A Clinically Explainable AI-Based Grading System for Age-Related Macular Degeneration Using Optical Coherence Tomography

We propose an automated, explainable artificial intelligence (xAI) system for age-related macular degeneration (AMD) diagnosis. Mimicking the physician's perceptions, the proposed xAI system is capable of deriving clinically meaningful features from optical coherence tomography (OCT) B-scan images to differentiate between a normal retina, different grades of AMD (early, intermediate, geographic atrophy (GA), inactive wet or active neovascular disease [exudative or wet AMD]), and non-AMD diseases. Particularly, we extract retinal OCT-based clinical imaging markers that are correlated with the progression of AMD, which include: (i) subretinal tissue, sub-retinal pigment epithelial tissue, intraretinal fluid, subretinal fluid, and choroidal hypertransmission detection using a DeepLabV3+ network; (ii) detection of merged retina layers using a novel convolutional neural network model; (iii) drusen detection based on 2D curvature analysis; (iv) estimation of retinal layers' thickness, and first-order and higher-order reflectivity features. Those clinical features are used to grade a retinal OCT in a hierarchical decision tree process. The first step looks for severe disruption of retinal layers' indicative of advanced AMD. These cases are analyzed further to diagnose GA, inactive wet AMD, active wet AMD, and non-AMD diseases. Less severe cases are analyzed using a different pipeline to identify OCT with AMD-specific pathology, which is graded as intermediate-stage or early-stage AMD. The remainder is classified as either being a normal retina or having other non-AMD pathology. The proposed system in the multi-way classification task, evaluated on 1285 OCT images, achieved 90.82% accuracy. These promising results demonstrated the capability to automatically distinguish between normal eyes and all AMD grades in addition to non-AMD diseases.

1026 Good Prescribing Laxatives Practice for Trauma Admissions in Orthopaedic Wards at Altnagelvin Hospital

Aim

The aim of this QIP is to firstly increase percentage of T&O admissions to Orthopaedic Wards 23+25 prescribed laxatives by 25% by 1st of December over 1 month and to increase awareness among healthcare staff.

Background

Constipation in elderly during inpatient stay is common, 50% of pts>65years will develop this due to multifactorial reasons. Correct laxatives are very important to curb this predicament.

Method

These data were assessed over the following criteria, laxatives prescribed on admission, administered following prescription, monitoring bowel output, suppositories prescribed after admission. Following each week QI cycles, appropriate interventions were made to improve the adherence and data was re-measured again.

Results

From Baseline data, only 45% of patient were prescribed laxatives and only 20% patients received the medication initially. Of this group, only 20% pts had suppositories prescribed following admission. Lastly, 40% of patients had Bowel Opened (BO)>3days ago. First intervention was educating all SHOs to ensure patients received prescription on admission. Following this, mainly laxative prescription increased by 40%, and patient received their laxatives by 2% respectively in PDSA 1.

In PDSA 2, we actively ensured educating nursing staff to encourage laxative prescriptions and to inform doctors for patients with Last BO>3days ago for suppositories prescribing. Following this, laxative prescription increased to 80% while 65% pts received their prescription. Only 15% pts had BO>3days too.

Conclusion

Regular laxatives are superior to PRN & Recommended regime is Senna+Lactulose for patient adherence. Additionally, suppositories should be given as STAT rather than Prn as well.

Evaluation of the Impact of Immunization Second Year of Life Training Interventions on Health Care Workers in Ghana

Applying performance-based training interventions that follow adult learning principles and include follow-up activities after training may help to solve specific performance problems and improve health care workers’ performance in immunization service delivery. These strategies facilitate learning, minimize the forgetting curve for health care workers, and should be considered as a standard practice for future training interventions.

Introduction:

As part of a suite of training interventions to improve the knowledge and practice of immunization in the second year of life (2YL), training of trainers workshops were conducted with regional and district health management teams (DHMTs) in 15 districts in 3 regions of Ghana. Using adult learning principles, DHMTs implemented several capacity-building activities at the subdistrict and health facility levels, including health facility visits, on-the-job training, and review meetings. The current evaluation investigated whether frontline health care workers (HCWs) reported or demonstrated improvements in knowledge, attitudes, and practices after training interventions.

Methods:

Quantitative and qualitative methods with a utilization-focused approach guided the framework for this evaluation. A systematic random sample of 115 HCWs in 3 regions of Ghana was selected to complete a competency survey before and after training, which focused on 3 core competency areas—Expanded Programme on Immunization (EPI) policy; communication with caregivers; and immunization data management, recording, and use. Interviews and direct observations by data collectors were done to assess HCWs’ knowledge, self-reported attitude, and behavior changes in practices.

Results:

Of 115 HCWs, 102 were surveyed before and 4 months after receiving capacity-building interventions. Modest but not statistically significant improvements were found in knowledge on EPI policy, immunization data management, and communication skills with caregivers. HCWs reported that they had improved several attitudes and practices after the 2YL training. The most improved practice reported by HCWs and observed in all 3 regions was the creation of a defaulter list.

Discussion:

Findings of this evaluation provide encouraging evidence in taking the first step toward improving HCW knowledge, attitudes, and practices for 3 core immunization competency areas. The use of learner-focused teaching methods combined with adult learning principles is helpful in solving specific performance problems (such as lack of knowledge of EPI policy).

Applying Adult Learning Best Practices to Design Immunization Training for Health Care Workers in Ghana

INTRODUCTION

A 2016 assessment of frontline health care workers (HCWs) in Ghana identified knowledge, skill, and attitude gaps related to immunization during the second year of life (2YL). The U.S. Centers for Disease Control and Prevention subsequently supported the Ghana Health Service Immunization Program to apply best practices of adult learning and training of trainers (TOT) for a cascade training program for 2YL.

METHODS

Five districts from each of the 3 regions (Greater Accra, Northern, and Volta) were selected for the TOT based on key measles and rubella vaccination coverage indicators. The design incorporated best practices of adult learning and TOT. The curriculum integrated 3 major topical themes: technical (immunization topics), operational, and training adults. The technical and operational content was based on HCW tasks most directly affecting 2YL objectives. A cross-functional team developed all classroom, field activity, and training evaluation materials.

RESULTS

Seventy-four participants attended TOT workshops in 2017. Based on a rubric defined by the course designers, 99% of the participants reported an acceptable level of confidence to apply and teach the course content. After the TOTs, participants conducted 65 workshops, 43 field visits, and 4 review meetings, reaching 1,378 HCWs within 7 months. Fifty-four percent of HCWs who received training from TOT participants reported an acceptable level of confidence in using the skills, and 92% reported they would prioritize applying the skills acquired during the training.

