Predictors for long-term relapse of orthodontic treatment in patients with cleft lip and palate. A clinical follow-up study

OBJECTIVES

To identify predictors for long-term relapse of orthodontic therapy in patients with cleft lip and palate (CLP).

MATERIALS AND METHODS

Patients with uni- and bilateral non-syndromal CLP were followed up at least two years after completion of their orthodontic therapy. Plaster casts of the start of treatment (T1), after completion of treatment (T2), and at follow-up (T3) were measured using the modified Huddart Bodenham Index. Characteristics of multidisciplinary therapy were taken from the patient files. Potentially influencing factors of relapse were investigated using logistic regression analyses and Spearman correlations.

RESULTS

In total 58.07% of the included 31 patients showed a stable treatment outcome at follow-up after an average of 6.9 years. Even if relapse occurred, 61.54% of these patients still showed improvement regarding their occlusion compared to baseline. Predictors for the occurrence of relapse were the severity of dysgnathia at baseline (p = 0.039) and the extent of therapeutic change (p = 0.041). The extent of therapeutic change was additionally a predictor for the extent of post-therapeutic relapse (ρ = 0.425; p = 0.019).

CONCLUSIONS

Patients with CLP benefit from their orthodontic therapy in the long term despite an increased tendency to relapse.

CLINICAL RELEVANCE

Results of this long-term study could be used to adapt the treatment concept for patients with CLP and reinforce the significance of a patient-centered orthodontic treatment concept for affected patients.

Bold or shy? Examining the risk–taking behavior and neophobia of invasive and non–invasive house sparrows

Behavior provides a useful framework for understanding specialization, with animal personality aiding our understanding of the invasiveness of birds. Invasions imply dispersion into unknown areas and could require changes in behavior or spatial clustering based on personality. Reduced neophobia and increased exploring behavior could allow individuals to colonize new areas as they test and use non–familiar resources. Here, we hypothesized that house sparrow (Passer domesticus) individuals from invasive populations would exhibit bolder behavior than in non–invasive populations. We assessed risk taking and neophobia in male house sparrows in Barcelona (where it is considered native) and in Mexico City (where it has become widely invasive), captured in two different habitats, urban and non–urban. We assessed latency to enter an experimental cage and to explore it, and latency to feed and feeding time in the presence of a novel object. We found that sparrows from Mexico City, both from urban and non–urban areas, were quicker to enter the experimental cage than the sparrows from Barcelona. The time it took the birds to start exploring the cage gave a similar result. We found no differences between cities or habitats in the latency to feed and feeding time while exposed to a novel object. Our results partially support the view that the invader populations from Mexico City are bolder than those from Barcelona. Behavior is an important component of plasticity and its variability may have an important effect on adaptation to local situations. Future studies should disentangle the underlying mechanisms that explain the different personalities found in populations of different regions, contrasting populations of different densities, and taking different food availability scenarios into account.

Three-dimensional printing-guided fenestrated endovascular aortic aneurysm repair using open source software and physician-modified devices

Fenestrated endovascular aneurysm repair is frequently used for juxtarenal and pararenal aortic aneurysms. In urgent cases, however, the use of premanufactured patient-specific devices is not an option. Physician-modified endografts may be used to treat these patients but require experience and a steep learning curve for accurate planning to position fenestrations and to perform the graft modifications. Despite experience, a margin of error in placing fenestrations always exists, and a mismatch possibility between the fenestration and vessel ostium can lead to increased cannulation time and stent complications, including target vessel loss. Aortic three-dimensional printing has been widely described in medicine for simulation, training, and surgical planning. Commercial software is currently under investigation for planning of fenestrated endovascular aneurysm repair at high costs. We describe an effective and inexpensive technique using free computer-aided design software to create a real 1:1 aortic 3D model that can easily be printed and quickly sterilized. This aortic model can be used to create a physician-modified endograft and to place fenestrations in an accurate way, with potential for shorter and more precise procedures and better long-term results. Two cases are presented to illustrate the technique, demonstrating that 3D printing is a valuable tool to plan, design, and create fenestrated devices more accurately.

