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Objective The aim of this work is to correlate between endodontic case complexities and treatment quality outcomes. Methods Three hundred and forty nine radiographs of patients who had received endodontic treatment at a postgraduate dental institute in Dubai were retrieved from the Institute's data base. The majority of the cases were referred by in house general dental practitioners (GDPs). Unreadable radiographs were all excluded. From the original sample of 349,in total 51 radiographs were discarded. The final sample thus consisted of 298 root canal fillings of 211 patients treated by the endodontic postgraduate students. All radiographs were individually evaluated following the American Association of Endodontic Case Difficulty Assessment Form. Based on this, the technical quality of the root filling was evaluated for each individual case. Results The sample consisted of 53% high,35% moderate and 12% minimal difficulty cases. Adequate homogeneity of root canal fillings were found in 93% of the cases. This compared with 90% of cases with adequate length of root fillings. There were statistically significant differences between the length of root canal filling and level of difficulty (p = 0.016) but, no statistically significant difference between homogeneity of root canal filling and case difficulty (p = 0.794). Conclusion Eighty four percent (0.93 × 0.90 = 0.84) of the cases treated proved to be adequate in terms of length and homogeneity which is in line with published work of Endodontic treatment carried out by specialists. Clinical Significance GDPs require robust guidelines to help with appropriate referral of patients to Endodontic specialists.

Introduction Traditional Chinese medicine (TCM) is used to treat mental illnesses but attitudes to its use may vary. This study aimed to explore the attitude towards, and practice of, TCM among leading Chinese psychiatrists, and to explore the possibility of future TCM-psychiatry cooperation. Methods Psychiatrists who were committee members of two major academic and professional associations considered to be leading psychiatrists were sent an online questionnaire which focused on their attitudes towards and their practice of using TCM. Results A total of 49 responses (a 50% response rate) were received. Many leading psychiatrists had prescribed TCM and had recommended TCM to junior psychiatrists. The respondents showed a mild positive attitude of TCM. Being used as an adjunct therapy (t = 7.65, P 0.05). Respondents who recommended TCM to junior psychiatrists showed a significantly more positive attitude than those who did not (t = 5.42, P Conclusions Future TCM-biomedicine cooperation in China is potentially feasible because the leading psychiatrists hold a broadly positive attitude towards the use of TCM in psychiatry. However, more quality evidence and academic exchange are needed.

Objectives LEOPARD syndrome is a rare congenital disease that can manifest with cardiac anomalies, multiple lentigines, ocular hypertelorism, growth retardation, and deafness. The purpose of this case series was to review the most prominent comorbidities associated with LEOPARD syndrome, and describe perioperative outcomes in a series of patients undergoing anesthesia. Design Retrospective case series review Setting Tertiary care institution Participants Patients diagnosed with LEOPARD syndrome who underwent surgical procedures requiring anesthesia at this institution. Intervention The medical and anesthesia records of patients with LEOPARD syndrome were reviewed. Demographic information, clinical features of LEOPARD syndrome, comorbidities, intraoperative and postoperative events and complications were recorded. A systematic literature review also was conducted. Measurements and Main Results Nine patients with LEOPARD syndrome underwent 49 procedures under general anesthesia (n = 40) or monitored anesthesia care (n = 9). The majority of operations were related to correction of cardiac anomalies (n = 20). The most common cardiac malformations were ventricular septal hypertrophy and pulmonary (or subpulmonary) stenosis, and major perioperative complications were related to severe arrhythmias and/or cardiac decompensation. Conclusions Dominant pathology associated with perioperative complications in patients with LEOPARD syndrome is related to cardiac disease. A large proportion of patients with this condition have ventricular septal hypertrophy, which tends to progress with age; therefore, these patients undergoing anesthesia should have recent cardiologist evaluation.

