Postoperative Radiographic Outcomes Following Primary Open Coracoid Transfer (Bristow-Latarjet) Vary in Definition, Classification, and Imaging Modality: A Systematic Review

PURPOSE

To analyze radiographic outcomes by conventional radiography, computed tomography (CT), or both and complication rates of open coracoid transfer at a minimum of 12-months follow-up.

METHODS

A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Medline (Ovid), and EMBASE library databases. Inclusion criteria were clinical studies reporting on open Latarjet as the primary surgical procedure(revision coracoid transfer after failed prior stabilization excluded) with postoperative radiographic outcomes at a minimum mean 1-year follow-up. Patient demographics, type of postoperative imaging modality, and radiographic outcomes and complications including graft union, osteoarthritis, and osteolysis were systematically reviewed. Data were summarized as ranges of reported values for each outcome metric. Each radiographic outcome was graphically represented in a Forest plot with point estimates of the incidence of radiographic outcomes with corresponding 95% confidence intervals and I2.

RESULTS

Thirty-three studies met inclusion criteria, with a total of 1,456 shoulders. The most common postoperative imaging modality was plain radiography only (n = 848 [58.2%]), both CT and radiography (n = 287 [19.7%]), and CT only (n = 321 [22.1%]). Overall, the reported graft union rate ranged from 75% to 100%, of which 79.8% (n = 395) were detected on plain radiography. The most common reported postoperative radiographic complications after the open coracoid transfer were osteoarthritis (range, 0%-100%, pooled mean 28%), graft osteolysis (range, 0%-100%, pooled mean 30%), nonunion (range, 0%-32%, pooled mean 5.1%), malpositioned graft (range, 0%-75%, pooled mean 14.75%), hardware issues (range, 0%-9.1%, pooled mean 5%), and bone block fracture (range, 0%-8%, pooled mean 2.1%). Graft healing was achieved in a majority of cases (range, 75%-100%).

CONCLUSION

Postoperative radiographic outcomes after open coracoid transfer vary greatly in definition, classification, and imaging modality of choice. Greater consistency in postoperative radiographic outcomes is essential to evaluate graft healing, osteolysis, and nonunion.

LEVEL OF EVIDENCE

Level IV, systematic review of Level III-IV studies.

Outcomes for Treatment of Capsulolabral Adhesions With a Capsular Spacer During Revision Hip Arthroscopy

BACKGROUND

The presence of adhesions is a common source of pain and dysfunction after hip arthroscopic surgery and an indication for revision surgery. The placement of a capsular spacer in the capsulolabral recess after lysis of adhesions has been developed to treat and prevent the recurrence of adhesions.

PURPOSE

To evaluate patient-reported outcomes (PROs) and survivorship at a minimum of 2 years after revision hip arthroscopic surgery with capsular spacer placement for capsular adhesions.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Between January 2013 and June 2018, a total of 95 patients (99 hips) aged ≥18 years underwent revision hip arthroscopic surgery for the treatment of capsular adhesions with the placement of a capsular spacer. Overall, 53 patients (56 hips) met the inclusion criteria and had a minimum 2-year follow-up, forming the cohort of this study. Exclusion criteria included confounding metabolic bone diseases (eg, Legg-Calve-Perthes disease, Marfan syndrome), labral deficiency, or advanced osteoarthritis (Tönnis grade 2 or 3). Preoperative and postoperative outcome scores (modified Harris Hip Score [mHHS], Hip Outcome Score-Activities of Daily Living [HOS-ADL], Hip Outcome Score-Sport-Specific Subscale [HOS-SSS], 12-Item Short Form Health Survey [SF-12], and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) were collected and compared in addition to the revision rate, conversion to total hip arthroplasty, and patient satisfaction.

RESULTS

The mean age of the cohort was 32 ± 11 years, with 32 female hips (57%) and a median number of previous hip arthroscopic procedures of 1 (range, 1-5). The arthroplasty- and revision-free survivorship rate at 2 years was 91%. Overall, 5 patients (6 hips; 11%) underwent revision surgery at a mean of 2.4 ± 1.4 years after capsular spacer placement, with symptomatic capsular defects being the most common finding. There were 4 patients (7%) who converted to total hip arthroplasty. For hips not requiring subsequent surgery (n = 46), there was a significant improvement in outcome scores except for the SF-12 Mental Component Summary, with rates of achieving the minimal clinically important difference of 70%, 70%, and 65% for the mHHS, HOS-ADL, and HOS-SSS, respectively.

CONCLUSION

Capsular spacers, as part of a systematic approach including lysis of adhesions with early and consistent postoperative physical therapy including circumduction exercises, resulted in improved PROs as well as high arthroplasty- and revision-free survivorship (91%) at a minimum 2-year follow-up. Capsular spacers should be considered in revision hip arthroscopic procedures when an adequate labral volume remains but adhesions continue to be a concern.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

Utilization of Screening Mammography in Women Before 50: Cross-Sectional Survey Results from the National Health Interview Survey

OBJECTIVE

While the American College of Radiology recommends annual screening mammography starting at age 40 years, the US Preventive Services Task Force (USPSTF) recommends that screening mammography in women younger than age 50 years should involve shared- decision making (SDM) between clinicians and patients, considering benefits and potential harms in younger women. Using a nationally representative cross-sectional survey, we aimed to evaluate patient-reported reasons and predictors of screening mammography utilization in this age group.

METHODS

Respondents aged 40-49 years from the 2018 National Health Interview Survey (NHIS) without a history of breast cancer were included (response rate 64%). Participants reported sociodemographic variables and reasons they did not engage in mammography screening within the last two years. Multiple variable logistic regression analyses were performed to evaluate the association between sociodemographic characteristics and patient-reported screening mammography use, accounting for complex survey sampling design elements.

