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proliferation of microbes to the parts open to the oral cavity. Hence, microbial colonization on various intraoral suture materials from patients undergoing periodontal flap surgery and its impact on healing of gingival tissues was compared. Patients and Methods: During periodontal flap surgery, three different suture materials (silk, polyamide, & vicryl) were used in 25 patients. Eight days postoperatively, the sutures were removed, and adhered micro-organisms were counted by culturing on nutrient agar. Additionally clinical parameters, bleeding on probing and papillary position to assess healing were recorded to baseline, at 2 weeks, 4 weeks, and 6 weeks. Wilcoxon signed ranks test was used for statistical analysis. Results: Mean CFU’s for silk, polyamide and vicryl sutures were 6.239 ±1.476 X 108, 2.425 ± 1.010 X 108, 4.431 ± 1.069 X 108. There was no inter-group statistical difference in the clinical parameters i.e. bleeding on probing, papillary position at all time periods (p>0.05). There was a significant statistical improvement in bleeding on probing in all the three groups from base line (p

Aim: To evaluate the efficacy of Clorni* gel as an adjunct to phase 1 therapy, in the treatment of gingivitis. Methodology: The study was carried out on 30 patients. Group 1(control group): scaling and root planing, oral hygiene instruction and Hexi* gel application. Group 2(test group): scaling and root planing, oral hygiene instruction and Clorni* gel application. Clinical parameters like Gingival Index, Plaque Index and Papillary Bleeding Index were recorded at baseline, one week and after one month for each patient. Results: There were reduction in the PI, GI and Papillary bleeding index scores in both the groups. Within the groups (group1 and group 2) clinical parameters showed overall reduction from baseline to 1 month and on multiple analysis the results were statistically significant from baseline to one month, but no statistical significance was seen from one week to one month. On comparison between the groups there was no statistical significance in the clinical parameters. Conclusion: Clorni gel can be used as an adjunct to SRP in the treatment of gingivitis.

The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has led to a major pandemic. While vaccine development moves forward, optimal treatment continues to be explored. Efforts include an ever‐expanding number of clinical trials along with newly proposed experimental and off‐label investigational therapies; one of which is therapeutic plasma exchange (TPE). There have been a number of publications on TPE use as adjunctive therapy for coronavirus disease 2019 (COVID‐19), but no prospective randomized controlled trials (RCTs) have been completed. This article critically appraises the current available evidence on TPE as a treatment modality for SARS‐CoV‐2 infection.

Aim: The aim of the present study was to evaluate the knowledge, attitude and practice towards the treatment of periodontal disease among general dentists. Materials and methods: The study involved 150 general dentists from Bangalore. KAP study using a questionnaire was conducted with a total of 15 questions, and the questions were divided under 3 domains assessing the knowledge, attitude, and practice towards periodontal treatment procedures. Results: Out of the 150 dentists who received the questionnaire, 100% returned properly filled forms with a mean value of 12.2 in knowledge, 15.6 in attitude and 10.2 in the practice. With pearson correlation coefficient, it is understood that there is positive relationship between the knowledge that the dentists possess and their attitude towards periodontal treatment procedures. But, the correlation between knowledge and practice is not significant, however, on the negative side. Conclusion: General dentists have good knowledge and attitude towards periodontal treatment procedures whereas, their practice towards periodontal treatment procedure is still truncated. Hence, the oral perception of general dentists towards periodontal treatment needs to be gauged for betterment of their service. Keywords: Dentists, knowledge, periodontal diseases

COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for a global pandemic that can cause severe infections in children, especially those with comorbid conditions. Here, we report a case of a child with a newly diagnosed medulloblastoma, Fanconi Anemia, and SARS-CoV-2 infection. Through multidisciplinary care coordination and meticulous planning, we were able to safely initiate this patient's oncology care and implement a long-term model to address the patient's care. This approach could be replicated with any newly diagnosed pediatric patient that requires monitoring for signs of COVID-19 with concurrent oncology care.

Therapeutic plasma exchange is used to treat neurological diseases in the pediatric population. Since its first use in pediatric patients with hepatic coma in the form of manual whole blood exchange, therapeutic plasma exchange has been increasingly used to treat these disorders of the nervous system. This expansion is a result of improved techniques and apheresis instruments suitable for small children, as well as the recognition of its applicability to many diseases in the pediatric population. This review provides a historical overview of the use of therapeutic apheresis in children and highlights the most common applications for therapeutic plasma exchange to treat neurological disorders in children.

