Integration of TB into child health policies in Africa's high-burden countries: a normative analysis

Integration of paediatric TB care into decentralised child health services has the potential to reduce the large proportion of childhood TB that remains undiagnosed. We performed a review of national guidelines and policies for TB and child health to evaluate the normative integration of paediatric TB into existing child health programmes in 15 high TB burden countries in Africa. While integration is addressed in 80% of the national strategic plans for TB, the child health strategies insufficiently address TB in their plans to reduce child mortality. Emphasis needs to be put on multi-sectoral collaboration among national health programmes.

Cryoballoon pulmonary-vein isolation for atrial fibrillation with heart failure: results from a single-center cohort

Background

Atrial fibrillation (AF) and heart failure (HF) are of growing prevalence and increasing mortality. Radiofrequency ablation is safe and effective for patients with AF and HF. Prognosis might be improved in patients treated. However, there is no prospective trial investigating efficacy and safety of cryoballon ablation in patients with AF and HF.

Objective

To prospectively compare cryoballoon ablation in patients with and without HF (defined as LVEF ≤40%) in terms of safety and efficacy.

Methods

Ongoing POLAR-HF trial is a prospective, investigator-initiated, single-center, non-inferiority, open-label study. We analyzed 244 consecutive patients who underwent cryoballoon ablation. Of these 217 had normal LVEF (age 68.1±9.6 years, CHA2DS2-VASc Score 2.5±1.3, 55.3% male) while 27 patients (11%) suffered from HF (age 70.4±8.6 years, CHA2DS2-VASc Score 3±1.2, 70.4% male). Follow-up was performed at 3, 6 and 12 months after ablation. Kaplan-Meier method was used to calculate 12-month event-rate estimates. Log-Rank Test to estimate hazard ratios in the primary analysis. Endpoints were: symptomatic AF relapse for efficacy and bleeding, stroke or death for safety.

Results

Analysis showed no difference in AF-free survival rate between patients with and without HF (81% vs. 76.3%, Log-Rank-Test P=0.81, Figure). Primary safety end point occurred in 5 patients with normal LVEF (2.3%) and none in the HF-group. No deaths were observed.

Conclusion

Results of POLAR-HF indicate that cryoballoon ablation is an effective ablation method for patients suffering from AF and HF.

Event-Free Survival (Efficacy Endpoint)

Funding Acknowledgement

Type of funding source: None

TELOMERE AND TELOMERASE MODULATION BY BERGAMOT POLYPHENOLIC FRACTION IN EXPERIMENTAL PHOTOAGEING IN HUMAN KERATINOCYTES

Photoageing represents the addition of extrinsic chronic ultraviolet radiation-induced damage on intrinsic ageing and accounts for most age-associated changes in skin appearance. In this study, we evaluated the effect of 38% BPF, a highly concentrated extract of the bergamot fruit (Citrus bergamia) on UVB-induced photoageing by examining inflammatory cytokine expression, telomere length/telomerase alterations and cellular viability in human immortalized HaCaT keratinocytes. Our results suggest that 38% BPF protects HaCaT cells against UVB-induced oxidative stress and markers of photoageing in a dose-dependent manner and could be a useful supplement in skin care products. Together with antioxidant properties, BPF, a highly concentrated extract of the bergamot fruit, appears to modulate basic cellular signal transduction pathways leading to anti-proliferative, anti-aging and immune modulating responses.

On-farm evaluation of the effect of metabolic diseases on the shape of the lactation curve in dairy cows through the MilkBot lactation model

