Stability, survival, patient satisfaction, and cost-minimization of CAD/CAM versus conventional multistranded fixed retainers in orthodontic patients: a 2-year follow-up of a two-centre randomized controlled trial

BACKGROUND

CAD/CAM (computer-aided design/computer-aided manufacturing) fixed retainers (FRs) as an alternative to multistranded FRs to maintain orthodontic treatment outcome.

OBJECTIVES

The primary aim was to compare CAD/CAM versus conventional multistranded FRs in terms of stability until 2 years. Secondary outcomes were failure rates, patient satisfaction, and cost-minimization.

TRIAL DESIGN

2-arm parallel, two-centre randomized controlled trial.

METHODS

Patients were randomized to CAD/CAM or conventional FRs in both arches, in a 1:1 ratio and blocks of four. Allocation concealment was secured by using sequentially numbered envelopes. Patients were blinded. FRs were bonded at the end of treatment, and patients were recalled after 12 and 24 months. First-time retainer failures were recorded and digital impressions were taken. Arch widths and lengths, as well as Little's Irregularity Index (LII), were measured. Additionally, patients answered satisfaction questionnaires. Linear mixed models were applied for measurements and patient satisfaction. Survival analyses were estimated with Kaplan-Meier curves, along with Cox-regression modelling. Cost-minimization analysis was undertaken.

RESULTS

One hundred and eighty-one patients were randomized (98 in Centre 1, and 83 in Centre 2): 90 in CAD/CAM and 91 in conventional group. One hundred and fifty three patients attended T24 follow-up. There were no significant differences in LII and arch dimensions between groups for failure-free patients. Within 24 months, 34% maxillary CAD/CAM FRs and 38% maxillary conventional FRs failed, along with 42% mandibular CAD/CAM FRs and 40% mandibular conventional FRs, with no significant difference in survival between groups (hazard ratios conventional to CAD/CAM: maxillary arch: 1.20 [P = 0.46], mandibular arch: 0.98 [P = 0.94]). There were no significant differences in patient satisfaction between groups. No harms were observed. Cost-minimization analysis showed that CAD/CAM FRs were slightly cheaper than conventional FRs.

CONCLUSIONS

There were no clinically significant differences in LII, arch widths, and lengths between CAD/CAM and conventional FRs after 24 months. There were no differences in failures and patient satisfaction between groups. CAD/CAM FRs were slightly cheaper than conventional FRs.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04389879.

Striving for Perfection: How Stable Is Orthodontic Treatment When Excellent Outcomes Are Achieved? A 9-Year Post-Treatment Retrospective Study

(1) Aims: The main objective of this retrospective study was to assess the long-term stability of difficult orthodontic treatments treated to an excellent result and to correlate stability to possible prognostic factors. Secondary objectives were to observe the changes in retention protocol over time and to assess Oral Health-related Quality of Life (OHRQoL) after a long-term post-treatment follow-up. (2) Methods: Cases presented for final examination by orthodontic postgraduate students were retrospectively screened for eligibility. Eligible patients were recalled for a post-treatment recall appointment (T2), consisting of a clinical examination and intraoral scan, and were asked to complete the Oral Health Impact Profile-14 (OHIP-14-DK). Gender, age at treatment commencement (T0), treatment modality and duration, and retention protocol were extracted from the records. At T2, the duration of the retention period was recorded, and retainers in place were clinically compared to the original retention protocol. The following variables were assessed on the sets of models at T0, T1 (end of treatment), and T2: arch length and width, overjet and overbite, Dental Aesthetic Index (DAI), Peer Assessment Rating score (PAR), and Little's Irregularity Index (LII). Multiple regression models were conducted. (3) Results: Eighty-five subjects attended T2. The mean post-treatment follow-up was 9.4 years +/- 2.4. In the upper arch, at T1, 74 patients had a combination of fixed and removable retainers, while at T2, 55 had a fixed retainer only. In the lower arch, at T1, 67 patients had a fixed retainer only, with this number increasing to 76 at T2. From T0 to T1, the PAR score improved by 96.1%, with the improvement remaining at 77.5% at T2. The stability of lower inter-canine and upper inter-premolar widths was significantly correlated with the extent of changes during treatment. The presence of a lower fixed retainer at T2 and a low LII at T1 were prognostic factors for stability. The mean weighted total OHIP-14 score at T2 was very low (1.6 ± 2.4 points). (4) Conclusions: In a sample with an initial high-severity malocclusion and treated to an excellent outcome, long-term stability was very good. Good stability can be retained when a lower fixed retainer is present at T2 and when a low LII is achieved at T1.

Stability, survival, and patient satisfaction with CAD/CAM versus conventional multistranded fixed retainers in orthodontic patients: a 6-month follow-up of a two-centre randomized controlled clinical trial

OBJECTIVES

The primary aim of this two-arm parallel two-centre randomized controlled trial was to compare computer-aided design and computer-aided manufacturing (CAD/CAM) versus conventional multistranded fixed retainers (FRs) in terms of stability over 6 months. Secondary outcomes were failure rates and patient satisfaction.

METHODS

Patients were randomized to CAD/CAM or conventional FRs in both arches, in 1:1 ratio and blocks of four. Allocation concealment was secured by using sequentially numbered envelopes. Patients were blinded. Retainers were bonded at the end of orthodontic treatment (T0), and patients were recalled after 1 (T1), 3 (T3), and 6 (T6) months. First-time retainer failures were recorded and digital impressions were taken. Arch widths and lengths, as well as Little's Irregularity Index (LII), were measured. Additionally, patients answered satisfaction questionnaires. Linear mixed models were applied for measurements and patient satisfaction. Survival analyses were estimated with Kaplan-Meier curves, along with Cox-regression modelling.