Phenotypic characters and ISSR markers in forty nine potato onion cultivars ( Allium cepa L. var. aggregatum G. Don) were investigated. Twenty three phenotypic characters, including sprouting time, plant height, spherical index, and yield, were investigated. Cluster analysis separated forty nine cultivars into five groups ( D = 0.52). 143 polymorphic amplified bands, with an average of 8.41 polymorphic bands per primer, were obtained from seventeen ISSR primers. The number of polymorphic bands detected with each primer ranged from 6 to 12, with an average of 8.82. The percentage of polymorphisms was 93.5%. Genetic similarity varied from 0.4969 to 0.8616, the average value of the effective number of alleles, Nei's genetic diversity and Shannon's information index was 1.4716, 0.3072 and 0.4590, respectively. Forty nine varieties were classified into six groups according to the ISSR ( D = 0.72). These results showed that two methods combined were accuracy for characterization of the genetic diversity and identification of potato onion cultivars.

Introduction. There is continuing concern that patient information leaflets, tailored to current regulatory requirements, fail to meet patients' needs. Provision of comprehensible information is vital if patients are to provide valid informed consent. The design of the ARIX (acupuncture for radiation induced xerostomia) trial provided an opportunity to deliver researcher led, enhanced patient information to groups of potential participants. Methods. Between November 2009 and September 2010, 149 patients attended a trial introduction meeting at their local site. All meetings followed the same format. The study coordinator delivered a PowerPoint presentation containing standard trial information together with customised local details. This was followed by group questions and answers. Patients could sign a consent form immediately afterwards or with local staff at a later date. Participants who completed the study were invited to feedback their views on these meetings. Results. One hundred and forty nine patients attended a meeting of whom 116 ultimately participated in ARIX and provided feedback. Eighty four (72%) reported that the meeting helped their understanding of the trial ‘very much’. Fourteen attendees reported feeling uncomfortable at having the information presented in a group setting but of these, only one felt under pressure to join the trial. Eighty three patients (71%) felt ‘not at all’ uncomfortable and 111 (95%) ‘not at all’ under pressure to participate. Conclusion. Trial introduction meetings involving researcher led presentation of information, followed by group discussion, can help enhance the information provided in the patient information leaflet in a useful and non coercive manner.

Objective: Falls are a common cause of injury, and fracture is a frequent outcome. However, fractures of the facial skeleton are less common than fractures of the limbs. This study examined the epidemiology, pattern, and management of maxillofacial fractures secondary to accidental falls in a tertiary trauma centre. Patients and Methods: The medical records of patients who were treated for maxillofacial fractures from 1996 to 2006 were reviewed retrospectively. Variables examined included demographics, type of fractures, mode of injury, and treatment. Results: 349 patients presented with maxillofacial fractures following accidental falls. The age range was 1 to 95 years, with a mean age of 52 years. Forty nine percent of patients were men. Patients older than 75 years accounted for 26% of all fractures while 18% was accounted for by those in the 16- to 30-year-old group. Sixty five percent of fractures involved the midface. Over half of the patients (52%) were admitted to hospital and 29% of patients required some form of surgery. Alcohol involvement at the time of injury was noted for 19% of patients. Conclusions: Maxillofacial fractures secondary to falls predominantly affected elderly people. The most common site of fracture was the midface. Although most patients were admitted to hospital, surgery was not frequently required.

Experiments were conducted to evaluate digestible (dig) Lys requirements of male and female broiler chickens from 49 to 63 d of age. A dose-response diet consisting of corn, soybean meal, and corn gluten meal was formulated to be adequate in dig amino acid concentrations with the exception of Lys. l -Lysine · HCl was added to the dose-response diet to create 7 experimental diets. Concentrations of dig Lys of experimental diets ranged from 0.50 to 1.04% in increments of 0.09%. Variables measured consisted of standardized dietary Lys digestibility, feed intake, dig Lys intake, BW gain, feed conversion, mortality, abdominal fat weight and percentage, carcass weight and yield, and total breast meat weight and yield. In experiment 1, dig Lys of the dose-response diet was determined as 0.51% with cecectomized roosters. In experiment 2, dig Lys requirements of male broilers for BW gain, feed conversion, breast meat weight, and breast meat yield were 0.86, 0.88, 0.90, and 0.90%, respectively, based on 95% of the responses. From 49 to 63 d of age, male broilers optimized growth and meat yield measurements with approximately 3.0 g of dig Lys intake. In experiment 3, dig Lys requirements of female broilers were estimated as 0.79 and 0.83%, respectively, for BW gain and feed conversion. Digestible Lys intake necessary to optimize growth performance was 2.8 g/bird during 49 to 63 d of age. These results indicate that dig Lys requirements for male broilers were 0.87 and 0.90% of the diet, respectively, for growth performance and breast meat yield. Conversely, the dig dietary Lys requirement for females was 0.81% based only on growth performance.