The effects of metabolic diseases (MD) occurring during the transition period on milk production of dairy cows have been evaluated in many different ways, often with conflicting conclusions. The present study used a fitted lactation model to analyze specific aspects of lactation curve shape and magnitude in cows that avoided culling or death in the first 120 d in milk (DIM). Production and health records of 1,946 lactations in a 1-yr follow-up study design were collected from a transition management facility in Germany to evaluate both short- and long-term effects of MD on milk production. Milk production data were fitted with the nonlinear MilkBot lactation model, and health records were used to classify cows as healthy (H), affected by one MD (MD), or by multiple MD (MD+). The final data set contained 1,071 H, 348 MD, and 136 MD+ cows, with distinct incidences of 3.7% twinning, 4.8% milk fever, 3.6% retained placenta, 15.4% metritis, 8.3% ketosis, 2.0% displaced abomasum, and 3.7% mastitis in the first 30 DIM. The model containing all healthy and diseased cows showed that lactations classified as H had milk production that increased faster (lower ramp) and also declined faster (lower persistence) compared with cows that encountered one or more metabolic problems. The level of production (scale) was only lowered in MD+ cows compared with H and MD cows. Although the shape of the lactation curve changed when cows encounter uncomplicated (single) MD or complicated MD (more than one MD), the slower increase to a lower peak seemed to be compensated for by greater persistency, resulting in the overall 305-d milk production only being lowered in MD+ cows. In the individual disease models, specific changes in the shape of the lactation curve were found for all MD except twinning. Milk fever, retained placenta, ketosis, and mastitis mainly affected the lactation curve when accompanied by another MD, whereas metritis and displaced abomasum affected the lactation curve equally with or without another MD. Overall, 305-d milk production was decreased in complicated metritis (10,603 ± 50 kg vs. 10,114 ± 172 kg). Although care should be taken in generalizing conclusions from a highly specialized transition management facility, the current study demonstrated that lactation curve analysis may contribute substantially to the evaluation of both short- and long-term effects of metabolic diseases on milk production by detecting changes in the distribution of production that are not apparent when only totals are analyzed.

More safety with more energy: survival of electrical storm with 40-J shocks

We report the first clinical case of ineffective high-voltage therapy with 36 J and subsequent effective therapy with 40 J in a patient with electrical storm who had previously received a high-energy implantable cardioverter defibrillator (ICD, Fortify VR, 1233-40Q St. Jude Medical, Sylmar, CA, USA). Using a combination of high energy and optimized fixed millisecond duration biphasic waveform shock, successful defibrillation could be achieved at 8 J below the programmed maximum energy level.

Adults with type 1 diabetes eat a high-fat atherogenic diet that is associated with coronary artery calcium

AIMS/HYPOTHESIS

Coronary heart disease is the leading cause of mortality among people with type 1 diabetes. Diet is an important lifestyle factor that relates to risk of CHD. The aim of this study was to examine how diet and adherence to dietary guidelines differ between adults with and without type 1 diabetes, and their correlation with CHD risk factors and coronary artery calcium (CAC).

METHODS

The study involved 571 people with type 1 diabetes and 696 controls, aged 19 to 56 years, who were asymptomatic for CHD. CAC was measured by electron-beam computed tomography.

RESULTS

Compared with the controls, adults with type 1 diabetes reported a diet higher in fat, saturated fat and protein but lower in carbohydrates. Fewer than half of those with type 1 diabetes met dietary guidelines for fat and carbohydrate intake, and only 16% restricted saturated fat to less than 10% of daily energy intake. Adults with type 1 diabetes were significantly less likely to meet dietary guidelines than controls. Fat and saturated fat intakes were positively correlated, but carbohydrate intake was negatively correlated with CHD risk factors and HbA(1c). A high-fat diet and higher intake of protein were associated with greater odds of CAC, while higher carbohydrate intake was associated with reduced odds of CAC.

CONCLUSIONS/INTERPRETATION

Adults with type 1 diabetes reported consuming higher than recommended levels of fat and saturated fat. High fat intake was associated with increased CHD risk factors, worse glycaemic control and CAC. An atherogenic diet may contribute to the risk of CHD in adults with type 1 diabetes.

"Safe" charge-injection waveforms for iridium oxide (AIROF) microelectrodes

Use of anodic bias improves the charge-injection limits of activated iridium oxide (AIROF) microelectrodes. Asymmetric waveforms, in which the charge balancing anodic phase is delivered at a lower current density and longer pulse width, has been found to allow for higher values of anodic bias voltages, thus maximizing the AIROF charge-injection capacity. Limiting the voltage excursion of the AIROF below the value at which electrolysis of water occurs is essential to maintaining the long-term viability of implanted electrodes. However, maintaining the electrodes at an anodic bias state while keeping the electrode voltage within these electrochemically "safe" limits complicates the topology of the electronic driver circuitry. We present two possible driver topologies that use compliance-voltage limitation in combination with cathodic current modification.