RESULTS

1,948 women between the ages of 40-49 years were included. Of this group, (758/1948) 46.6% reported receiving a screening mammogram within the last year, and 1196/1948 (61.4%) reported receiving a screening mammogram within the last two years. The most common reasons for not undergoing screening included: "No reason/never thought about it" 744/1948 (38.2%), "Put it off" 343/1948 (17.6%), "Didn't need it" 331/1948 (16.9%), "Doctor didn't order it" 162/1948 (8.3%), and "I'm too young" 63/1948 (5.3%). Multiple variable analyses demonstrated that lack of health insurance was the strongest predictor of mammography non-engagement (p< 0.001).

CONCLUSION

Deficits in shared- decision-making in women younger than 50 years related to mammography utilization exist. Radiologists may be key in addressing this issue among ambulatory care providers and patients, educating about the benefits and harms of screening younger women, particularly in racial/ethnic minorities and uninsured patients, who experience additional barriers to care and SDM discussions.

The accumulation of reproductive isolation in early stages of divergence supports a role for sexual selection

Models of speciation by sexual selection propose that male-female coevolution leads to the rapid evolution of behavioural reproductive isolation. Here, we compare the strength of behavioural isolation to ecological isolation, gametic incompatibility and hybrid inviability in a group of dichromatic stream fishes. In addition, we examine whether any of these individual barriers, or a combined measure of total isolation, is predicted by body shape differences, male colour differences, environmental differences or genetic distance. Behavioural isolation reaches the highest values of any barrier and is significantly greater than ecological isolation. No individual reproductive barrier is associated with any of the predictor variables. However, marginally significant relationships between male colour and body shape differences with ecological and behavioural isolation are discussed. Differences in male colour and body shape predict total reproductive isolation between species; hierarchical partitioning of these two variables' effects suggests a stronger role for male colour differences. Together, these results suggest an important role for divergent sexual selection in darter speciation but raise new questions about the mechanisms of sexual selection at play and the role of male nuptial ornaments.

Incomplete behavioural isolation and asymmetric female preference in darter sister species (Percidae: Etheostoma)

In this study, female preferences and behavioural isolation were estimated in a pair of allopatric sister species, Etheostoma duryi and Etheostoma flavum. Dichotomous mate preference trials were conducted to determine whether females prefer to associate with conspecific over heterospecific males and free-spawning assays were conducted to determine whether those preferences translated into behavioural isolation. Dichotomous mate choice trials revealed asymmetric female preference, as female E. flavum preferred conspecific males, whereas female E. duryi showed no preference. Free-spawning assays indicated that behavioural isolation remains incomplete between E. duryi and E. flavum (IB = 0·19). In addition to female mating preferences, male behaviour also appeared to influence mating outcomes as male E. flavum consistently courted conspecific females more often in free-spawning assays whereas male E. duryi did not. The data therefore suggest that despite marked divergence in male nuptial colour, divergence in female preferences between these species may not be sufficient to maintain species boundaries upon secondary contact. These results contrast with similar work in a sympatric darter species pair and may be explained by considering the contributions of reinforcement and differences in colour pattern as well as colour value.

Build up of off-diagonal long-range order in microcavity exciton-polaritons across the parametric threshold

We report an experimental study of the spontaneous spatial and temporal coherence of polariton condensates generated in the optical parametric oscillator configuration, below and at the parametric threshold, and as a function of condensate area. Above the threshold we obtain very long coherence times (up to 3 ns) and a spatial coherence extending over the entire condensate (40 μm). The very long coherence time and its dependence on condensate area and pump power reflect the suppression of polariton-polariton interactions by an effect equivalent to motional narrowing.

External validation and applicability of the EORTC risk tables for non-muscle-invasive bladder cancer

PURPOSE

To perform an external validation of the EORTC risk tables and to evaluate their applicability in the patients of our institution by comparing the actual risk of recurrence and progression in our series to those obtained through the application of the EORTC tables.

METHODS

Retrospective study, based on a prospective cohort of 417 patients in follow-up with primary TaT1 bladder tumors, operated on in our center between 1998 and 2008 and collected in our database. Risk scores were assigned depending on the tumor characteristics to divide our series into four risk groups according to these ratings. An analysis of survival was carried out to calculate the probability of recurrence by the method of Kaplan-Meier.

RESULTS

A total of 417 patients with a median follow-up of 59 months were studied. The overall recurrence and progression rates of our series were 25.95% (21.97-30.49) and 4.86% (3.16-7.43) at 1 year and 53.46% (48.06-59.05) and 8.43% (5.95-11.86) at 5 years, respectively. When we compare our rates of recurrence and progression by groups with the corresponding values from Sylvester's publication, an overlapping of the confidence intervals between both populations is detected.

CONCLUSIONS

In terms of the applicability of the EORTC risk tables in our patients' population, we conclude that these tables predict accurately the clinical course of patients with NMIBC. Due to the sample size of our study, we can only validate the recurrence model of the EORTC tables.

A randomized clinical trial of chlorhexidine in the maintenance of oral candidiasis-free period in HIV infection

OBJECTIVE

To determine if chlorhexidine can be used as an intervention to prolong the time to relapse of oral candidiasis.