RESULTS

One hundred and eighty-one patients were randomized (98 in Centre 1, and 83 in Centre 2): Ninety in the CAD/CAM group and 91 in the conventional group. Three subjects dropped out at baseline, as they did not attend any of the follow-up appointments.168 patients attended the T6 visit. There were no significant differences in arch dimensions between T0 and T6, whilst the LII was different only in the CAD/CAM group (mean difference: 0.2 mm; 95% confidence interval: 0.1 to 0.4; P < 0.001). Within 6 months, 39 upper retainers (19 out of 88 CAD/CAM and 20 out of 90 conventional retainers) and 52 lower retainers failed (26 out of 88 CAD/CAM and 26 out of 90 conventional retainers), with no significant difference between the survival of both types of retainers (hazard ratios conventional to CAD/CAM: upper arch: 0.99 [P =0.99], lower arch: 0.93 [P = 0.80]). There were no significant changes in patient satisfaction between the groups. No harms were observed.

CONCLUSIONS

There were no clinically significant differences in LII, arch widths and lengths between CAD/CAM and conventional retainers after 6 months. There was no difference in failures and in patient satisfaction between both types of FRs.

REGISTRATION

ClinicalTrials.gov NCT04389879.

Malocclusion and oral health-related quality of life among young Danish adults. Is there a difference between subjects who received orthodontic treatment during adolescence and subjects without treatment need? A cross-sectional study

OBJECTIVES

To evaluate and compare malocclusion traits and oral health-related quality of life (OHRQoL) between untreated young adults assessed to have no orthodontic treatment need during childhood, and young adults treated orthodontically during childhood. In addition, to investigate the relationship between malocclusion and OHRQoL.

MATERIALS AND METHODS

One hundred undergraduate students were screened for eligibility. Subjects had intraoral scans and completed OHIP-14 questionnaires. Angle molar relationship, overjet, overbite, arch length and width, Little's Irregularity Index (LII), Peer Assessment Rating (PAR) index and Dental Aesthetic Index (DAI) scores were assessed. Unpaired t-tests were used to compare outcomes between treated and untreated subjects. Multiple regression analyses were conducted to model the relationship between OHIP-14 and several prognostics simultaneously.

RESULTS

Ninety-six subjects were included (mean age ± SD = 23.7 ± 1.8 years): 41 treated and 55 untreated. The untreated subjects had significantly higher LII (p = .02), PAR (p = .01), DAI (p < .01) and overbite (p = .03). The treated subjects had significantly larger inter-canine and inter-premolar distances. No relationship was found between OHIP-14 and LII, PAR, DAI, age, gender and presence/absence of previous orthodontic treatment. However, the DAI score was significantly correlated with the OHIP-14 functional limitation domain.

CONCLUSIONS

Untreated subjects had significantly higher LII, PAR and DAI scores than the treated subjects. DAI score was significantly correlated with the OHIP-14 functional limitation domain.

Does quality of orthodontic treatment outcome influence post-treatment stability? A retrospective study investigating short-term stability 2 years after orthodontic treatment with fixed appliances and in the presence of fixed retainers

OBJECTIVE

The present study aimed to evaluate stability 2 years after orthodontic treatment and to investigate the influence of various pre-treatment and post-treatment prognostic factors on stability.

SETTING AND SAMPLE POPULATION

Consecutive patients treated with full fixed appliance and retained with fixed retainers were retrospectively assessed for eligibility.

MATERIALS AND METHODS

Digital models were analysed at treatment start (T0), end of treatment (T1) and 2 years post-treatment (T2). The Peer Assessment Rating (PAR) index, Little's Irregularity Index (LII), arch width and length, overjet, overbite and presence of unexpected post-treatment changes were assessed. Multiple regression analyses were conducted to model the relationship of all outcomes with several prognostics simultaneously.

RESULTS

The sample consisted of 287 subjects (mean treatment time: 25.1 months, standard deviation [SD] 7.5; mean post-treatment follow-up: 27.5 months, SD 6.1) with a mean weighted PAR score of 29.5 (SD 8.6) at T0, 1.8 (SD 2.9) at T1 and 3.2 (SD 3.6) at T2. At T1, 95% of the subjects had a perfect LII versus 86% at T2. An increased LII at T1 correlated with increased LII and PAR changes from T1 to T2. PAR at T1 as well as overjet at T0 was a significant prognostic factor for PAR at T2. At T2, five cases (1.7%) showed unexpected post-treatment changes related to fixed retainers.

CONCLUSION

Short-term post-treatment stability with fixed retainers was very good. Prognostic factors for stability included LII and PAR at T1, suggesting that high-quality treatment outcome in the presence of fixed retainers may ensure post-treatment stability.

Validity and Reproducibility of the Peer Assessment Rating Index Scored on Digital Models Using a Software Compared with Traditional Manual Scoring

The aim of this study was to assess the validity and reproducibility of digital scoring of the Peer Assessment Rating (PAR) index and its components using a software, compared with conventional manual scoring on printed model equivalents. The PAR index was scored on 15 cases at pre- and post-treatment stages by two operators using two methods: first, digitally, on direct digital models using Ortho Analyzer software; and second, manually, on printed model equivalents using a digital caliper. All measurements were repeated at a one-week interval. Paired sample t-tests were used to compare PAR scores and its components between both methods and raters. Intra-class correlation coefficients (ICC) were used to compute intra- and inter-rater reproducibility. The error of the method was calculated. The agreement between both methods was analyzed using Bland-Altman plots. There were no significant differences in the mean PAR scores between both methods and both raters. ICC for intra- and inter-rater reproducibility was excellent (≥0.95). All error-of-the-method values were smaller than the associated minimum standard deviation. Bland-Altman plots confirmed the validity of the measurements. PAR scoring on digital models showed excellent validity and reproducibility compared with manual scoring on printed model equivalents by means of a digital caliper.

A Danish version of the oral health impact profile-14 (OHIP-14): translation and cross-cultural adaptation

Background

The Oral Health Impact Profile-14 (OHIP-14) questionnaire assesses quality of life related to people’s perception of oral disorders on their well-being. However, a translated and validated Danish version of OHIP-14 is not yet available.

The purpose of this pilot study was to translate and cross-culturally adapt the English version of the OHIP-14 into Danish (OHIP-14-DK). In addition, to assess its content and face validity, internal consistency and test-retest reliability.