LAVIA--an evaluation of the potential safety benefits of the French intelligent speed adaptation project

This paper presents the potential safety benefits of the experimental French LAVIA Intelligent Speed Adaptation system, according to road network and system mode, based on observed driving speeds, distributions of crash severity and crash injury risk. Results are given for car frontal and side impacts that together, represent 80% of all serious and fatal injuries in France. Of the three system modes tested (advisory, driver select, mandatory), our results suggest that driver select would most significantly reduce serious injuries and death. We estimate this 100% utilization of cars equipped with this type of speed adaptation system would decrease injury rates by 6% to 16% over existing conditions depending on the type of crash (frontal or side) and road environment considered. Some limitations associated with the analysis are also identified. LAVIA is the acronym for Limiteur s'Adaptant à la VItesse Autorisée, a French Intelligent Speed Adaptation (ISA) project that was set up towards the end of 1999. At the time, 1998 French national road safety statistics recorded 8437 road related deaths, a figure which had shown virtually no positive evolution since 1994. Detailed analysis of the contributory factors involved in fatal road crashes highlighted the time-honoured crash and injury causation mechanisms - alcohol, speed and seatbelts. Of the three, excessive speed (over and above the posted speed limit) was a contributory factor in half of all fatal crashes Inappropriate behaviour such as excessive speeding can be dealt with either by legislative or driver-incentive programmes. The first of these two solutions involves the introduction of new legislation and/or the enforcement of existing laws. This is the domain of Public Authorities and will not be discussed in detail here. Alternatively, incentive schemes can involve the implementation of speed related driver assistance systems, categorised according to their voluntary or mandatory character and the degree of autonomy proposed to or imposed on the driver. The LAVIA project set out to address several possible combinations of these two factors. The generic term Intelligent Speed Adaptation (ISA) encompasses a wide range of different technologies aimed at improving road safety by reducing traffic speed and homogenising traffic flow, within the limit of posted speed limits. "Fixed speed limit" systems inform the vehicle of the posted speed limit whereas "variable speed limit" systems take into account certain locations on the road network where a speed below the posted limit is desirable, such as sharp curves, pedestrian crossings or crash black spots. Taken one step further, speed limit systems may also take into account weather and traffic flow conditions. These systems are known as "dynamic speed limit" systems and benefit from real time updates for a specific location. The different ISA systems are generally characterised by the degree of freedom of choice given to the driver in moderating his or her speed. Speed limit technologies may be advisory (informing drivers of the current speed limit and speed limit changes), voluntary (allowing the driver to decide whether or not to implement speed limitation) or mandatory (imposing the current speed limit). The information supplied may be provided by way of the road infrastructure (and associated equipment), may be acquired autonomously by the vehicle or may be based on an interaction between the infrastructure and the vehicle. Even the most basic of these systems should be considered as a very useful driver aid, helping the driver to stay within the posted speed limit, avoiding "unnecessary" speeding fines through inattention, modelling driver behaviour through the long term reduction of speeds and reducing driver workload by limiting visual speedometer controls. Vehicle-based ISA systems should not be confused with internal systems. These latter systems rely upon the driver entering the desired travel speed, which is then maintained by cruise control or set as a maximum value by automatic speed regulators. Although these systems will not be discussed in detail here, it should be noted that the engine management technologies that they employ are a vital component of ISA systems.

Measurement of abdominal fat by CT compared to waist circumference and BMI in explaining the presence of coronary calcium

OBJECTIVE

To evaluate the association between standard and computed tomography (CT)-based measures of obesity and subclinical atherosclerosis, defined as coronary artery calcium (CAC) by Electron Beam Computed Tomography (EBCT).

DESIGN

Cross-sectional, observational study of anthropometric and CT obesity measures and presence of CAC.

SUBJECTS

Participants were 383 men and 379 women, aged 20-58 y and asymptomatic for coronary artery disease (CAD).

MEASUREMENTS

Intra-abdominal fat (IAF) and subcutaneous fat (SQF) were measured at the level of lumbar 2-3 and 4-5 spaces, using EBCT. Body mass index (BMI) was calculated from height and weight, and minimum waist circumference and maximum hip circumference were measured. CAC was measured by EBCT.

RESULTS

In both men and women, BMI, waist circumference, IAF, and SQF were significantly related to CAC. However, BMI or waist circumference explained variation in the presence of CAC as well as IAF or SQF, univariately and after adjustment for additional cardiovascular risk factors.

CONCLUSION

CT-based obesity exposure measures are not superior to BMI or waist circumference in association studies of subclinical CAD.