DISCUSSION

The success factors for effective adult learning and TOT can be applied to design and implement high-quality TOT even in resource-limited settings. The factors include using a variety of approaches, spending enough class time to prepare TOT participants for their training role, setting specific expectations for cascading the training, and following up through mentorship and reporting. Strong collaboration across the administrative levels of the Ghana Health Service enabled cascade training.

Oral pain and infection control strategies for treating children and adolescents in India

Introduction:

Oral and dental health form an integral part of complete well being of an individual and society at large. Promoting oral health and societal progression go hand in hand.

Aim:

To investigate dentists' attitudes about pain and infection control while treating children and adolescents by assessing their recommendations of pre- and postoperative analgesics and antibiotics, and use of local anesthesia (LA) for definitive treatment in different clinical scenarios.

Materials and Method:

A total of 400 dentists, both general dental practitioners (GDPS) as well as specialist dentists, were surveyed over a period of 2 months by using a pre-tested close-ended questionnaire. The data was statistically analyzed using Pearson's Chi-square test and backward logistic regression analysis for analysis of categorical variables and independent variables, respectively. Level of significance was set at 5%.

Results:

It was found that there was a gross overuse of antibiotics and analgesics and under use of LA by GDPs compared to specialist dentists. Postoperative antibiotics and analgesics were used more commonly than preoperative antibiotics and analgesics. These strategies were used more often in permanent teeth than primary teeth except the use of LA, which was used with equal frequency in both primary as well as permanent dentition.

Conclusion:

Dependence on antibiotics and analgesics for achieving pain and infection control in children has to be minimized and focus has to be shifted on judicious definitive treatment involving use of LA, aseptic techniques, and behavior management techniques.

Effect of Sugarcane Cultivar and Foliar Insecticide Treatment on Infestations of the Invasive Sugarcane Thrips, Fulmekiola serrata (Thysanoptera: Thripidae), in Florida

Fulmekiola serrata (Kobus) was observed infesting sugarcane, Saccharum spp. hybrids, in the United States for the first time in January 2017 in Florida. Field studies were conducted to determine F. serrata infestation levels on popular sugarcane cultivars and to determine the efficacy of foliar insecticide treatments that could be used for management. Cultivar evaluations comparing six and five commercial cultivars representing >46% of the sugarcane production area in Florida were conducted in 2017 and 2018, respectively. Fulmekiola serrata infestation levels did not differ among cultivars in 2017. However, infestation levels on CP 00-1101 were greater than on CP 96-1252 grown on organic soils, and infestation levels on CP 96-1252 were greater than on CPCL 97-2730 grown on mineral soils in 2018. Three insecticide evaluations, two in 2017 and one in 2018, were conducted. The pyrethroid lambda-cyhalothrin, which is registered for use on sugarcane, was consistently associated with the greatest decreases in F. serrata infestation levels. The neonicotinoids imidacloprid and thiamethoxam, as well as the butenolide flupyradifurone, decreased infestation levels but to a lesser extent than did lambda-cyhalothrin. The spinosyn spinetoram was associated with the lowest decreases in F. serrata infestation levels. Our results supported short-term F. serrata management recommendations: Popular Florida sugarcane cultivars should be considered equally susceptible to F. serrata until additional evaluations are conducted and F. serrata outbreaks can be treated with lambda-cyhalothrin when infestations stress the crop beyond acceptable levels.

Building health workforce capacity for planning and monitoring through the Strengthening Technical Assistance for routine immunization training (START) approach in Uganda

INTRODUCTION

The Global Vaccine Action Plan identifies workforce capacity building as a key strategy to achieve strong immunization programs. The Strengthening Technical Assistance for Routine Immunization Training (START) approach aimed to utilize practical training methods to build capacity of district and health center staff to implement routine immunization (RI) planning and monitoring activities, as well as build supportive supervision skills of district staff.

METHODS

First implemented in Uganda, the START approach was executed by trained external consultants who used existing tools, resources, and experiences to mentor district-level counterparts and, with them, conducted on-the-job training and mentorship of health center staff over several site visits. Implementation was routinely monitored using daily activity reports, pre and post surveys of resources and systems at districts and health centers and interviews with START consultants.

RESULTS

From July 2013 through December 2014 three START teams of four consultants per team, worked 6 months each across 50 districts in Uganda including the five divisions of Kampala district (45% of all districts). They conducted on-the-job training in 444 selected under-performing health centers, with a median of two visits to each (range 1-7, IQR: 1-3). More than half of these visits were conducted in collaboration with the district immunization officer, providing the opportunity for mentorship of district immunization officers. Changes in staff motivation and awareness of challenges; availability and completion of RI planning and monitoring tools and systems were observed. However, the START consultants felt that potential durability of these changes may be limited by contextual factors, including external accountability, availability of resources, and individual staff attitude.

CONCLUSIONS

Mentoring and on-the-job training offer promising alternatives to traditional classroom training and audit-focused supervision for building health workforce capacity. Further evidence regarding comparative effectiveness of these strategies and durability of observed positive change is needed.

Using the Stop Transmission of Polio (STOP) Program to Develop a South Sudan Expanded Program on Immunization Workforce

In 2009, the international Stop Transmission of Polio (STOP) program began supporting the Global Polio Eradication Initiative in the Republic of South Sudan to address shortages of human resources and strengthen acute flaccid paralysis surveillance. Workforce capacity support is provided to the South Sudan Expanded Program on Immunization by STOP volunteers, implementing partners, and non-governmental organizations. In 2013, the Polio Technical Advisory Group recommended that South Sudan transition key technical support from external partners to national staff as part of the Polio Eradication and Endgame Strategic Plan, 2013–2018. To assist in this transition, the South Sudan Expanded Program on Immunization human resources development project was launched in 2015. This 3-year project aims to build national workforce capacity as a legacy of the STOP program by training 56 South Sudanese at national and state levels with the intent that participants would become Ministry of Health staff on their successful completion of the project.

RANDOMISED, CONTROLLED, BLINDED FIELD TRIAL ON THE EFFICACY OF BIOCIDE FORMULATION (BACILLUS SPP.) IN THE CONTROL OF MOSQUITO VECTORS

A randomised, controlled, blinded field trial was conducted in a large cantonment area, to study the efficacy of the biocide formulation (Bacillus spp.) indigenously produced by Central Drug Research Institute, Lucknow, India, as a mosquito larvicide, in comparison with Fenthion and Temephos. The study revealed that the biocide formulation in dosage of 5 grams per square metre brought about a very high level of control of culicine larvae from third day of application and the effect persisted till at least 28 days (median values of percentage reduction achieved being 93% to 100%). This effect was statistically significant from 7th to 28th day, as compared to Fenthion, Temephos or the biocide in dosage of 2 grams per square metre. Fenthion, on the other hand was statistically more efficacious in bringing about a quick reduction, with a 100% reduction being obtained within a day, but the effect declined to a low level by 7th day.