Consciousness as a global property of brain dynamic activity

We seek general principles of the structure of the cellular collective activity associated with conscious awareness. Can we obtain evidence for features of the optimal brain organization that allows for adequate processing of stimuli and that may guide the emergence of cognition and consciousness? Analyzing brain recordings in conscious and unconscious states, we followed initially the classic approach in physics when it comes to understanding collective behaviours of systems composed of a myriad of units: the assessment of the number of possible configurations (microstates) that the system can adopt, for which we use a global entropic measure associated with the number of connected brain regions. Having found maximal entropy in conscious states, we then inspected the microscopic nature of the configurations of connections using an adequate complexity measure and found higher complexity in states characterized not only by conscious awareness but also by subconscious cognitive processing, such as sleep stages. Our observations indicate that conscious awareness is associated with maximal global (macroscopic) entropy and with the short time scale (microscopic) complexity of the configurations of connected brain networks in pathological unconscious states (seizures and coma), but the microscopic view captures the high complexity in physiological unconscious states (sleep) where there is information processing. As such, our results support the global nature of conscious awareness, as advocated by several theories of cognition. We thus hope that our studies represent preliminary steps to reveal aspects of the structure of cognition that leads to conscious awareness.

Richness and Abundance of Ichneumonidae in a Fragmented Tropical Rain Forest

Because of the magnitude of land use currently occurring in tropical regions, the local loss of animal species due to habitat fragmentation has been widely studied, particularly in the case of vertebrates. Many invertebrate groups and the ichneumonid wasps in particular, however, have been poorly studied in this context, despite the fact that they are one of the most species-rich groups and play an important role as regulators of other insect populations. Here, we recorded the taxonomic composition of ichneumonid parasitoids and assessed their species richness, abundance, similarity, and dominance in the Los Tuxtlas tropical rain forest, Mexico. We compared two forest types: a continuous forest (640 ha) and a forest fragment (19 ha). We sampled ichneumonids using four malaise traps in both forest types during the dry (September-October) and rainy (March-April) seasons. A total of 104 individuals of Ichneumonidae belonging to 11 subfamilies, 18 genera, and 42 species were collected in the continuous forest and 11 subfamilies, 15 genera, and 24 species were collected in the forest fragment. Species richness, abundance, and diversity of ichneumonids were greater in the continuous forest than in the forest fragment. We did not detect differences between seasons. Species rank/abundance curves showed that the ichneumonid community between the forest types was different. Species similarity between forest types was low. The most dominant species in continuous forest was Neotheronia sp., whereas in the forest fragment, it was Orthocentrus sp. Changes in the ichneumonid wasp community may compromise important tropical ecosystem processes.

Gender-dependent differences in serum profiles of insulin and leptin in caloric restricted rats

In the present study, we have investigated whether differences between male and female rats described in response to 40% caloric restriction (CR) were influenced by circulating level variations of sex hormones and/or insulin and leptin. Body weights (BW), organ weights, and adipose depot weights (ADW) were also measured. The most affected tissues by CR were the fat depots. Metabolically active organs were the least affected, especially more in females than in males (male weight lost: 24.3% vs. female: 17.3%). Testosterone and estradiol circulating levels did not show changes by CR. Insulin levels were decreased by CR in both genders, but was more evident in female rats than males. Leptin serum levels were higher in male rats than in females, and CR caused a circulating leptin level reduction only in males. In conclusion, our results indicate that leptin and insulin could be one of the keys of the different hormonal control of energy homeostasis in response to CR between female and male rats. In this sense, leptin serum levels correlated statistically with BW and with individual ADW only in male rats, whereas insulin serum levels correlated statistically with BW and with any of the ADW studied only in females.