In this study nine organochlorine pesticide residues ([alpha]-, [beta]-, and [gamma]-hexachlorocyclohexane (HCH), hexachlorobenzene (HCB), aldrin, p,p'-DDE, p,p'-DDD, o,p'-DDT, and p,p'-DDT) in forty nine samples of honey collected from markets of Portugal and Spain during 2001 and 2002, respectively, were evaluated. For this evaluation, three analytical procedures were studied. The analytical procedure, based on LLE extraction with ethyl acetate followed by gas chromatography-electron-capture detection (GC-ECD) for quantification, and mass spectrometry (GC-MS) for confirmation, has been selected. Recoveries of spiked samples ranged from 68%, for [beta]-HCH, and 126% for p,p'-DDT, for fortification levels between 10 and 100 [mu]g/kg, and 64%, for [alpha]-HCH, and 143% for [gamma]-HCH for fortification levels between 20 and 200 [mu]g/kg. Limits of quantification, using GC-ECD, were from 0.01 and 0.10 mg/kg, and limits of detection between 0.001 and 0.02 mg/kg. Fourteen Valencian samples were contaminated, containing residues of HCB or/and HCH isomers. The frequency of detection was 56% for Spanish samples. In Portugal, 23 samples were contaminated, what means 95.8%. In Spanish samples, concentrations range from nd to 0.03 mg/kg for HCB, and nd to 2.24 mg/kg for HCH-total. The mean concentration and standard deviation were 0.017 ± 0.011 mg/kg for HCB, and 0.579 ± 0.747 mg/kg for HCH-total, contributing the [gamma] isomer with the highest values. The samples from Portugal showed higher levels. Levels of HCB ranged from nd to 0.39 mg/kg. HCH-total ranged from nd to 4.86 mg/kg, and DDT-total from nd to 0.658 mg/kg. Mean concentration and standard deviation were 0.09 ± 0.116 mg/kg for HCB, 1.357 ± 1.30 mg/kg for HCH-total, and 0.143 ± 0.193 mg/kg for DDT-total. http://www.sciencedirect.com/science/article/B6TG8-4D75MJM-2/1/228ba9bcfae0d95d011e1a86b66f79dc

Aim: To compare the emotional effects of tooth loss in three partially dentate populations. Design: A questionnaire survey. Materials and Methods: A questionnaire was completed by 150 partially dentate subjects undergoing routine prosthodontic care at Guy's, King's and St Thomas's Dental Institute, London; the Dental School, Dundee, Scotland; and the Faculty of Dentistry, University of Hong Kong. Data were analysed using the Chi-square test. Results: Forty nine per cent of all participants reported difficulties in accepting the loss of some of their teeth. People from Dundee were less likely to have difficulties accepting tooth loss (P = 0.001). People from London took longer to come to terms with their tooth loss and were more likely to feel less confident (P < 0.001). Fifty five per cent of all participants restricted their choice of foods and 54 per cent had not enjoyed their food as much as before. Fewer people in Dundee restricted their choice of food (P < 0.001) and were more likely to enjoy their food (P = 0.009). People in Hong Kong were most likely to restrict their choice of food (P = 0.006). Thirty five percent of all subjects felt unprepared for the effects that tooth loss had upon them. People in Hong Kong were more prepared for tooth loss than those in Dundee and London (P = 0.003). In addition, they were less concerned about leaving their dentures out overnight (P = 0.024). Conclusions: The emotional effects of tooth loss were significant in all groups. People from London took longer to come to terms with their tooth loss.