Comparative evaluation of the tensile bond strength of two silicone based denture liners with denture base resins

BACKGROUND

To evaluate and compare tensile bond strength of two silicone based liners with heat cure and heat cure high impact denture base resin at baseline and after storage in artificial saliva for 30 and 60 days.

METHOD

Heat cure conventional and high impact acrylic blocks (120 blocks each) prepared with final test specimen of two blocks of each resin with a liner. The baseline samples and those tested after 30 and 60 days interval stored in artificial saliva in thermal incubator, all were pulled apart in UTM at 20 mm/min. The tensile bond strength and mode of failure (adhesive/cohesive) were assessed. Mean, SD determined and analysis using one way ANOVA and paired 't' test.

RESULTS

The highest mean tensile bond strength (1.028 MPa) and the least i.e. 0.289 MPa was observed with Permaflex silicone liner against heat cure PMMA after storage in artificial saliva at 37 ± 1 °C.

CONCLUSION

The study rejected the null hypothesis because storage time in artificial saliva affected the bond strength of the resilient liners examined. The results revealed a statistically significant difference (p < 0.05) of artificial saliva storage on the bond strength of both the liners. After storage in artificial saliva for 30 days and 60 days at 37 ± 1 °C, all the specimens showed a significant reduction in the tensile bond strength.

Determination of mesiodistal width of maxillary anterior teeth using inner canthal distance

BACKGROUND

Selection of appropriately sized maxillary anterior teeth is one of the important aspects of complete denture prosthodontics. In the past several methods have been proposed, but little consensus on an effective method for anterior teeth selection has been reached. Inner canthal distance is one of the reliable anatomic dimension that may provide a valid approach to anterior teeth selection. This study was aimed to ascertain the co-relation between inner canthal distance (ICD) and combined mesiodistal width of maxillary anterior teeth.

METHOD

This study was conducted in Army Dental Centre (R & R) Delhi Cantonment between Aug 2006 to Mar 2008. Eight hundred dentate Indian subjects of four different ethnic group; Such as Rajputs, Marathas, Sikh and Tamilian. 100 males and 100 females from each race under the age group of 18-30 years formed the subjects of study. The ICD and mesio-distal width of maxillary anteriors were measured using Digital Vernier Caliper. The Data obtained was statistically analyzed.

RESULTS

A consistent ratio of 1.61 was found between ICD and combined mesiodistal width of maxillary anteriors in all four ethnic group. The mean value showed no statistically significant difference between sex. The variation in the ratio between the ethnic groups was negligible.

CONCLUSION

The findings of the study indicated that, to select the combined mesiodistal width of maxillary anterior teeth, ICD of the required patient should be multiplied by 1.61. This ratio was consistent with all the four ethnic groups irrespective of sex.

Expansion of syndromic vaccine preventable disease surveillance to include bacterial meningitis and Japanese encephalitis: evaluation of adapting polio and measles laboratory networks in Bangladesh, China and India, 2007-2008

BACKGROUND

Surveillance for acute flaccid paralysis with laboratory confirmation has been a key strategy in the global polio eradication initiative, and the laboratory platform established for polio testing has been expanded in many countries to include surveillance for cases of febrile rash illness to identify measles and rubella cases. Vaccine-preventable disease surveillance is essential to detect outbreaks, define disease burden, guide vaccination strategies and assess immunization impact. Vaccines now exist to prevent Japanese encephalitis (JE) and some etiologies of bacterial meningitis.

METHODS

We evaluated the feasibility of expanding polio-measles surveillance and laboratory networks to detect bacterial meningitis and JE, using surveillance for acute meningitis-encephalitis syndrome in Bangladesh and China and acute encephalitis syndrome in India. We developed nine syndromic surveillance performance indicators based on international surveillance guidelines and calculated scores using supervisory visit reports, annual reports, and case-based surveillance data.

RESULTS

Scores, variable by country and targeted disease, were highest for the presence of national guidelines, sustainability, training, availability of JE laboratory resources, and effectiveness of using polio-measles networks for JE surveillance. Scores for effectiveness of building on polio-measles networks for bacterial meningitis surveillance and specimen referral were the lowest, because of differences in specimens and techniques.

CONCLUSIONS

Polio-measles surveillance and laboratory networks provided useful infrastructure for establishing syndromic surveillance and building capacity for JE diagnosis, but were less applicable for bacterial meningitis. Laboratory-supported surveillance for vaccine-preventable bacterial diseases will require substantial technical and financial support to enhance local diagnostic capacity.

Limitations of using administratively reported immunization data for monitoring routine immunization system performance in Nigeria

BACKGROUND

Efforts are underway to strengthen Nigeria's routine immunization system, yet measuring impact poses a challenge. We document limitations in using administrative data from 12 states in Nigeria and explore alternative approaches.

METHODS

We compared state-reported coverage with the third dose of diphtheria-tetanus-pertussis vaccine (DTP3) to district-reported coverage and data from coverage surveys conducted during 2006-2013. We used district-reported data during 2010-2013 to calculate the annual change in immunization coverage, the percentage of the target population that was unimmunized, and the number of vaccine doses administered. Data quality indicators were also assessed.

RESULTS

State-reported DTP3 coverage was 66%-102% in 2010, 49%-98% in 2011, 38%-84% in 2012, and 75%-123% in 2013 and was a median 46%-114% greater than survey coverage during 2006-2013. The mean local government area (LGA)-reported coverage varied substantially (standard deviation range, 10%-33% across years). For 2010-2013, the mean annual percentage change in LGA-reported DTP3 coverage was -15% from 2010 to 2011, -9% from 2011 to 2012, and 74% from 2012 to 2013; the mean annual percentage change in the percentage of the target population unimmunized was -62%, 426%, and -62%, respectively; and the mean annual percentage change in the number of doses administered was -13%, -7%, and 90%, respectively. Annually, a mean 14% of LGAs reported DTP3 coverage of >100%.

DISCUSSION

Assessing immunization system performance by using administrative data has notable limitations. In addition to long-term improvements in administrative data management, alternatives for measuring routine immunization performance should be considered.

Population-based surveillance for bacterial meningitis in China, September 2006-December 2009

During September 2006-December 2009, we conducted active population and sentinel laboratory-based surveillance for bacterial meningitis pathogens, including Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b, in 4 China prefectures. We identified 7,876 acute meningitis and encephalitis syndrome cases, including 6,388 among prefecture residents. A total of 833 resident cases from sentinel hospitals met the World Health Organization case definition for probable bacterial meningitis; 339 of these cases were among children <5 years of age. Laboratory testing confirmed bacterial meningitis in 74 of 3,391 tested cases. The estimated annual incidence (per 100,000 population) of probable bacterial meningitis ranged from 1.84 to 2.93 for the entire population and from 6.95 to 22.30 for children <5 years old. Active surveillance with laboratory confirmation has provided a population-based estimate of the number of probable bacterial meningitis cases in China, but more complete laboratory testing is needed to better define the epidemiology of the disease in this country.