[Splinting--a review of the literature]

Early evidence for the use of splints can be seen in ancient civilizations, but the concept of Splinting teeth to support and immobilize teeth, by joining several teeth together continues to be a topic of controversy. Splints can be classified based on their purpose and duration of use, the way of fabrication, and the location of the splinted teeth in the jaw. The biomechanical mechanism of splint is related to the mechanism of tooth mobility. The indications for splint usage in the healthy and diseased periodontium are variable, among them are: prevention of mobility after acute trauma, for occlusal therapy, to allow function, to allow periodontal repair, in case of occlusal trauma, to prevent teeth drifting after orthodontic treatment or when a tooth is missing. Due to the many disadvantages splints have, splinting should be used cautiously, specially in splinting teeth and implants.

Cognitive factors and stress-induced changes in catecholamine biochemistry

The purpose of the present research was to determine whether dysfunctional attitudes, a cognitive attribute, predicted changes in catecholamine biochemistry. A cognitive task was used to induce stress in female subjects (n=21), and levels of plasma norepinephrine (NE) and homovanillic acid (HVA) were measured at three time points: at baseline (T1); immediately after stress exposure (T2); and 40 min later (T3). Dysfunctional attitudes were significantly and positively related to levels of plasma NE at T3, controlling for baseline levels. Dysfunctional attitudes were not significantly related to plasma HVA levels at any time point. Our findings provide initial support for the idea that dysfunctional attitudes, an attribute shown to play an important role in some forms of unipolar depression, predict stress-induced alterations in noradrenergic output.

The utility of quantitative body surface isoarea mapping for predicting ventricular tachyarrhythmias

Noninvasive techniques, such as the signal averaged ECG, have been used to assess risk of ventricular tachyarrhythmias (VT). However, these methods produce false positive and negative results. The purpose of this study was to develop body surface map algorithms which would enhance prediction of susceptibility to VT. Fifty-three patients referred for programmed electrical stimulation were enrolled in this study. All patients underwent signal averaged ECG, body surface map, programmed electrical stimulation. Group I patients had no sustained inducible VT and group II patients had either inducible sustained VT at electrophysiology study or previously documented spontaneous, sustained VT. For body surface map analysis, the difference between extrema on isoarea maps was calculated and defined as the gradient range. An abnormal body surface map was defined as a QRST gradient range < or = 109 mv.ms. The mean QRST gradient range in group II was significantly < that in group I (P < 0.05). By logistic regression analysis, the presence of coronary artery disease, a QRST gradient range < or = 109 mv.ms, an EF < 40% and a signal averaged ECG QRS duration > 114 ms predicted VT. The sensitivity, specificity, positive and negative predictive values for predicting VT susceptibility of an algorithm which combines the signal averaged ECG QRS duration and the QRST gradients were 0.93, 0.76, 0.79, and 0.91, respectively, while those for the signal averaged ECG alone were 0.52, 0.69, 0.63, and 0.59 for VT susceptibility. A combined body surface map-signal averaged ECG algorithm was more sensitive in detecting susceptibility to VT than the signal averaged ECG alone.

Antibodies to cytomegalo and Epstein-Barr viruses in human saliva and gingival fluid

The prevalence of antibodies to EBV and CMV was studied in 34 samples of whole saliva and gingival crevicular fluids (GCF) obtained from clinically healthy volunteers and compared to the corresponding antibodies present in the serum of each individual. Higher prevalence of serum antibodies was found to EBV (85.2%) than to CMV (64.7%) (P < 0.04). The percentage of saliva samples containing IgG and/or IgA antibodies was not significantly different for the two viruses (79.4% for EBV and 58.8% for CMV). However, in the GCF the percentage to EBV was lower-32.3% as compared to 70.5% for CMV (P < 0.002). The prevalence of CMV in serum saliva and GCF was similar. However, while in the saliva similar levels of IgG and IgA were found, in the GCF IgA prevails. The picture for EBV is different: a similar percentage of antibodies was noticed in serum and saliva, but it was significantly lower in the GCF. However, antibodies to EBV were mostly IgA both in the saliva and the GCF. Although a similar number of samples were positive to both viruses in the saliva, the IgA response to EBV was higher than to CMV (P < 0.05), while in GCF IgA response was higher to CMV (P < 0.05). Passive transudation rather than active transport of plasma-derived Ig is probably responsible for the presence of IgG, while the IgA found in saliva and GCF is derived from local synthesis by plasma cells rather than from selective transport from blood.