background We designed a program to evaluate the morbidity, mortality, survival rates, and patient's quality of life after Whipple resection for pancreatic and other periampullary adneocarcinoma. patients and methods After studying 11 fresh and unembalmed cadavers to learn the regional anatomy and to practice the surgical techniques for traditional Whipple procedure by the senior author (JS), 49 patients aged 56 to 84 years old were treated with Whipple's pancreatoduocenectomy. results There was no postoperative mortality or morbidity from anastomotic leakage. All 49 patients were discharged in an improved condition following surgery, including 5 patients with emergency resection. Eight patients are alive at the time of this writing, including 2 patients who had their pancreatic cancer resected 168 and 139 months ago. conclusions In the opinion of these authors, treatment of all resectable cancers with Whippie's pancreatoduodenectomy offers not only a superior palliation but also the hope of cure.

Two studies were conducted to evaluate feeding reduced levels of amino acids (AA) to broilers during the finisher period. Birds grown to 42 days on nutritionally complete diets were fed diets formulated to contain a minimum of 70, 80, 90, 100, or 110% of recommended AA levels for periods of 3, 5, or 7 days prior to slaughter at 49 days of age. Body weight, feed intake, feed utilization, dressing percentage, and abdominal fat content were determined. For finisher periods of 3 to 5 days, a reduction in recommended dietary AA levels may be utilized without impairment of body weight gains of broilers. Extending the finisher period to 7 days resulted in significant (P less than .05) reduction of body weight gains on diets with AA levels less than 90% of recommended levels. Feed utilization was more sensitive to reduction in AA levels and may be affected adversely even by a 5-day withdrawal period. Dressing percentage was reduced in some instances, and abdominal fat generally increased when reduced AA levels were fed. The economics of feeding reduced AA levels must be considered in evaluating the results of the present studies.

We studied 49 hearts with juxtaposition of the atrial appendages, concentrating on the associated malformations and features of operative importance. Left juxtaposition was found in 42 cases (86%) and right juxtaposition in seven cases (14%). In the group of hearts with right juxtaposition, a normal segmental arrangement was present in three cases, double inlet in two cases, and double-outlet right ventricle in the remaining two cases. Hearts with left juxtaposition had usual atrial arrangement with concordant atrioventricular connection, together with anomalous ventriculoarterial connection in 22 cases and univentricular atrioventricular connection in 19 cases. Only one specimen had a normal segmental arrangement A partial form of left juxtaposition was present in 60% of the specimens. Hearts with left juxtaposition had a transverse orientation of the atrial septum, which was displaced posteriorly and inferiorly in the medial atrial wall, separated from the orifice of the juxtaposed appendage by a muscular band. A small right atrial chamber was noted in hearts with anomalous ventriculoarterial connection, creating the potential for anatomic difficulties during operation conducted within the atria. In two thirds of the cases with classic tricuspid atresia, the size of the orifice of the juxtaposed appendage was larger than the atrial septal defect, and an anastomosis of the appendage with the pulmonary trunk was morphologically feasible.

s S77 Conclusions: Overall, ROSAE is considered to be a highly valuable or valuable experience (78%) for trainees. However, the growing number of requests has led to the adoption of institution-specific practices to provide coverage. Forty nine percent of programs do not provide ROSAE coverage for all FNA procedures, 82% of programs use a combination of pathology personnel to provide coverage that includes residents and cytotechnologists. Twenty four percent of programs use telepathology and 27% have future intentions for its use.

