PURPOSE: Management of soft tissue and bone sarcoma presents many challenges, both diagnostically and therapeutically, and requires multidisciplinary collaboration; however, such collaboration is often challenging to establish, especially in the community setting. We share our experiences of a virtual multidisciplinary sarcoma case conference (VMSCC). METHODS: We conducted retrospective review of the VMSCC data—initially via Webex, now Microsoft Teams—and the surveys of referring physicians to understand the feasibility and value of the VMSCC. RESULTS: The VMSCC was established in March 2013 in Kaiser Permanente Northern California with consistent participation of the Departments of Musculoskeletal Oncology (orthopedic oncology), Musculoskeletal Radiology, Pathology, Medical Oncology, Radiation Oncology, Nuclear Medicine, Surgical Oncology, and Genetics. Pediatric Oncology participated ad hoc when pediatric sarcoma cases were presented. Referrals were from multiple specialties and regions, including the Kaiser Permanente Mid-Atlantic and Hawaii regions. From March 2013 to December 2019, 1,585 cases were reviewed encompassing 36 histologic types. More than 300 cases were reviewed per year from 2017 to 2019. Survey results of referring physicians demonstrate that the VMSCC enhanced the confidence of treating physicians, and its recommendations frequently led to treatment changes. CONCLUSION: Establishing a valuable community-based VMSCC is feasible. VMSCC recommendations frequently led to treatment changes and improved the confidence of treating physicians.
Pancreatic islet zinc levels vary widely between species. Very low islet zinc levels in Guinea pigs were thought to be driven by evolution of the INS gene that resulted in the generation of an isoform lacking a histidine at amino acid 10 in the B chain of insulin that is unable to bind zinc. However, we recently showed that the SLC30A8 gene, that encodes the zinc transporter ZnT8, is a pseudogene in Guinea pigs, providing an alternate mechanism to potentially explain the low zinc levels. We show here that the SLC30A8 gene is also inactivated in sheep, cows, chinchillas and naked mole rats but in all four species a histidine is retained at amino acid 10 in the B chain of insulin. Zinc levels are known to be very low in sheep and cow islets. These data suggest that evolution of SLC30A8 rather than INS drives variation in pancreatic islet zinc content in multiple species.
With the advent of a digital workflow in dentistry, the inter-occlusal articulation of digital models is now possible through various means. The Cadent iTero intraoral scanner uses a buccal scan in maximum intercuspation to record the maxillomandibular relationship. This in-vitro study compares the occlusion derived from conventionally articulated stone casts versus that of digitally articulated quadrant milled models. Thirty sets of stone casts poured from full arch polyvinyl siloxane impressions (Group A) and thirty sets of polyurethane quadrant models milled from digital impressions (Group B) were used for this study. The full arch stone casts were hand-articulated and mounted on semi-adjustable articulators, while the digitally derived models were pre-mounted from the milling center based on the data obtained from the buccal scanning procedure. A T-scan sensor was used to obtain a bite registration from each set of models in both groups. The T-scan data derived from groups A and B were compared to that from the master model to evaluate the reproducibility of the occlusion in the two groups. A statistically significant difference of the contact region surface area was found on #11 of the digitally articulated models compared to the master. An analysis of the force distribution also showed a tendency for a heavier distribution on the more anterior #11 tooth for the digitally articulated models. Within the limitations of this study, the use of a digitally articulated quadrant model system may result in a loss of accuracy, in terms of occlusion, the further anteriorly the tooth to be restored is located. Care must be taken to consider the sources of inaccuracies in the digital workflow to minimize them for a more efficient and effective restorative process.
Background The restoration of dental implants presents a unique challenge due to the intrinsic biomechanical differences between osseointegrated implants and natural teeth, and their subsequent responses to occlusal loading. However, controversy exists regarding the role that occlusion plays in the physiology of the peri‐implant complex. Purpose To provide an overview of the scientific literature regarding occlusion as it relates to implant dentistry and peri‐implant disease. Materials and Methods This article presents a narrative review on occlusal loading and its potential effects on the peri‐implant complex, as well as some generally accepted guidelines for occlusion in implant dentistry. Results and Conclusions Although there is strong evidence linking occlusal factors to mechanical complications of dental implants, the same cannot be said regarding biological complications. There is no clear scientific evidence on the relationship between occlusal overload and peri‐implant disease. However, occlusal overload may be an accelerating factor for peri‐implant disease in the presence of inflammation. As the biomechanical properties of dental implants differ from that of the natural dentition, modifications to classic concepts of occlusion may be necessary when dental implants are involved. Thus, clinical recommendations are proposed which function to minimize unfavorable occlusal forces on implant restorations and reduce the associated biological and mechanical complications.
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