Malnutrition, gastroenteritis and trypsinogen concentration in hospitalised Aboriginal children

OBJECTIVE

To explore relationships between malnutrition and pancreatic damage in hospitalised aboriginal children.

METHODS

Immunoreactive trypsinogen (IRT) concentrations were measured in two populations of hospitalised aboriginal children in Australia: 472 children aged 0-3 years, in Alice Springs (Northern Territory); and 187 children aged 0-16 years in Mount Isa (Queensland). Correlation of whole blood IRT with height and weight z-scores, four-site skinfold thickness and upper arm circumference was sought.

RESULTS

In Mount Isa, the geometric mean IRT concentration rose with decreasing weight z-score. The IRT concentration was otherwise unrelated to nutritional indices. Sixty percent of the 39 Mount Isa patients with gastroenteritis and 24.5% of the 358 Alice Springs patients with gastroenteritis had an IRT concentration in the upper quartile for their population, compared with 16% for patients with other diagnoses in both populations.

CONCLUSIONS

A high IRT concentration in patients with low weight z-scores is a confounding effect of gastroenteritis, and may result from subclinical pancreatic disease in gastroenteritis.

Synteny conservation and chromosome rearrangements during mammalian evolution

An important problem in comparative genome analysis has been defining reliable measures of synteny conservation. The published analytical measures of synteny conservation have limitations. Nonindependence of comparisons, conserved and disrupted syntenies that are as yet unidentified, and redundant rearrangements lead to systematic errors that tend to overestimate the degree of conservation. We recently derived methods to estimate the total number of conserved syntenies within the genome, counting both those that have already been described and those that remain to be discovered. With this method, we show that approximately 65% of the conserved syntenies have already been identified for humans and mice, that rates of synteny disruption vary approximately 25-fold among mammalian lineages, and that despite strong selection against reciprocal translocations, inter-chromosome rearrangements occurred approximately fourfold more often than inversions and other intra-chromosome rearrangements, at least for lineages leading to humans and mice.

Vulnerability to stress: self-criticism and stress-induced changes in biochemistry

It has been hypothesized that individuals who are high on the attribute of self-criticism are particularly vulnerable to failure stress. To test this hypothesis, we examined the relationship between self-criticism and changes in plasma homovanillic acid (HVA; the metabolite of dopamine) and emotion during exposure to an induced-failure task. Participants consisted of 21 women. Plasma HVA and emotion were assessed at three time points: baseline (T1), during stress exposure (T2), and 40 minutes after cessation of the stressor (T3). We found that self-criticism was significantly and positively related to changes in plasma HVA during stress exposure. In addition, the personality attribute was significantly and positively related to subjective ratings of stress and changes in scores on the Confusion-Bewilderment scale of the Profile of Mood States during the task. To our knowledge, this is the first study to report that self-criticism is related to stress-induced changes in biochemistry.

Physiologic occlusion vs pathologic occlusion and rationale for treatment

Treatment concepts in dentistry are generally based on a preconceived normal state derived from clinical observation and theories rather than scientific evidence. Before treatment is proposed, the clinician should observe physiologic signs and symptoms to determine the presence of a particular pathology. This article presents different theories of occlusion, diagnostic characteristics that can be used to distinguish between physiologic occlusion and pathologic occlusion requiring treatment, and guidelines for reconstructive occlusal therapy.

Late-onset infections of infants in neonatal units

OBJECTIVE

To examine regional variations in the incidence of late-onset neonatal infections in Australian and New Zealand neonatal units.

METHODOLOGY

A longitudinal, prospective surveillance study of systemic sepsis (septicaemia or meningitis) in 11 neonatal units: 10 in the Australian States of the Northern Territory, New South Wales, Queensland, Victoria and Western Australia, and 1 in Christchurch, New Zealand. The results are reported of late-onset neonatal infection (defined as sepsis after 48 h) for the second year of prospective surveillance, data being collected from 1 October 1992 to 30 September 1993.

