A longitudinal assessment of sex differences in the growth of the mandibular retromolar space

OBJECTIVE

To assess longitudinal variation in patterns of retromolar space growth, with regard to sex and cervical vertebrae maturation.

DESIGN

We utilized serial lateral cephalograms from three craniofacial growth studies (Denver, Iowa, Oregon), measuring retromolar space and cervical vertebrae maturation in 99 subjects (56% male) from 8 to 18 years of age for each subject. Repeated measures ANOVA and a linear mixed effects model were used to assess retromolar space growth through time.

RESULTS

Our analyses revealed an average increase in retromolar space of 8.73 mm from 8 to 18 years. While t-tests failed to find differences in retromolar space growth between males and females at the measured age points, repeated measures ANOVA and linear mixed effects models revealed modest differences in growth trends between sexes, with females having more growth earlier but a younger age of deceleration of growth (between 12 and 14 years of age).

CONCLUSIONS

Our results confirm large increases in retromolar space through growth, reaching an average of 1.38 mm/year around puberty. Importantly, we add to the conversation regarding sex differences, showing differences in timing of growth. This highlights the importance of using longitudinal data and analytical approaches to address questions of this nature.

Nutrition, obesity, and dental development in young adolescents in Chicago

OBJECTIVES

Childhood obesity is a systemic disease with multiple downstream consequences, including shifts in timing of growth and development. It has been documented that children with high body mass index (BMI) show accelerated timing of dental development, but the mechanism for this acceleration is unknown. Prior work has suggested that inflammation and/or nutrition may play a role. We investigate the potential association between diet (caloric intake, macronutrients), obesity, and accelerated dental development.

METHODS

Children and adolescents (age 10-15; n = 112) were recruited from dental clinics at the University of Illinois Chicago. We collected subjects' height, weight, panoramic radiographic records, and each subject filled out a Block Food Frequency Questionnaire.

RESULTS

The only macronutrient level associated with BMI was a negative correlation to Total Fat consumption (p = .01), though this relationship was not significant in the path analysis (p > .05). Regression analyses indicated that BMI (p = .003) and total caloric intake (controlling for BMI; rho = 0.19; p = .04) were both significantly correlated with timing of dental development. However, when a path analysis was conducted, it was revealed that only BMI was statistically significant (p = .008).

CONCLUSIONS

Body mass index percentile, regardless of caloric intake, is positively associated with accelerated dental development. While it is possible that excess caloric intake itself plays a minor role in timing of dental development, we do not see unambiguous evidence for this in our sample. We posit that another mechanism, such as inflammation, may be the link between obesity status and dental development.

Assessment of Handicapping Labio-Lingual Deviation index scoring methods and their effect on orthodontic treatment coverage by Medicaid

BACKGROUND

The purpose of this study was to assess the validity and reliability of Handicapping Labio-Lingual Deviation index (HLDI) scoring methods as calculated by digital models (DM) and visual inspection (VI) and their agreement to either meet or fail to meet the Medicaid coverage threshold. An additional objective was to assess the agreement with Medicaid managed care organizations (MCO) coverage decisions.

METHODS

The study included the orthodontic records of 401 patients who applied for Medicaid coverage. Two methods were used to calculate HLDI scores: (1) Measurements derived from DMs using OrthoCAD software; and (2) VI of intraoral photographs. The levels of agreement between the two methods and the Medicaid coverage decision by a MCO were evaluated.

RESULTS

The study results show a high level of agreement between the two HLDI calculation methods, DM and VI evaluation methods(Cramer's V = 0.812). The agreement on coverage decisions (eligible/not eligible) between VI methods and the official MCO decision was Cramer's V = 0.318. The agreement on coverage decisions between the DM method and the official MCO decision was Cramer's V = 0.318.

CONCLUSIONS

MCO assessment results of the patients using HLDI showed low agreement with the results obtained by DM and VI scoring methods used in this study. The Illinois Medicaid system is apparently using unknown factors other than the HLDI score when determining when approving or disapproving orthodontic coverage.

PRACTICAL IMPLICATIONS

MCO decisions on eligibility for orthodontic treatment coverage were not consistent with patients' treatment needs.

Childhood obesity may accelerate timing of human facial growth

OBJECTIVE

We hypothesize that childhood obesity influences both facial and mandibular size and form in children and adolescents.