Haematological alterations induced by oral subacute exposure to fenvalerate, nitrate and their combination in domestic buffalo, Bubalus bubalis

The present study investigated haematological alterations induced by oral subacute exposure to fenvalerate, nitrate and their combination in the domestic buffalo, Bubalus bubalis. Fenvalerate exposure produced significant declines in haemoglobin (Hb), total leukocyte count (TLC), total erythrocyte count (TEC) and mean corpuscular haemoglobin concentration (MCHC), and a corresponding elevation in mean corpuscular volume (MCV). Following oral exposure to sodium nitrate, significant declines in blood Hb, TLC, TEC, MCH and MCHC, and a significant elevation in MCV occurred. Combined exposure to fenvalerate and sodium nitrate produced severe effects with an appreciably more prominent decline in Hb, TLC, TEC and MCHC and a significant elevation in MCV. The percentage of methaemoglobin was observed to follow an elevating trend in animals exposed to sodium nitrate alone (0.69 %-13.8 %) and in combination with fenvalerate (0.75 %-13.7 %).

Maternal, fetal, and neonatal outcomes associated with measles during pregnancy: Namibia, 2009-2010

BACKGROUND

Previous studies of maternal, fetal, and neonatal complications of measles during pregnancy suggest the possibility of increased risk for morbidity and mortality. In 2009-2011, a nationwide laboratory-confirmed measles outbreak occurred in Namibia, with 38% of reported cases among adults. This outbreak provided an opportunity to describe clinical features of measles in pregnant women and assess the relative risk for adverse maternal, fetal, and neonatal outcomes.

METHODS

A cohort of pregnant women with clinical measles was identified retrospectively from 6 district hospitals and clinics over a 12-month period. Each pregnant woman with measles was matched with 3 pregnant women without measles, randomly selected from antenatal clinic registers at the same hospital during the same time interval. We reviewed hospital and clinic records and conducted in-person interviews to collect demographic and clinical information on the pregnant women and their infants.

RESULTS

Of 55 pregnant women with measles, 53 (96%) were hospitalized; measles-related complications included diarrhea (60%), pneumonia (40%), and encephalitis (5%). Among pregnant women with known human immunodeficiency virus (HIV) status, 15% of those without measles and 19% of those with measles were HIV positive. Of 42 measles-related pregnancies with known outcomes, 25 (60%) had ≥1 adverse maternal, fetal, or neonatal outcome and 5 women (12%) died. Compared with 172 pregnancies without measles, after adjusting for age, pregnancies with measles carried significantly increased risks for neonatal low birth weight (adjusted relative risk [aRR] = 3.5; 95% confidence interval [CI], 1.5-8.2), spontaneous abortion (aRR = 5.9; 95% CI, 1.8-19.7), intrauterine fetal death (aRR = 9.0; 95% CI, 1.2-65.5), and maternal death (aRR = 9.6; 95% CI, 1.3-70.0).

CONCLUSIONS

Our findings suggest that measles virus infection during pregnancy confers a high risk of adverse maternal, fetal, and neonatal outcomes, including maternal death. Maximizing measles immunity among women of childbearing age would decrease the incidence of gestational measles and the attendant maternal, fetal, and neonatal morbidity and mortality.

Evaluation of shear bond strength of composite resin bonded to alloy treated with sandblasting and electrolytic etching

Conservation of natural tooth structure precipitated the emergence of resin-retained fixed partial dentures. The weakest link in this modality is the bond between resin cement and alloy of the retainer. Various alloy surface treatment have been recommended to improve alloy-resin bond. This in vitro study was carried out to observe changes in the Nickel-Chromium alloy (Wiron 99, Bego) surface following sandblasting or electrolytic etching treatment by scanning electron microscope (SEM) and to evaluate the shear bond strength of a resin luting cement bonded to the surface treated alloy. 80 alloy blocks were cast and divided into four groups of 20 each. In groups-A & B, the test surfaces were treated by sandblasting with 50 and 250 μm sized aluminium oxide particles respectively. In groups-C & D, the test surfaces were first treated by sandblasting with 50 and 250 μm sized aluminium oxide particles respectively followed by electrolytic etching. Test surfaces were observed under SEM at 1,000× magnification. Two alloy blocks of each group were luted together by a resin luting cement (Rely X, 3M) and their shear bond strength was tested. The mean shear bond strength in MPa of groups-A to D were 6.44 (±0.74), 8.18 (±0.51), 14.45 (±0.59) and 17.43 (±1.20) respectively. Group-D showed bond strength that is more than clinically acceptable bond strength. It is recommended that before luting resin-retained fixed partial dentures, the fitting surface of the retainer should be electrolytically etched to achieve adequate micromechanical retention.

An economic evaluation of the use of Japanese encephalitis vaccine in the expanded program of immunization of Guizhou province, China

BACKGROUND

Historically, China's Japanese encephalitis vaccination program was a mix of household purchase of vaccine and government provision of vaccine in some endemic provinces. In 2006, Guizhou, a highly endemic province in South West China, integrated JE vaccine into the provincial Expanded Program on Immunization (EPI); later, in 2007 China fully integrated 28 provinces into the national EPI, including Guizhou, allowing for vaccine and syringe costs to be paid at the national level. We conducted a retrospective economic analysis of JE integration into EPI in Guizhou province.

METHODS

We modeled two theoretical cohorts of 100,000 persons for 65 years; one using JE live-attenuated vaccine in EPI (first dose: 95% coverage and 94.5% efficacy; second dose: 85% coverage and 98% efficacy) and one not. We assumed 60% sensitivity of surveillance for reported JE rates, 25% case fatality, 30% chronic disability and 3% discounting. We reviewed acute care medical records and interviewed a sample of survivors to estimate direct and indirect costs of illness. We reviewed the EPI offices expenditures in 2009 to estimate the average Guizhou program cost per vaccine dose.

RESULTS

Use of JE vaccine in EPI for 100,000 persons would cost 434,898 US$ each year (46% of total cost due to vaccine) and prevent 406 JE cases, 102 deaths, and 122 chronic disabilities (4554 DALYs). If we ignore future cost savings and only use EPI program cost, the program would cost 95.5 US$/DALY, less than China Gross Domestic Product per capita in 2009 (3741 US$). From a cost-benefit perspective taking into account future savings, use of JE vaccine in EPI for a 100,000-person cohort would lead to savings of 1,591,975 US$ for the health system and 11,570,989 US$ from the societal perspective.

CONCLUSIONS

In Guizhou, China, use of JE vaccine in EPI is a cost effective investment. Furthermore, it would lead to savings for the health system and society.