Sexual dimorphism in liver mitochondrial oxidative capacity is conserved under caloric restriction conditions

Caloric restriction (CR) without malnutrition has been shown to increase maximal life span and delay the rate of aging in a wide range of species. It has been proposed that reduction in energy expenditure and oxidative damage may explain the life-extending effect of CR. Sex-related differences also have been shown to influence longevity and energy expenditure in many mammalian species. The aim of the present study was to determine the sex-related differences in rat liver mitochondrial machinery, bioenergetics, and oxidative balance in response to short-term CR. Mitochondria were isolated from 6-mo-old male and female Wistar rats fed ad libitum or subjected to 40% CR for 3 mo. Mitochondrial O2 consumption, activities of the oxidative phosphorylation system (complexes I, III, IV, and V), antioxidative activities [MnSOD, glutathione peroxidase (GPx)], mitochondrial DNA and protein content, mitochondrial H2O2 production, and markers of oxidative damage, as well as cytochrome C oxidase and mitochondrial transcription factor A levels, were measured. Female rats showed a higher oxidative capacity and GPx activity than males. This sexual dimorphism was not modified by CR. Restricted rats showed slightly increased oxygen consumption, complex III activity, and GPx antioxidant activity together with lower levels of oxidative damage. In conclusion, the sexual dimorphism in liver mitochondrial oxidative capacity was unaffected by CR, with females showing higher mitochondrial functionality and ROS protection than males.

[Poor adherence to diet in hemodialysis: role of anxiety and depression symptoms]

OBJECTIVE

To determine whether symptoms of anxiety or depression are factors associated with poor compliance of fluid restriction and dietary selection in chronic renal failure patients in hemodialysis.

PATIENTS AND METHODS

A cross-sectorial, descriptive, comparative and correlation study was designed between january and march of 2000, patients were selected in 3 hemodialysis centers of Social Security in Lima with Karnofsky index > 80, without an acute failure of treatment or default from therapy in the last 3 months. Depressive symptoms were evaluated with Beck Depression Inventory and Anxiety Symptoms with the Zung Scale. Poor compliance with fluid restriction was defined as an interdialytic weight gain > or = 2.5 kg and dietary restriction as a level of predialysis serum potassium > or = 6 meq/L. The evaluation of risk factors was made with a simple and multiple logistic regression analysis.

RESULTS

Eighty eight patients were selected, 47 (53.4%) were men, the average values of age, time on dialysis, level of creatinine and hemoglobin were respectively 55.9 +/- 15.8 years old, 48.8 +/- 38.8 months, 8.5 +/- 1.9 mg/dl and 7.7 +/- 1.4 g/dl. The number of patients with adequacy of dialysis, depressive symptoms, anxiety symptoms, poor compliance with fluid restriction and dietary selection were respectively 50 (62.5%), 54 (61.4%), 46 (52.3%), 47 (53.4%) and 31 (35.2%). The multiple logistic regression analysis showed that depressive symptoms are the only factor associated with poor compliance with fluid restriction (OR = 2.7, p = 0.002) and dietary selection (OR = 2.5, p = 0.0067). Depressive symptoms and them severity had a positive correlation with poor compliance.

CONCLUSION

Depressive symptoms and its severity is associated with a higher interdialitytic weight gain and higher predialysis serum potassium in hemodialysis patients. Early diagnosis and therapeutic intervention might benefit these patients.

Genetic diversity of Nostoc microsymbionts from Gunnera tinctoria revealed by PCR-STRR fingerprinting

The cyanobacteria belonging to the genus Nostoc fix atmospheric nitrogen, both as free-living organisms and in symbiotic associations with a wide range of hosts, including bryophytes, gymnosperms (cycads), the small water fern Azolla (Pteridophyte), the angiosperm genus Gunnera, and fungi (lichens). The Gunnera-Nostoc symbiosis is the only one that involves a flowering plant. In Chile, 12 species of Gunnera have been described with a broad distribution in the temperate region. We examined the genetic diversity of Nostoc symbionts from three populations of Gunnera tinctoria from Abtao, Chiloé Island, southern Chile, and microsymbionts from other two species of Gunnera from southern Chile, using PCR amplification of STRR (short tandemly repeated repetitive) sequences of the Nostoc infected tissue. To our knowledge, this is the first report of PCR fingerprinting obtained directly from symbiotic tissue of Gunnera. Genetic analyses revealed that Nostoc symbionts exhibit important genetic diversity among host plants, both within and between Gunnera populations. It was also found that only one Nostoc strain, or closely related strains, established symbiosis with an individual plant host.