DESIGN

Pre-treatment records of patients (n = 181; 86 males, 95 females) from the Department of Orthodontics at the University of Illinois at Chicago representing six different ancestry groups (Asian, African-American, Caucasian Non-Hispanic, Hispanic, Multiracial, Unknown) were reviewed retrospectively. Body mass index (BMI) scores and categories were calculated using the Center for Disease Control and Prevention (CDC) guidelines. Twenty-two landmarks were collected on lateral cephalometric radiographs. The landmark dataset was analyzed as a whole (facial shape) and a subset of landmarks was also used to study mandibular shape in isolation.

RESULTS

Evidence of allometry (size related shape differences) was detected. Principal Component Analyses (PCA) were performed on the allometric regression residuals. Overall facial shape did not correlate with BMI. A series of one-way ANOVA tests on PC1-6 on a mandible-only subset of the landmarks using BMI category (normal, overweight, obese) showed PC5 and PC6 were significant (p = 0.003; p = 0.027). Centroid size was positively correlated with BMI when controlling for age (facial: p = 0.011, r = 0.196; mandibular: p < 0.001, r = 0.256).

CONCLUSIONS

Our results mostly did not support a relationship between high BMI and facial shape. However, we found larger facial skeletal sizes in high BMI children, providing tentative evidence that childhood obesity may lead to accelerated timing of facial growth.

The implementation of the Handicapping Labio-Lingual Deviation index on access to orthodontic care

OBJECTIVES

In 2017, the state of Illinois changed the system by which they define severe malocclusion from the DentaQuest Orthodontic Criteria Index to the Handicapping Labio-Lingual Deviation Index (HLD). The purpose of this study was to compare subjects who were submitted for coverage under either the DentaQuest Orthodontic Criteria Index or the HLD index to see if a difference exists in the number of subjects who received coverage and the type of malocclusions that were covered.

METHODS

All subjects evaluated for orthodontic coverage by the Illinois Department of Human Services for treatment at the University of Illinois, College of Dentistry during the years 2016 and 2017 were included in this study. One hundred consecutively approved and 100 consecutively denied subjects from both 2016 and 2017 were selected for further analysis.

RESULTS

There was a statistically significant decrease in the overall rate of approval in 2017 compared to 2016. No difference was found in the approval rate of Class I, II, or III subjects, but there was a significant decrease in the approval rate of subjects with impacted teeth.

CONCLUSIONS

The implementation of the HLD index has significantly decreased access to orthodontic care for Medicaid patients in Illinois.

Interceptive Dentofacial Orthopedics (Growth Modification)

Although all dentofacial deformities involve deviation of skeletal and dental units that require correction, the timing and method of treatment can vary considerably. Growth is a key consideration when managing dentofacial deformities, because it has a direct impact on the timing and method of management. Some deformities may be intercepted and managed during growth, whereas others can only be definitively managed after cessation of growth. This article focuses on clinical considerations of growth in managing dentofacial deformities, and discusses methods of growth evaluation and interceptive orthodontic management strategies in different types of dentofacial deformities.

Antibiofilm potential of purified environmental bacteriophage preparations against early stage Pseudomonas aeruginosa biofilms

AIMS

This paper presents the potential of environmentally sourced bacteriophages to affect the growth of clinical isolates of Pseudomonas aeruginosa biofilms, and assesses the respective plaque morphotypes presented by each bacteriophage, in vitro.

METHODS AND RESULTS

Bacterial host strains were typed for their ability to produce the quorum sensing-controlled virulence factor pyocyanin, and then tested for bacteriophage susceptibility using the spot test method. The bacteriophages were co-administered with ciprofloxacin in order to determine whether the bacteriophages would demonstrate synergistic or antagonistic behaviour to the antibiotic in vitro. Results suggest a potential relationship between the bacteriophage plaque size and biofilm inhibition, where those producing smaller plaques appear to be more effective at reducing bacterial biofilm formation.

CONCLUSIONS

This phenomenon may be explained by a high adsorption rate leading to the rapid formation of smaller plaques, and greater biofilm reduction associated with the loss of viable bacterial cells before the cells can adhere to the surface and form a biofilm. Results from the co-administration of bacteriophage and ciprofloxacin suggest that the two work synergistically to affect P. aeruginosa biofilms.

SIGNIFICANCE AND IMPACT OF THE STUDY

The data indicate enhanced efficacy of ciprofloxacin by ≥50%. This could offer an alternative strategy for targeting antibiotic-resistant infections.

The application of phage-based faecal pollution markers to predict the concentration of adenoviruses in mussels (Mytilus edulis) and their overlying waters

AIM

This study set out to determine whether phage-based indicators may provide a 'low-tech' alternative to existing approaches that might help maintain the microbial safety of shellfish and their overlying waters.

METHODS AND RESULTS

Mussels and their overlying waters were collected biweekly from an estuary in southeast England over a 2-year period (May 2013-April 2015) (n = 48). Levels of bacterial indicators were determined using membrane filtration and most probable number methods and those of bacteriophages were determined by direct plaque assay. The detection of adenovirus was determined using real-time polymerase chain reaction. The results revealed that somatic coliphages demonstrated the most significant correlations with AdV F and G in mussels (ρ = 0·55) and overlying waters (ρ = 0·66), followed by GB124 phages (ρ = 0·43) while Escherichia coli showed no correlation with AdV F and G in mussels.

CONCLUSION

This study demonstrates that the use of somatic coliphages and GB124 phages may provide a better indication of the risk of adenovirus contamination of mussels and their overlying waters than existing bacterial indicators.

SIGNIFICANCE AND IMPACT OF THE STUDY

Phage-based detection may be particularly advantageous in low-resource settings where viral infectious disease presents a significant burden to human health.

The immediate and long-term outcome of enhanced external counterpulsation in treatment of chronic stable refractory angina

BACKGROUND

Treatment of angina recalcitrant to conventional pharmacological therapy and revascularization remains problematic. Safe, effective and affordable treatments with high patient acceptability are desirable. Enhanced external counterpulsation (EECP) may fulfil these criteria better than many other proposed interventions.

OBJECTIVE

To examine the immediate and long-term effect of EECP in treatment of chronic stable refractory angina.

DESIGN

Prospective observational study of consecutive patients treated with EECP and follow-up for 1 year.

SETTING

Teaching hospital.

MAIN OUTCOME MEASURES

Canadian Cardiovascular Society (CCS) angina grading, weekly angina frequency and glyceryl trinitrate (GTN) use.

RESULTS

Sixty-one patients were treated with EECP and 58 completed a course of treatment. Further analysis is confined to those who completed EECP. About 52% of patients suffered from CCS III and IV angina prior to EECP. Immediately post-EECP, angina improved by at least one CCS class in 86% and by two classes in 59%. At 1-year follow-up, sustained improvement in CCS was observed in 78% of the patients. The median weekly angina frequency and GTN use were significantly reduced immediately after EECP [7 (4-14) vs. 1 (0-4) episodes per week and 7 (2-16) vs. 0 (0-2) times per week respectively, P < 0.0001; data in median (interquartile range)]. The reduction was sustained at 1-year follow-up. In 48 patients, their mean exercise time improved significantly after EECP [301 +/- 130 s vs. 379 +/- 147 s, P < 0.0001]. Major adverse treatment-related events were rare.

CONCLUSION

This study shows that for patients who fail to respond to conventional measures, a high proportion gain symptomatic benefit from EECP.

Multicentre, prospective, randomized trial of 4 vs. 6 French catheters in 410 patients undergoing coronary angiography

The aim of this study was to assess the quality of angiograms obtained using 4 Fr catheters compared with 6 Fr catheters, the ease of use of the 4 Fr catheters, and the safety of patient mobilization 1 hr following 4 Fr angiography. Details of catheter performance and procedural details were recorded at the time of the angiogram. The angiographic images were scored on the quality and completeness of vessel opacification throughout systole and diastole. A total of 410 patients were recruited. There was no difference between 4 and 6 Fr for procedural variables. All angiograms were considered to be of diagnostic quality. The angiographic scores for the right coronary artery and left ventricular injections were no different between 4 and 6 Fr. However, the angiographic scores for the left anterior descending and circumflex arteries were lower with 4 than with 6 Fr (both P < 0.05). Patients who had 4 Fr angiography mobilized safely at 1 hr and reported significantly less discomfort and bruising than 6 Fr patients. Good-quality diagnostic coronary angiograms can be achieved using 4 Fr catheters with the advantage of earlier postprocedural mobilization and reduced discomfort and bruising for the patient.