Evaluation of Four Elastomeric Interocclusal Recording Materials

BACKGROUND

The fabrication of dental prosthesis requires the transfer of interocclusal records from patient's mouth to semi-adjustable articulators using different kinds of recording media. Any inaccuracy in these interocclusal records leads to occlusal errors in the final prosthesis. This study was conducted to evaluate the dimensional changes occurring in the interocclusal recording material over a given period of time and the material's resistance to compression during the cast mounting on the articulator.

METHODS

In this in vitro study, the linear dimensional change and compressive resistance of four commercially available elastomeric interocclusal recording media was tested. Three were addition silicones and the fourth was a polyether material. Cylindrical samples of 10mm diameter of each material were prepared in three different thicknesses of 2, 4 and 6mm. Ten samples each of thickness of 2, 4 and 6mm for all four materials were prepared (total of 120 samples). The linear dimensional changes of the samples were evaluated after 24 hours of fabrication. The compressive resistance was measured when each of these was subjected to a constant compressive load of 25 Newtons.

RESULTS

The mean linear dimensional change in a horizontal plane was minimum for Kanibite Hard, an addition silicone. Ramitec showed the maximum linear dimensional change. The mean compression distance was least for Futar D Occlusion (an addition silicone) and maximum for Ramitec (a polyether). It was observed that the samples of thickness 2mm for all the materials underwent least compression.

CONCLUSION

The compressive resistance of each elastomer was inversely proportional to the thickness of the sample. This implies that minimum thickness of the recording materials should be used for recording maxillomandibular relations without sacrificing the strength of the interocclusal record.

Toxic impacts of cypermethrin on behavior and histology of certain tissues of albino rats

In the present investigation, the behavioral, morphological, and histopathological effects of cypermethrin, a widely used synthetic pyrethroid insecticide, was ascertained in male and female albino rats (Rattus norvegicus). Cypermethrin administered at repeated oral doses of 5 and 20 mg/kg/day for 30 days produced varying degree of mild to moderate toxic symptoms and behavioral changes in both male and female rats. The lower dose produced very mild toxicosis characterized by intermittent diarrhea, decreased feed intake, and thick eye discharge, whereas higher dose displayed mild to moderate toxicosis with diarrhea, decreased feed intake, loss of body weight, dyspnoea, ataxia, eye discharge, and salivation. Two female and one male albino rats died between 23 to 28 days after displaying signs of incoordination and tremors. Repeated oral doses of cypermethrin for 30 days enhanced the relative weight of liver and heart, but significantly decreased that of brain, kidneys, and testes. Microscopically, cypermethrin produced neuronal degeneration and increase in glial cells in brain, and disorganization of hepatic laminae, increase in sinusoid, and necrosis of hepatocytes in liver. Section of kidney displayed hemorrhage and sloughing off renal epithelial cell in the convoluted tubules, shrinkage of glomeruli, and necrosis of renal tubules. Repeated administration of cypermethrin also produced hemorrhages within myocardium, disruption of branching structure, and loss of striation of cardiac tissue; thickening of alveolar septa in lungs, partial to extensive loss of various stages of spermatogenesis in testes, and loss of follicular cells and oocytes in ovaries. The study suggested that repeated oral exposure of cypermethrin has considerable harmful effects on body organs in R. norvegicus.

Clinicopathological Studies on Vitamin D(3) Toxicity and Therapeutic Evaluation of Aloe vera in Rats

A study was conducted to examine the clinical signs, hematological, biochemical and histopathological changes in vitamin D₃ toxicity at a dose rate 2 mg/kg b.wt. of vitamin D₃ and to assess the protective effect of Aloe vera in vitamin D₃ toxicity. The clinical signs observed were anorexia, progressive weight loss, difficulty in movement and respiration, diarrhea, epistaxis, subnormal body temperature and nervous signs before death. Mortality was observed in treated rats between day 10 and day 19 of treatment. The gross postmortem changes observed were severe emaciation, white chalky deposits on epicardial surface of heart, pin point white deposits on cortical surface of kidneys with pale yellow discoloration and diffused white deposits on serosal surface of stomach and intestine with bloody ingesta in lumen. The hematological changes included non-significant increase in hemoglobin and total leukocyte count and significant increase in relative neutrophil count. The biochemical changes observed were significant increase in plasma concentration of calcium, phosphorus and blood urea nitrogen, whereas a significant decrease in the concentration of albumin and total plasma protein was observed. The histopathological lesions included calcification of various organs, viz., tongue, stomach, intestines, kidney, heart, aorta, larynx, trachea, lungs, spleen, choroid plexus arteries of brain and vas deferens. The Aloe vera juice (2.5% in drinking water) has no protective effect on vitamin D₃ toxicity (2 mg/kg b.wt.).

Poliomyelitis-related case-fatality ratio in India, 2002-2006

BACKGROUND

On the basis of studies from developed countries, the case-fatality ratio (CFR) of poliomyelitis generally ranges from 2%-5% among children <5 years of age to 10%-30% among adults. However, little information is available for poliomyelitis-related CFR in developing countries. We conducted a study to determine the CFR in India, 1 of the 4 remaining countries with endemic wild poliovirus (WPV) circulation, during outbreaks of WPV infection during 2002 and 2006 and during the inter-epidemic years of 2003-2005.

METHODS

We conducted a descriptive analysis with use of data from the acute flaccid paralysis surveillance system in India. Variables analyzed included age, caregiver-reported vaccination status, date of paralysis onset, laboratory results, final case classification, and survival outcome. Our analysis also accounted for surveillance changes that occurred in 2005, impacting case definitions and final classification.

RESULTS

In 2006, 45 deaths occurred among 676 WPV cases in India, yielding a CFR of 6.7%. By comparison, in 2002, there were 66 deaths among 1600 reported WPV cases (CFR, 4.2%) and during 2002-2005, CFR was 1.5%-5.2%. All 45 deaths were among 644 (95%) WPV cases in children aged <5 years (CFR, 7.0%). Among those who died, 33 (73%) were children aged <2 years (CFR, 7.1%).

CONCLUSIONS

The CFR among children aged <2 years in India is high compared with previously published CFRs for young children, in part because of improved case finding through enhanced surveillance techniques. Fatal cases emphasize the lethal nature of the disease and the importance of achieving polio eradication in India.

Evaluation of three commercially available Japanese encephalitis virus IgM enzyme-linked immunosorbent assays

We evaluated performance of three commercial Japanese encephalitis virus (JEV) IgM antibody capture enzyme-linked immunosorbent assay (MAC ELISA) kits with a panel of serological specimens collected during a surveillance project of acute encephalitis syndrome in India and acute meningitis and encephalitis syndrome in Bangladesh. The serum and cerebral spinal fluid specimens had been referred to the Centers for Disease Control and Prevention (CDC) for confirmatory testing. The CDC results and specimen classifications were considered the reference standard. All three commercial kits had high specificity (95-99.5%), but low sensitivities, ranging from 17-57%, with both serum and cerebrospinal fluid samples. Specific factors contributing to low sensitivity compared with the CDC ELISA could not be determined through further analysis of the limits and dilution end points of IgM detection.