Background: Golden proportion, recurrent esthetic dental proportion and golden percentage are the widely accepted tools to measure perceived mesiodistal width of maxillary anterior teeth. Our study was aimed to identify appropriate tool among the above mentioned proportion to measure perceived mesiodistal width.Methods: A cross-sectional observational study was conducted in National Academy of Medical Sciences, Bir Hospital, Nepalese Army Institute of Medical Sciences and Patan Academy of Health Sciences between March 2014 to March 2015.Sixty-three respondents were recruited in the study by the convenient sampling technique. Photographs of the maxillary anterior teeth were taken using digital single reflex camera with macrolens. Data analysis was done using SPSS version 17.0 and paired sample t- test was performed.Results: In our study the golden proportion was 14.28% between central and lateral incisor and 12.69% between canine and lateral incisor. Therefore, golden proportion in our scenario doesn’t exist. Recurrent esthetic dental proportion in female Aryans was 71 and 71 on left side and 71and 75 on right side. Golden percentage of respondents was near to values 11, 15, 22, 22, 15, and 12%.Conclusions: Golden percentage is an appropriate anterior tooth proportion which may serve as a guideline for the restoration of anterior tooth. RED proportion is applicable only in Mongoloid female population.

Two children with congenital heart disease status post surgical correction presented with prolonged constitutional symptoms, hepatosplenomegaly and pancytopenia. Concern for malignancy prompted bone marrow biopsies that were without evidence thereof. In case 1, echocardiography identified a multilobulated vegetation on the conduit valve. In case 2, transthoracic, transesophageal and intracardiac echocardiography were performed and were without evidence of cardiac vegetations; however, pulmonic emboli raised concern for infective endocarditis. Both patients underwent surgical resection of the infected material and had histopathologic evidence of infective endocarditis. Further diagnostics identified elevated cytoplasmic antineutrophil cytoplasmic antibodies and antiproteinase 3 antibodies in addition to acute kidney injury with crescentic glomerulonephritis on renal biopsy. Serologic evidence of infection with Bartonella henselae was observed in both patients. These 2 cases highlight the potential multiorgan involvement that may confound the diagnosis of culture-negative infective endocarditis caused by B. henselae.

Background Hemophagocytic lymphohistiocytosis (HLH) is an increasingly recognized life-threatening syndrome characterized by excessive inflammation and immune dysregulation. However, little is known about HLH presenting in neonates. Methods To describe the phenotype, etiology, and efficacy of therapy for infants presenting within 28 days of birth and diagnosed with HLH prior to 90 days of life, a retrospective multi-center study was conducted identifying 13 previously unreported cases from 8 centers. A systematic literature review identified 58 additional cases that were sufficiently similar to allow pooling for meta-analysis (n=71). Results Presenting symptoms and laboratory findings of HLH were non-specific and indistinguishable from other neonatal critical illnesses. More than 85% of patients demonstrated hepatomegaly, splenomegaly, hyperferritinemia, transaminitis, hypoalbuminemia, and severe thrombocytopenia. Notably, liver dysfunction appears more common in neonatal HLH compared to published reviews of HLH cases across the age spectrum. Genetic testing was pursued in 60% of the cohort with pathogenic variants identified in a third of patients (PRF1 in 15, UNC13D in 8). Ten additional cases occurred with a family history of HLH, for a total of 46% (33/71) of cases of presumed familial HLH. Seventeen cases (24%) represented secondary HLH with an identified trigger for immune dysregulation (e.g. infection or non-HLH disease) in the absence of an HLH-associated genetic mutation or family history. Twenty-one (30%) neonatal HLH cases were of unknown etiology. Two-year survival from presentation was low at 27%, with a trend toward superior 2-year overall survival for those with secondary HLH at 65% (unknown etiology 21%, familial HLH 18%, p=0.06; Figure). Ten patients (n=6 familial HLH, n=4 unknown etiology) underwent allogeneic hematopoietic cell transplantation (HCT) at a median of 4.8 months of age. HCT was associated with improved 2-year overall survival (OS) from HLH diagnosis (78% with HCT versus 11% without HCT, p Conclusion Liver dysfunction in a severely ill neonate should prompt consideration of HLH as an etiology. Our study supports consideration of HCT for any neonate with HLH, except those with an identified trigger and absence of an HLH-associated gene mutation prompting classification as secondary HLH. Early lethality combined with superior HCT outcomes when HLH is well-controlled additionally highlight the need for novel HLH therapies to bridge to HCT. Further studies to better elucidate details of pre-HCT therapy, HCT conditioning regimens and how best to navigate multi-organ failure at HLH presentation are needed. Figure Disclosures No relevant conflicts of interest to declare.