SUBJECTS AND METHODS

A double-blinded randomized clinical trial was performed in 75 HIV/AIDS subjects with oral candidiasis. Clotrimazole troche was prescribed, and the subjects were re-examined every 2 weeks until the lesions were completely eradicated. The subjects were then randomly divided into two groups; 0.12% chlorhexidine (n = 37, aged 22-52 years, mean 34 years) and 0.9% normal saline (n = 38, aged 22-55 years, mean 38 years). They were re-examined every 2 weeks until the next episode was observed.

RESULTS

The time to recurrence of oral candidiasis between the chlorhexidine and the saline group was not statistically significant (P > 0.05). The following variables were significantly associated with the time of recurrence; frequency of antifungal therapy (P = 0.011), total lymphocyte (P = 0.017), alcohol consumption (P = 0.043), and candidiasis on gingiva (P = 0.048). The subjects with lower lymphocyte showed shorter oral candidiasis-free periods (P = 0.034).

CONCLUSIONS

Chlorhexidine showed a small but not statistically significant effect in maintenance of oral candidiasis-free period. This lack of significance may be due to the small sample size. Further study should be performed to better assess the size of the effect, or to confirm our findings.

Evaluation of a 7-year school-based community dental hygiene programme in Portugal by high school teachers

OBJECTIVES

To obtain high school teachers evaluation of a Community Dental Hygiene programme, developed as part of a clinical trial designed to assess the safety of low-level mercury exposure from amalgam restorations.

METHODS

A questionnaire to assess programme evaluation, personal opinion on programme relevance and satisfaction with activities was distributed among teachers. It had a total of 22 questions organized into three groups.

RESULTS

A total of 25 questionnaires were obtained from teachers who participated in the programme. Ninety-two per cent of the respondents had a positive opinion concerning the existence of the programme. Eighty-eight per cent of the teachers believed that the programme changed student's knowledge about dental hygiene. Ninety-two per cent of teachers supported the existence of the programme and 88% of them disagreed with a statement that participation in the programme was a waste of time. Teachers who did not collaborate actively with dental hygiene activities indicated belief that the programme affected school activities (P = 0.003). Teachers who actively participated in the programme believe that dental hygiene activities were important for students (P = 0.005).

CONCLUSIONS

Teacher evaluations of this kind of programme are critical for the development of school-based Dental Hygiene Education programmes. Teachers believe that Dental Hygiene Education is crucial for students' well-being.

Comparison of two low-calorie diets: a prospective study of effectiveness and safety

OBJECTIVE

To evaluate the cost-effectiveness and safety of two distinct low calorie diets (LCD).

DESIGN

Prospective controlled study.

METHODS

67 obese patients [body mass index (BMI) 40 kg/m2] were included in two study groups. Group A: 26 patients followed a 458 kcal diet given in three meals for 1 month. Group B: 41 patients followed a 800 kcal diet for 3 months and with outpatient control.

MEASUREMENTS

Anthropometric, cardiovascular risk and nutritional profile changes were evaluated, as well as total direct and indirect costs, and the incidence of complications.

RESULTS

No significant initial differences were observed between the two study groups. Eighty-six point two per cent of the patients completed the therapy correctly. After treatment a significant decrease was observed in the following variables for both groups, but no differences were detected between Groups A and B: mean weight loss (A= 9.28 kg, B= 8.7 kg), ponderal loss percentage (A/B= 7.2/6.8%), glycemia (A/B= 18.6/12.1 mg/dl), systolic blood pressure (SBP) (A/B= 11.8/6.5 mmHg), diastolic blood pressure (DBP) (A/B 5.9/6.8 mmHg), and final insulin-resistance (IR) index (A= 4.4, B= 4.3). Group A had the highest drop in total cholesterol (37.7 vs 8.1 mg/dl) and triglycerides (54.4 vs 2.5 mg/dl). No changes were observed in ureic acid, renal function and serum albumin. Thirty-six patients (55.3%) suffered trivial complications associated to the VLCD (16.9% gastrointestinal, 20% anxiety), with no differences between groups. Group A patients were on sick leave due to asthenia, and two patients in this group had serious complications (transient ischemic attack and atrial fibrillation). The total cost of Group A treatment was 3018.9 against 582.6 euros for Group B.

CONCLUSIONS

The 3-month 800 kcal/day VLCD was more cost-effective and safer than the 1-month 458 kcal/day diet.

The inhibition of mercury absorption by dietary ethanol in humans: cross-sectional and case-control studies

BACKGROUND

Since the inhibition of mercury absorption by ethanol was serendipitously discovered in 1965,(1) a limited number of small number studies with both animal and human subjects have reported results consistent with this finding.

AIMS

To investigate this phenomenon in a large scale human study with low level Hg exposed dentists.

METHODS

Data were collected for a sample of 1171 dentists, and both cross sectional and case-control methods were utilised to examine the data.

RESULTS

Abstainers (n = 345) had significantly higher urinary mercury concentrations (HgU) than drinkers (n = 826): 5.4 microg/l v 4.8 microg/l. Multiple linear regression showed a significant effect of ethanol dose on HgU after adjusting for potential confounders. A case-control analysis in which cases were defined as those individuals with urinary Hg concentrations of > or =15 microg/l (approximately top 5%), and controls as those with concentrations of <1.0 microg/l ( approximately bottom 5%), showed a clear protective dose-response relation; there was a decreasing risk of being a "case" (having an HgU > or =15 microg/l) with increasing ethanol consumption. The significance of the adjusted model is p<0.001, and the chi2 test for trend across ethanol consumption categories in the adjusted model is p<0.05, confirming the dose-response relation.

CONCLUSION

We believe that this straightforward investigation provides the first specific confirmation in a large scale human study of the inhibitory effect of ethanol on urinary mercury concentration, and by inference, on mercury absorption.