Improved respiratory and cardiac management along with glucocorticoid therapy have contributed to increasing survival of patients with DBMD.This has led to a growing population of adults with DBMD. The purpose of this population based study was to describe the sociodemographic profile and health related outcomes of individuals with DBMD followed in the MD STARnet. MD STARnet is a multi state population based surveillance system that collects data on all individuals with DBMD born since 1/1/1982. In addition to epidemiologic data, MD STARnet collects extensive sociodemograhic and clinical data related to natural history milestones and treatments and services received by individuals with DBMD. The cohort for this analysis was all individuals born from 1/1/1982 to 12/31/1992 and followed through 8/31/2011. Overall, 384 individuals were identified of which 32% have died [mean age 17.6 years (8.7–25.5)], and 20% were lost to follow up [mean age 15.3 (0.9–25.8)]. The remainder continue to be followed [mean age 21.5 (17–28.6)]. Most individuals were white, non-Hispanic (59%) and live with parent/s/family (98%), have post high school/college training (24%). The number of individuals and the average age (range) at which they crossed clinical milestones or required specific treatments were as follows: loss of ambulation [ N = 300, 11.7 years (6.9–24.50)], scoliosis surgery [ N = 128, 14.7 years (10.3–20.2)], night time ventilator support [ N = 158, 16.9 years (9.4–26.2)], cardiomyopathy (SF N = 188, 16.5 years (9–25.5)], PEG [ N = 58, 19.2 years (11.8–26.0)]. Forty nine percentage have been treated with corticosteroids. Our population based data support an emerging population of adults with DBMD. This sociodemographic and health related profile provides information for providers, payors and policy makers to help design the appropriate care models for the needs of adults with DBMD and their families.

Introduction Rectal cancer accounts for the largest distribution within one anatomical region of the large bowel, with approximately one third of all CRC located within the rectum. The gold standard treatment of primary rectal cancer is curative surgical resection; however, a fine balance remains between disease cure and restoration of gastrointestinal continuity. Combined modality has proven efficacy in many malignant tumors with advantage of organ preservation. In this study we assess different surgical techniques after chemoradiation to preserve anal sphincter Methods Forty nine patients (49) patients with low rectal carcinoma were included in a prospective study, between Jan. 2007 and Jan. 2011. Preoperative chemo radiation was administrated to all patients and subjected different techniques of sphincter saving surgery. Stage IV disease at diagnosis were excluded from study. Results Forty nine patients (49) patients were included in the study. 27 (55%) patients were male and 22 (45%) were female, the age range from 23 years to 70 years with the mean age 38 years. The main presenting symptoms were bleeding per rectum and Tenesmus. Stage I 4 patients (8.1%), stage II 15patients (30.6%), Stage III 30 patients (61.2. Complete clinical and pathological response in 3 patients (6%), complete clinical response in 11 patients (22%), partial response in 27 patients (55%), no significant response in 8 patients (16%). low anterior resection (LAR) in 22 patients (44.9%), Hartman's procedure in 4 patients (8.1%), coloanal pull through ( COP) was done in 19 patients (38.9%) and perineal colostomy was done in 4 patients(8.1). For patients with coloanal pull-through technique complete dehiscent and retraction in one case, major leakage in one case, stenosis in 4 cases. Conclusion There is tendency of colorectal cancers to affect younger groups. Most patients presented in advanced stage due to lack of awareness. Neoadjuvant chemo-radiation is an excellent tool in sphincter saving surgery. Coloanal pull-through operation is new technique for very low rectal cancer with good oncological safety and functional outcome.