A Case of Intranasal Hemangioma and Concurrent Tetracycline-induced Ulcerative Gastritis in Dogs

Incidence of drug-induced gastritis and ulceration in human medicine is well established. Besides, unilateral hemangioma, a unique concurrent case of tetracycline induced gastric toxicity in a dog, characterized by gastritis and ulceration is being reported here. Grossly, the appearance of gastric ulcers mimicked the appearance of Italian pizza. Histological examination further supported drug-induced etiology in this case. This is probably the one of the few cases in the annals of veterinary medicine to be documented as drug-induced gastric toxicity in dog.

Japanese encephalitis disease burden and clinical features of Japanese encephalitis in four cities in the People's Republic of China

The incidence rate of Japanese encephalitis (JE) in the People's Republic of China has decreased substantially with the wide use of JE vaccine, but the accuracy of JE reporting is uncertain. We established active surveillance for acute meningitis and encephalitis syndrome (AMES) in four prefectures in China during 2006-2008 and performed JE laboratory testing on AMES cases identified from six sentinel hospitals in each prefecture. We estimated JE incidence for each prefecture by applying age-adjusted and season-adjusted JE positivity rates from sentinel hospitals to the total AMES resident cases. We identified 4,513 AMES cases, including 3,561 (79%) among residents of four prefectures. Among 2,294 AMES cases from sentinel hospitals, we identified 213 (9.2%) laboratory-confirmed JE cases. Adjusted estimates of JE incidence per 100,000 persons ranged from 0.08 in Shijiazhuang to 1.58 in Guigang. Active surveillance and laboratory confirmation provides a better estimate of the actual JE disease burden and should be used to further refine JE prevention strategies.

In vivo changes in antioxidant system and protective role of selenium in chlorpyrifos-induced subchronic toxicity in bubalus bubalis

Chlorpyrifos, an organophosphate, is one of the widely used insecticides for control of pests in various agricultural and animal husbandry operations. The objective of the present investigation was to assess the effect of subchronic exposure of chlorpyrifos on the antioxidant status of buffalo calves and to perceive the role of selenium in cases of chlorpyrifos toxicity. Chlorpyrifos at a dose rate of 0.05mg/kg per day for 20 consecutive weeks, significantly elevated the enzymic activity of glutathione peroxidase (GPx) (54.8%), glutathione reductase (GR) (79.4%), glutathione-S-transferase (GST) (34.2%), glucose-6-phosphate dehydrogenase (G6PD) (33.2%), superoxide dismutase (SOD) (19.3%) and catalase (CAT) (63.8%). The altered antioxidant status was well evident from the depleting glutathione levels and a two-fold rise in the extent of lipid peroxidation. Supplementation of selenium in the form of sodium selenite @ 0.05mg/kg per day for 20 weeks in chlorpyrifos intoxicated calves had a marked beneficial effect on the overall antioxidant potential of the animals as evident by no significant alteration in the extent of lipid peroxidation, levels of blood glutathione and activities of various antioxidant enzymes viz. GST, GR, SOD, CAT and G6PD. There was only a significant increase in the activity of GPx to the tune of 27.4%. Therefore, on the basis of the present investigation it can be suggested that oxidative stress is one of the main mechanism involved in chlorpyrifos toxicity and supplementation with sodium selenite in such cases can have significant beneficial and therapeutic effects.

Plasma Concentrations, Pharmacokinetics and Urinary Excretion of Gatifloxacin after Single Intravenous Injection in Buffalo Calves

The pharmacokinetics and urinary excretion of gatifloxacin were investigated after a single intravenous injection of 4 mg/kg body weight in buffalo calves. The therapeutic plasma drug concentration was maintained for up to 12 h. Gatifloxacin rapidly distributed from blood to tissue compartments, which was evident from the high values of the distribution rate constant, alpha1 (11.1 +/- 1.06 h(-1)) and the rate constant of transfer of drug from central to peripheral compartment, k12 (6.29 +/- 0.46 h(-1)). The area under the plasma drug concentration-time curve and apparent volume of distribution were 17.1 +/- 0.63 (microg.h)/ml and 3.56 +/- 0.95 L/kg, respectively. The elimination half-life (t (1/2 beta)), total body clearance (ClB) and the ratio of drug present in tissues and plasma (T/P) were 10.4 +/- 2.47 h, 235.1 +/- 8.47 ml/(kg.h) and 10.1 +/- 2.25, respectively. About 19.7% of the administered drug was excreted in urine within 24 h. A satisfactory intravenous dosage regimen for gatifloxacin in buffalo calves would be 5.3 mg/kg at 24 h intervals.

Gabapentin in the treatment of fibromyalgia: A randomized, double-blind, placebo-controlled, multicenter trial

OBJECTIVE

To assess the efficacy and safety of gabapentin in patients with fibromyalgia.

METHODS

A 12-week, randomized, double-blind study was designed to compare gabapentin (1,200-2,400 mg/day) (n=75 patients) with placebo (n=75 patients) for efficacy and safety in treating pain associated with fibromyalgia. The primary outcome measure was the Brief Pain Inventory (BPI) average pain severity score (range 0-10, where 0=no pain and 10=pain as bad as you can imagine). Response to treatment was defined as a reduction of >or=30% in this score. The primary analysis of efficacy for continuous variables was a longitudinal analysis of the intent-to-treat sample, with treatment-by-time interaction as the measure of effect.

RESULTS

Gabapentin-treated patients displayed a significantly greater improvement in the BPI average pain severity score (P=0.015; estimated difference between groups at week 12=-0.92 [95% confidence interval -1.75, -0.71]). A significantly greater proportion of gabapentin-treated patients compared with placebo-treated patients achieved response at end point (51% versus 31%; P=0.014). Gabapentin compared with placebo also significantly improved the BPI average pain interference score, the Fibromyalgia Impact Questionnaire total score, the Clinical Global Impression of Severity, the Patient Global Impression of Improvement, the Medical Outcomes Study (MOS) Sleep Problems Index, and the MOS Short Form 36 vitality score, but not the mean tender point pain threshold or the Montgomery Asberg Depression Rating Scale. Gabapentin was generally well tolerated.

CONCLUSION

Gabapentin (1,200-2,400 mg/day) is safe and efficacious for the treatment of pain and other symptoms associated with fibromyalgia.