RESULTS

Data were available on 24535 live births in Australia, representing approximately 10% of all live births in the country. There were 320 episodes of sepsis in Australian units affecting 294 babies. One hundred of these episodes (31%) were early-onset; 3.0% of babies admitted to six tertiary care neonatal units attached to maternity hospitals developed late sepsis, and this rate did not differ between units. The proportion of babies infected was inversely related to birthweight: 22.6% of babies under 1OOOg, but 0.6% over 2000g. Coagulase negative staphylococci were the commonest cause of late-onset sepsis. There were 26 episodes of S. aureus septicaemia, of which only one was due to MRSA. Meningitis occurred in 13 babies (5.9%) with late-onset sepsis. The mortality from late-onset sepsis was 7.7%.

CONCLUSIONS

Coagulase-negative staphylococci are the commonest cause of late-onset sepsis of babies in neonatal units. There were no major regional differences in the incidence of, or the organisms causing, late sepsis.

Skeletal and functional effects of treatment for unilateral posterior crossbite

Unilateral posterior crossbite (UPXB) is a common malocclusion, frequently presenting a lower midline deviation, accompanied by Class II subdivision relationships in final closure and a very high prevalence of the reverse sequencing (RS) pattern of jaw movement. These features often persist even after the elimination of the crossbite. The purpose of the present study was to examine in detail the morphologic, skeletal, and functional effects of the treatment for this malocclusion category. The experimental group consisted of 24 children in the mixed dentition stage with UPXB who were treated with removable expansion plates and a control group of 10 age-matched children with normal occlusion. Longitudinal follow-up revealed a stable dental maxillary arch expansion of at least 1.5 mm but a complete elimination of crossbite in only 50% of the cases. The frequent persistence of Class II subdivision relations and lower midline deviation that were not due to functional mandibular shift was striking. The pretreatment posteroanterior (P-A) cephalograms indicated reduced facial and maxillary widths. After treatment, the achieved maxillary width increase was greater than expected with normal growth. Longitudinal assessment of the mandibular movement response revealed by the electrognathograph showed a high prevalence of RS, which was reduced after treatment. In conclusion, (1) a higher than expected prevalence of skeletal transverse aberrations at the maxillary and zygomatic levels were found in the UPXB group; (2) the removable expansion appliance induces transverse growth of the maxilla; and (3) an inherent pattern of jaw movement is characteristic to the UPXB and does not change significantly with orthodontic treatment.

Tooth contact during dynamic lateral excursion in young adults

Tooth contact in mediotrusion as well as the signs and symptoms of periodontal and mandibular dysfunction were recorded in healthy patients aged between 20 and 31 with Angle class I or II. Non-functional side contact (NFSC) was found in 94% of the patients, indicating that it is a common phenomenon. In cases of NFSC, the entire range of movement, and not only the final stage of tip-to-tip contact on the working side, should be recorded. Slight positive mobility with tooth faceting, as compared to the adjacent and contralateral teeth, was observed in 56 patients. There was no correlation between mediotrusion and mandibular dysfunction. The cumulative effects of NFSC are not well documented, and longitudinal follow-up studies should be carried out to clarify these.

Prevalence of viral antibodies in gingival crevicular fluid

The prevalence of antibodies to CMV, Mumps and Coxsackie virus strains 1, 3 and 4 was studied in 39 samples of gingival crevicular fluids (GCF) obtained from clinical healthy patients and compared to the corresponding antibodies present in the serum of each individual. In spite of the high prevalence of humoral antibodies to CMV (75%), only 24% of the gingival crevicular fluid samples exhibited IgG or IgA antibodies to this virus. The differences in the prevalence of antibodies against Mumps virus in the sera and GCF were even greater: whereas 87% of the patients exhibited serum antibodies, not even a single gingival fluid sample was found to be positive. Antibodies to Coxsackie B strains 1, 3 and 4 were found in 72%, 63% and 52% of the sera and in 25%, 19% and 33% of the gingival fluid samples (IgG only). The presence of the antibodies and their profile in GCF and serum is different. The mechanism of possible permeation is not clear but it seems that viral antibodies in this milieu are not derived from the serum solely by passive transudation, and that the antibodies are produced locally at least in some of the GCF specimens.