The aim of present case report is to discuss surgical lip repositioning technique for the management of excessive gingival display related with vertical maxillary excess and increase mobility of the upper lip. By restricting the muscle pull by elevator lip muscles, this procedure reduces excessive gingival display during smiling. For patient, this procedure is safe, less invasive with minimal side effects and an alternative to orthognathic surgery in the correction of gummy smile.

Restoration of excessively worn dentition is a challenging treatment procedures. It requires efficient diagnosis and treatment plan. Hobo's techniques and Pankey Mann Schuyler's philosophy are widely used and documented for full mouth rehabilitation. We have reported the case of a 56-year- old male patient who presented with the severely worn dentition and had difficulty in chewing. To rehabilitate this case Hobo's twin stage technique had been adopted as it is based on scientific data and mathematical analysis for both disocclusion and anterior guidance thus reducing chair side time. Keywords: attrited; hobo; occlusion; rehabilitation.

Aim The aim of the present study is to evaluate the efficacy of curcumin gel as local drug delivery post-scaling and root planing and its effect on clinical parameters like plaque, gingival scores, pocket depth, and clinical attachment level (CAL). Materials and methods Ten patients with two sites in the contralateral quadrants having probing pocket depths (PPDs) of ≥5 mm were selected. Full-mouth scaling and root planing (SRP) was performed followed by the application of curcumin gel on a single side. Assessment of plaque index (PI), gingival index (GI), PPD, and CALs were done at the baseline and at the 4th week. Results The results revealed that there was a statistically significant reduction in PI and probing depth in the test group when compared with the control group. CAL was improved but the results were not statically significant. Conclusion The local application of curcumin gel when used in conjunction with SRP showed a significant improvement in periodontal parameters and has a beneficial effect in patients with chronic periodontitis. Clinical significance Curcumin gel as an adjunct to SRP showed a marked improvement in restoring gingival health by an improvement in clinical parameters. It has proven properties like anti-inflammatory, antioxidant, antimicrobial, hepatoprotective, immunostimulant, antiseptic, antimutagenic, and it also accelerates wound healing. It may be a more acceptable and viable option for the common man. Curcumin can be used as an effective alternative local drug delivery agent.

Warm autoimmune hemolytic anemia (WAIHA), the most common of the relatively uncommon autoimmune-mediated hemolytic anemias (AIHAs), is mediated by polyclonal immunoglobulin (Ig)G autoantibodies in most cases. Herein, we present a case of WAIHA involving a direct antiglobulin test (DAT) with an initially negative result. Using a modified DAT protocol, repeat testing of the same specimen material from a previously healthy 53-year-old man yielded positive results. This case demonstrates that investigation of an apparently negative DAT result plays a critical role in the differential diagnosis of patients with rapidly progressing hemolytic anemia and the reversal of that decline.

An ideal emergence profile is vital for maintaining gingival health and developing esthetics. The ovate pontic which mimics a natural tooth gives the most appropriate emergence profile. For a successful ovate pontic restoration, an alveolar ridge of sufficient height and width is necessary to enhance the deficient ridge and to achieve an esthetic emergence profile. Interpositional graft was carried out along with ovate pontic to achieve an ideal esthetic restoration. After three months of the postoperative period, there was an increased horizontal dimension in the deficient ridge and an esthetic emergence profile. Interpositional graft technique is a simpler and predictable technique for pontic site development in moderate cases of bucco-lingual ridge deficiency.

