 Aim and Objective: This study aimed to compare the shear bond strength (SBS) of treated and untreated brackets on treated and untreated enamel surfaces in rebonding. The null hypothesis was that there was no difference between the SBS of the treated and untreated rebonded brackets on treated and untreated enamel surfaces. Materials and Methods: Fifty extracted premolars were bonded by the same conventional bonding method and then debonded, and the SBS of each tooth was recorded. The debonded brackets and teeth were divided into two equal groups. In the first group, the debonded brackets were recycled by direct flaming followed by alumina oxide sandblasting, and the teeth were treated with a tungsten carbide bur applied with a low-speed hand piece. In the second group, neither the teeth surfaces nor the bracket bases were treated. Rebonding was performed followed by debonding, and the SBS of each tooth was recorded again. Results: Both rebonded bracket groups showed lower SBS results than that of the first debonding tests. A statistically significant difference was found within the untreated bracket groups between the first and second debonding test (P < 0.001). Conclusion: The rebonding of treated enamel surfaces and treated bracket bases showed higher SBS values compared to the untreated ones. The null hypothesis was rejected.

Association of Maternal and Child Dental Anxiety With Dental Caries Experience and Dental Attendance Pattern of the Child Shruti Balasubramanian, Suprabha B Shrikrishna, Ramya Shenoy, Arathi Rao Journal of Orofacial Sciences 2018 10(2):75-79 Introduction: Children with early childhood caries may have dental anxiety. Maternal anxiety can influence the child dental anxiety. Aims and Objective: To explore the association of maternal and child dental anxiety with the dental caries experience and the dental attendance pattern of the child. Materials and Methods: This cross-sectional study involved 227 mother–child dyads with children aged between 3 and 6 years. Mothers answered a questionnaire on dental attendance pattern. Corah’s dental anxiety scale was used to assess maternal anxiety, and facial image scale was used to assess dental anxiety in children. The “dmft” index of the child was recorded by a calibrated dentist. Statistical tests (Chi-square and Student’s t-tests) were employed to analyze the data, and P < 0.05 was considered significant. Result: Maternal anxiety was significantly associated with the mean number of missing and filled teeth in children (P = 0.005; P < 0.001, respectively). Child anxiety was significantly associated with the mean number of missing teeth (P < 0.001), increased frequency of missed dental appointments (P = 0.003), and decreased the frequency of dental visits (P = 0.008). Conclusion: Both maternal and child dental anxiety can influence the dental caries experience of the child. The dental anxiety of the child can influence the dental attendance pattern.

Assessment of Sagittal Skeletal Base Relationship of Maxilla and Mandible by Horizontal Appraisal Method—A Comparative and Reliability Study Paoulomi Roy, Supriya Nambiar, B. Unnikrishnan, Asavari Desai, C. Suresh Journal of Orofacial Sciences 2018 10(2):80-85 Introduction: The evaluation of antero-posterior apical base relationship is crucial before orthodontic diagnosis and treatment planning. Aim and Objectives: The present study is aimed to compare the credibility of five cephalometric measurements in assessing the antero-posterior jaw relationship and to assess the correlation between various measurements used for antero-posterior discrepancy, including ANB, Yen angle, Beta angle, Wits appraisal, and horizontal appraisal. Materials and Methods: A total of 99 patients aged 16 years and above patients were subdivided into skeletal Classes I, II, and III groups of 33, each based upon the ANB angle derived from the pretreatment cephalogram. Results: The results showed that AH/BH and ANB had very high sensitivity and specificity to discriminate a Class II from Class I and Class III from Class I. Wits, YEN, and Beta showed lower specificity to differentiate Class II from Class I and Wits and Yen to differentiate Class III from Class I except Beta which had 100% sensitivity to differentiate Class III from Class I. Conclusion: The horizontal appraisal method enriches the current cephalometric tools available for the clinician to assess the antero-posterior jaw relationship accurately and reproducibly.