[Neurovegetative diseases in dementia]

Dementia is the result of the dysfunction and death of cells in the central and peripheral nervous system. Of diverse etiology, these processes are insidious in their onset and are characterized by a progressive neural depletion resulting in a range of cognitive deficits, including a deterioration in the capacity to learn and a tendency to forget what has been learned. Neurodegenerative diseases resulting in dementia include: Alzheimer, Parkinson, Huntington, Pick, and Creutzfeld Jakob, as well as dementias with multiple etiologies. The population with the highest probability of suffering from one of these diseases are those over 50 years of age, because they have reduced circulating levels of gonadal hormones, one of several risk factors associated with the onset of dementia. Anatomical areas most commonly affected include the hippocampus, the primary motor and somatosensory areas, various limbic structures, and the parieto-temporal, frontal, and entorhinal corticies. Affliction of this last area has been suggested to account for the early olfactory dysfunction often shown by patients after the onset of Alzheimer and Parkinson, leading to the suggestion that olfactory testing could be useful in the early diagnosis of such neurodegenerative diseases.

[Balantidiasis in a rural community from Bolivar State, Venezuela]

Balantidium coli is the etiologic agent of balantidiasis, an infrequent zoonose of worldwide distribution. The objective of the present study was to determine the clinical and epidemiological aspects of balantidiasis in a rural community in the Bolivar State in Venezuela. Fifty persons and 12 pigs were evaluated. Fecal samples were analyzed by direct examination and by the methods of Faust and Willis. The global rate of intestinal parasitoses detected was 88.0% for the human population and 83.3% for the pigs. The prevalence of human and porcine balantidiais was 12.0% (6/50) and 33.3% (4/12), respectively. The disease was only detected in children, all of them with multiple parasites and with clinical manifestations. Deficient environmental sanitation, absence of basic services in the dwellings, low socioeconomic level, and the presence of pigs infected with B. coli are the factors that explain and maintain the conditions favorable to the transmission of balantidiasis in the population studied.

An outbreak of multidrug-resistant pneumococcal pneumonia and bacteremia among unvaccinated nursing home residents

BACKGROUND

Outbreaks of pneumococcal disease are uncommon and have occurred mainly in institutional settings. Epidemic, invasive, drug-resistant pneumococcal disease has not been seen among adults in the United States. In February 1996, there was an outbreak of multidrug-resistant pneumococcal pneumonia among the residents of a nursing home in rural Oklahoma.

METHODS

We obtained nasopharyngeal swabs for culture from residents and employees. Streptococcus pneumoniae isolates were serotyped and compared by pulsed-field gel electrophoresis. A retrospective cohort study was conducted to identify factors associated with colonization and disease.

RESULTS

Pneumonia developed in 11 of 84 residents (13 percent), 3 of whom died. Multidrug-resistant S. pneumoniae, serotype 23F, was isolated from blood and sputum from 7 of the 11 residents with pneumonia (64 percent) and from nasopharygeal specimens from 17 of the 74 residents tested (23 percent) and 2 of the 69 employees tested (3 percent). All the serotype 23F isolates were identical according to pulsed-field gel electrophoresis. Recent use of antibiotics was associated with both colonization (relative risk, 2.3; 95 percent confidence interval, 1.3 to 4.2) and disease (relative risk, 3.6; 95 percent confidence interval, 1.2 to 10.8). Only three residents (4 percent) had undergone pneumococcal vaccination. After residents received pneumococcal vaccine and prophylactic antibiotics, there were no additional cases of pneumonia, and the rates of carriage decreased substantially.