The Choosing Wisely campaign has stimulated clinicians to think about the appropriateness of various tests and procedures, compelling physicians to make smarter, safer and more effective choices for high quality patient care and to reduce healthcare cost. The American Society for Apheresis (ASFA) strives to advance apheresis medicine through education, evidence-based practice, research and advocacy. To complement these shared missions, ASFA created a working group, consisting of representatives from the various ASFA committees, to produce recommendations for apheresis medicine that reflect the Choosing Wisely guiding principles. A diverse group of ASFA physician and allied health members reviewed, rated and ranked 9 original draft proposals. Additional revisions and refinements were made prior to external review and adoption of five final recommendations by the ASFA Board of Directors. The ASFA Choosing Wisely recommendations encourage apheresis practitioners, patients and donors to discuss and prioritize best clinical practices that avoid harm and waste while optimizing clinical benefit.

Little information exists on the effect of race and ethnicity on collection of peripheral blood stem cells (PBSC) for allogeneic transplantation. We studied 10,776 donors from the National Marrow Donor Program who underwent PBSC collection from 2006 to 2012. Self-reported donor race/ethnic information included Caucasian, Hispanic, Black/African American (AA), Asian/Pacific Islander (API), and Native American (NA). All donors were mobilized with subcutaneous filgrastim at an approximate dose of 10 μg/kg/day for 5 days. Overall, AA donors had the highest median yields of mononuclear cells per liter and CD34(+) cells per liter of blood processed (3.1 × 10(9) and 44 × 10(6), respectively), whereas Caucasians had the lowest median yields at 2.8 × 10(9) and 33.7 × 10(6), respectively. Multivariate analysis of CD34(+) per liter mobilization yields using Caucasians as the comparator and controlling for age, gender, body mass index, and year of apheresis revealed increased yields in overweight and obese AA and API donors. In Hispanic donors, only male obese donors had higher CD34(+) per liter mobilization yields compared with Caucasian donors. No differences in CD34(+) per liter yields were seen between Caucasian and NA donors. Characterization of these differences may allow optimization of mobilization regimens to allow enhancement of mobilization yields without compromising donor safety.

Acquired hemophilia A (AHA) is a rare autoimmune disorder that leads to factor VIII (FVIII) deficiency via autoantibody formation. Standard treatment options include FVIII bypassing factors and immunosuppression. However, the role of therapeutic plasma exchange (TPE) is not clear in the treatment of AHA. We present a case of idiopathic AHA in a 66 year old female with severe bleeding and a FVIII inhibitor of 17.6 Bethesda units (BU). She failed to respond to standard treatment including maximum dose of recombinant FVIIa (rFVIIa), rituximab, and other immunosuppressive agents. Her FVIII inhibitor rapidly increased to 140 BU and FVIII was below 5%. TPE was initiated 3 weeks after admission and her bleeding stabilized after the first treatment and completely stopped after three treatments. Repeat testing revealed increased FVIII to 15% and FVIII inhibitor decreased to 2.0 BU. After an additional TPE treatment, her FVIII increased to 27% and FVIII inhibitor decreased to 0.6 BU and she was discharged without bleeding 40 days after admission. In this case, TPE played a critical role in reducing FVIII inhibitor, which resulted in a recovery of FVIII activity and hemostasis. Therefore, TPE should be initiated early in AHA patients with bleeding and high titer of FVIII inhibitor.

Background Diamond-Blackfan anemia (DBA), an inherited marrow failure syndrome, has severe hypoplastic anemia in infancy and association with aplastic anemia, MDS/leukemia, and other malignancies. Short stature is present in most patients. Isolated cases have demonstrated improved growth on growth hormone (GH) therapy. Procedures GH treatment data were obtained from 19 children with DBA (6 at our site and 13 from Genentech). Control data from 44 non-GH treated children were provided by Diamond Blackfan Anemia Registry. Annual growth velocity (GV) and height-for-age Z-scores (HAZ) were compared between groups and for up to 4y of GH treatment. Results Constructed DBA-specific male and female height-for-age charts for non-GH treated patients revealed short stature compared to CDC norms. GH-treated patients had significantly lower HAZ prior to treatment initiation compared to non-GH-treated controls. Among GH-treated patients, GV significantly improved in the first two years relative to pre-treatment. HAZ significantly improved in each of 4y of GH therapy compared to baseline. After 2y of therapy, HAZ for GH-treated patients were not significantly different from controls, demonstrating successful catch-up growth. Conclusions GH treatment in children with DBA improves both GV and HAZ during treatment sustained for up to 4y. Very short children with DBA can be treated successfully with GH to restore stature to levels comparable to less affected patients. DBA height charts are useful tools for assessing age-specific growth in this typically short population. Careful consideration of individualized benefit of GH therapy versus risk is important in view of long-term underlying ∼5% malignancy risk in DBA. Pediatr Blood Cancer 2015;62:402–408. © 2014 Wiley Periodicals, Inc.