Methods

The English version of OHIP-14 was translated into Danish following a standard protocol of cross-cultural adaptation. Stages I-IV: translation phase to generate a pre-final version “OHIP-14-DK”. Stage V: pre-testing phase. A random sample of 22 orthodontic patients (mean age 24.7 years, SD ±14.8; 14 females, 8 males) were selected at the Section of Orthodontics, Aarhus University, Denmark. All patients self-completed the OHIP-14-DK and were then interviewed to assess its content and face validity. Internal consistency was assessed with Cronbach’s alpha coefficients. All patients completed the same questionnaire again at a one-week interval. Test-retest reliability was assessed using Spearman’s correlation coefficient and intra-class correlation coefficient (ICC).

Results

The initial and back translations were very similar: the OHIP-14-DK proved to have a good level of equivalence with no translation errors or deviations. Furthermore, the OHIP-14-DK seemed well-adapted to Danish culture and was understood by individuals down to 12 years of age. Pre-testing demonstrated good face and content validity; interviews had a response rate of 100% and confirmed that each item was understandable without inducing reluctance or hesitation. Thus, responses were related to their corresponding item. Therefore, no final adjustments were required for the pre-tested version. Cronbach’s alpha for the OHIP-14-DK subscales fell in the 0.75–0.84 range, indicating an adequate-to-good internal consistency. Spearman’s correlation coefficient for the OHIP-14-DK total score was 0.77. The ICC for the OHIP-14-DK total score was 0.91.

Conclusions

The OHIP-14-DK seems well adapted to Danish culture, proved to be face and content valid and also showed good internal consistency and excellent reliability. However, its psychometric properties still need to be tested.

Study registration

Not applicable

'Candidatus Liberibacter solanacearum' Is Tightly Associated with Carrot Yellows Symptoms in Israel and Transmitted by the Prevalent Psyllid Vector Bactericera trigonica

Carrot yellows disease has been associated for many years with the Gram-positive, insect-vectored bacteria, 'Candidatus Phytoplasma' and Spiroplasma citri. However, reports in the last decade also link carrot yellows symptoms with a different, Gram-negative, insect-vectored bacterium, 'Ca. Liberibacter solanacearum'. Our study shows that to date 'Ca. L. solanacearum' is tightly associated with carrot yellows symptoms across Israel. The genetic variant found in Israel is most similar to haplotype D, found around the Mediterranean Basin. We further show that the psyllid vector of 'Ca. L. solanacearum', Bactericera trigonica, is highly abundant in Israel and is an efficient vector for this pathogen. A survey conducted comparing conventional and organic carrot fields showed a marked reduction in psyllid numbers and disease incidence in the field practicing chemical control. Fluorescent in situ hybridization and scanning electron microscopy analyses further support the association of 'Ca. L. solanacearum' with disease symptoms and show that the pathogen is located in phloem sieve elements. Seed transmission experiments revealed that while approximately 30% of the tested carrot seed lots are positive for 'Ca. L. solanacearum', disease transmission was not observed. Possible scenarios that may have led to the change in association of the disease etiological agent with carrot yellows are discussed. [Formula: see text] Copyright © 2018 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .

Diagnosis and Management of Hidden Caries in a Primary Molar Tooth

Hidden caries is a dentinal lesion beneath the dentinoenamel junction, visible on radiographs. A single report described this lesion in primary dentition. This case report describes a case of hidden caries in a mandibular second primary molar, misdiagnosed as malignant swelling. A 3-year-old white girl was referred to the Department of Pediatric Dentistry with a chief complaint of pain and extraoral swelling on the right side of the mandible for the last 3 months. She was earlier referred to the surgical department for biopsy of the lesion. Radiographic and computed tomography scan examination showed a periapical lesion with buccal plate resorption and radiolucency beneath the enamel on the mesial part of tooth 85. The tooth was extracted, and follow-up of 2 years showed normal development of tooth 45. The main problem is early detection and treatment, since the outer surface of enamel may appear intact on tactile examination.

Comparison of scoring systems and outcome of patients admitted to a liver intensive care unit of a tertiary referral centre with severe variceal bleeding

BACKGROUND

Acute variceal haemorrhage (AVH) is associated with significant mortality.

AIMS

To determine outcome and factors associated with hospital mortality (HM) in patients with AVH admitted to intensive care unit (ICU) and to compare outcomes of patients requiring transfer to a tertiary ICU (transfer group, TG) to a local in-patient group (LG).

METHODS

A retrospective study of all adult patients (N = 177) admitted to ICU with AVH from 2000-2008 was performed.

RESULTS

Median age was 48 years (16-80). Male represented 58%. Median MELD score was 16 (6-39), SOFA score was 8 (6-11). HM was higher in patients who had severe liver disease or critical illness measured by MELD, SOFA, APACHE II scores and number of failed organs (NFO), P < 0.05. Patients with day-1 lactate ≥ 2 mmol/L had increased HM (P < 0.001). MELD score performed as well as APACHE II, SOFA and NFO (P < 0.001) in predicting HM (AUROC = 0.84, 0.81, 0.79 and 0.82, respectively P > 0.05 for pair wise comparisons). Re-bleeding was associated with increased HM (56.9% vs. 31.6%, P = 0.002). The TG (n = 124) had less severe liver disease and critical illness and consequently had lower HM than local patients (32% vs. 57%, P = 0.002). TG patients with ≥2 endoscopies prior to transfer had increased 6-week mortality (P = 0.03). Time from bleeding to transfer ≥3 days was associated with re-bleeding (OR = 2.290, P = 0.043).

CONCLUSIONS

MELD score was comparable to ICU prognostic models in predicting mortality. Blood lactate was also predictive of hospital mortality. Delays in referrals and repeated endoscopy were associated with increased re-bleeding and mortality in this group.

The complete nucleotide sequence of Passiflora latent virus and its phylogenetic relationship to other carlaviruses

A virus identified as Passiflora latent virus (PLV) was isolated from passion fruit plants. Particle morphology, host range and serological properties suggested that this virus belongs to the genus Carlavirus. The complete genomic sequence of PLV was determined by sequencing overlapping cDNA fragments. The genome consisted of 8386 nt, excluding the poly (A) tail and contained six open reading frames, typical of carlaviruses. The overall similarities of the predicted amino acid sequence of PLV to those of other carlaviruses ranged from 25 to 73%. Phylogenetic analysis indicated that PLV was closely related to lily symptomless virus and blueberry scorch virus. This is the first report of the complete nucleotide sequence and genome structure of PLV.

