Skokie Hospital

Background/Objectives: Limited residual bone height in the atrophic posterior maxilla complicates implant placement. Transcrestal sinus elevation can be used to correct bone shrinkage after sinus pneumatization or crestal bone loss. This study evaluated a minimally invasive, one-stage transcrestal sinus lift using a double-layer crosslinked collagen scaffold (MCCS) with autogenous bone from the implant osteotomy site in patients with RBH ≤ 6 mm. Methods: In this prospective series, 11 patients (48–64 years, mean RBH 4.75 mm, SD 0.95 mm) underwent one-stage transcrestal sinus floor elevation with simultaneous implants. After osteotomy, autogenous bone chips collected during drilling were compacted into the site, and two layers of MCCS were placed under the elevated Schneiderian membrane. Buccal and palatal bone heights were measured on CBCT before and after surgery to assess vertical bone gain (ΔRBH). Results: All implants achieved stable osseointegration. Mean ΔRBH was approximately 3.1 ± 0.9 mm (combined buccal–palatal). No postoperative complications occurred. Two small Schneiderian membrane perforations were sealed intraoperatively by MCCS placement, with uneventful healing. Follow-up imaging showed maintenance of the augmented bone around the implants. Conclusions: This double-layer MCCS plus autogenous bone approach is a safe, effective, and minimally invasive transcrestal sinus lift for atrophic maxillae. It yielded crestal bone gains even with minimal initial RBH, leveraging the palatal sinus wall’s osteogenic potential and the implant’s tent-pole effect. The MCCS scaffold maintained space for bone formation and enabled immediate sealing of any membrane perforations. This one-stage protocol is viable for implant placement in low-RBH sites.

Crowned by the word “Allah,” a piece of Arabic calligraphy carved of stainless steel wraps around an embellished center. The text is the ayat al-kursī, a portion of the Qur’an often recited before sleep or travel. While the Illinois-based company Modern Wall Art produces the above “Ayat Al Kursi Round,” at least six other businesses manufacture their own ayat al-kursī pieces in the same visual style. By attending to the specific production method and branding of the “Ayat Al Kursi Round,” we can identify how the materialization of God’s words in wall art entangles Islamic ethics and the aesthetics of class formation.

The anatomic proximity of the maxillary sinus to the apices of molar and premolar teeth is a significant factor when considering implant therapy to replace maxillary posterior teeth. An emerging field within tissue engineering is the application of xenografts capable of stimulating de novo bone regeneration. This article presents a technique using a crestal approach to sinus grafting utilizing a novel bone graft material composed of porcine, ribose cross-linked collagen seeded with a nanocrystalline hydroxyapatite mineral. This highly cohesive biomaterial is able to minimize graft migration, which is particularly important in case of undetected Schneiderian membrane perforations. The material also has been demonstrated in animal studies to be capable of osteoconduction, resulting in increased bone volume in ridge augmentation procedures.

Medicolegal—Malpractice and Ethical Issues in RadiologyErrors, Blame, Guilty Conscience, and Just CultureLeonard Berlin1,2Audio Available | Share

Medicolegal—Malpractice and Ethical Issues in RadiologyWarn Referring Physicians That Errors May Be Present on Reports Proofread Using Speech Recognition Software?Leonard Berlin1,2Audio Available | Share

IntroductionAndexanet alfa (zhzo, coagulation factor Xa recombinant) is approved for such factor Xa inhibitors as apixaban and rivaroxaban. Unfractionated heparin (UFH) is commonly used for therapeutic, interventional and surgical indications. Protamine sulfate is commonly used to neutralize UFH. The study investigated the comparative neutralization profiles of andexanet alfa and protamine sulfate for heparins of bovine, ovine or porcine origin.Materials and MethodPowdered form of pharmaceutical grade heparins of bovine (140 U/mg), ovine (200 U/mg) and porcine (190 U/mg) origin were obtained from commercial vendors. Andexanet alfa was obtained from the hospital pharmacy (Skokie Hospital, Skokie, Illinois) and reconstituted at 10 mg/ml according to the manufacturer's instructions. Powdered protamine sulfate (USP grade) was reconstituted at 1.0 mg/ml in saline. To investigate the neutralization profile of these two antidotes for various heparins, each of the bovine, ovine and porcine heparins was supplemented to plasma over a concentration range of 0–10 ug/ml. The effect of protamine sulfate at 10 ug/ml was studied in the activated partial thromboplastin time (aPTT), anti‐Xa and anti‐IIa assays. Similar studies were carried out with andexanet alfa at a concentration of 100 ug/ml. The neutralization effect of protamine sulfate and andexanet alfa was also studied on an approximate surgical/interventional concentration of heparin by supplementing freshly drawn whole blood from healthy individuals (n=5–10) with each of the heparins at a concentration of 25 ug/ml. The neutralization effect of andexanet alfa was studied at 100 ug/ml and protamine sulfate was studied at 25 ug/ml.ResultsBoth andexanet alfa (100 ug/ml) and protamine sulfate (10 ug/ml) completely neutralized the anticoagulant effects of all three heparins in the aPTT assay. However, protamine sulfate was more effective in neutralizing the amidolytic anti‐Xa and anti‐IIa effects in comparison to andexanet alfa which only partially neutralized these effects. In the whole blood clotting ACT studies, all three heparins produced a strong anti‐coagulant effects (400–450 seconds) in comparison to saline (130–150 seconds). Both andexanet alfa (100 ug/ml) and protamine sulfate (25 ug/ml) almost completely neutralized the anti‐coagulant effects of heparins (140–160 seconds).ConclusionThese results clearly suggest that andexanet alfa at 100 ug/ml is effective in neutralizing both the therapeutic and surgical/interventional concentrations of heparins in the in‐vitro settings. While differences in the anti‐Xa and anti‐IIa effects between heparins are noted, the anti‐coagulant effect of these agents in the aPTT assay were comparable and similar neutralization profile was observed in the ACT assays by both agents. The pharmacologic implication of these observations require further investigations.Support or Funding InformationN/AThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Medicolegal—Malpractice and Ethical Issues in RadiologyDoctors Whose Names Are Given by Self-Referred Patients Will Not Accept Radiology Reports: What Should We Do?Leonard Berlin1,2Audio Available | Share