Urolithiasis in Australian aboriginal children

Thirty-six Australian Aboriginal children with urolithiasis were reviewed. Males dominated the series. The age distribution ranged from 8 months to 12 years and nearly 70% were 2 years or younger. Thirty-five patients had upper tract stones. Ultrasound was diagnostic in 35 patients and was falsely negative in one. Dietary factors, dehydration and recurrent diarrhoea are incriminated in the aetiology, because ammonium urate and oxalate were the main constituents of the stones. Malformations of the urinary tract were rare and known metabolic disorders were not seen. Chemical dissolution of the stones was found to be a safe and effective adjuvant in the management of urate stones.

The masticatory pattern as an adjunct for diagnosis and treatment

The sagitally-viewed masticatory pattern was investigated in 125 dentate patients. In 25 patients, the phenomenon of an incisal guided phase during mastication was observed. Clinical examination of these cases revealed slight to severe incisal attrition or various degrees of flaring. The hypothesis that the incisal guided phase contributes to this phenomenon and should therefore be taken into consideration during treatment is put forward.

Detection of herpes simplex virus in gingival tissue

The presence of herpes simplex virus (HSV) antigens was shown by immunofluorescence staining in 26 of 66 (39.3%) specimens of clinically healthy gingiva, but only one sample contained infectious virus. HSV DNA sequences were clearly identified in intact gingival cells by dot blot hybridization in one specimen, and a weak pattern in a second one. Both specimens harbored viral antigens. These findings of viral genome and protein expression suggest that the virus is present in the latent form in the gingiva.

A functional aspect of anterior attrition or flaring and mode of treatment

The phenomenon of occlusal wear has been generally reported, with no distinction being made between wear of the anterior or posterior teeth. This paper describes a group of patients without oral habits and exhibiting anterior tooth attrition or flaring with minimal posterior tooth attrition. The mandibular anterior movement patterns of the patients studied were evaluated using a Sirognathograph. These patterns appear to be the etiology for the anterior attrition or flaring present. A treatment mode allowing coexistence of this phenomenon with an anterior guidance that does not interfere with the mastication pattern is proposed. A hypothesis that might explain the clinical findings and a mode of treatment are described.

Splinting: a retrospective 17-year follow-up study

A retrospective 17-year, longitudinal study monitoring 66 patients with fixed partial denture and removable partial denture restorations revealed that perceptive splinting was beneficial and enhanced the longevity of the restoration. The study discussed the advantages and disadvantages of splinting, the survival rate of splints and splinted teeth, and the importance of oral hygiene and a periodic maintenance program.

Contribution of oral habits to dental disorders

Oral habits or parafunction may contribute to dental, periodontal, or neuromuscular damage. Such habits, of which the patient is often unaware, may cause considerable damage. Habits may be occlusal or non-occlusal, and may affect the dentition and/or the oral soft tissues. Drawing a patient's attention to the damage caused by some habits of which he or she is unaware often leads to cessation, whereas with certain conscious habits, such as nail or finger biting, success is much more limited.

Iatrogenic exfoliation of a tooth following abuse of a rubber dam: a case report

This report presents a case in which tooth exfoliation followed rubber dam abuse. A 40-year-old patient was referred to the prosthodontic clinic with complaints of mobility and discomfort in tooth 44, which had received an amalgam restoration. While this tooth was scaled, a piece of rubber dam appeared in the buccal sulcus. Removal of the rubber piece was followed by thorough scaling and tooth splinting. Tooth deterioration continued, and concern for the adjacent teeth necessitated extraction of tooth 44. To avoid such undesirable consequences, the integrity of the dam should be verified on its removal.

Effect of occlusal bite-raising splint on electromyogram, motor unit histochemistry and myoneuronal dimensions in rats

Composite resin bite-raising splints were fabricated on both sides of the upper jaw in rats. EMG activity of the deep masseter muscle was monitored continuously for 24 h before and up to 4 weeks after treatment. Together with the EMG activity, measurements of the neuromuscular junction area and muscle fibre histochemistry were made. EMG activity showed great variability immediately after splint fabrication. Some of the animals showed increased EMG activity, while others exhibited less activity 48 h after splint application. Overall, the fluctuation lasted for about 4 days, and after approximately 7 days all the animals exhibited decreased EMG activity, followed by a gradual increase in activity towards baseline levels. The neuromuscular junction territory increased significantly 5-10 days after splint application. Histochemical characterization of the deep masseter muscle revealed that it contained the three main types of muscle fibre: slow oxidative (SO), fast-oxidative-glycolytic (FOG) and fast glycolytic (FG). The frequency distribution of fibre types did not change after bite-raising splint treatment. These findings indicated that splint treatment in rats is effective in reducing EMG activity, while the muscle type characteristics remain stable. The effect of lower activity on the motor end-plates suggested that the neuromuscular junctions are quite sensitive to functional changes.

