Research Spotlight

Chiruvolu, A., B. Petrey, K. C. Stanzo and Y. Daoud (2019). “An Institutional Approach to the Management of Asymptomatic Chorioamnionitis-Exposed Infants Born >/=35 Weeks Gestation.” Pediatr Qual Saf 4(6): e238.

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Our newborn practice routinely treated asymptomatic chorioamnionitis-exposed infants born at 35 weeks gestation or greater with empiric antibiotics. Starting April 1, 2017, we implemented an algorithm of not treating, unless there was an abnormal clinical and/or laboratory evaluation. The goal of this quality improvement initiative was to reduce the percentage of chorioamnionitis-exposed infants treated with antibiotics (primary outcome measure) to <50%. Methods: We compared 123 chorioamnionitis-exposed infants born 1 year before implementation (pre-algorithm group, April 1, 2016, to March 31, 2017) with 111 born 1 year following implementation (post-algorithm group, April 1, 2017, to March 31, 2018). The primary outcome measure was analyzed monthly using a run chart. Results: The maternal and neonatal characteristics were similar between both groups. Significantly fewer infants in the post-algorithm group received antibiotics compared with the pre-algorithm group (4.5% versus 96.8%; P < 0.01). There were no differences in median hospital length of stay or incidence of neonatal intensive care unit admissions between both groups. There were no positive blood cultures or readmissions within 7 days for early-onset sepsis in either group. Conclusion: An institutional approach of monitoring chorioamnionitis-exposed infants with a clinical and laboratory evaluation decreased antibiotic utilization in the mother-baby unit by 95% without an increase in hospital length of stay, neonatal intensive care unit admissions, or readmissions for early-onset sepsis.

Zhang, H., Li, L., Kesterke, M. J., Lu, Y. and Qin, C. (2020). “High-Phosphate Diet Improved the Skeletal Development of Fam20c-Deficient Mice.” Cells Tissues Organs Feb 26:1-12. [Epub ahead of print].

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FAM20C (family with sequence similarity 20 – member C) is a protein kinase that phosphorylates secretory proteins, including the proteins that are essential to the formation and mineralization of calcified tissues. Previously, we reported that inactivation of Fam20c in mice led to hypophosphatemic rickets/osteomalacia along with increased circulating fibroblast growth factor 23 (FGF23) levels and dental defects. In this study, we examined whether a high-phosphate (hPi) diet could rescue the skeletal defects in Fam20c-deficient mice. Fam20c conditional knockout (cKO) mice were generated by crossing female Fam20c-floxed mice (Fam20cfl/fl) with male Sox2-Cre;Fam20cfl/+ mice. The pregnant female Fam20cfi/fl mice were fed either a normal or hPi diet until the litters were weaned. The cKO and control offspring were continuously given a normal or hPi diet for 4 weeks after weaning. Plain X-ray radiography, micro-CT, histology, immunohistochemistry (FGF23, DMP1, OPN, and SOX9), and in situ hybridization (type II and type X collagen) analyses were performed to evaluate the effects of an hPi diet on the mouse skeleton. Plain X-ray radiography and micro-CT radiography analyses showed that the hPi diet improved the shape and mineral density of the Fam20c-deficient femurs/tibiae, and rescued the growth plate defects in the long bone. Histology analyses further demonstrated that an hPi diet nearly completely rescued the growth plate-widening defects in the long bone and restored the expanded hypertrophic zone to nearly normal width. These results suggested that the hPi diet significantly improved the skeletal development of the Fam20c-deficient mice, implying that hypophosphatemia partially contributed to the skeletal defects in Fam20c-deficient subjects.

Zapata, U. and Wang, Q. (2020). “Material properties of the skull layers of the primate parietal bone: A single-subject study.” PLoS One 15(3): e0229244.