Electron-polariton scattering in semiconductor microcavities

In semiconductor microcavities, electron-polariton scattering has been proposed as an efficient process that can drive polaritons from the bottleneck region to the ground state, achieving Bose amplification of the optical emission. We present clear experimental observation of this process in a structure that allows control of the electron density and we report substantial enhancement of photoluminescence. We show that this enhancement is more effective at higher temperatures due to the different way that electron scattering processes either broaden or relax polaritons.

Risk factors for diagnostic subgroups of painful temporomandibular disorders (TMD)

Temporomandibular Disorders (TMD) encompass several entities, which may have differing etiologies. To test this hypothesis, we investigated risk factors for three diagnostic subgroups of painful TMD. Ninety-seven subjects with myofascial pain only, 20 with arthralgia only, 157 with both myofascial pain and arthralgia, and 195 controls without TMD pain met criteria for study eligibility. Investigated risk factors included both physical and psychological variables. Adjusted odds ratios were calculated by multiple logistic regression analyses. Myofascial pain occurring alone was significantly associated with trauma (Odds Ratio [OR] = 2.0), clenching (OR = 4.8), third molar removal (OR = 3.2), somatization (OR = 3.7), and female gender (OR = 4.2). Myofascial pain with arthralgia was significantly associated with trauma (OR = 2.1), clenching (OR = 3.3), third molar removal (OR = 4.0), somatization (OR = 5.1), and female gender (OR = 4.7). No significant associations were found for the small-arthralgia-only group.

Examination of dietary methylmercury exposure in the Casa Pia Study of the health effects of dental amalgams in children

This study examined methylmercury concentrations in blood of children participating in the Casa Pia Study of the Health Effects of Dental Amalgams in Children over a 1-yr period and related them to their diets in terms of fish and other seafood consumption. One hundred and fifty children between the ages of 8 and 10 yr who were residents of the Casa Pia School System of Lisbon, Portugal, participated. Parents or caregivers completed a food frequency questionnaire designed specifically for this study at baseline. Children provided urinary and blood samples for mercury determinations at baseline and at 1 yr following placement of dental tooth fillings. Mercury levels in fish samples from children's diets were also obtained. Mercury determinations in urine, blood, and fish were performed using cold vapor atomic fluorescence spectroscopy. The mean value of baseline methylmercury concentrations in blood increased as the report of seafood consumption increased, although not statistically significantly. However, blood methylmercury and total mercury concentrations were significantly lower at 1-yr follow-up than at baseline. Sixty-one percent of parents/caregivers reported that their children consumed fish on a weekly basis. The fish offered at a sample of the schools contained low levels of methylmercury (range 13.9-23.6 ng/g). Thus, children participating in the Casa Pia dental amalgam study are exposed to low dietary levels of methylmercury by way of fish consumption, and this finding was reflected in the low mean blood methylmercury concentrations observed. The present findings indicate that dietary methylmercury is not a significant source of mercury exposure and is not likely to confound the association of dental amalgam mercury with potential health effects in the present study.

Analysis of a growth-promoting factor for Babesia caballi cultivation

Serum-free media were examined to culture Babesia caballi. Daigo's T (DT) basal medium supplemented with Daigo's GF21 (GF21) or GIT medium, which already contains GF21, supported the parasite propagation at 37 C in a humidified atmosphere under 5% CO2 in air. Growth of B. caballi was dependent of the suitable concentration (10-20%) of GF21. Therefore, GF21 was suggested as the growth-promoting factor for B. caballi. However, GIT medium did not support the growth of parasites from cryopreserved stabilates, and serum supplementation was essential for the retrieval of parasites.

Loss of heterozygosity events impeding breast cancer metastasis contain the MTA1 gene

Breast cancer mortality is seldom attributable to the primary tumor, but rather to the presence of systemic (metastatic) disease. Axillary lymph node dissection can identify the presence of metastatic breast cancer cells and serves as a marker for systemic disease. Previous work in our laboratory determined that rates of loss of heterozygosity (LOH) of a 1.6-Mb region of chromosome 14q 31.2 is much higher in axillary lymph node-negative primary breast tumors than in axillary lymph node-positive primary breast tumors (P. O'Connell et al., J. NATL: Cancer INST:, 91: 1391-1397, 1999.). This unusual observation suggests that, whereas the LOH of this region promotes primary breast cancer formation, some gene(s) mapping to this 1.6-Mb region is rate-limiting for breast cancer metastasis. Thus, if primary breast cancers delete this region, their ability to metastasize decreases. To identify this gene(s), we have physically mapped this area of chromosome 14q, confirmed the position of two known genes and 13 other expressed sequence tags into this 1.6-Mb region. One of these, the metastasis-associated 1 (MTA1) gene, previously identified as a metastasis-promoting gene (Y. Toh et al., J. BIOL: CHEM:, 269: 22958-22963, 1994.), mapped to the center of our 1.6-Mb target region. Thus, MTA1 represents a strong candidate for this breast cancer metastasis-promoting gene.

Determination of methyl mercury in whole blood by ethylation-GC-CVAFS after alkaline digestion-solvent extraction

A method for the determination of methyl mercury in whole blood samples based on ethylation-gas chromatography-cold vapor atomic fluorescence spectrometry after alkaline digestion-solvent extraction is described. The extraction procedure and conditions were optimized, and the matrix interference after extraction was critically investigated. The storage stability of MeHg in blood samples and a series of extracts was determined. The method detection limit was found to be approximately 0.02 ng/g for a 0.5-g blood sample with relative standard deviations of less than 10%. The accuracy and precision were evaluated by summarizing the quality-control (QC) data generated over a one and one half year period. Appropriate procedures for sample collection, transportation, and storage were adapted to the method. Using this method accompanied by explicit QC protocols and procedures, background levels of MeHg and total mercury in blood for 150 8-10-year-old Portuguese children with nonoccupational and nonamalgamal exposure were determined and reported with summarized QC data.