Natural Infection of Verbena and Phlox by a Recently Described Member of the Carmovirus Genus

A novel carmovirus infecting angelonia (Angelonia angustifolia) was recently described independently by researchers in the United States, Israel, and Germany (1,2,4). Angelonia flower break virus (AnFBV) and Angelonia flower mottle virus were proposed as appropriate names for this carmovirus. The virus, causing stunting, mild leaf mottle, flower mottling, and flower breaking symptoms has been detected in naturally infected angelonia in the United States, Israel, and Germany (2,4). Here we report the first detection of natural infection of verbena (in the United States and Israel) and phlox (in the United States) by using a recently developed double-antibody sandwich enzyme-linked immunosorbent assay (DAS-ELISA; Agdia, Elkhart, IN). Prior to this report, verbena was considered insusceptible to carmovirus infection (3) and phlox was known as an experimental host for AnFBV (2). A comparative serological study including 27 virus species, demonstrated that DAS-ELISA did not cross-react with any viruses that commonly infect ornamentals or are related to carmoviruses, showing that the polyclonal antibodies are specific to AnFBV. Antibody specificity was confirmed by the carmovirus group PCR test (Agdia). Furthermore, reverse transcription-polymerase chain reaction with AnFBV specific primers (2) produced the expected 1172-bp band from all ELISA-positive samples tested. Between November 2005 and March 2006, AnFBV was detected in 181 of 567 verbena, 26 of 143 phlox, and 193 of 267 angelonia samples submitted to Agdia Testing Services by commercial ornamental propagators for virus testing. Most samples were asymptomatic, although a few exhibited mild leaf mottle. It should be noted that the number of AnFBV-infected samples might not accurately reflect the actual number of commercially produced plants infected with AnFBV because most of the samples analyzed originated from virus elimination programs. The detection of natural AnFBV infection of verbena, phlox, and angelonia suggests that AnFBV may be more widespread in the ornamental industry than previously thought. References: (1) S. Adkins et al. Phytopathology (Abstr.) 95(suppl.):S2, 2005. (2) S. Adkins et al. Phytopathology 96:460, 2006. (3) G. P. Martelli and M. Russo. Online publication. ICTVdB-The Universal Virus Database. 00.074.0.02, 2004. (4) S. Winter et al. New Disease Reports. Vol 12. Brit. Soc. Plant Pathol. Online publication, 2005.

Association of a Virus with Wheat Displaying Yellow Head Disease Symptoms in the Great Plains

Wheat with yellow head disease (YHD) (yellow heads and mosaic leaf symptoms) has been observed in Kansas since 1997. A pathogen was transmitted from the infected wheat to maize by vascular puncture inoculation and to Nicotiana benthamiana by rub inoculation. The original infected wheat and infected maize and N. benthamiana test plants all produced a unique 32- to 34-kDa protein when analyzed by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Time-of-flight mass spectrometry analysis of the unique 32- to 34-kDa protein showed that the amino acid sequence was most closely related to the nucleoprotein of Rice hoja blanca virus, indicating that the virus causing YHD symptoms in wheat is a tenuivirus. Antiserum made to this protein failed to react with extracts made from healthy wheat or wheat infected with Wheat streak mosaic virus or the High Plains virus. The antiserum did react to extracts made from symptomatic wheat, maize, and N. benthamiana, shown by SDS-PAGE to contain the unique protein, and to extracts of wheat with YHD symptoms from Kansas, North Dakota, South Dakota, and Oklahoma. The name Wheat yellow head virus is proposed for this virus.

Use of IgG Avidity test in case definitions of toxoplasmosis in pregnancy

A survey network for congenital toxoplasmosis (TOXO-NET) was set up in December 1996 in Piedmont (Italy). Participants were asked to classify the infections in pregnant mothers and newborns by the criteria of the European Network on Congenital Toxoplasmosis published by Lebech in 1996. Because the IgG Avidity test is largely employed as a 2nd level test in toxoplasmosis diagnosis and it could be helpful to date infection, the co-ordinators of TOXO-NET suggested including it in the "case definition" of "probable" infection and "unlikely" infection. 117 cases of toxoplasmosis in pregnancy divided into the risk categories under Lebech's criteria were re-examined using the "new" case definitions. 77 out of 117 (65.8%) Toxoplasma gondii infections during pregnancy could be defined with only one serum sample using the IgG Avidity test. The IgG Avidity test proved a useful method to classify the Toxoplasma gondii infections in pregnancy, especially when we had only one serum sample.

Characterization of a distinct carlavirus isolated from Verbena

Avirus was isolated from Verbena plants that bore virus-like symptoms. The virus, for which the name Verbena latent virus (VeLV) is proposed, was consistently isolated from these plants, both with and without disease symptoms. Electron microscopy studies of ultrathin sections of infected Verbena tissues revealed the presence of elongated flexuous virus particles, ca. 650 nm in length. Its experimental host range was limited to Verbena spp. and Nicotiana clevelandii. No inclusion bodies or specific cytopathological effects, were observed. Electrophoresis of dissociated purified virus preparation in sodium dodecyl sulfate-polyacrylamide gel revealed a major protein component with a molecular mass of 38.9 kDa. Polyclonal antibodies which could specifically bind to virus particles were produced. A portion of the viral RNA was cloned and sequenced; it comprised 2503 nucleotides and contained part of three open reading frames (ORFs) which from the 5' to the 3'-ends, potentially encode for 489 amino acids (ORF1), a 25.8-kDa protein (ORF2) and a 12-kDa protein (ORF3). Comparison of the predicted amino acid sequence with those of other plant viruses revealed 40-60% identity with several carlaviruses. In the light of particle morphology, absence of specific cytopathological effects in ultrathin sections, and genomic and serological properties, it is suggested that this virus belongs to the genus Carlavirus.