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The outer cortical table of the parietal bone has been commonly used as a calvarial bone graft site for the craniofacial reconstruction. However, little is known about how removing the outer table may affect the function and structure of the inner table, and how the knowledge of the biomechanics and material properties of cortical bones will help the calvarial graft to better integrate into the biological and mechanical functions of its surrounding native tissues. In this study, it was hypothesized that there were significant differences in both density and material properties between inner and outer cortical plates in cranial bones. Twelve cylindrical specimens, including inner-outer layers, of cortical parietal bone of a female baboon were collected. Cortical thicknesses and densities were measured, and elastic properties were assessed using an ultrasonic technique. Results demonstrated remarkable difference in both thickness (t = 8.248, p

Upadhyaya, J. D., Fitzpatrick, S. G., Cohen, D. M., Bilodeau, E. A., Bhattacharyya, I., Lewis, J. S., Jr., Lai, J., Wright, J. M., Bishop, J. A., Leon, M. E., Islam, M. N., Seethala, R., Padilla, R. J., Carlos, R., Muller, S. and Thompson, L. D. R. (2020). “Inter-observer Variability in the Diagnosis of Proliferative Verrucous Leukoplakia: Clinical Implications for Oral and Maxillofacial Surgeon Understanding: A Collaborative Pilot Study.” Head Neck Pathol 14(1): 156-165.

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The use of diverse terminology may lead to inconsistent diagnosis and subsequent mistreatment of lesions within the proliferative verrucous leukoplakia (PVL) spectrum. The objectives of this study were: (a) to measure inter-observer variability between a variety of pathologists diagnosing PVL lesions; and (b) to evaluate the impact of diverse terminologies on understanding, interpretation, and subsequent treatment planning by oral and maxillofacial surgeons (OMFS). Six oral pathologists (OP) and six head and neck pathologists (HNP) reviewed 40 digitally scanned slides of PVL-type lesions. Inter-observer agreement on diagnoses was evaluated by Fleiss’ kappa analysis. The most commonly used diagnostic terminologies were sent to ten OMFS to evaluate their resulting interpretations and potential follow-up treatment approaches. The overall means of the surgeons’ responses were compared by Student t test. There was poor inter-observer agreement between pathologists on the diagnosis of PVL lesions (kappa = 0.270), although there was good agreement (kappa = 0.650) when diagnosing frankly malignant lesions. The lowest agreement was in diagnosing verrucous hyperplasia (VH) with/without dysplasia, atypical epithelial proliferation (AEP), and verrucous carcinoma (VC). The OMFS showed the lowest agreement on identical categories of non-malignant diagnoses, specifically VH and AEP. This study demonstrates a lack of standardized terminology and diagnostic criteria for the spectrum of PVL lesions. We recommend adopting standardized criteria and terminology, proposed and established by an expert panel white paper, to assist pathologists and clinicians in uniformly diagnosing and managing PVL spectrum lesions.

Saghiri, M. A., Asatourian, A., Kazerani, H., Gutmann, J. L. and Morgano, S. M. (2020). “Effect of thermocycling on the surface texture and release of titanium particles from titanium alloy (Ti6Al4V) plates and dental implants: An in vitro study.” J Prosthet Dent Feb 6. pii: S0022-3913(19)30750-4. [Epub ahead of print].

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STATEMENT OF PROBLEM: The release of titanium (Ti) particles from the surface of endosseous dental implants is not well understood. PURPOSE: The purpose of this in vitro study was to evaluate the effect of thermocycling on the surface texture and release of Ti particles from the surface of dental implants. MATERIAL AND METHODS: Three MSI dental implants and 3 Ti alloy (Ti6Al4V) plates were divided into 6 subgroups (n=3). Specimens in each group were subjected to 0 (control group), 100, 200, 500, 1000, and 2000 thermocycles. After each cycling process, artificial saliva was collected, and the concentrations of released Ti particles were quantified by inductively coupled plasma-mass spectrophotometry (ICP-MS). The surfaces of the dental implants and Ti plates were evaluated before and after thermocycling by scanning electron microscopy (SEM), and SEM images were analyzed by using the ImageJ software. Data were analyzed by mixed-model ANOVA and post hoc Tukey tests (alpha=.05). RESULTS: The greatest Ti release was seen after 2000 thermocycles. After increasing the number of cycles, additional Ti particles were released. SEM images of the surfaces of the dental implants and Ti plates displayed significant changes in surface texture. CONCLUSIONS: Thermocycling continuously removed the protective TiO2 layer on the surface of dental implants, resulting in the release of Ti particles. The surface treatment and texture did not affect the release of Ti particles.