Characteristics of dental emergency clinic patients with and without disabilities

This study compared oral health and demographic characteristics of patients with and without disabilities at a dental school emergency clinic. Of 407 consecutive patients surveyed, 20.4% reported disabilities. Two groups matched by age and gender, those with disabilities (DIS, n = 79) and those without disabilities (ND, n = 177), were compared on questionnaire responses; two subgroups, DIS (n = 38) and ND (n = 44), were assessed clinically. The mean ages of the DIS and ND groups were 44.0 years (SD +/- 11.6) and 43.0 years (SD +/- 12.3), respectively. By chi-squared analysis, DIS vs. ND subjects had significantly lower levels of education, employment, income, and dental insurance, and greater dependence on Government funding. In the DIS group, 79.5% were not working, while 6.4% did work regularly. In the ND group, the corresponding values were 30.9% and 46.9%, respectively. In the DIS group, 51.9% identified Medicaid acceptance as the reason they sought care at the clinic, while 62.7% of the subjects in the ND group identified the lower fee structure as the reason for clinic selection. More DIS than ND subjects reported dentists' unavailability and inability to manage the disability, lack of transportation, effect of dental problems on health, and referral by a health professional. DIS vs. ND subjects had significantly fewer sound teeth and more missing teeth. The results suggest that one in five dental school emergency clinic patients has disabilities.

Validity of spot urine samples as a surrogate measure of 24-hour porphyrin excretion rates. Evaluation of diurnal variations in porphyrin, mercury, and creatinine concentrations among subjects with very low occupational mercury exposure

Porphyrin, mercury, and creatinine levels in single-void urine specimens ("spot samples") were compared with calculated 24-hour urine concentrations among 146 (77 male and 69 female) practicing dentists who are participating in an ongoing study of urinary porphyrin changes as a biomarker of mercury body burden. All subjects had urinary mercury concentrations < or = 5 micrograms/L, a level comparable to that of the general US population and which is below that determined to be associated with mercury-induced changes in urinary porphyrin excretion rates. The results confirmed previous findings of no significant diurnal variation in any of the porphyrin levels normally found in urine or in total porphyrin levels combined among males but describe significant diurnal variations in most porphyrin levels as well as concentrations of total porphyrins combined among females. Similarly, no evidence of large diurnal variation in mercury excretion among males was apparent, whereas significant diurnal variation in the mercury excretion rate among females was found. Creatinine adjustment of porphyrin or mercury concentrations had no significant effect on these findings. Moreover, no evidence of diurnal variation in urinary creatinine excretion among either male or female subjects was obtained, despite substantial between-subject variability in this parameter. These results support the view that spot urine samples may be utilized to derive reasonably accurate estimates of 24-hour porphyrin and mercury excretion rates in male subjects. In contrast, time of day appears to be of considerably greater importance when spot samples are utilized as 24-hour estimates of either porphyrin or mercury excretion rates among females. Additionally, time of day may be an important consideration in studies involving serial (repeated) porphyrin or mercury measurements using spot urine samples, irrespective of gender distribution of study subjects.

Efficacy of a sonic toothbrush for plaque removal by caregivers in a special needs population

Oral hygiene and oral health are a major concern for long-term-care facility residents who are unable to care for themselves. In this six-week study, the efficacy of a sonic toothbrush (Sonicare) was compared with traditional manual brushing in a setting where hygiene care was provided by caregivers. Evaluations of plaque levels were made at baseline and at 2, 4, and 6 weeks according to the Silness and Löe index. The sonic brush was found to be significantly superior to the manual brush over the trial period (MANCOVA; p = 0.026). Plaque reduction at 6 weeks was found to be 38% with the sonic brush and 6% with the manual brush. The results indicate that the sonic brush may be an effective way to provide improved oral health to nursing home subjects when oral care is caregiver-provided.

Behavioral effects of low-level exposure to Hg0 among dental professionals: a cross-study evaluation of psychomotor effects

A Across-study design was used to evaluate the sensitivities of five psychomotor tasks previously used to assess preclinical effects of low-level Hg0 (urinary < or =55 microg/l). Pooling dental professional subject populations from six studies conducted over the last 6 years, a larger study population was obtained with a high degree of uniformity (N = 230). The five psychomotor tests were: Intentional Hand Steadiness Test (IHST); Finger Tapping: The One-Hole Test: NES Simple Reaction Time (SRT); and Hand Tremor. Multivariate analyses were conducted following the hierarchical analysis of multiple responses (HAMR) approach. First, multiple scores of each test were combined into a single-factor (or related summary) variable and its reliability was estimated. Second. multiple regression analyses were conducted including log-transformed [Hg0]U levels, age, gender, and alcohol consumption in each model. Computed were both B and bu, the magnitudes of the log-Hg0 standardized coefficient. respectively uncorrected and corrected for dependent variable attenuation due to unreliability. Results indicated remarkable differences in the effects of relative level of Hg0 on psychomotor performance. Significant associations were found for the IHST factor (B = 0.415, p < 10(-6)), followed by finger tapping, which was relatively meager and insignificant (B 0.141, p = 0.17). The IHST results hold the greatest occupational relevance for dental professionals who rely on manual dexterity in restorative dentistry. Further, this statistical approach is recommended in future studies for condensation of multiple scores into summary scores with enhanced reliabilities useful in correcting for attenuation relationships (B(u)s) with exposure levels.