Functional and esthetic rehabilitation of an adolescent cleft lip and palate patient

Many patients with clefts that also affect the alveolar ridge present with congenital absence of the permanent maxillary lateral incisors. This paper describes the treatment of an adolescent cleft lip and palate patient whose missing and unesthetic maxillary incisors were replaced by a combination of fixed and removable partial dentures.

Severe vertical overlap: a modified method of treatment

Severe vertical overlap may predispose the patient to abnormal function, improper mastication, excessive stress, and functional problems such as bruxing, clenching, and craniomandibular disorders. This report describes the establishment of a new occlusal relationship by using the potential of posterior tooth eruption with the Hawley bite plane or the canine platform method. It was used in patients with a full complement of teeth or with some missing teeth. Patients treated by either the Hawley bite plane or the canine platform demonstrate a stable and long-lasting new occlusal relationship. The method described is efficient, inexpensive, and convenient to the patient.

Various methods in achieving anterior guidance

The anterior teeth are essential for esthetics, phoentics, and mastication and are equally involved in protecting posterior teeth. A 10-year longitudinal study of treatment modalities was conducted for overbite-overjet occlusal relationships. Comprehensive treatment combining orthodontics, occlusal adjustment, and selective restorations minimized the need for extensive restorative dentistry. The treatment of selected patients with a 10-year postoperative evaluation was discussed.

Oral cavity herpes simplex virus--a risk factor to dental personnel and patients. An overview

Herpes virus antigens were found in the sulcular epithelium of approximately 60% of patients with clinically healthy gingiva. In addition, specific antigens for herpes simplex virus (HSV) were found in the sulcular epithelial cells of patients undergoing periodontal treatment. Specific antibodies were also detected in 70-80% of the gingival fluids collected. On the basis of these data we hypothesized that the oral cavity may act as a preferential site for latent HSV. Thus, stressful events such as traumatic dental treatment and tissue damage may elicit herpetic episodes, risking dental personnel. Measures of precaution are indicated for routine dental treatment.

Rating communication behaviours in the head-injured adult

Evaluation of certain communication skills in head-injured adults has generally been limited to informal clinical impressions. A rating scale has been developed which addresses several of these communication abilities in a behaviourally based model. Preliminary data based on a sample of four head-injured adults and four trained raters revealed robust inter- and intra-rater reliability. Statistical relationships between the scale and three linguistic measures for a group of 20 head-injured adults were addressed with negative results. Individually the items selected appear to quantify aspects of complex communication behaviour.

Nonlinear directional coupler with a diffusive Kerr-type nonlinearity

We present numerical results showing the effects of a diffusive Kerr-type nonlinearity on the switching characteristics of a nonlinear directional coupler. It is found that switching can still occur even when the diffusion length is equal to the waveguide separation but that then its threshold increases and becomes less pronounced.

The cantilever fixed partial denture: a 10-year follow-up

A 10-year study of patients with cantilever fixed partial dentures suggests that these prostheses can be used for both anterior and posterior replacements. Guidelines for cantilever prostheses are described. Fixed cantilever prostheses are favorable alternatives to certain types of unilateral removable partial dentures. Proper oral hygiene is essential.

Effect of occlusal (mechanical) stimulus on bone remodelling in rat mandibular condyle

Mechanical load influences the remodelling of skeletal tissues. In the mandibular condyle, occlusal alterations and the consequent mechanical stimulus induce changes in chondrocytes and cartilage mineralization. In the present study we quantified in the mandibular condyle the effect of occlusal interference on remodelling of the subchondral bone. Computerized histomorphometry after 5-21-day exposure to the influence of a unilateral occlusal splint revealed an increased rate of trabecular remodelling, consisting of enhancement in osteoblast and osteoclast numbers and activities. The bone formation parameters reached their high values on Days 5 or 9 and remained stable thereafter. Bone resorption showed a gradual increase throughout the experimental period. These results further characterize the temporomandibular joint reaction to occlusal alterations. It is suggested that the present increase in bone turnover together with the known enhancement in chondrogenesis are part of a process of functional adaptation in response to mechanical stimulus.