A global network for early warning and response to infectious diseases and bioterrorism: applied epidemiology and training programs, 2001

In many ministries of health, applied epidemiology and training programs (AETPs) are responsible for detecting and responding to acute health events, including bioterrorism. In November 2001, we assessed the bioterrorism response capacity of 29 AETPs; 17 (59%) responded. Fifteen countries (88%) had bioterrorism response plans; in 6 (40%), AETPs took the lead in preparation and in 6 (40%) they assisted. Between September 11 and November 29, 2001, 12 AETPs (71%) responded to a total of 3024 bioterrorism-related phone calls. Six programs (35%) responded to suspected bioterrorism events. AETPs play an important role in bioterrorism surveillance and response. Support for this global network by various health agencies is beneficial for all developed and developing countries.

A placebo-controlled multi-centred evaluation of an anaesthetic gel (Oraqix) for periodontal therapy

AIMS

Six Canadian dental schools investigated the ability of a thermosetting gel containing 25 mg/g prilocaine and 25 mg/g lidocaine as active agents to produce analgesia in periodontal pockets utilizing a randomized, double-blind, placebo-controlled study.

MATERIALS AND METHODS

The study consisted of 130 patients, each of whom received the active or placebo gel in periodontal pockets in one quadrant of the mouth for 30 s prior to periodontal debridement (scaling and root planing). Pain was measured using both a 100-mm Visual Analogue Scale (VAS) and a Verbal Rating Scale (VRS).

RESULTS

The median VAS pain score for the patients treated with the anaesthetic gel was 5 mm (range 0-85 mm) as opposed to 13 mm (range 0-79 mm) in the placebo-treated patients (P=0.015). There was no significant difference in the percentage of patients reporting no or mild pain (78% and 76% for the anaesthetic gel and placebo, respectively). No significant differences were seen in patient demographics, or mandible versus maxilla.

CONCLUSIONS

The VAS pain scores showed that the anaesthetic gel 5% was statistically more effective than the placebo in reducing pain during periodontal debridement.

Surveillance for anthrax cases associated with contaminated letters, New Jersey, Delaware, and Pennsylvania, 2001

In October 2001, two inhalational anthrax and four cutaneous anthrax cases, resulting from the processing of Bacillus anthracis-containing envelopes at a New Jersey mail facility, were identified. Subsequently, we initiated stimulated passive hospital-based and enhanced passive surveillance for anthrax-compatible syndromes. From October 24 to December 17, 2001, hospitals reported 240,160 visits and 7,109 intensive-care unit admissions in the surveillance area (population 6.7 million persons). Following a change of reporting criteria on November 8, the average of possible inhalational anthrax reports decreased 83% from 18 to 3 per day; the proportion of reports requiring follow-up increased from 37% (105/286) to 41% (47/116). Clinical follow-up was conducted on 214 of 464 possible inhalational anthrax patients and 98 possible cutaneous anthrax patients; 49 had additional laboratory testing. No additional cases were identified. To verify the limited scope of the outbreak, surveillance was essential, though labor-intensive. The flexibility of the system allowed interim evaluation, thus improving surveillance efficiency.

Predictors of functional outcome in elderly patients undergoing posterior lumbar spine surgery

To ascertain the predictors of functional outcome in elderly patients undergoing posterior lumbar spinal decompression and fusion, a modified low back outcome score questionnaire survey in 83 elderly patients (49 men, 34 women) was carried out at our hospital. The average follow-up was 35.8 months (range: 22-57 months). The outcomes were as follows: excellent to good, 83%; fair, 7%; and poor, 10%. Multiple regression analysis revealed that significant predictors of unfavorable outcome included coexistence of other bone and joint degenerative disorders (p < 0.001) and history of heart disease (p < 0.01). Patients who had undergone previous lumbar surgery had significantly lower modified low back outcome score than those without previous lumbar spine surgery (p < 0.05). The modified low back outcome score questionnaire system is a reliable method in elderly patients.

Demineralized bone matrix, bone morphogenetic proteins, and animal models of spine fusion: an overview

Preclinical investigations on the use of bone morphogenetic proteins (BMP) in the spine have yielded promising results. This has led to the preliminary introduction of these growth factors in controlled clinical trials. Initial data made available suggest that these differentiating factors will play a major role in the treatment of spinal disorders in the future. This article reviews key preclinical studies and their results that formed the basis for introduction into clinical trials. Non-primate and non-human primate models of spine fusion with BMP are reviewed objectively, and important issues regarding carrier, dose, and site of implantation are discussed. Finally, exciting new gene therapy research is discussed, with comments made on its applicability for the future.

Sudden sensorineural hearing loss after spinal surgery under general anesthesia

Two patients, ages 72 and 71, who underwent lumbar decompressive surgery for spinal stenosis, were evaluated for postoperative sudden sensorineural hearing loss (SSHL). After two uncomplicated spinal procedures, both patients developed SSHL immediately after surgery. Hearing loss was moderate to profound in these two patients. None of the patients had a significant otologic history. Nitrous oxide administration, Valsalva maneuvers during general anesthesia, and transient drops in cerebrospinal fluid pressure stemming from spinal decompression may, in some combination, lead to an implosive force on the inner ear, causing SSHL. Further causes of postlumbar surgery SSHL may include microemboli or viral infections. SSHL is a rare but possible complication after nonotologic, noncardiac bypass surgery; only 26 cases of SSHL after this surgery have been reported. We encourage the continued reporting of sudden sensorineural hearing loss after spinal surgery.

A practical guide to tobacco cessation in dental offices

Tobacco use is an important risk factor for advanced periodontitis, poor response to periodontal therapy, oral neoplasms, and dental implant failure. Given the effect of tobacco use on oral health, the dental office may be an ideal place for tobacco cessation intervention, especially since a large proportion of smokers visit their dentist on a regular basis. This paper reviews various tobacco cessation strategies for the dental office and provides practical information on assessing patients' readiness to quit and choosing appropriate tobacco cessation interventions.

Proactive management of air quality

Traditional air resource management systems have difficulty in addressing global issues, sustainable development, direct citizen participation, and integration with broad economic interests. As reactive management systems, they tend to be compliance-driven, static, and rigid. In contrast, proactive management systems are principle-driven, innovative, and flexible. Bridge scientists play a key role in supporting the transformation of raw data into wise action. Decision-makers need to integrate social values with knowledge about emissions, atmospheric processes, and potential environmental effects using the primary tools of measurements, monitoring, and modeling. The Alberta Clean Air Strategic Alliance, a unique partnership of governments, industry, and public interest groups formed in 1994, operates a comprehensive air management system that is capable of addressing air issues of greater complexity and uncertainty. Its success is measured by the satisfaction of its diverse stakeholders and by the number and scope of its initiatives.