A Study on Drug-Induced Tardive Dyskinesia: Orofacial Musculature Involvement and Patient's Awareness Arunachalam M Anusa, Rooban Thavarajah, Dinesh Nayak, Elizabeth Joshua, Umadevi Krishnamohan Rao, Kannan Ranganathan Journal of Orofacial Sciences 2018 10(2):86-95 Aim and Objective: Schizophrenia is a psychiatric disorder that requires long-term treatment. Long-term antipsychotic treatment is often associated with the emergence of tardive dyskinesia (TD), the severity of which is measured by Abnormal Involuntary Movement Scale (AIMS). This study examined the relationship among TD, orofacial musculature activity, and patient’s awareness of Abnormal Involuntary Movement (AIM). The knowledge would help dentists to deliver oral care for schizophrenics with TD. Materials and Methods: We identified 317 patients from a standard, data sharing initiative, of whom 38.3% exhibited AIM score of 2 to 15. The patient demographics, drug history, details of AIMS were subjected to descriptive and inferential statistical analysis using SPSS with P ≤ 0.05 as significance. Results: The mean of only orofacial features (n = 56) was 3.43 ± 2.68. Muscles of facial expression was involved in nine (7.9% of all TD), lip/perioral area in 27 (23.68%), jaw in 52 (45.61%), and tongue in 77 (67.54%). The patient’s perception of AIM precipitated stress when involving jaw, tongue, limbs, and trunk was statistically significant (P ≤ 0.05). The multiple regression model statistically significantly predicted TD for factors considered. Conclusion: Around 1% of global population is being diagnosed with schizophrenia, carry an inherent risk of developing TD. They might have orodental care requirements, including prosthodontic and restorative services. Primary physicians and dentists need to be aware of TD and its mechanism for appropriate patient management.

Effect of Orthodontic Sealant Containing Antimicrobial Selenium on the Shear Bond Strength of Orthodontic Bracket Pinandi S Pudyani, Fibriana Safitri, Ananto A Alhasyimi Journal of Orofacial Sciences 2018 10(2):96-100 Intoduction: Fixed orthodontic treatment has a high risk of enamel demineralization. Sealant containing selenium is a material that has been developed to prevent enamel demineralization and stated to be applicable as a primer bracket adhesion. Aim and Objective: This aim of this study was to investigate the shear bond strength (SBS) of an orthodontic bracket after application of sealant containing selenium as a primer. Materials and Methods: A total of 100 extracted human premolars were used in this study, which were randomly divided into two groups. Group I consisted of 50 teeth as the control group, to which a conventional primer (CP) was applied, whereas for group II comprising 50 teeth, a sealant containing selenium selenium primer (SP) was applied. SBS of the orthodontic brackets was measured using a universal testing machine. The adhesive remnant index (ARI) scores were calculated to determine the location of the bond failure using a stereomicroscope. A t test was used for analyzing the SBS data, whereas the Mann–Whitney test was used for analyzing the ARI scores. Results: There was no significant SBS difference (P > 0.05) between CP and SP groups. CP groups showed slightly higher SBS [9.05 ± 3.10 megapascal (MPa)] than that in the SP groups (8.21 ± 3.78 MPa). The bond failures of both the groups occurred at the adhesive–adhesive interface. Conclusion: The results showed that sealant containing selenium can be used as a primer within orthodontic adhesive material, as the physical–mechanical properties remained unchanged.