The route of tomato spotted wilt virus inside the thrips body in relation to transmission efficiency

The route of tomato spotted wilt virus (TSWV) in the body of its vectors, Frankliniella occidentalis and Thrips tabaci (Thysanoptera: Thripidae) was studied during their development. First instar larvae were allowed, immediately upon hatching, to acquire virus from mechanically infected Datura stramonium plants for 24 h. The rate of transmission by adults was determined in inoculation access feeding test on Emilia sonchifolia leaf disks. Thrips tissues were analysed for infection at 24 h intervals after the acquisition-access feeding period, and assayed by the whole-mount immuno-fluorescent staining technique. The virus was initially detected in the proximal midgut region in larvae of both species, and then in the second and third midgut regions, foregut, and salivary glands. Occasionally the first infections of the salivary glands were already detected in one-day-old second stage larvae. The intensity of the infection in the various organs of the thrips of each species was positively related to the transmission efficiency. In both thrips populations good agreement was found between the percentage of second instar larvae and adults with at least one infected salivary gland lobe and the percentage of transmitting adults. These results support the contention that the virus must reach the salivary glands before thrips pupation in order to be transmitted by old second instar larvae and adults.

Stylalgia: an Indian perspective

OBJECTIVE

The main objective was to study the stylalgia profile in Indians and the outcome of styloidectomy in such cases.

DESIGN

This prospective study was carried out by random selection of patients with stylalgia using periodic random numbers.

SETTING

This was a hospital-based study.

METHODS

Surgical excision of the symptomatic enlarged styloid process was performed by the transtonsillar route using a dilation and curettage (D and C) curette.

MAIN OUTCOME MEASURES

The patients were followed postoperatively for their pain relief.

RESULTS

Of 40 patients operated on, 31 (77.5%) became symptom free, 5 (12.5%) had considerable improvement in their symptoms, and 4 (10%) had no relief.

CONCLUSIONS

The incidence of an enlarged styloid process was found to be higher in an Indian rural population with female preponderance owing to their carrying of heavy weight on head. Styloidectomy was very rewarding. The D and C curette was found to be a very effective instrument for styloidectomy.

Distribution and Transmission of Iris yellow spot virus

Iris yellow spot virus (IYSV), a new tospovirus associated with a disease in onion (Allium cepa) that is known to growers in Israel as "straw bleaching," was identified and further characterized by host range, serology, electron microscopy, and molecular analysis of the nucleocapsid gene. The transmissibility of IYSV by Thrips tabaci and Frankliniella occidentalis was studied. IYSV was efficiently transmitted by T. tabaci from infected to healthy onion seedlings and leaf pieces. Two biotypes of F. occidentalis, collected from two different locations in Israel, failed to transmit the virus. Surveys to relate the incidence of thrips populations to that of IYSV were conducted in onion fields. They revealed that the onion thrips T. tabaci was the predominant thrips species, and that its incidence was strongly related to that of IYSV. Forty-five percent of the thrips population collected from IYSV-infected onion and garlic fields in Israel transmitted the virus. IYSV was not transmitted to onion seedlings from infected mother plants through the seed, and was not located in bulbs of infected plants.

First Report of Sweet potato sunken vein virus Occurring in Lisianthus

During a survey of Lisianthus (Eustoma grandiflorum) plots in the Northern Negev in Israel, plants infected with Iris yellow spot virus (IYSV) (Genus Tospovirus; 1) were identified. In addition, during electron microscope observations of ultrathin sections through parenchyma phloem cells from some of the IYSV-infected plants, vesicles and virus particles typical of closteroviruses (850 × 12 nm) were observed. As sweet potatoes grown in this area often are infected with Sweet potato sunken vein virus (SPSVV), it was of interest to see if SPSVV also had naturally infected Lisianthus. Using immunosorbent electron microscopy (ISEM) with an antiserum developed against SPSVV (2), trapping and decoration of the suspected chlostero-like particles were observed in some of the field-collected Lisianthus plants. This antiserum did not react with two other closteroviruses, Citrus tristeza virus and Lettuce infectious yellow virus. Inoculation of non-infected Lisianthus plants with SPSVV acquired from sweet potato by whitefly (Bemisia argentifolii), resulted in the presence of vesicles and clostero-like particles in ultrathin sections of parenchyma phloem cells 1 month after inoculation. ISEM tests with SPSVV antiserum were positive. Inoculations of sweet potato from SPSVV-infected Lisianthus plants by whiteflies were not successful. No leaf symptoms of SPSVV were observed in Lisianthus plants, but flower stems were shorter by about one third. These data indicate that Lisianthus is a host for SPSVV. To our knowledge, this is the first report of SPSVV infecting Lisianthus and any species of the Genetianaceae. References: (1) A. Kritzman, H. Beckelman, S. Alexandrov, J. Cohen, J. Lampel, M. Zeidan, B. Raccah and A. Gera. Plant. Dis. 84:1185, 2000. (2) J. Cohen, A. Franck, H. J. Vetten, D. E. Lesemann and G. Loebenstein. Ann. Appl. Biol. 121:257, 1992.

Okra (Hibiscus esculentus)-A New Host of Turnip mosaic virus in Israel

In July 1999, Hibiscus esculentus plants, grown in garden plots in Galilee, Israel, exhibited chlorosis, vein clearing accompanied by necrosis, and growth reduction. All samples (n = 10) tested positive for Turnip mosaic virus (TuMV) in enzyme-linked immunosorbent assay (ELISA), using a polyclonal antibody produced in our laboratory against purified virus. Virus in crude sap extracted from symptomatic tissue was mechanically transmitted to Chenopodium quinoa, C. amaranticolor, Nicotiana tabacum Xanthi nc and White Burley, N. clevelandii, N. benthamiana, N. sylvestris, and N. rustica, all of which developed symptoms characteristic of TuMV infection (1). ELISA testing of leaf sap extracted from mechanically inoculated indicator plants gave a strong positive reaction to TuMV. Leaf dip preparations of H. esculentus were analyzed by transmission electron microscopy. Filamentous virus particles typical of a potyvirus were observed in samples from symptomatic leaves. General primer pairs, which cover the complete 3'-end of the potyvirus genome were used in a reverse transcription-polymerase chain reaction assay (RT-PCR), gave an expected amplification product of approximately 300 bp. The nucleotide sequence of the PCR product was 97% identical to the CP sequence of other TuMV, thus verifying TuMV infection of H. esculentus. This is the first report of H. esculentus infection by TuMV. Reference: (1) A. Gera et al. J. Phytopathol. 145:289-293, 1997.