Physician practice variation may be a barrier to informing hematopoietic cell transplant (HCT) recipients about fertility preservation (FP) options. We surveyed HCT physicians in the United States to evaluate FP knowledge, practices, perceptions and barriers. Of the 1035 physicians invited, 185 completed a 29-item web-survey. Most respondents demonstrated knowledge of FP issues and discussed and felt comfortable discussing FP. However, only 55% referred patients to an infertility specialist. Most did not provide educational materials to patients and only 35% felt that available materials were relevant for HCT. Notable barriers to discussing FP included perception that patients were too ill to delay transplant (63%), patients were already infertile from prior therapy (92%) and time constraints (41%). Pediatric HCT physicians and physicians with access to an infertility specialist were more likely to discuss FP and to discuss FP even when prognosis was poor. On analyses that considered physician demographics, knowledge and perceptions as predictors of referral for FP, access to an infertility specialist and belief that patients were interested in FP were observed to be significant. We highlight variation in HCT physician perceptions and practices regarding FP. Physicians are generally interested in discussing fertility issues with their patients but lack educational materials.

Key Points HCT prior to onset of neurologic symptoms in children with OSTM1 osteopetrosis does not halt neurologic progression.

Aim The study was carried to find a relationship between the postextraction stable landmark, the incisive papilla, and the most labial position of the maxillary central incisor teeth, which occurred in Nepalese population. Materials and methods Casts of the subjects selected by nonprobability random sampling meeting the inclusion criteria were obtained. Each casts were standardized with respect to the occlusal plane and a photographic technique was used to measure the distance from the tangent of the labial surface of the central incisors to the posterior border of the incisive papilla. The measurements were made using Adobe Photoshop and results were analyzed by using appropriate statistical methods. Most appropriate software (SPSS) for the purpose was used to generate all desired values. Results The data obtained suggested that the distance from the labial surface of maxillary central incisors to the posterior border of the incisive papilla ranged from 9 to 15.9 mm with a mean of 11.59 mm (SD 1.3). Various other results were also found after evaluation of the arch forms in relation to sex and race. Conclusion Within the limitations of the study, these results suggested that there is a relationship between the maxillary central incisors and the incisive papilla aiding in the anteroposterior positioning of the anterior tooth. The clinical relevance of the study lies in application of the incisive papilla as a starting point in the preliminary location of maxillary incisors and canines during construction of the denture in absence of preextraction records. How to cite this article Shrestha S, Joshi SP, Yadav SK. Relationship of Incisive Papilla to Maxillary Incisors and Canines. J Contemp Dent Pract 2016;17(4):306-312.

With implant therapy becoming increasingly popular and acceptable for replacement of single to multiple teeth, strategies have evolved for maintaining and regenerating bone after extraction to provide an optimal environment for subsequent implant placement. Though these strategies include onlay grafting, ridge expansion, distraction osteogenesis, and guided bone regeneration (GBR). The application of these techniques involves the use of a wide range of materials including autogenous bone graft, allografts, xenografts, alloplasts, bone promoting factors and resorbable/nonresorbable barrier membranes used either alone or in a variety of combinations. Although numerous reports and case series document the success of individual materials and techniques, there are few articles that document their performance over time.This article describes a series of 7 patients treated with GBR using a bovine bone mineral Bio-Oss (Geistlich) and a resorbable collagen membrane Bio-Gide (Geistlich) with 12 implants placed and followed up for a minimum 18 months period.

Juvenile granulosa cell tumor (JGCT) of the ovary, a rare pediatric cancer, carries a very poor prognosis in advanced and recurrent cases. A 10-year-old girl with stage IA JGCT, initially treated with resection only, presented with extensive unresectable multifocal pelvic recurrence. She underwent surgery, chemotherapy (cisplatin/paclitaxel alternating with cisplatin/cyclophosphamide/etoposide/bleomycin), myeloablative chemotherapy (carboplatin/etoposide/melphalan) with autologous bone marrow transplant, and pelvic radiation. She tolerated therapy well and is in complete remission 69 months after her recurrence.