Does Darkening of Roots or Loss of White Line on Panoramic Radiographs Pose a Risk for Inferior Alveolar Nerve Damage? A CBCT Evaluation Chintan M Savani, Kishan Panicker, B. Sarat Ravi Kiran, Uday Kiran Uppada Journal of Orofacial Sciences 2018 10(2):101-107 Introduction: Surgical removal of impacted mandibular third molars may cause dysesthesia due to damage to the inferior alveolar nerve (IAN), and the risk increases when there is direct contact between the nerve and the tooth root. An accurate preoperative radiographic examination using Cone beam computed tomography (CBCT) provides precise information pertaining the relationship between the third molar roots and the inferior alveolar canal. Aim & Objective: This study was intended to correlate the two panoramic radiographic findings in predicting the absence of corticalization between the mandibular canal and the third molar on cone beam computed tomography (CBCT) images and to evaluate the possibility of inferior alveolar nerve (IAN) injury. Materials and Methods: The study was conducted on 60 patients, who were divided into two groups of 30 each. Group I included 30 patients whose panoramic radiographic findings showed darkening of the root of impacted mandibular third molar. Group II included 30 patients whose panoramic radiographic findings showed interruption of white line of mandibular canal. The patients whose panoramic radiographic findings showed darkening of the root or interruption in the white line of the canal were subjected to CBCT examination. Surgical removal of impacted mandibular third molar in all the patients was performed under local anesthesia (LA). Evaluation for any nerve injury was performed and recorded as presence or absence of paresthesia at regular postoperatively. Results: The results of this study showed that 46.7% patients had absence of cortication in Group I (darkening of roots), whereas it was absent in 33.3% of patients in Group II (loss of white lines). Presence of cortication was seen in 53.3% of patients in Group I when compared to 66.7% in Group II. The difference between the groups was not found to be statistically significant. Conclusion: Darkening of roots and interruption of white line observed on panoramic radiographs, both as isolated findings and in association, were effective in determining the risk relationship between the tooth roots and the mandibular canal necessitating CBCT evaluation.

Cytological Method of Barr Body Expression in Dental Pulp Tissue at Varying Temperature Ambika Murugesan, Sekar Balakrishnan, Indra Priyadharshini Kumaresan, Arun Jayakumar, Jayashree Mohan, Bharath Champakesan Journal of Orofacial Sciences 2018 10(2):108-111 Introduction: Natural disasters in large population need major attention in person identification. It can be performed by means of simple techniques that are easier to use. Aim: To identify the Barr body in female dental pulp by cytological method, after exposing at varying temperature. Objective: The expression of Barr bodies was compared among different age groups, various temperature, and two types of stain. Materials and Methods: Teeth obtained from 60 female individuals were divided into two groups based on their age. In each group, 30 teeth were exposed at three different temperatures (200&#176;C, 300&#176;C, and 400&#176;C), 10 teeth in each temperature. The pulp tissue obtained from teeth was centrifuged and stained with hematoxylin and eosin (H&E) and Papanicolaou stain (PAP). Presence of visible sex chromatin in the nuclear periphery was considered positive for Barr chromatin test. The results obtained were analyzed by both descriptive analysis and independent t-test. Result: The peripherally condensed Barr body in hyperchromatic nuclear outline was clearly visible in younger individuals at 200&#176;C and is more accurately expressed in H&E stain. Conclusion: In our study, based on the results obtained from the smear of pulp tissue, expression of Barr bodies&#8217; decreases as age and temperature increases. Further study with increase in sample size is mandatory to confirm the above conclusion.  