Correlation between vertebral body rotation and two-dimensional vertebral bone density measurement

The aim of this study was to determine the effect of vertebral rotation, as seen in idiopathic scoliosis, on bone mineral density determination for the lumbar spine. Bone mineral content, biplanar vertebral segment area and calculated bone mineral density of each vertebra from L1 to L4 were obtained for a human cadaveric specimen. The average density for the entire L1-L4 segment was also recorded. This was done with the spine in the midline position as well as in rotation up to a maximum of 60 degrees either side of the midline. The spine was rotated in each direction using 10 degrees increments and two bone density readings were done at each rotation interval. The measured biplanar vertebral segment area increased with increasing rotation from 0 degrees to 50 degrees but decreased after 50 degrees of rotation (r = 0.73, p<0.001). The bone mineral density was significantly negatively correlated with the degree of rotation (r = -0.92, p<0.001). The decrease in measured bone mineral density was nearly 20% when the lumbar spine was rotated from neutral to 60 . This study demonstrates that degree of spinal rotation influences apparent bone mineral density by increasing the apparent vertebral segment area. The measurement change may be as high as 20%. This fact should be considered when investigating scoliotic patients with vertebral segment rotation.

Hydroxyurea-induced hypersensitivity pneumonitis: A case report and literature review

Hydroxyurea is a cytotoxic agent indicated in the treatment of a variety of malignant and nonmalignant conditions. Apart from dose-related bone marrow suppression, this antineoplastic agent is generally well tolerated. This report describes a patient with chronic myeloid leukemia who developed severe pneumonitis within four weeks of beginning therapy with hydroxyurea. Pathological examination of a lung specimen obtained by video-assisted thoracoscopic lung biopsy revealed extensive active alveolar and interstitial inflammation, and poorly formed granulomas. After the cessation of hydroxyurea and treatment with systemic corticosteroids, both clinical and radiological resolution of pneumonitis occurred. Physicians using hydroxyurea must be aware of its potentially life-threatening pulmonary toxicity.

Incidental durotomy in spine surgery

STUDY DESIGN

Retrospective review of a large series of patients who underwent spinal surgery at a single institution during a 10-year period.

OBJECTIVES

To further clarify the frequency of incidental durotomy during spine surgery, its treatment, associated complications, and results of long-term clinical follow-up.

SUMMARY OF BACKGROUND DATA

Incidental durotomy is a relatively common occurrence during spinal surgery. There remains significant concern about it despite reports of good associated clinical outcomes. There have been few large clinical series on the subject.

METHODS

A retrospective review was conducted of clinical and surgical records and radiographic data for consecutive patients who underwent spinal surgery performed by the two senior surgeons from January 1989 through December 1998.

RESULTS

A total of 2144 patients were reviewed, and 74 were found to have dural tears occurring during or before surgery. Incidental durotomy occurred at the time of surgery in 66 patients (3.1% overall incidence). Incidence varied according to the specific procedure performed but was highest in the group that underwent revision surgery. The incidence of clinically significant durotomies occurring during surgery but not identified at the time was 0.28%. All dural tears that occurred during surgery and were recognized (60 of 66) were repaired primarily. Pseudomeningoceles developed in five of the remaining six patients. All six patients had subsequent surgical repair of dural defects because of failure of conservative therapy. A mean follow-up of 22.4 months was available and showed good long-term clinical results for all patients.

CONCLUSIONS

Incidental durotomy, if recognized and treated appropriately, does not lead to long-term sequelae.

Association between findings of provocative discography and vertebral endplate signal changes as seen on MRI

Provocative discography is a controversial diagnostic tool for pathologic discs. Modic has identified vertebral endplate signal changes on magnetic resonance imaging (MRI) that are thought to signify advanced discogenic degeneration. These two distinct diagnostic tools are examined to determine if there is association between them. Fifty-three consecutive patients who underwent both investigations were retrospectively reviewed. In discs that had negative T1 MRI findings, 28.2% of patients had concordant pain and 17.3% had discordant pain. In discs with positive T1 MRI findings, 34.8% of patients had concordant pain and 17.4% had discordant pain. 79.5% and 74.4% of levels with patient concordant pain on discography had no endplate changes on T1- and T2 weighted MR images, respectively (compared with 84.5% and 81.7%, respectively, for levels with no patient pain on discography). Our data showed no significant relationship between these distinct diagnostic tools. Further investigation of their relative roles in this application is recommended.

Gene therapy for spine fusion

Gene therapy is a novel therapeutic modality for repair and regeneration of musculoskeletal tissues, including the spine. Various methods for therapeutic gene transfer are presented in this article. Several studies in which gene transfer has been used specifically to enhance spine fusion in animal models are reviewed.

Current concepts in intervertebral disc restoration

A current focus of treatment for degenerative disk disease is the restoration of the intervertebral disk. This article summarizes the structure and function of the intervertebral disk, the pathogenesis of its degeneration, and the clinical relevance of degenerative disk disease. Current literature relating to intervertebral disk replacement and regeneration is reviewed.

Surgical options in the management of residual foot problems in poliomyelitis

Although poliomyelitis is not encountered in the Western countries, it is still endemic in the underdeveloped world. Because the foot commonly is involved, an understanding of the causative factors and the available options of treatment is essential before surgical intervention. It is important to note that inadequate or improper surgical procedures potentially can lead to more disability; a well-planned approach to the foot problem, after considering the patient as a whole and understanding the principles involved, is the best option.

The use of rhBMP-2 in interbody fusion cages. Definitive evidence of osteoinduction in humans: a preliminary report

STUDY DESIGN

A prospective randomized controlled human clinical pilot trial.

OBJECTIVES

To determine the feasibility of using rhBMP-2/collagen as a substitute for autogenous bone graft inside interbody fusion cages to achieve arthrodesis in humans.

SUMMARY OF BACKGROUND DATA

Preclinical studies have shown rhBMP-2 to be an effective substitute for autogenous bone graft, but there are no studies to date documenting such efficacy for human spine fusion.

METHODS

Fourteen patients with single-level lumbar degenerative disc disease refractory to nonoperative management were randomized to receive lumbar interbody arthrodesis with a tapered cylindrical threaded fusion cage filled with rhBMP-2/collagen sponge or autogenous iliac crest bone. Patients were evaluated with radiographs, sagittally reformatted computed tomography scans, and Short Form-36 and Oswestry outcome questionnaires.

RESULTS

All 11 patients who received rhBMP-2 were judged by three independent radiologists to have solid fusions (at 6, 12, and 24 months postimplantation), whereas only 2 of the 3 control patients, who received the standard treatment of autogenous iliac crest bone, were deemed to be fused. The Oswestry Disability Questionnaire scores of the rhBMP-2 group improved sooner (after 3 months) than those of the autograft group, with both groups demonstrating similar improvement at 6 months. Short Form 36 scores continued to improve up to 24 months.

CONCLUSION

The arthrodesis was found to occur more reliably in patients treated with rhBMP-2-filled fusion cages than in controls treated with autogenous bone graft, although the sample size was limited. There were no adverse events related to the rhBMP-2 treatment. This study is one of the first to show consistent and unequivocal osteoinduction by a recombinant growth factor in-humans.