NSAID facial angioedema in a selected pediatric atopic population

Epidemiological data for drug reactions in pediatric medical literature as well as in specialized periodicals are scarce. A relationship between nonsteroidal antiinflammatory drugs (NSAIDs), facial angioedema and atopic status has been described in adults. A 10-year retrospective random review of 1,007 charts of atopic children (60.9% male) attending an allergy clinic for management of asthma and/or rhinitis was carried out. Careful attention was given to the written history of NSAID facial angioedema reactions (41 out of 1007, 4.07%) and atopy was confirmed if the patient had a family history and at least one positive skin prick test (>3 mm wheal compared to glycerosaline control) to aeroallergens. Telephone recall was performed when available. Patients were classified into four age groups as follows: a) 0-5 years old; b) 6-10 years old; c) 11-15 years old; and d) 16-21 years old. NSAID facial angioedema rates were as follows: group a 10/493 (2.0%), group b 14/361 (3.8%), group c 10/121 (8.2%), and group d 7/32 (21.8%). Aspirin was the most commonly reported NSAID, and less common were pyrazolones and ibuprofen. Of the 41 patient with chart-reported reactions, 27 (66%) could be contacted by telephone. Of these, 17 patients confirmed the facial angioedema NSAID reaction occurring once or more due to inadvertent exposure. No reactions were reported in the remaining 10 patients since no other NSAID, except acetaminophen, had been used for fever or pain. In conclusion, our data show the age dependency of these reactions and its rather frequent occurrence in such selected pediatric atopic populations. Since NSAIDs are used more frequently in younger children, exposure would not be a plausible explanation for these observations.

Epidemiology and ecology of enterococci, with special reference to antibiotic resistant strains, in animals, humans and the environment. Example of an ongoing project within the European research programme

The objectives of the present study are to generate knowledge of the ecology and epidemiology of enterococci in the food chain by studying the following: (1) the population structure (in measures of abundance, number of vancomycin resistant strains, antibiotic resistance patterns, diversity, and stability) among enterococcal populations in different geographical regions and in different links of the food chain (2) possible transmission of strains through the food chain and between hospital environments and the food chain (3) the association between vancomycin resistance and individual strains of enterococci and (4) the diversity of the drug resistance genes in enterococci. So far, 1578 samples have been collected from different countries within the EU (Sweden, Denmark, UK and Spain), and from different habitats (pig farms, carcasses in slaughter houses, soil, manure, water, sewage, and humans). Total and vancomycin resistant enterococcal populations in each sample have been enumerated and more than 12000 isolates have been characterised by phenotyping. Representative isolates are further species identified and characterised by genotyping and MIC determination and from antibiotic resistant isolates the resistance genes are characterised.

The hibernating heart: reversible left ventricular dysfunction in chronic heart failure

A patient with severe heart failure secondary to coronary heart disease is presented. Following investigation he was thought to have significant areas of myocardial hibernation and was therefore treated with coronary revascularisation, with major clinical benefit.

Nuclear cardiology in the UK 1994: activity relative to Europe, USA, and British Cardiac Society targets

OBJECTIVE

To survey practice in nuclear cardiology in the UK in 1994.

DESIGN

A questionnaire was sent to 219 centres performing nuclear imaging asking for details of current practice in nuclear cardiology. Replies were received from 192 centres (88%).

MAIN OUTCOME MEASURES

Activity in performance of myocardial perfusion imaging (MPI) and radionuclide ventriculography (RNV), anticipated changes in activity, differences between regional and district hospitals, technical imaging parameters, and referral sources.

RESULTS

Of the responding centres, 125 (65%) performed nuclear cardiology procedures. More regional than district hospitals performed nuclear cardiology procedures (85% v 55%, p < 0.0003) and regional centres performed a higher proportion (62% v 24%, p < 0.001) of nuclear cardiology activity. Nuclear cardiology activity was 0.82 scans per 1000 population per year (MPI 0.56, RNV 0.26). There has been a significant increase (24%) in nuclear cardiology since 1988. There has been a pronounced rise in MPI (350%) while RNV has fallen by 47%. Myocardial perfusion activity in the UK remains very low (25% and 5% in regional and district hospitals, respectively) compared with the 1994 figures of 2.2/1000/year for Europe or 10.8/1000/year for the USA.

CONCLUSIONS

MPI has increased on average by 23%/annum (compound rate) since 1988, but in 1994 was still only 32% of the British Cardiac Society target of 2.6/1000/year. Proper resources for capital expenditure on new equipment and new staff will be important to maintain momentum in closing the gap. Also important is improved clinical understanding, as already implemented by including nuclear cardiology in guidelines for specialist cardiology training.