Spontaneous exfoliation of teeth following severe elemental mercury poisoning: case report and histological investigation for mechanism

BACKGROUND

Although the spontaneous exfoliation of teeth and breakdown of oral tissues from severe mercury intoxication have been noted for over a century, there are no published reports investigating the mechanisms of these phenomena. Severe mercury poisoning is rare in modern times, but it does occur. We present a case report and a histopathologic investigation into the mechanism of the associated tooth loss.

METHODS

An exfoliated tooth and periodontal and gingival tissues were obtained from a 15-month-old patient who had been severely intoxicated with elemental mercury over a period of months and hospitalized for severe neurologic and renal effects. The tissues were examined both by routine hematoxylin and eosin stain and by autometallography specific for mercury. For comparison, control tissue from an age-matched subject was examined with the autometallography technique.

RESULTS

Under light microscopy, the gingival tissue showed evidence of moderate to severe acute and chronic inflammation. The tooth pulp tissue showed evidence of moderate vascular dilatation and congestion, and it was infiltrated by many neutrophils. The autometallographic sections showed intense accumulations of mercury in the soft tissues of the mercury-exposed subject, but not in the tissues of the control subject. The deposits were primarily found in fibroblasts, which are essential to maintaining the integrity of the oral tissues.

CONCLUSIONS

Histopathologic and autometallographic examination of the affected tissue indicates that the primary mechanism of the spontaneous sloughing of tissue and loss of teeth may be the cytotoxic effects of the accumulation of mercury in fibroblasts. Studies of additional cases would be valuable to confirm this hypothesis.

Functional effects on the acetylcholine receptor of multiple mutations of gamma Asp174 and delta Asp180

Residues gamma Asp174 and delta Asp180, previously implicated in the binding of acetylcholine (ACh) by the mouse muscle ACh receptor, were each mutated to nine other residues, Asn, Glu, Thr, Ala, Cys, His, Val, Tyr, and Lys. The effects of the mutations on ACh-induced current was determined on surface receptors containing wild-type alpha and beta subunits and mutant gamma and delta subunits. The mutations increased the concentration of ACh eliciting half-maximal current (EC50) by factors from 22 for the Glu mutant to 660 for the Lys mutant. Analysis of the effects in terms of the difference in the accessible surface areas of the mutant and wild-type side chains and the difference in side-chain charges indicated that, per binding site, Delta DeltaG0 for activation was a sum of 10 cal mol-1 A-2 of change in side-chain accessible surface area and of 0.95 kcal mol-1 positive step-1 in side-chain charge, equivalent to 1 mol of charge falling through 42 mV. The effects on the concentration of ACh (IC50, ACh) and of d-tubocurarine (IC50,dTC) causing half-maximal retardation of alpha-bungarotoxin binding were determined on complexes containing wild-type alpha and beta subunits and either mutant gamma or mutant delta subunit. The effects on IC50,ACh correlated well with the effects on EC50, with a similar magnitude for the influence of side-chain charge on the free energy of binding (in this case to the desensitized state) and on the electrostatic potential at the binding site. The effects on IC50,dTC were in all cases less than the effects on IC50,ACh, and the two sets of effects were poorly correlated. In line with the higher ACh affinity and lower d-tubocurarine affinity of the alpha-delta binding site compared to the alpha-gamma binding site, mutations of delta Asp180 had a greater effect on IC50,ACh than did the same mutations of gamma Asp174, and vice versa for effects on IC50,dTC. Consequently, all mutations decreased the asymmetry in the binding properties of the two types of sites.

Comparison of incoming dental school patients with and without disabilities

A survey of incoming dental school patients compared 64 adult patients (DECOD) and 73 patients without disability (ND), regarding past dental experience, current needs, and basis for selecting the school's clinics. The responses indicated that, for DECOD patients, clinic selection was based largely on Medicaid acceptance, staff experience, and inability of other dentists to manage their disability; for ND patients, selection was based on lower fee structure. Both groups expressed high treatment need, but the rate was lower for DECOD than for ND patients. More DECOD patients reported severe dental anxiety and adverse effects of dental problems on general health. Chart records revealed that clinical findings exceeded perceived need for both DECOD and ND patients. While both groups had high periodontal disease rates (91%), DECOD patients had significantly poorer oral hygiene and less restorative need than ND patients. The findings suggest differences between persons with disabilities and other patient groups in difficulty of access to dental services in the community, reasons for entering the dental school system, and in presenting treatment need and/or treatment planning.

Epidemiologic assessment of measures used to indicate low-level exposure to mercury vapor (Hg)

Mercury (Hg) concentrations in individual spot urine samples collected over consecutive 1-d periods were compared with Hg concentrations measured in combined 24-h urine samples from 69 practicing dental professionals with low exposure to Hg vapor (Hg) in order to validate the use of spot urine samples as an indicator of Hg exposure. The level of Hg in air as an exposure measure was also evaluated by comparing air concentrations of Hg in dental offices with both spot and 24-h urine Hg levels. The results showed: (1) There was little diurnal variation (approximately 9%) in urinary Hg values; (2) a strong correlation (R2 = .85) exists between the Hg concentration in the first morning void and that in a complete 24-h urine sample; (3) adjustment of urinary Hg levels for creatinine concentrations did not improve this correlation; (4) there was no added value in the speciation of total urinary Hg into the inorganic Hg fraction; and (5) concentrations of Hg in air did not significantly correlate with measures of Hg in urine at this low Hg exposure level. We conclude from this study that first morning void urine samples may be used to derive reasonably valid estimates of Hg concentrations found in the total amount of urine collected over a 24-h period. Thus, due to its comparability, ease of collection, and lower cost, the first morning urine void may be used in place of a sample collected over a full 24 h to facilitate Hg exposure assessments in epidemiologic studies that use urinary Hg levels as a measure of low-level Hg exposure.