Purpose To assess bladder behaviour after detrusorectomy and check whether good short time outcome remains unchanged at long-time follow-up. Material and methods Between 1990 and 2001 forty nine detrusorectomies were done (mean follow up 9,6 years). Urodynamic study (UDS) was done before surgery and at 12 months and 3 to 5 years post-op. Bladder capacity (BC) was considered good when more than 80% of EBC. Compliance was defined as good when less than 20 H2O at 80% of EBC. Twenty patients had good BC and compliance before surgery (group I). Indication for detrusorectomy in this group was: detrusor overactivity and/or complex surgery (fascial sling/reimplantation). Twenty nine patients had poor BC or/and compliance preoperatively (group II). Good BC and compliance postoperatively were considered as good result. Results All had UDS with success rate of 70% (14 pts) in group I and 31% (9 pts) in group II. Long term follow-up (min. 6 years) revealed 28 good bladders (16 group I and 12 in group II). Six patients had only one control UDS. Those patients did clinically very well and did not need 2nd UDS. Overall success rate was 57%. Two bladders deteriorated in function and 3 improved. Nine patients (18%) needed formal bladder augmentation (group I – 3pts; group II – 6pts). In eleven patients anticholinergics could be stopped (group I – 5pts; group II – 6pts) and in 2 patients reduced to once daily. Conclusions Bladder behaviour improves after detrusorectomy and can obviate the need of antimuscarinics in most of succesfull cases. Good short term result remain usually unchanged at long term outcome.

Some of the material for this contribution has been excerpted from Dr. Arnold's paper, "Academy Achievements over the Years," published in the Special Fortieth Anniversary Historical Issue (Fall 1978) of the Bulletin of the American Academy of Dermatology with permission.

Verrucous carcinoma is a distinctive, extremely well-differentiated, slow-growing variant of the squamous cell carcinoma. Forty-nine cases of this neoplasm were gathered from the Oral Pathology Service at the Emory University School of Dentistry from 1965 to 1979. The most common site of occurrence was the buccal mucosa, followed by the mandibular alveolar ridge and gingiva. The majority of our patients were between the ages of 50 and 80 years, and most of them were Caucasians. Although most other series of oral verrucous carcinoma show a male predominance, almost 60 percent of our cases occurred in females. The role of radiation therapy in treatment of oral verrucous carcinoma is controversial, and adequate surgical excision appears to be the treatment of choice.

Forty-nine cases originally diagnosed as sarcoma of the uterus were critically reviewed. Twenty-nine of the cases proved, upon review, to be sarcoma and 20 were not. Sixteen of the 20 cases ruled out of the sarcoma group were benign. Our criteria for the diagnosis of sarcoma have been stated. More sections from blocks and the cutting of additional blocks, as well as the use of special stains, can aid in the diagnosis. The knowledge of what is not sarcoma and familiarity with some of the less common tumors of the uterus can greatly facilitate the correct diagnosis of sarcoma. There are no symptoms characteristic of sarcoma. The diagnosis is most often made in the laboratory. The treatment is surgical if no distant metastases are present. In this series the prognosis was poor; 57 per cent of the patients have already died and only 5 patients, or 19 per cent, are alive more than five years. Our corrected mortality rate is 78 per cent.

Summary A controlled trial has been undertaken to determine whether prednisolone, added to standard chemotherapy, hastens clinical and radiographic improvement, and clears the sputum more rapidly of tubercle bacilli, in acute extensive pulmonary tuberculosis in West Africans, during a short period of hospital treatment. Forty nine cases were treated with prednisolone combined with chemotherapy, and fifty one with chemotherapy alone. Clinical improvement was more rapid in the prednisolone treated group, particularly in those severely ill or in poor condition, during the first month of treatment. There were no significant differences in respect of weight change, radiographic clearing or cavity closure. Clearance of bacilli from the sputum was not hastened, and an initial rise in the bacterial count was noted in the prednisolone treated cases. A well marked rise in the circulating white cells (including a rise in eosinophils) was observed in the prednisolone cases.

the properitoneal fat and did not involve the overlying peritoneal mesothelium. The marked development of decidua paralleled the development of decidua in miillerian stroma rather than the decidual reaction occasioned by the reaction of the peritoneum to female sex hormones or nonspeciftc irritation of the peritoneum. The above facts indicated • endometrial implants spread by the lymphatic route. A regional lymph node was not obtained. The most logical interpretation o.f these observations would seem to be that the dissemination occurred through the channt>l~ of the lymphatics opened by the implantation and growth of a recent ovum.

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