International audience; With broadening indications, more options for hematopoietic cell transplantation (HCT) and improvement in survival, the number of long-term HCT survivors is expected to increase steadily. Infertility is a frequent problem that long-term HCT survivors and their partners face and it can negatively impact on the quality of life. The most optimal time to address fertility issues is before the onset of therapy for the underlying disease; however, fertility preservation should also be addressed before HCT in all children and patients of reproductive age, with referral to a reproductive specialist for patients interested in fertility preservation. In vitro fertilization (IVF) and embryo cryopreservation, oocyte cryopreservation and ovarian tissue banking are acceptable methods for fertility preservation in adult women/pubertal females. Sperm banking is the preferred method for adult men/pubertal males. Frequent barriers to fertility preservation in HCT recipients may include the perception of lack of time to preserve fertility given an urgency to move ahead with transplant, lack of patient-physician discussion because of several factors (for example, time constraints, lack of knowledge), inadequate access to reproductive specialists, and costs and lack of insurance coverage for fertility preservation. There is a need to raise awareness in the medical community about fertility preservation in HCT recipients.

BACKGROUND: Severe Aplastic Anemia (SAA) in childhood is fatal if untreated and has a reported incidence of 2.34/ million. With the use of treatment guidelines, outcomes have improved over the years. In the United States (US), Hematopoietic Stem Cell Transplantation (HSCT) is preferentially utilized in young patients with an HLA matched sibling donor, whereas Immunosuppressive Therapy (IST) comprised of Horse Antithymocyte Globulin (ATG) and Cyclosporine (CSA) is utilized in those that lack one. Upon failure of IST, the latter typically undergo unrelated donor HSCT. At this time, national trends in resource utilization and the financial impact of this diagnosis and its treatment are unknown. Our objective was to ascertain whether treatment paradigms could be identified within a national database and compare cost and outcomes within Childrens hospitals across the US within the context of SAA. METHODS: We utilized the Pediatric Hospital Information System (PHIS) database to perform a retrospective cohort study of patients admitted to Childrens Hospital Association Hospitals (36 of 48 were free-standing) to compare length of stay (LOS), billed charges and inpatient mortality in patients with SAA who received IST compared to SCT. This database was queried to identify all patients ≤21 years of age who were first admitted between 2010 to 2014 with a diagnosis of SAA, as defined by ICD 9 codes (284. 0, 284.1, 284.9, 284.89, 284.12). Within this data set we identified patients with a Bone Marrow Aspiration (BMA) procedure code (41.3, 41.31) billed within 6 months of the code for SAA and use of transplant procedure codes (41.0, 41.00, 41.02, 41.03, 41.05, 06, and 08) drug codes for agents typically utilized as IST (164130, 164131, and 167115) or conditioning for HSCT (171103, 171125, 164130, and 164131). Patients were excluded for constitutional bone marrow failure, cancer and other diagnoses. Those meeting criteria were summarized using descriptive statistics and comparisons among groups were assessed using non-parametric methods. Cost, number of admissions, LOS, intensive care unit (ICU) utilization, inpatient mortality and comorbidities were analyzed with various charge codes that were adjusted by the CMS wage/price index for the hospital's location. The data set was validated by internal chart review. RESULTS: A total of 446 patients (57% male, 43% female, median age at diagnosis 10 years) met study criteria. 282(63%) patients were treated with IST alone, 98(22.3%) patients who underwent SCT without IST and 66(14.7%) patients received both forms of therapy. The overall mortality rate for the cohort was 8.6%. The likelihood of death correlated with the presence of Graft versus Host Disease (GVHD) and LOS > 100 days in the group that underwent SCT. A total of 1631 admissions were evaluated with a total LOS of 24,369 days. Median LOS for the cohort was 36 days but significantly lower for those that underwent IST only (p CONCLUSIONS: This is the first reported evaluation of inpatient resource utilization, mortality and costs in children treated for SAA in the US. While the overall cost of care for these patients is high, it is >3 fold higher for patients undergoing HSCT and over 6 times higher if HSCT is utilized upon failure of IST. With further comparative analyses, stakeholders can better understand where excess variation in care and cost occurs and define best practices required to further improve outcomes at lower cost. Disclosures No relevant conflicts of interest to declare.

Recent experience suggests that reduced-intensity conditioning (RIC) regimens can improve the outcomes of patients with hemophagocytic lymphohistiocytosis (HLH) undergoing allogeneic hematopoietic cell transplantation (HCT). However, studies directly comparing RIC to myeloablative conditioning (MAC) regimens are lacking. Forty patients with HLH underwent allogeneic HCT between 2003-2009 at Cincinnati Children's Hospital. Fourteen patients received MAC consisting of busulfan, cyclophosphamide, and antithymocyte globulin plus or minus etoposide. Twenty-six patients received RIC consisting of fludarabine, melphalan, and alemtuzumab. All patients engrafted. Acute graft-versus-host disease grades II to III occurred in 14% of MAC patients and 8% of RIC patients (P = .3171). Posttransplantation mixed donor/recipient chimerism developed in 18% of MAC patients and 65% of RIC patients (P = .0110). The majority of patients with mixed chimerism received intervention with reduction of immune suppression plus or minus donor lymphocyte infusion or stem cell boost, which stabilized or increased donor contribution to hematopoiesis and prevented relapse of HLH in all but 1 patient. Grade II to III graft-versus-host disease occurred in 5 of 14 RIC patients after donor lymphocyte infusion. The overall estimated 3-year survival after HCT was 43% (confidence interval = ± 26%) for MAC patients and 92% (confidence interval = ± 11%) for RIC patients (P = .0001). We conclude that RIC significantly improves the outcome of patients with HLH undergoing allogeneic HCT.

Presence or absence of a minimal zone of keratinized tissue around dental implants has been a matter of controversy. However, a consensus exists that a thick zone of keratinized zone around implants provides a prosthetic friendly environment, facilitates precise prosthetic procedures, allows oral hygiene maintenance, resists recession, and enhances esthetic blending. The aim of the present case series was to increase the zone of keratinized soft tissue around dental implants supporting overdentures. Three different surgical techniques modified palatal roll technique with and without apical positioning and connective tissue graft (CTG) were used to achieve this goal. There was a significant gain of keratinized soft tissue with all the three techniques, which remained stable over a period of 6 months. Modified palatal roll technique with and without apical positioning and CTG are simpler surgical techniques, which can be successfully and predictably used for increasing the zone of keratinized tissue around implants.

Myriads of materials have been used for replacement of missing teeth through implantation. The success of these materials depend on the ability to integrate with the host environment showing biological compatibility, mechanical compatibility, and morphological compatibility to the surrounding vital tissues. Certain materials have shown this promising property and have been used in dental implantology. With recent advances in technology, these materials are better able to improve fixation to bone through various surface modifications and bioengineering

Hall sensors place themselves in important position, in the fields right form scientific and research to the industrial and related applications. Various materials e.g. InSb, InAs, Si are reported for use even in commercially available Hall sensors. The use of Si, not only makes it possible to apply the highly developed and sophisticated batch production methods of integrated circuits to transducer field, but also makes it feasible to integrate sensor and signal processing circuits on a single chip.© (1999) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

This first known case of concurrent congenital dyserythropoietic anaemia (CDA) and autoimmune haemolytic anaemia (AIHA) which occurred in a hispanic male and spanned 6 years from the age of 2. Light and electron microscopy of bone marrow erythroblasts and immunophenotyping confirmed CDA; serum/eluate warm autoantibodies and positive direct antiglobulin tests (DAT) associated with severe, episodic anaemias established AIHA. Cytogenetic analysis of bone marrow cells and peripheral blood lymphocytes ascertained sex chromosome aneuploidy (48 XY,+ Y,+ Y). Recurrent, life-threatening episodes of transfusion-dependent anaemia refractory to steroids and intravenous immune globulin, were put into stable remission at age 8 years when splenectomy successfully managed both disorders.

Bone marrow aspiration is performed to assess cellular morphology and to conduct tests on the bone marrow. Bone marrow biopsy is often performed in tandem to provide information about the marrow and the extent of disease. This video demonstrates both procedures.