Nuclear cardiology in the UK: British Nuclear Cardiology Society survey 1994

This study surveyed practice in nuclear cardiology in the UK in 1994. A questionnaire was sent to 219 centres performing nuclear imaging asking for details of current practice in nuclear cardiology. Replies were received from 192 centres (88%). Activity in performance of myocardial perfusion imaging (MPI) and radionuclide ventriculography (RNV), anticipated changes in activity, differences between regional and district general hospitals, technical imaging parameters and referral sources were surveyed. Of the responding centres, 125 (65%) performed nuclear cardiology. More regional centres (85 vs 55%, P < 0.0003) performed a higher proportion (62 vs 24%, P < 0.001) of nuclear cardiology activity compared with district general hospitals. Nuclear medicine activity was estimated at 9.3 scans/1000/year, of which 8.9% was cardiology (0.82/1000/year; MPI, 0.56/1000/year; RNV, 0.26/1000/year). A comparison with previous surveys showed a significant increase of 24% in nuclear cardiology since 1988, with a strong rise in MPI (350%); however, RNV has fallen by 47%. Myocardial perfusion activity in the UK remains very low (25 and 5% for MPI and RNV respectively) when compared with the average of 2.2/1000/year for Europe and 10.8/1000/year for the USA. In conclusion, MPI has increased on average by 23% per annum (compound rate) since 1988, but in 1994 was still only 32% of the British Cardiac Society target of 2.6 scans/1000/year. Proper resourcing for capital expenditure on new equipment and new staff will be important to maintain momentum in closing the gap. Also important is clinical understanding, as already implemented by including nuclear cardiology in guidelines for specialist cardiology training.

"Pseudo reinfarction": a consequence of electrocardiogram lead transposition following myocardial infarction

Unexpected or bizarre new electrocardiographic changes should alert the physician to the possibility of lead transposition and, if in doubt, the electrocardiogram should be repeated. The classic form of limb lead transposition leading to the appearance of dextrocardia is well recognized. We report a patient with myocardial infarction where lead transposition led to a diagnosis of reinfarction and to the inappropriate use of thrombolytic therapy.

Effect of blood upon the selective ablation of atherosclerotic plaque with a pulsed dye laser

Laser angioplasty systems with laser energy preferentially absorbed by atherosclerotic plaque may offer a safe method of plaque removal. This study evaluated the effect of blood upon selective energy absorption using a pulsed dye laser at 480 nm. Intra-arterial laser irradiation of normal rabbit femoral arteries demonstrated a perforation threshold energy with blood perfusion of 13.1 mJ per pulse compared to 87.9 mJ with saline (P less than .0001), indicating a deleterious effect in the presence of blood. An adverse effect upon arterial healing at 3 days was noted in sheep following intra-arterial irradiation during blood but not saline perfusion. Normal and atherosclerotic human aorta ablation thresholds differed significantly (P less than .0002) under saline (plaque: 20 mJ and normal: 120 mJ) but the difference under blood (plaque: 5 mJ and normal: 20 mJ) was not significant. We conclude that absorption of laser energy by blood can reduce the effect of differential absorption by endogenous chromophores in normal and pathologic vascular tissues and, therefore, removal of blood may be a prerequisite for selective ablation of atherosclerotic plaques.

Non-invasive assessment of early cardiac involvement in systemic sclerosis

Twenty-eight patients with wide spectrum organ involvement of progressive systemic sclerosis but without signs or symptoms suggestive of cardiac involvement were studied by non-invasive cardiac techniques. The 12-lead electrocardiogram showed abnormalities in 6 patients: one had abnormal T waves and 5 had complete or incomplete right bundle branch block. Twenty-four hour ambulatory electrocardiography demonstrated higher average heart rates than in similar aged controls (82 +/- 9 vs 74 +/- 9 beats/min, P less than 0.05). In one patient a short run of ventricular tachycardia was recorded. No other significant arrhythmia was documented. Echocardiographic measurements were within normal ranges but small pericardial effusions were observed in two patients (7%). Resting first pass radionuclide angiography, utilizing 12 mCi of technetium 99m were performed in 23 patients. Seven patients (30%) had abnormal wall motion (diffuse hypokinesia), with a significant decrease in ejection fraction in comparison to those with normal wall motion (44 +/- 6% vs 60 +/- 6% P less than 0.01). Those with abnormal wall motion had suffered the disease longer than those with normal wall motion (13 +/- 4 vs 9.5 +/- 7 y). In conclusion, the heart is involved in half of the patients in this series; non-invasive cardiac assessment is useful in disclosing the early cardiac involvement and may influence long-term management.