Lisianthus Leaf Necrosis: A New Disease of Lisianthus Caused by Iris yellow spot virus

Unusual viral symptoms were seen on lisianthus (Eustoma russellianum) grown in the Besor area in Israel. Symptoms included necrotic spots and rings on leaves and systemic necrosis. Preliminary analyses suggested that the disease was caused by a tospovirus. Virus particles typical of a tospovirus were observed with electron microscopy in samples taken only from symptomatic leaves. Double-antibody sandwich enzyme-linked immunosorbent assay tests of leaf sap, extracted from lisianthus and mechanically inoculated indicator plants, gave a strong positive reaction to Iris yellow spot virus (IYSV). Polyclonal antibodies prepared against IYSV enabled specific detection of the virus in crude sap from infected plants. Western blot analysis showed that IYSV was serologically distinct from Tomato spotted wilt virus (TSWV). Primers specific to the nucleocapsid gene of IYSV were used in a reverse transcription-polymerase chain reaction assay (RT-PCR) to verify the presence of IYSV. RT-PCR gave an expected PCR product of approximately 850 bp. The sequence of the cloned nucleocapsid gene confirmed the identity of IYSV, thus confirming IYSV infection of lisianthus. This is the first report of IYSV infection in dicotyledons.

Conservative management of malocclusion in mixed dentition

The treatment planning in mixed dentition period has changed from extraction to non extraction. Any orthodontic treatment must take into consideration the growth trends and the pubertal growth spurt. The two cases presented here were treated during mixed dentition period in different ways: one with fixed appliances and the other with removable myofunctional appliance therapy, with satisfactory results. Hence for a conservative treatment approach, the non-extraction treatment is recommended in mixed dentition period.

Nasal mucociliary clearance in adenotonsillar hypertrophy

The nasal mucociliary clearance time was studied using Andersen saccharin method in 50 normal children and 50 age and sex matched patients of adenotonsillar hypertrophy, which was repeated one month after adenotonsillectomy. The normal mucociliary clearance time in healthy children was found to be 8.55 +/- 2.11 minutes. A significant impairment in nasal mucociliary clearance time was noted in children suffering with adenotonsillar hypertrophy which was 16.97 +/- 3.1 minutes, and early adenotonsillectomy restored the mucociliary clearance to a normal 8.7 +/- 2.14 minutes.

Multiple papilloma larynx

Multiple papilloma of larynx is caused by human papilloma virus. We treated sixteen such cases (10 males and six females) in the last 10 years. All presented with hoarseness while six presented with difficulty in respiration. Three patients needed tracheostomy, all had difficult decanulation, and one developed laryngotracheal stenosis and could not be decanulated. All were treated by surgical excision; ten had recurrence. Four patients were treated with post operative Acyclovir with no recurrence in three cases.

Biological and Molecular Characterization of a New Carlavirus Isolated from an Aconitum sp

ABSTRACT A new virus was isolated from symptomless Aconitum napellus plants. The virus, for which the name Aconitum latent virus (AcLV) is proposed, has flexuous particles 640 nm in length. The experimental host range was limited to Nicotiana clevelandii. Electron microscopy studies of ultrathin sections of infected A. napellus tissues revealed the presence of elongated virus particles. No inclusion bodies characteristic of potyvirus infection were observed. AcLV was purified from naturally infected A. napellus by cesium chloride step gradient centrifugation. In sodium dodecyl sulfate-polyacrylamide gel electrophoresis of dissociated purified virus preparations, a major protein component with a molecular mass of 35 kDa was observed. Diagnostic antibodies that could specifically bind to virus particles were produced. The 5' terminus (620 nucleotides) of the viral RNA was cloned and sequenced. It comprised 71 nucleotides from the untranslated 5' terminus and 549 nucleotides of an open reading frame encoding 183 amino acids. Comparison of the predicted amino acid sequence with those of other plant viruses revealed 40 to 60% identity with several carlaviruses. Based on particle morphology, absence of inclusion bodies in ultrathin sections, the relative molecular weight of the coat protein, the nucleotide sequence, and predicted amino acid homology, it is suggested that this virus belongs to the carlavirus group.

Pittosporum tobira: A New Host for Tomato spotted wilt virus

In July 1998, Pittosporum tobira shrubs, grown in a nursery in the Sharon Valley of Israel, developed foliar ring spots, mild mosaic, and tip necrosis. Of 15 samples tested for the presence of Tomato spotted wilt virus (TSWV) with a commercially available enzyme-linked immunosorbent assay (ELISA) kit (Loewe Biochemica, Otterfing, Germany), 14 were positive for TSWV. Virus in crude sap extracted from symptomatic tissue was mechanically transmitted to Emilia spp., Petunia hybrida, Nicotiana glutinosa, N. benthamiana, and N. rustica plants, which developed symptoms characteristic of TSWV infection (1). ELISA tests of leaf sap extracted from naturally infected P. tobira and mechanically inoculated indicator plants gave a strong positive reaction to TSWV. Leaf samples of P. tobira were analyzed by transmission electron microscopy in leaf-dip preparations and thin sections of leaf tissues. Virus particles typical of a tospovirus were observed only in samples taken from symptomatic leaves. Primers specific to the nucleocapsid gene of TSWV were used in a reverse transcription-polymerase chain reaction (RT-PCR) assay to verify the presence of TSWV. RT-PCR gave an expected PCR product of ≈850 bp. The amplicon was cloned in the pGEM-T vector, and the recombinant clone was sequenced. The sequence of the cloned PCR product confirmed the identity of TSWV, verifying TSWV infection of P. tobira. This is the first report of infection of P. tobira by TSWV. Reference: (1) Y. Antignus et al. Phytoparasitica 25:319, 1997.