The validity of spot urine samples for low-level occupational mercury exposure assessment and relationship to porphyrin and creatinine excretion rates

Hg and porphyrin levels in single void urine specimens (spot samples) were compared with calculated 24-hr urine levels in 35 (20 [correction of 25] male and 15 female) practicing dentists who had been occupationally exposed to low levels of elemental Hg. The study aimed to: 1) determine the individual variability for Hg and porphyrin concentrations in spot samples over a 24-hr period; 2) test for the presence of diurnal variation in urinary Hg and porphyrin concentrations; and 3) determine the time of day at which a spot sample would give a Hg concentration closest to the 24-hr average concentration. Results confirmed previous reports of a first-order diurnal pattern with a mid-morning peak for Hg concentration (P < .001). A second-order model best described creatinine excretion (P = .0089), with peaks at about 5:00 and 19:00. The use of creatinine adjustment for Hg concentration significantly reduced the intraindividual variation around the diurnal curve. No diurnal patterns were found for any of the porphyrins examined. We recommend that, for small clinical studies using urinary Hg concentration, 24-hr sampling would be ideal, but that for mass screenings and cross-sectional studies, spot samples may be useful because they correlate fairly well with 24-hr averages (creatinine adjusted, r = 0.61; unadjusted, r = 0.74). Because of the existence of diurnal variation, for all cases using serial sampling attention should be paid to time of day.

Circadian variation in urinary excretion of bone collagen cross-links

Bone resorption can be evaluated by measuring the urinary excretion of collagen type I cross-linked N telopeptides (NTx). Since it is difficult to obtain (and verify) 24 h urine collections from patients, untimed spot urines are more practical. Such measurements, however, need correction for urine dilution and potentially may vary with collection time since a circadian rhythm in bone metabolism has been reported. This study examined cross-link excretion in urine voids serially collected during a 24 h period from subjects living their normal daily routine (as opposed to a controlled hospital setting). This mimics the situation for walk-in patients visiting a clinician and providing a spot urine. A total of 35 dentists (20 males, 15 females) collected all urine voids separately over a 24 h period. Urines were analyzed for creatinine and NTx. The effects of time of day on the excretion rates of these metabolites (in nmol/h) and on the cross-link:creatinine ratio were assessed. A circadian rhythm was evident in the excretion rate of creatinine with a peak in the late afternoon (18% higher than the 24 h mean, p = 0.0004). The NTx excretion rate peaked in the morning (9% higher than the 24 h mean) but this latter rhythm was not statistically significant (p = 0.31). The NTx:creatinine ratio fell during the day from a high (122% of the 24 h mean) in the early morning to a low in the early evening. This rhythm in the NTx:creatinine ratio in untimed spot urines was statistically significant (p < 0.0001). In conclusion, the NTx:creatinine ratio in spot urines from adult outpatient subjects showed a significant circadian rhythm. Variations in creatinine excretion were the primary cause. Time of day should, therefore, be taken into account when comparing test results of spot urines with normal ranges or with other samples from the same subject.

Factors contributing to mercury exposure in dentists

Although mercury exposure levels among dentists have been steadily decreasing, occupational mercury exposure among dental professionals continues to be a matter of interest. This study examined personal professional and office characteristics of dentists to determine which factors contribute most to exposure. The resulting information will help dental professionals change their practices to minimize unnecessary exposure to elemental mercury.

Distribution of the HLA-DQA1 polymorphism in the population of the Basque Country (Spain)

Allele and genotype frequencies at the HLA-DQA1 locus were determined in Basque Country populations using PCR methodology and a dot-blot assay with ASO probes. The results showed no deviation from the Hardy-Weinberg equilibrium. No differences were found between the three Basque Provinces, but gene frequencies were significantly different from those of some other Spanish and world populations.

Behavioral effects of low-level exposure to elemental Hg among dentists

Exposure thresholds for health effects associated with elemental mercury (Hg degree) exposure were examined by comparing behavioral test scores of 19 exposed (mean urinary Hg = 36 micrograms/l) with those of 20 unexposed dentists. Thirty-six micrograms Hg/l is 7 times greater than the 5 micrograms Hg/l mean level measured in a national sample of dentists. To improve the distinction between recent and cumulative effects, the study also evaluated porphyrin concentrations in urine, which are correlated with renal Hg content (a measure of cumulative body burden). Subjects provided an on-site spot urine sample, were administered a 1-h assessment consisting of a consent form, the Profile of Mood Scales, a symptom and medical questionnaire, and 6 behavioral tests: digit-span, symbol-digit substitution, simple reaction time, the ability to switch between tasks, vocabulary, and the One Hole Test. Multivariate regression techniques were used to evaluate dose-effects controlling for the effects of age, race, gender and alcohol consumption. A dose-effect was considered statistically significant below a p value of 0.05. Significant urinary Hg dose-effects were found for poor mental concentration, emotional lability, somatosensory irritation, and mood scores. Individual tests evaluating cognitive and motor function changed in the expected directions but were not significantly associated with urinary Hg. However, the pooled sum of rank scores for combinations of tests within domains were significantly associated with urinary Hg, providing evidence of subtle preclinical changes in behavior associated with Hg exposure. Coproporphyrin, one of three urinary porphyrins altered by mercury exposure, was significantly associated with deficits in digit span and simple reaction time.(ABSTRACT TRUNCATED AT 250 WORDS)