EDITORIAL   Dentists as Vanguard of Oral Health p. 57 Rooban Thavarajah DOI:10.4103/jofs.jofs_147_18   [HTML Full text]  [PDF]  [Sword Plugin for Repository]Beta ORIGINAL ARTICLES Clinical Complications in Procedures for Horizontal Bone Augmentation Through Autologous Onlay Grafts Obtained From the Mandibular Ramus: An Observational Study p. 59 Daniel R.B de Resende, Aline Siqueira, Eduardo Rosas, Eduardo Borie Echevarría DOI:10.4103/jofs.jofs_119_17   Aim and Objective : The aim of this study was to describe clinically the prevalence of postsurgical complications in a group of patients treated with autologous bone grafts obtained from the mandibular ramus. Materials and Methods: Data were obtained from a sample of 76 adults, who were subjected to a surgical procedure of horizontal bone augmentation through autologous onlay bone grafts obtained from the oblique line of mandible. A total of 113 onlay grafts were removed and placed in 152 recipients' area, previously fitted to the receptor site and stabilized through two fixation screws. All complications were recorded in relation to the recipient and donor sites, and the follow-up time of the sample was of 2 years. Results: Of the entire sample studied, 69.7% did not show any type of postsurgical complication; however, 30.3% of them exhibited a type of complication, with temporary paresthesia being the most prevalent (7.9%). Conclusion: More than 30% of the patients that received horizontal bone augmentation through autologous onlay bone grafts obtained from the oblique line according to the conventional technique showed some type of postsurgical complication. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Age Estimation by Modified Demirjian's Method in Children and Adolescents of Hyderabad Population—A Panoramic Study p. 63 M. Priyanka, G. Kiran, R. Poornima, R. Shravani, K. C. Shobhita, P. Preethi DOI:10.4103/jofs.jofs_61_18   Introduction: Human identification is one of the most important tasks of forensic practitioner. Estimation of age is one of the essential factors which play a significant role in each aspect of life, including forensic medicine and dentistry, wherein race, age, and sex determination are used in person identification. Aims and Objectives: To correlate the relationship between chronological age (CA) with dental age (DA) using modified Demirjian's method and to establish the applicability of modified Demirjian's method in Hyderabad population. Materials and Methods: Our study samples consist of 113 randomly selected samples (39 males and 74 females) of age ranging from 8 to 20 years of Hyderabad population for children and adolescents. Panoramic radiographs of these patients were evaluated based on the modified Demirjian's method. The obtained data were tabulated and analyzed using SPSS version 20.0. Results: The present study showed a significant correlation between CA and DA in both females (r = 0.84) and males (r = 0.882). The overall mean difference between the DA and CA for females and males was +1.14 and +0.86, respectively. In the whole sample, DA was found to be over estimated by +1.04 with CA. Conclusion: DA overestimated the CA by +1.04 years. According to the present study, there was a difference and overestimation of DA in comparison with CA in Hyderabad population and hence population specific formula for each area is necessary. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comparison of the Shear Bond Strength of Treated and Untreated Brackets on Treated and Untreated Enamel Surfaces in Rebonding p. 69 Delal Dara Kilinc, Gülşilay Sayar DOI:10.4103/jofs.jofs_39_18   Aim and Objective: This study aimed to compare the shear bond strength (SBS) of treated and untreated brackets on treated and untreated enamel surfaces in rebonding. The null hypothesis was that there was no difference between the SBS of the treated and untreated rebonded brackets on treated and untreated enamel surfaces. Materials and Methods: Fifty extracted premolars were bonded by the same conventional bonding method and then debonded, and the SBS of each tooth was recorded. The debonded brackets and teeth were divided into two equal groups. In the first group, the debonded brackets were recycled by direct flaming followed by alumina oxide sandblasting, and the teeth were treated with a tungsten carbide bur applied with a low-speed hand piece. In the second group, neither the teeth surfaces nor the bracket bases were treated. Rebonding was performed followed by debonding, and the SBS of each tooth was recorded again. Results:Both rebonded bracket groups showed lower SBS results than that of the first debonding tests. A statistically significant difference was found within the untreated bracket groups between the first and second debonding test (P < 0.001). Conclusion: The rebonding of treated enamel surfaces and treated bracket bases showed higher SBS values compared to the untreated ones. The null hypothesis was rejected. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Association of Maternal and Child Dental Anxiety With Dental Caries Experience and Dental Attendance Pattern of the Child p. 75 Shruti Balasubramanian, Suprabha B Shrikrishna, Ramya Shenoy, Arathi Rao DOI:10.4103/jofs.jofs_7_18   Introduction: Children with early childhood caries may have dental anxiety. Maternal anxiety can influence the child dental anxiety. Aims and Objective: To explore the association of maternal and child dental anxiety with the dental caries experience and the dental attendance pattern of the child. Materials and Methods:This cross-sectional study involved 227 mother–child dyads with children aged between 3 and 6 years. Mothers answered a questionnaire on dental attendance pattern. Corah's dental anxiety scale was used to assess maternal anxiety, and facial image scale was used to assess dental anxiety in children. The "dmft" index of the child was recorded by a calibrated dentist. Statistical tests (Chi-square and Student's t-tests) were employed to analyze the data, and P < 0.05 was considered significant. Result: Maternal anxiety was significantly associated with the mean number of missing and filled teeth in children (P = 0.005; P < 0.001, respectively). Child anxiety was significantly associated with the mean number of missing teeth (P < 0.001), increased frequency of missed dental appointments (P = 0.003), and decreased the frequency of dental visits (P = 0.008). Conclusion: Both maternal and child dental anxiety can influence the dental caries experience of the child. The dental anxiety of the child can influence the dental attendance pattern. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Assessment of Sagittal Skeletal Base Relationship of Maxilla and Mandible by Horizontal Appraisal Method—A Comparative and Reliability Study p. 80 Paoulomi Roy, Supriya Nambiar, B. Unnikrishnan, Asavari Desai, C. Suresh DOI:10.4103/jofs.jofs_14_18   Introduction: The evaluation of antero-posterior apical base relationship is crucial before orthodontic diagnosis and treatment planning. Aim and Objectives: The present study is aimed to compare the credibility of five cephalometric measurements in assessing the antero-posterior jaw relationship and to assess the correlation between various measurements used for antero-posterior discrepancy, including ANB, Yen angle, Beta angle, Wits appraisal, and horizontal appraisal. Materials and Methods: A total of 99 patients aged 16 years and above patients were subdivided into skeletal Classes I, II, and III groups of 33, each based upon the ANB angle derived from the pretreatment cephalogram. Results: The results showed that AH/BH and ANB had very high sensitivity and specificity to discriminate a Class II from Class I and Class III from Class I. Wits, YEN, and Beta showed lower specificity to differentiate Class II from Class I and Wits and Yen to differentiate Class III from Class I except Beta which had 100% sensitivity to differentiate Class III from Class I. Conclusion: The horizontal appraisal method enriches the current cephalometric tools available for the clinician to assess the antero-posterior jaw relationship accurately and reproducibly. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta A Study on Drug-Induced Tardive Dyskinesia: Orofacial Musculature Involvement and Patient's Awareness p. 86 Arunachalam M Anusa, Rooban Thavarajah, Dinesh Nayak, Elizabeth Joshua, Umadevi Krishnamohan Rao, Kannan Ranganathan DOI:10.4103/jofs.jofs_82_18   Aim and Objective: Schizophrenia is a psychiatric disorder that requires long-term treatment. Long-term antipsychotic treatment is often associated with the emergence of tardive dyskinesia (TD), the severity of which is measured by Abnormal Involuntary Movement Scale (AIMS). This study examined the relationship among TD, orofacial musculature activity, and patient's awareness of Abnormal Involuntary Movement (AIM). The knowledge would help dentists to deliver oral care for schizophrenics with TD. Materials and Methods:We identified 317 patients from a standard, data sharing initiative, of whom 38.3% exhibited AIM score of 2 to 15. The patient demographics, drug history, details of AIMS were subjected to descriptive and inferential statistical analysis using SPSS with P ≤ 0.05 as significance. Results: The mean of only orofacial features (n= 56) was 3.43 ± 2.68. Muscles of facial expression was involved in nine (7.9% of all TD), lip/perioral area in 27 (23.68%), jaw in 52 (45.61%), and tongue in 77 (67.54%). The patient's perception of AIM precipitated stress when involving jaw, tongue, limbs, and trunk was statistically significant (P ≤ 0.05). The multiple regression model statistically significantly predicted TD for factors considered. Conclusion: Around 1% of global population is being diagnosed with schizophrenia, carry an inherent risk of developing TD. They might have orodental care requirements, including prosthodontic and restorative services. Primary physicians and dentists need to be aware of TD and its mechanism for appropriate patient management. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Effect of Orthodontic Sealant Containing Antimicrobial Selenium on the Shear Bond Strength of Orthodontic Bracket p. 96 Pinandi S Pudyani, Fibriana Safitri, Ananto A Alhasyimi DOI:10.4103/jofs.jofs_16_18   Intoduction: Fixed orthodontic treatment has a high risk of enamel demineralization. Sealant containing selenium is a material that has been developed to prevent enamel demineralization and stated to be applicable as a primer bracket adhesion. Aim and Objective: This aim of this study was to investigate the shear bond strength (SBS) of an orthodontic bracket after application of sealant containing selenium as a primer. Materials and Methods: A total of 100 extracted human premolars were used in this study, which were randomly divided into two groups. Group I consisted of 50 teeth as the control group, to which a conventional primer (CP) was applied, whereas for group II comprising 50 teeth, a sealant containing selenium selenium primer (SP) was applied. SBS of the orthodontic brackets was measured using a universal testing machine. The adhesive remnant index (ARI) scores were calculated to determine the location of the bond failure using a stereomicroscope. A t test was used for analyzing the SBS data, whereas the Mann–Whitney test was used for analyzing the ARI scores. Results: There was no significant SBS difference (P > 0.05) between CP and SP groups. CP groups showed slightly higher SBS [9.05 ± 3.10 megapascal (MPa)] than that in the SP groups (8.21 ± 3.78 MPa). The bond failures of both the groups occurred at the adhesive–adhesive interface. Conclusion: The results showed that sealant containing selenium can be used as a primer within orthodontic adhesive material, as the physical–mechanical properties remained unchanged. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Does Darkening of Roots or Loss of White Line on Panoramic Radiographs Pose a Risk for Inferior Alveolar Nerve Damage? A CBCT Evaluation p. 101 Chintan M Savani, Kishan Panicker, B. Sarat Ravi Kiran, Uday Kiran Uppada DOI:10.4103/jofs.jofs_98_18   Introduction: Surgical removal of impacted mandibular third molars may cause dysesthesia due to damage to the inferior alveolar nerve (IAN), and the risk increases when there is direct contact between the nerve and the tooth root. An accurate preoperative radiographic examination using Cone beam computed tomography (CBCT) provides precise information pertaining the relationship between the third molar roots and the inferior alveolar canal. Aim & Objective: This study was intended to correlate the two panoramic radiographic findings in predicting the absence of corticalization between the mandibular canal and the third molar on cone beam computed tomography (CBCT) images and to evaluate the possibility of inferior alveolar nerve (IAN) injury. Materials and Methods: The study was conducted on 60 patients, who were divided into two groups of 30 each. Group I included 30 patients whose panoramic radiographic findings showed darkening of the root of impacted mandibular third molar. Group II included 30 patients whose panoramic radiographic findings showed interruption of white line of mandibular canal. The patients whose panoramic radiographic findings showed darkening of the root or interruption in the white line of the canal were subjected to CBCT examination. Surgical removal of impacted mandibular third molar in all the patients was performed under local anesthesia (LA). Evaluation for any nerve injury was performed and recorded as presence or absence of paresthesia at regular postoperatively. Results: The results of this study showed that 46.7% patients had absence of cortication in Group I (darkening of roots), whereas it was absent in 33.3% of patients in Group II (loss of white lines). Presence of cortication was seen in 53.3% of patients in Group I when compared to 66.7% in Group II. The difference between the groups was not found to be statistically significant. Conclusion: Darkening of roots and interruption of white line observed on panoramic radiographs, both as isolated findings and in association, were effective in determining the risk relationship between the tooth roots and the mandibular canal necessitating CBCT evaluation. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Cytological Method of Barr Body Expression in Dental Pulp Tissue at Varying Temperature p. 108 Ambika Murugesan, Sekar Balakrishnan, Indra Priyadharshini Kumaresan, Arun Jayakumar, Jayashree Mohan, Bharath Champakesan DOI:10.4103/jofs.jofs_102_18   Introduction: Natural disasters in large population need major attention in person identification. It can be performed by means of simple techniques that are easier to use. Aim: To identify the Barr body in female dental pulp by cytological method, after exposing at varying temperature. Objective: The expression of Barr bodies was compared among different age groups, various temperature, and two types of stain. Materials and Methods: Teeth obtained from 60 female individuals were divided into two groups based on their age. In each group, 30 teeth were exposed at three different temperatures (200°C, 300°C, and 400°C), 10 teeth in each temperature. The pulp tissue obtained from teeth was centrifuged and stained with hematoxylin and eosin (H&E) and Papanicolaou stain (PAP). Presence of visible sex chromatin in the nuclear periphery was considered positive for Barr chromatin test. The results obtained were analyzed by both descriptive analysis and independent t-test. Result: The peripherally condensed Barr body in hyperchromatic nuclear outline was clearly visible in younger individuals at 200°C and is more accurately expressed in H&E stain. Conclusion: In our study, based on the results obtained from the smear of pulp tissue, expression of Barr bodies' decreases as age and temperature increases. Further study with increase in sample size is mandatory to confirm the above conclusion. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta The Effect of Platelet-Rich Fibrin on Soft Tissue and Crestal Bone in One-Stage Implant Placement in Fresh Extraction Sockets: A Randomized Controlled Clinical Trial p. 112 Kishore K Avula, Uma D Rayavaram, Sravanthi Gujjula, Siva Sai Prasad R Dandu, Prasuna Egatela, Ravindra R Nagireddy DOI:10.4103/jofs.jofs_132_18   Introduction: The goal of modern dentistry is to prevent tooth loss and provide a healthy dentition with optimal functional efficiency, structural balance, and aesthetic harmony. The placement of an implant immediately after tooth extraction helps to maintain the bone crest and leads to ideal implant positioning from a prosthetic point of view and has the potential of decreasing the total treatment time for patients. Aim and Objective: To evaluate the platelet rich fibrin with or without bone ceramic on soft issue and crestal bone in one stage implant placement in fresh extraction socket. Materials and Methods: A total of 30 patients were randomly assigned into two groups—each group comprising 15 patients based on platelet-rich fibrin with and without bone ceramic and one-stage implant placement in fresh extraction socket. All patients were prospectively evaluated clinically and radiographically. All the data were analyzed using a software statistical package for social sciences (SPSS) version 11.5 (Chicago, Illinois, USA). Results: During the 6-month interval, no implant was lost; the mean bone level at the implants increased in platelet-rich fibrin (PRF) with bone ceramic group and decreased in PRF group and papillary index increased in both the groups, whereas modified sulcus bleeding index and probing pocket depth (PPD) decreased in both the groups. Conclusion: It can be concluded that mean crestal bone levels increased in PRF with bone ceramic group, whereas decrease in PRF group and both the groups are statistically significant. When the papillary levels are compared between the two groups, there was no statistical significance, but increased papillary levels were found in both the groups. The mean PPD was decreased in both the groups, but there was no statistical significance between the two groups. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Two Different Methods for Collection of Gingival Crevicular Blood to Estimate Random Blood Glucose Levels—A Comparative Study p. 117 Aarthi Nisha Venkatesan, Julius Amaldas, Mohan Valiathan, Vidya Jayaram, Parthiban Jayaraman DOI:10.4103/jofs.jofs_141_18   Aim and Objective: The present study was done to validate a reliable method for collection of gingival crevicular blood (GCB) and to use it as an alternative to routinely collected venous blood (VB) to estimate random blood glucose (RBS) levels. Materials and Methods: The study group comprised of 50 type 2 diabetic patients (n = 50), aged between 21 and 80 years attending the outpatient department of Sree Balaji Dental College and Hospital, Chennai. The study was a cross-sectional observational study that comprised of thorough clinical evaluation and estimation of RBS levels from GCB by two different methods, namely, direct glucometric method and collection through capillary tube method. Results: Out of the 50 patients, 27 (54%) were females and 23 (46%) were males. All the patients were among 20 to 70 years of age. On comparing the RBS levels from gingival crevicular obtained by direct intraoral method and capillary tube method, a statistically significant correlation of P < 0.05 was obtained proving statistically significant results. Further on comparing the results with VB glucose levels, there was no statistically significant difference found among the methods. Conclusion: The above study concludes that GCB collected by both capillary tube and direct intraoral method yielded almost similar blood glucose results which conclude either of the methods can be used to collect the sample. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Is the Intention Being Realized in Execution: Evaluation of Oral Health Promotion Program at a South Indian University p. 121 Viswa C Chandu, Srinivas Pachava, Viswanath Vadapalli, Suresh Sanikommu DOI:10.4103/jofs.jofs_140_18   Introduction: There are accessibility problems for rural Indian population with respect to oral health care. Dental Council of India envisioned that establishment of satellite clinics would be a beneficial strategy for rural population to have better access to oral health care, curtailing the accessibility problems and financial barriers for oral health care utilization to some extent. Aim and Objective: The aim of this study was to procure data on the functioning of these satellite clinics and evaluate an oral health promotion program in a satellite clinic located in a South Indian university. Materials and Methods: A total of 301 participants were selected through two-stage random sampling to evaluate the functioning of a dental satellite clinic located in a South Indian university. The data collected include demographics, utilization of services at the satellite clinics, and self-reported oral and general health status. Results: The utilization of services was only 9.3%, and a majority of the participants were not aware of the existence of the clinic. Promotion of available services and provision of oral health education were the major suggestions received from the study participants. Conclusion:Evaluation of satellite clinics both from the students' perspective and with regard to oral health status of concerned populations must be seriously undertaken. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Bone Cells and Mast Cells Express MMP-9 During Tooth Eruption In Vivo p. 127 Nayra S.C Lima, Isabela R Magalhães, Lívia F Lima-Pansini, Letícia N Gama-de-Souza, Marcos S Pacheco, Karla L.A Coburn DOI:10.4103/jofs.jofs_122_18   Context: Tooth development takes place inside a bony crypt in the alveolar bones. Tooth eruption requires, therefore, the removal of bone and lamina propria to establish the eruptive pathway. Matrix metalloproteinases (MMPs) belong to a family of enzymes responsible for the degradation of the extracellular matrix (ECM). MMP-9 is a member of this family and is secreted by a variety of cells, including mast cells. Both have been identified as possible collaborators for tissue remodeling during tooth eruption. Aims: The aim of this study is to analyze the bone remodeling, MMP-9 expression, and the prevalence of mast cells throughout the eruptive process of rat molars. Materials and Methods: Twenty-eight rats (4–17 days old) were used in this study. Histomorphometric analyses were performed to determine the bone area in the basal and coronal regions of the bony crypt and the prevalence of mast cells at the lamina propria along the eruptive process. Immunohistochemistry was performed to detect MMP-9 expression in the lamina propria and alveolar bone. Results: Increased bone apposition at the base of the bony crypt was observed at 14 days and increased resorption of the coronal bone was detected after 9 days. An elevated number of mast cells was observed in 9-day-old rats, and MMP-9 was strongly expressed in mast cells and osteoclasts. Conclusion: Taken together, we suggest that mast cells may contribute to the recruitment of osteoclast precursors during tooth eruption and that MMP-9 is possibly involved in the removal of the ECM during the eruptive process. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta