JVD 2018 #1 - abstracts Flashcards
In Peralta S, Fiani N, Kan-Rohrer KH, Verstraete FJM, “Morphological evaluation of clefts of the lip, palate, or both in dogs”,
What was the goal of the study?
To apply a more accurate and detailed characterization system for palatal defects in dogs.
In Peralta S, Fiani N, Kan-Rohrer KH, Verstraete FJM, “Morphological evaluation of clefts of the lip, palate, or both in dogs”,
What does LAHSHAL stand for in the classification system, what do upper and lower case letters mean?
Each letter represents an anatomic location
(L = lip, A = alveolus, H = hard palate, and S = soft palate).
In this diagrammatic classification system, letters to the left of the S represent defects on the right side of the soft palate at midline and vice versa.
Uppercase and lowercase letters represent complete or incomplete defects, respectively.
In Peralta S, Fiani N, Kan-Rohrer KH, Verstraete FJM, “Morphological evaluation of clefts of the lip, palate, or both in dogs”,
What was most common: Cleft lip (CL), cleft palate (CP) or both lip and palate (CLP)?
- Cleft palate 23/32
- Cleft lip (5/32)
- Cleft lip and palate (4/32)
In Peralta S, Fiani N, Kan-Rohrer KH, Verstraete FJM, “Morphological evaluation of clefts of the lip, palate, or both in dogs”,
What was the most common LAHSHAL type identified in cleft palate dogs?
HSH (21/23)
hSh (2/23)
In Peralta S, Fiani N, Kan-Rohrer KH, Verstraete FJM, “Morphological evaluation of clefts of the lip, palate, or both in dogs”,
Rank the following shapes of cleft palate defects from most to least common:
parallel, oval, pyriform, divergent
Pyriform (43%)
Parallel (22%)
Oval (17%)
Divergent (13%)
In Peralta S, Fiani N, Kan-Rohrer KH, Verstraete FJM, “Morphological evaluation of clefts of the lip, palate, or both in dogs”,
What additional bone was deformed in most dogs in the study overall?
Vomer
CLP (100%)
CP (74%)
CL (20%)
In Peralta S, Fiani N, Kan-Rohrer KH, Verstraete FJM, “Morphological evaluation of clefts of the lip, palate, or both in dogs”,
What skull type appears to be predisposed to CL and CLP, but not to CP?
Brachycephalic -
80% of CL;
100 % of CLP
only 44% of CP - 56% mesaticephalic
In Peralta S, Fiani N, Kan-Rohrer KH, Verstraete FJM, “Morphological evaluation of clefts of the lip, palate, or both in dogs”,
Among CL and CLP defects, between which teeth did the alveolar defect usually reside?
what other 3 dental/maxillofacial defects were common?
Second and third incisors (100%)
Deviated permanent incisor teeth,
(persistent) deciduous incisor teeth,
Nonfused incisivomaxillary and vomeroincisive sutures
In Peralta S, Fiani N, Kan-Rohrer KH, Verstraete FJM, “Morphological evaluation of clefts of the lip, palate, or both in dogs”,
Which side was more commonly associated with cleft lip, and what is the proposed embryological reason?
- Left sided lip clefts more common, and this is also reported in humans
- Discrepancy in the laterality of lip and alveolus clefts is explained by differences in embryological events during palatogenesis - the left palatal shelf goes into a horizontal position later than the right, allowing a wider timeframe for abnormalities to occur
In Peralta S, Fiani N, Kan-Rohrer KH, Verstraete FJM, “Morphological evaluation of clefts of the lip, palate, or both in dogs”,
How many indvividual LAHSHAL classifications were found in this study?
What were the limitations of the LASHSAL system as applied to dogs?
9 LAHSHAL subtypes detected. 2 in CP, rest in CL and CLP cases
No accounting for severity
No accounting for shape of lesion
In Fiani N, Verstraete FJM, Arzi B “Reconstruction of Congenital Nose, Cleft Primary Palate, and Lip Disorders”,
What is the most important factor in formation of primary clefts?
Genetics
(others are environmental teratogens, mystic emanations etc.)
In Fiani N, Verstraete FJM, Arzi B “Reconstruction of Congenital Nose, Cleft Primary Palate, and Lip Disorders”,
What are 3 reasons to delay surgery until 4-6 months of age?
1 - more growth = more tissue to harvest for closure
2 - surgery will interfere with maxillorfacial growth more if performed when younger
- permanent teeth if unerupted my erupt and be malpositioned or interfere with repair when they do erupt
In Fiani N, Verstraete FJM, Arzi B “Reconstruction of Congenital Nose, Cleft Primary Palate, and Lip Disorders”,
What is the first phase of a staged approach and what are 2 reasons to opt to perform a staged procedure?
Phase 1 is selective dental extractions
Phase 2 is definitive repair
Reasons
- Minimal soft tissue available and extraction will allow harvest of more tissue
- Teeth are erupting into the cleft and will interfere with repair
In Fiani N, Verstraete FJM, Arzi B “Reconstruction of Congenital Nose, Cleft Primary Palate, and Lip Disorders”,
What is the most common complication and what are the purported reasons?
Dehiscence
- tension at the surgical site
- poor surgical technique
- occlusal interference (lower canine)
In Fiani N, Verstraete FJM, Arzi B “Reconstruction of Congenital Nose, Cleft Primary Palate, and Lip Disorders”,
In which order should the repair proceed?
- Repair of lip, nasal planum, rostral portion of floor of nose
- Repair of palatal defect
- Repair of floor of nose, gingival margin, alveolar and labial mucosa
- Repair of palatal defect
- Repair of floor of nose, gingival margin, alveolar and labial mucosa
- Repair of lip, nasal planum, rostral portion of floor of nose
Note - work central to peripheral - separating nose from mouth is the goal, and a cosmetic notch in the lip is acceptable.
In Arzi, Clark, Sundaram et. al., “Therapeutic Efficacy of Fresh, Allogeneic Mesenchymal Stem Cells for Severe Refractory Feline Chronic Gingivostomatitis”,
What was the inclusion criteria for cats in the study?
- Full mouth extractions performed and non-responsive
- No major co-morbidities
- no steroids or immunosuppressives (D/C’d 2 weeks before trial)
- negative for FIV, FeLV
In Arzi, Clark, Sundaram et. al., “Therapeutic Efficacy of Fresh, Allogeneic Mesenchymal Stem Cells for Severe Refractory Feline Chronic Gingivostomatitis”,
How many stem cells were delivered, what was their source, and how many times were they given?
20 million
allogenic adipose derived stem cells from 3 SPF donor cats
given on day 0 and 1 month later (20 million per dose)
In Arzi, Clark, Sundaram et. al., “Therapeutic Efficacy of Fresh, Allogeneic Mesenchymal Stem Cells for Severe Refractory Feline Chronic Gingivostomatitis”,
How were the stem cells tracked to ensure their target delivery to the oral cavity? What other tissues had high levels of detection, why?
ASCs were radiolabeled with Technetium and administered to three additional FCGS affected cats and one healthy SPF cat.
Whole body images taken with a gamma camera 1h, 6h, 24h after injection
Cat with FCGS had more uptake in oral cavity than controls
lungs - trapping of cells in capillary beds
kidney/bladder - filtration of dissociated radioisotope
In Arzi, Clark, Sundaram et. al., “Therapeutic Efficacy of Fresh, Allogeneic Mesenchymal Stem Cells for Severe Refractory Feline Chronic Gingivostomatitis”,
What are 4 mechanisms by which stem cells cause immunomodulation?
- MSCs inhibit T-cell proliferation,
- alter B-cell function,
- downregulate MHC II on antigen-presenting cells
- inhibit dendritic cell maturation and differentiation
In Arzi, Clark, Sundaram et. al., “Therapeutic Efficacy of Fresh, Allogeneic Mesenchymal Stem Cells for Severe Refractory Feline Chronic Gingivostomatitis”
What histopathologic changes were seen in cats that responded versus cats that did not respond?
Upon completion of the study, a complete return to normal tissue architecture was observed in the biopsies of cats with complete clinical remission or substantial clinical improvement.
The biopsies from the cat with no clinical improvement were consistent with severe lymphoplasmacytic and neutrophilic ulcerative stomatitis prior to and after treatment
In Arzi, Clark, Sundaram et. al., “Therapeutic Efficacy of Fresh, Allogeneic Mesenchymal Stem Cells for Severe Refractory Feline Chronic Gingivostomatitis”
What differences were seen in results compared to the similar study using autologous stem cell therapy with respect to number improved, and time to cure?
- 4/7 responded in this study, 5/7 in the autologous study
- time to cure was ~12-20 months for this study versus 3-9 months for autologous study
*
In Arzi, Clark, Sundaram et. al., “Therapeutic Efficacy of Fresh, Allogeneic Mesenchymal Stem Cells for Severe Refractory Feline Chronic Gingivostomatitis”
Which cats were less likely to respond to ASC treatment?
cats with more severe systemic inflammation as measured by
- neutrophil count,
- interferon gamma
- globulin count
In Arzi, Clark, Sundaram et. al., “Therapeutic Efficacy of Fresh, Allogeneic Mesenchymal Stem Cells for Severe Refractory Feline Chronic Gingivostomatitis”
What changes to T-Cell subsets are observed in cats affected by FCGS?
Increased CD8+ cells
Decreased CD8:CD4 ratio
Low CD8lo numbers
In Arzi, Clark, Sundaram et. al., “Therapeutic Efficacy of Fresh, Allogeneic Mesenchymal Stem Cells for Severe Refractory Feline Chronic Gingivostomatitis”
Which T-cell subset change was predictive of response to therapy in the autologous stem cell trial, but was not predictive of response in this allogenic trial?
CD8lo T-cells increasing to normal was predictive of response to therapy in autologous trial but not in the allogenic trial (this one)