Topical anesthesia: differentiating the pharmacological and psychological contributions to efficacy

Pain can be influenced by both pharmacologic and psychologic factors. The purpose of this study was to investigate the pharmacologic and psychologic factors. The purpose of this study was to investigate the pharmacologic and psychologic processes that may play a role when topical anesthesia is used to reduce the pain of dental injections. Subjects were assigned to one of two belief manipulation conditions: one-half of the subjects were led to believe they would receive a placebo, while the remaining subjects were told they would receive the active agent. In reality, all subjects received two separate injections at contralateral sites, one preceded by a placebo and the other by a 20% benzocaine gel. The order in which injections were given was associated with differences in pain report. Second injections were more painful than first injections. Whether injections were preceded by an active or placebo agent did not alter subjects' experienced pain. Likewise, the belief manipulation did not affect the pain report. However, subjects who believed they would receive the active agent anticipated significantly less pain than subjects who thought they would receive placebo. The widespread belief that topical anesthetics are effective at reducing injection pain may serve to reduce the anticipatory anxiety associated with an impending dental injection, thus making the injection experience less aversive.

Urinary porphyrin profiles as a biomarker of mercury exposure: studies on dentists with occupational exposure to mercury vapor

Porphyrins are formed as intermediates in the biosynthesis of heme. In humans and other mammals, porphyrins with eight, seven, six, five, and four carboxyl groups are excreted in the urine in a well-established pattern. Mercury selectively alters porphyrin metabolism in kidney proximal tubule cells, leading to an altered urinary porphyrin excretion pattern. Previous studies in rats have shown that changes in the urinary porphyrin profile during exposure to mercury as methylmercury hydroxide are uniquely characterized by highly elevated (20- to 30-fold) levels of four- and five-carboxyl porphyrins and by the excretion of an atypical porphyrin ("precoproporphyrin"), which elutes on high performance liquid chromatography (HPLC) approximately midway between penta- and coproporphyrins. Changes in the urinary porphyrin profile are highly correlated with the dose and duration of mercury exposure and persist for up to 20 wk following cessation of mercury treatment. In the present studies, the utility of urinary porphyrin profile changes as a biomarker of mercury exposure in human subjects was evaluated. Urinary porphyrin concentrations were measured in dentists participating in the Health Screening Programs conducted during the 1991 and 1992 annual meetings of the American Dental Association and compared with urinary mercury levels measured in the same subjects. Among dentists with no detectable urinary mercury, mean concentrations of urinary porphyrins were within the established normal ranges for male human subjects. In contrast, among dentists with urinary mercury in excess of 20 micrograms/L, mean urinary concentrations of four- and five-carboxyl porphyrins as well as of precoproporphyrin were elevated three to four times those of unexposed subjects. Significant differences in urinary porphyrin concentrations remained when porphyrin concentrations in spot urine samples were adjusted for creatinine levels. These findings suggest that urinary porphyrin profiles may serve as a useful biomarker of mercury exposure in clinical or epidemiologic studies of mercury-related human health risks.

Skills in cardiopulmonary resuscitation: a survey of dental practitioners

Emergency preparedness questionnaires were mailed to 4,905 dentists in Florida and 1,600 dentists in Kentucky. A total of 1,605 questionnaires were returned. Of the respondents, 52% reported being certified currently as providers of cardiopulmonary resuscitation. Dentists reported that they used their skills in cardiopulmonary resuscitation more than 900 times during a 10-year period. More than a third of the life-threatening situations occurred in dental offices.

Emergency preparedness: a survey of dental practitioners

A total of 6,505 questionnaires were mailed to practicing dentists in Florida and Kentucky. The dentists represented all dental specialties and had been graduated from 72 different dental schools. The results of the survey indicate that improvement is needed in training, office organization, and advanced preparation for the emergency management of patients. The results also indicate that dentists encounter many medical emergencies in their offices.

The agoraphobic dental patient: report of case

Agoraphobia is considered to be the most common, yet distressing, phobia for adult phobic patients. Little has been written concerning the identification, problems, and treatment of dental disease in the agoraphobic patient. After a review of the clinical features, epidemiology, causes, and medical treatment of the syndrome, a case study is presented, showing how dental treatment can be a valuable part of the behavioral treatment of this patient.

Insect Moulting Hormones: Possible Intermediates in the Metabolism of Cholesterol to Ecdysteroids in an Insect

The possible ecdysteroid precursors 3β,5,14x-trihydroxy-5α-cholest-7- en-6-one (12) and 3β,14α-dihydroxycholesta-4,7-dien-6-one (19) have been synthesized and the metabolism of the corresponding 3α-tritium- labelled compounds studied in Calliphora stygia at the time of ecdysteroid biosynthesis. Labelled 20-hydroxyecdysone was isolated in both cases and the compounds may thus be ecdysteroid precursors. However, confirmation of these results with substrates labelled in another position is necessary.

Illusory biplane radiographic images

The commonly held belief that radiographs taken at right angles to one another will accurately portray the precise location of a metallic implant within a skeletal structure is erroneous. To the contrary, such biplane radiographs often provide misinformation about the exact location of metallic implants. The explanation for this phenomenon is discussed along with several methods to determine the accurate location of metallic implants when only biplane radiographs are available. Orthopedic surgeons should be particularly aware of this potential problem when biplane radiographs are taken at the time of insertion of multiple pins about the proximal femur.