CONCLUSIONS

In this outbreak a single pneumococcal strain was disseminated among the residents and employees of a nursing home. The high prevalence of colonization with a virulent organism in an unvaccinated population contributed to the high attack rate. Clusters of pneumococcal disease may be underrecognized in nursing homes, and wider use of pneumococcal vaccine is important to prevent institutional outbreaks of drug-resistant S. pneumoniae infection.

Detection of chlamydiosis in a shipment of pet birds, leading to recognition of an outbreak of clinically mild psittacosis in humans

Avian chlamydiosis was detected in a shipment of > 700 pet birds from a Florida bird distributor that were sold to nine Atlanta-area pet stores in August 1995. Respiratory illness among persons who had recently acquired birds from this shipment was reported to local public health officials. The attack rate of acute respiratory illness was 10.7% among persons in households exposed to birds from the implicated flock vs. 1.8% among control households (odds ratio, 6.60; 95% confidence interval, 1.39-31.2). Illness and serological evidence of infection in the absence of symptoms were more common among persons in households with recently purchased birds that were sick or that had died and among persons who had had direct contact with the birds. Clinical psittacosis or serological evidence of Chlamydia psittaci infection was found in 30.7% of households with birds from the infected flock. Mild illnesses and asymptomatic infections in exposed persons were unusual features of this outbreak.

Neural control of maternal behaviour and olfactory recognition of offspring

In terms of reproductive success the quality and duration of maternal care exhibited by any particular species is of paramount importance, and yet compared with the amount of research studying the control of reproductive cycles, sexual behaviour, and fertility, it has historically received considerably less attention. However, we are now beginning to understand how the brain is organised to mediate this complex behaviour and how its expression is orchestrated by different hormonal and neurochemical factors. This review summarises a series of neuroanatomical, electrophysiological, in vivo sampling and behavioural neuropharmacological experiments carried out in sheep. These have attempted to define the neural circuitry and hormonal neurotransmitter systems involved both in the control of maternal behaviour per se and in the selective olfactory recognition of lambs, which is the basis of an exclusive emotional bond between mother and offspring.

A simplified histoscore for the estrogen receptor assay in breast cancer

Different histoscores combining the number of positive cells and the intensity of staining have been used to evaluate the estrogen receptor immunocytochemical assay (ER-ICA). Our aim was to investigate if the simple estimation of the amount of positive cells could be sufficient for the semiquantitative analysis of ER-ICA. Tissue from 51 women with ductal breast carcinoma was used. Half of each sample was processed with the quantitative assay (ER-EIA) and the other half with ER-ICA. Microscopical analysis was performed by two independent observers and classified on a simple scale from 0 to 4+. With EIA 31 cases (60.78%) were positive and 20 (39.21%) negative. With ER-ICA 29 (56.86%) had immunostaining, whereas 22 (43.13%) did not. 95.83% of the ER-ICA positive cases and 77.7% of ER-ICA negative had a good correlation with EIA values. Statistical analysis showed a high degree of correlation (r = 0.88 p 0.001). Hence, simple semiquantitative estimation in ER-ICA is sufficient to provide useful information for clinical use about ER content in tissue sections.

Evaluation of a simple semiquantitative assay for estrogen receptors in breast cancer

A number of studies have been published to evaluate the inmunocytochemical assay for ER using monoclonal antibodies. Histoscores so far used consider two variables: the number of cells and the intensity of the reaction. There are however indications that only the proportion of stained cells are important for assessment and show a direct correlation with quantitative data. We studied 77 breast invasive adenocarcinomas stained with the Abbott ERICA kit and used a simple scale of 0 to 4 for the estimation of ER. Tissues were snap frozen in liquid N and immunostained with the specific antibody and peroxidase. Immunostaining was estimated in a simple observational scale from 0-4+ where 0 = no staining or few scattered positive cells; 1+ up to 25%; 2+ up to 50%; 3+ up to 75% and 4+ more than 75% of stained malignant cells. Counts were performed in at least 100 malignant cells in various microscopic fields. Staining was always nuclear and a considerable heterogeneity in the number of cells and the intensity of the reaction was observed. Grading specimens from 0-4+ was found simple and reproducible. In 45% there was no immunostaining and 54% were positive for ER. In patients greater than 50 years of age 67% were positive; in patients less than 50 years of age only 33% had ER. This procedure has many advantages for clinical use: it is simple, it does not require sophisticated equipment, it is reproducible and can be performed in small tissue fragments, such as needle aspiration material, as well as in cytological smears.

[Participation of the olfactory system in the regulation of food intake]

Evoked potentials in the olfactory bulb (OB), lateral hypothalamus (HL) and rostral portion of the nucleus of the tractus solitarius (NTS), were recorded after cervical vagus nerve stimulation. The slow component in the OB only was recorded in the periglomerular layer. Electrolytic lesion of the NTS, abolished the evoked potentials in the OB by vagus nerve stimulation. The results of the present experiments indicate that the pathway from the vagus nerve to OB go into the NTS but probably not into the LH.

Onchocerciasis endemic in the State of Bolivar, Venezuela

Microfilariae of Onchocerca volvulus were demonstrated by single shoulder-skin biopsy in 42.8% of inhabitants of seven Amerindian villages in an area of approximately 10,000 km2, near the Brasilian Roraima Territory. The highest prevalence was found among the Yanomama Indians of Chajuraña (84.6%, with a mean of 61.3 microfilariae per mg of skin). The six other communities were affected, but with lower prevalence and microfilaria skin densities. The absence of lymphoedema and the few subcutaneous nodules and eye lesions found among the infected individuals suggest a relatively recent introduction of the disease to the region. Mansonella ozzardi infections were also detected in the area.

Experimental uterine eosinophilia in the rat. The role of some inhibitors of arachidonic acid metabolism

The mechanism of estrogen induced eosinophilia is not well understood. It has been proposed that type II estrogen receptors, present both in eosinophils and uterine tissues, can act as anchorage mechanism for the attachment of eosinophils within the uterus. However an explanation based on the existence of chemotactic mediators is more likely. We studied the effects of the lipoxygenase inhibitor BW755 and two different doses of indomethacin in a model of acute uterine eosinophilia promoted by 17-beta-estradiol in young rats; simultaneously estrogen receptors were studied with immunocytochemical methods using monoclonal antibodies. BW755 and a high dose of indomethacin sharply reduced the estrogen induced eosinophilia, whereas a low dose of indomethacin enhanced the steroid effect. No estrogen receptors were found with immunohistochemical methods neither in eosinophils nor in endothelial cells in any of the groups. A role for the lipoxygenase products of arachidonic acid, mainly leukotrine B4 as the chemical mediators responsible of eosinophil chemotaxis in be estrogen primed uterus is suggested.

Immunoglobulin levels in maternal and neonatal sera from normal and abnormal pregnancies

IgG, IgM and albumin levels in sera from neonates with open neural tube defects (NTD), other congenital malformations, and matched controls were measured, as were levels in sera from their mothers. Neonates with NTD had significantly lower serum IgG levels than 22 control neonatal sera. On the other hand, the mothers of these neonates with NTD had elevated serum IgG levels resulting in a striking imbalance in the mother/neonate IgG ratio. In contrast to IgG, IgM levels in maternal and neonatal sera from the NTD group were within normal values. The maternal albumin levels were however significantly increased reflecting hemoconcentration. In sera from 3 neonates born with other congenital malformations (hydrocephaly, caudal appendage and sacral tumor) the only significant changes were higher IgM levels and lower mother/neonate IgM ratios. These results are discussed in the context of materno-fetal immune responses, placental transfer of plasma proteins and the possible involvement of immunoglobulins in fetal malformation.