First Report of Petunia vein clearing virus in Israel

Petunia vein clearing virus (PVCV), a possible member of the cauli-movirus group, was detected in several cultivars of vegetatively propagated petunias grown in commercial nurseries in Israel. Symptoms associated with PVCV infection in petunia cv. Chaplin consisted of stunted young shoots, leaf yellowing, and severe vein clearing. Virus incidence within this cultivar was 40 to 60%. Symptoms were most frequently expressed when plants were subjected to temperatures above 20°C and nutrient deficiencies. The virus was transmitted to petunia only by grafting, however, not by aphids or mechanical inoculation. Leaf dip preparations and thin sections of leaf tissue were analyzed by transmission electron microscopy. Spherical virus particles (45 to 50 nm diameter) were observed in samples from symptomatic petunia plants. In immunoelectron microscopy, the virus particles produced a distinct pattern with the specific antiserum against PVCV provided by D. Lesemann (Biologische Bundesanstalt, Braunschweig, Germany). Infection with PVCV also was confirmed by polymerase chain reaction with total nucleic acid extract preparations. Two primer pairs-5'-GAGGTCAGAGCAAGTCAGAGG-3' (nucleotides 4339 to 4359) and 5'-GTAATGATTTGACTTGTTGAG-3' (nucleotides 5055 to 5075)-were designed to flank a 736-bp sequence in the RNA-dependent RNA polymerase gene of the PVCV genome (GenBank Accession no. U95208). A DNA fragment of the predicted size was visualized in agarose gels. Authenticity of the amplified DNA fragment was confirmed by restriction analysis. The virus has been detected in the past in Germany (1) and recently in the United States (2). This is the first report of PVCV in commercial nurseries in Israel. References: (1) D. Lesemann and R. Casper. Phytopathology 63:1118, 1973. (2) B. Lockhart and D. Lesemann. Plant Dis. 82:262, 1998.

A cDNA from tobacco codes for an inhibitor of virus replication (IVR)-like protein

We have shown previously that localization of tobacco mosaic virus (TMV) in tobacco is associated with a ca. 23 kDa protein that inhibits replication of several plant viruses. This protein, named 'inhibitor of virus replication' (IVR), was purified from the medium of TMV-inoculated protoplasts derived from Nicotiana tabacum cv. Samsun NN. IVR was shown to be present also in induced-resistant leaf tissue of N. tabacum cv. Samsun NN. We prepared an expression cDNA library from such induced-resistant tissue and screened it with a polyclonal antibody raised against the IVR protein. A 1016 bp clone (named NC330) containing a 597 bp open reading frame, coding for a 21.6 kDa polypeptide, was isolated. The NC330 clone hybridized with RNA from induced-resistant tissue from N. tabacum cv. Samsun NN but not with RNA from non-induced tissue. Likewise, it did not hybridize with RNA from infected or uninfected tissue of N. tabacum cv. Samsun nn. Similarly, the NC330 cloned probe hybridized with the RT-PCR products from RNA of the induced-resistant tissue only. In Southern blot hybridization the NC330 DNA probe detected several genomic DNA fragments in both N. tabacum cv. Samsun NN and Samsun nn. The size of the DNA fragments differed in Samsun NN and Samsun nn. We suggest that DNA encoding the IVR-like protein is present in resistant and susceptible N. tabacum genotypes, but is expressed only in NN. We have inserted the NC330 into the expression vector pET22b and a 21.6 kDa protein was produced in Escherichia coli that reacted in immunoblots with the IVR antibody. This protein greatly reduced replication of TMV in N. tabacum cv. Samsun nn leaf disk assays.

First Report of Impatiens Necrotic Spot Tospovirus (INSV) in Israel

In January 1999, Anemone coronaria L. imported from Europe and grown in open fields near Jerusalem in Israel developed foliar ringspots and foliar necrosis. Within a few weeks of the first appearance of these symptoms, further anemone plants in the surrounding area were affected and seriously damaged. Impatiens necrotic spot tospovirus (INSV) was detected in affected plants by enzyme-linked immunosorbent assay (ELISA; anti-INSV monoclonal antibodies were provided by H. T. Hsu, USDA, Beltsville, MD, and a polyclonal antibody to INSV was purchased from Loewe, Otterfing, Germany). Crude sap extracted from symptomatic tissue was mechanically transmitted to Emilia spp., Petunia hybrida, Nicotian glutinosa, N. benthamiana, and N. rustica plants that developed symptoms characteristic of INSV infection (1). ELISAs of leaf sap extracted from anemone plants and mechanically inoculated indicator plants gave a strong positive reaction to INSV. Leaf-dip preparations prepared from leaf samples of anemone plants were analyzed by transmission electron microscopy (TEM). Virus particles typical of a tospovirus were observed in samples taken only from symptomatic plants. TEM studies with ultrathin sections of infected anemone and Emilia spp. leaves revealed the presence of tospovirus-like particles. This first report of INSV interception in Israel brings the count of the Tospovirus members in Israel to three, including tomato spotted wilt virus (TSWV), which was found in the past to infect anemone and other ornamental crops, and the Iris yellow spot tospovirus, infecting onion (2). INSV is known to occur in Europe and in the U.S., mostly in flowers grown in greenhouses. The virus is transmitted by the Western flower thrips (WFT; Frankliniella occidentalis Pergande). Although all infected plants were destroyed, precautions to prevent further introduction of the virus must be made. INSV might spread by the WFT, which is abundant in Israel year round, and might also infect other greenhouse or field crops. References: (1) M. Daughtrey et al. Plant Dis. 81:1220, 1997. (2) A. Gera et al. Plant Dis. 82:127, 1998.

Early development of transient hypothyroidism after I131 therapy for thyrotoxicosis

295 patients of Graves' disease were studied for early development of transient hypothyroidism (TH) and its prognostic value following I131 therapy. 278 patients received I131 < 10 mci (6.4 +/- 1.7 mci) and 17, a dose of > 10 mci (12.6 +/- 2.6). TH was diagnosed on the basis of low T4 regardless of TSH within the first year after I131 therapy followed by normal T4 and TSH. 32 patients developed TH following administration of < 10 mci I131 and it was symptomatic in 10 patients. No instance of TH after high dose of I131 was noted. I131 uptake > 60% at 2 hours before treatment was a risk factor for developing TH (odds ratio 2.6, 95% confidence interval 0.8-9.6). At diagnosis of TH basal TSH was high in 53%, normal in 32%, or low in 15%; Hypothyroidism recognized during the first six months with basal TSH of 50 microU/ml or higher ruled out TH. Development of TH and its hormonal profile did not influence long term thyroid functions. As no prognostic factors predicted TH before I131 therapy or at the time of diagnosis, re-evaluation of thyroid functions later is essential to avoid unnecessary chronic replacement therapy, if hypothyroidism has been diagnosed within a few months of I131 treatment.

Iris Yellow Spot Tospovirus Detected in Onion (Allium cepa) in Israel

During March 1997, 20 to 30% of field-grown onion (Allium cepa), observed in Bet Shean Valley, Israel, had unusual viral symptoms of straw-colored ringspots on leaves and flower stalks. Leaf samples were analyzed by transmission electron microscopy (EM) of leaf dip preparations. Typical tospovirus-like particles were observed only with samples taken from symptomatic plants. Crude sap from symptomatic tissue was mechanically transmitted to Nicotiana benthamiana, Chenopodium quinoa, and Gomphrena globosa. On inoculated plants of N. benthamiana, chlorotic spots developed on inoculated leaves, followed by systemic necrosis, 4 and 7 days post inoculation (DPI), respectively. On inoculated plants of C. quinoa and G. globosa, necrotic local lesions developed by 4 to 5 DPI. EM studies with ultrathin sections of infected onion and N. benthamiana leaves revealed the presence of tospovirus-like particles. Virus was purified from mechanically infected N. benthamiana and identified as Iris yellow spot tospovirus (IYSV) by Western blots (immunoblots) and enzyme-linked immunosorbent assay (ELISA) (anti-IYSV antiserum was provided by D. Peters, Wageningen, the Netherlands). A high incidence of the disease observed in the surrounding fields and in other onion-growing areas in Israel was associated with large populations of the onion thrips (Thrips tabaci). Although characteristic symptoms have been noted on a frequent basis, effects on yield have yet to be determined. IYSV is known to occur in the Netherlands, where it has been occasionally detected in Iris (1) and leek (A. Porrum) (J. Verhoeven, personal communication). The detection of IYSV in Israel and the wide distribution of thrips in the natural vegetation may be an important constraint on onion and other bulb-crop production in Israel. Reference: (1) A. F. L. M. Derks and M. E. C. Lemmers. Acta Hortic. 432:132, 1996.

Use of monoclonal antibodies in the purification of an inhibitor of virus replication by affinity chromatography

Mouse monoclonal antibodies (MAbs) were prepared to an inhibitor of virus replication (IVR), released from protoplasts or leaf tissue of hypersensitive tobacco plants infected with tobacco mosaic virus. The MAbs were highly specific for IVR and reduced its antiviral activity. Using these MAbs in affinity chromatography enabled the recovery of purified IVR. SDS-PAGE of the immunoaffinity-purified IVR gave a single Mr 23K band. Immunoblots of IVR from extracts of protoplast or leaf tissue also revealed a single Mr 23K band which suggests that protoplast and tissue IVR are closely related.

Antiviral activity of natural and recombinant human leukocyte interferons in tobacco protoplasts

Several purified species of human leukocyte interferon, including recombinant interferons, inhibit the multiplication of tobacco mosaic virus (TMV) in tobacco protoplasts derived from various cultivars. Viral RNA accumulation was determined by dot-blot hybridization to specific cDNA probes, and virus antigen was determined serologically. Interferon apparently inhibited both TMV-RNA replication and its expression into coat protein. However, these effects were of limited duration. Maximum effect was obtained when interferon was applied to the cells either prior to inoculation or within the first hour after inoculation. Antibodies to interferon abolished its antiviral activity in protoplasts. Tobacco protoplasts were about 1000 times more responsive to interferon than the reference animal viral-cell system and showed an "antiviral state" at a ratio of 1 molecule of interferon per cell.

5'-dephosphorylated 2',5'-adenylate trimer and its analogs. Inhibition of tobacco mosaic virus replication in tobacco mosaic virus-infected leaf discs, protoplasts, and intact tobacco plants

The effect of the 5'-dephosphorylated 2',5'-adenylate trimer and its 2',5'-trimer core analogs on the inhibition of tobacco mosaic virus (TMV) replication was determined in tobacco leaf discs, protoplasts, and whole tobacco plants, using infectivity tests and enzyme-linked immunosorbent assays. A structure-activity-metabolic stability-toxicity analysis of the 2',5'-adenylate trimer core molecule in TMV-infected Nicotiana glutinosa was determined. Modification at either the 6-amino position of the adenylate residues (i.e. inosinate trimer core) or at the 2' terminus (i.e. A-A-ara-A or A-A-Tu) inhibited replication of TMV. Modification of the 3'-hydroxyl group of the adenylate residues to 3-deoxyribose (i.e. the 2',5'-cordycepin trimer core) inhibited TMV replication better than the 2',5'-adenylate trimer core molecule. With enzyme-linked immunosorbent assays, there was complete inhibition of TMV replication by 200 nM 2',5'-adenylate trimer core for 60 h and by 200 nM 2',5'-cordycepin trimer core for 96 h. The amount of 2',5'-oligonucleotides associated with the leaves was determined using 2',5'-[3H]cordycepin trimer core; 1 X 10(-12) mol/cm2 of plant leaves inhibited TMV replication by 99%. No 2',5'-phosphodiesterase activity was detected in TMV-infected and noninfected leaf extracts. Therefore, the 2',5'-trimer cores were potent inhibitors of TMV replication at nanomolar concentrations, i.e. at 1000-fold lower concentration than that required in mammalian systems.

Inhibitor(s) of virus replication (IVR) and localization of viruses in plants

A substance(s) inhibiting virus replication (IVR) is released into the medium from tobacco mosaic virus-infected protoplasts of a cultivar in which the infection in the intact plant is localized. IVR inhibited virus replication in protoplasts from both resistant (Samsun NN) and susceptible (Samsun) plants, when applied up to 18 h after inoculation. It was not produced in protoplasts from susceptible plants or from noninoculated protoplasts of the resistant cultivar. IVR was partially purified using ZnAc2 precipitation, and yielded two biologically active principles with molecular weights of about 26,000 and 56,000 daltons. Preliminary results indicate that IVR inhibits replication of TMV and several other non-related viruses when applied to inoculated leaf disks.