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Hypercalcemia, occurring in up to 25% of patients within 12 months following renal transplantation, and persistent hyperparathyroidism were evaluated following renal transplantation, by retrospective chart review of 1000 adult patients transplanted between January 1, 2003 and January 31, 2008 with at least six months follow-up. Serum calcium, parathyroid hormone, and phosphate levels were recorded at 12, 24, 36, and 48 months. Average follow-up was 766 (535) d (mean ( SD); median 668 d). Majority were first transplants (85%); deceased donor 57%. Point prevalence of hypercalcemia (serum Ca2+ > 2.6 mM) was 16.6% at month 12, 13.6% at month 24, 9.5% at month 36, and 10.1% at month 48. Point prevalence of serum parathyroid hormone ( PTH) > 10 pM was 47.6% at month 12, 51.1% at month 24, 43.4% at month 36, and 39.3% at month 48. Estimated glomerular filtration rate ( GFR) was maintained throughout and was not different between patients with or without hypercalcemia or elevated PTH. Cinacalcet was prescribed in 12% of patients with hypercalcemia and persistent hyperparathyroidism; parathyroidectomy was performed in 112/1000 patients, 15 post-transplant. Persistent hyperparathyroidism, often accompanied by hypercalcemia, is common following successful renal transplantation, but the lack of clear management suggests the need for further study and development of evidence-based guidelines. [ABSTRACT FROM AUTHOR]

Aim To investigate the probability of and factors influencing periapical status of teeth following primary (1°RCTx) or secondary (2°RCTx) root canal treatment. Methodology This prospective study involved annual clinical and radiographic follow-up of 1°RCTx (1170 roots, 702 teeth and 534 patients) or 2°RCTx(1314 roots, 750 teeth and 559 patients) carried out by Endodontic postgraduate students for 2–4 (50%) years. Pre-, intra- and postoperative data were collected prospectively on customized forms. The proportion of roots with complete periapical healing was estimated, and prognostic factors were investigated using multiple logistic regression models. Clustering effects within patients were adjusted in all models using robust standard error. Results The proportion of roots with complete periapical healing after 1°RCTx (83%; 95% CI: 81%, 85%) or 2°RCTx (80%; 95% CI: 78%, 82%) were similar. Eleven prognostic factors were identified. The conditions that were found to improve periapical healing significantly were: the preoperative absence of a periapical lesion (P = 0.003); in presence of a periapical lesion, the smaller its size (P £ 0.001), the better the treatment prognosis; the absence of a preoperative sinus tract (P = 0.001); achievement of patency at the canal terminus (P = 0.001); extension of canal cleaning as close as possible to its apical terminus (P = 0.001); the use of ethylene-diamine-tetra-acetic acid (EDTA) solution as a penultimate wash followed by final rinse with NaOCl solution in 2°RCTx cases (P = 0.002); abstaining from using 2% chlorexidine as an adjunct irrigant to NaOCl solution (P = 0.01); absence of tooth/root perforation (P = 0.06); absence of interappointment flareup (pain or swelling) (P = 0.002); absence of root-filling extrusion (P £ 0.001); and presence of a satisfactory coronal restoration (P £ 0.001). Conclusions Success based on periapical health associated with roots following 1°RCTx (83%) or 2°RCTx (80%) was similar, with 10 factors having a common effect on both, whilst the 11th factor ‘EDTA as an additional irrigant’ had different effects on the two treatments. [ABSTRACT FROM AUTHOR]

Aim To investigate the probability of and factors influencing tooth survival following primary (1°RCTx) or secondary (2°RCTx) root canal treatment. Methodology This prospective study involved annual follow-up of 2 (100%) to 4 years (50%) of 1°RCTx (759 teeth, 572 patients) and 2°RCTx (858 teeth, 642 patients) carried out by Endodontic postgraduate students. Pre-, intra- and post-operative data were collected prospectively from consented patients. Information about extraction of the root filled tooth was sought from the patient, the referring dentist or derived from the patient’s records and included the timing and reasons for extraction. Tooth survival was estimated and prognostic factors were investigated using Cox regression. Clustering effects within patients were adjusted in all models using robust standard error. Results The 4-year cumulative tooth survival following 1°RCTx [95.4% (93.6%, 96.8%)] or 2°RCTx [95.3% (93.6%, 96.5%)] was similar. Thirteen prognostic factors were identified. Significant patient factors included history of diabetes and systemic steroid therapy. Significant pre operative factors included narrow but deep periodontal probing depth; pain; discharging sinus; and iatrogenic perforation (for 2°RCTx cases only). Significant intra-operative factors included iatrogenic perforation; patency at apical terminus; and extrusion of root fillings. Significant post-operative restorative factors included presence of cast restoration versus temporary restoration; presence of cast post and core; proximal contacts with both mesial and distal adjacent teeth; and terminal location of the tooth. The presence of pre-operative pain had a profound effect on tooth loss within the first 22 months after treatment [hazard ratio (HR) = 3.1; P = 0.001] with a lesser effect beyond 22 months (HR = 2.4; P = 0.01). Patency at the apical terminus reduced tooth loss (HR = 0.3; P < 0.01) within the first 22 months after treatment but had no significant effect on tooth survival beyond 22 months. Extrusion of gutta-percha root filling did not have any effect on tooth survival (HR = 1.1; P = 0.2) within the first 22 months but significantly increased the hazard of tooth loss beyond 22 months (HR = 3.0; P = 0.003). Conclusions The 4-year tooth survival following primary or secondary root canal treatment was 95%, with thirteen prognostic factors common to both. [ABSTRACT FROM AUTHOR]

Ng Y-L, Mann V, Gulabivala K. Tooth survival following non-surgical root canal treatment: a systematic review of the literature. International Endodontic Journal, 43, 171–189, 2010. Aims To investigate (i) the effect of study characteristics on reported tooth survival after root canal treatment (RCTx) and (ii) the effect of clinical factors on the proportion of root filled teeth surviving after RCTx. Methodology Longitudinal human clinical studies investigating tooth survival after RCTx which were published up to the end of 2007 were identified electronically (MEDLINE and Cochrane database 1966–2007 December, week 4). In addition, four journals (Dental Traumatology, International Endodontic Journal, Journal of Endodontics, Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics), bibliographies of all relevant articles and review articles were hand searched. Two reviewers (Y-LN, KG) assessed and selected the studies based on specified inclusion criteria and extracted the data onto a pre-designed proforma, independently. The criteria were as follows: (i) clinical study on RCTx; (ii) stratified analysis of primary and secondary RCTx available; (iii) sample size given and larger than 10; (iv) at least 6-month postoperative review; (v) success based on survival of tooth; and (vi) proportion of teeth surviving after treatment given or could be calculated from the raw data. Three strands of evidence or analyses were used to triangulate a consensus view. The reported findings from individual studies, including those excluded for quantitative analysis, were utilized for the intuitive synthesis, which constituted the first strand of evidence. Secondly, the pooled weighted proportion of teeth surviving and thirdly the combined effects of potential prognostic factors were estimated using the fixed and random effects meta-analyses on studies fulfilling all the inclusion criteria. Results Of the 31 articles identified, 14 studies published between 1993 and 2007 were included. The majority of studies were retrospective ( n = 10) and only four prospective. The pooled percentages of reported tooth survival over 2–3, 4–5 and 8–10 years following RCTx were 86% (95% CI: 75%, 98%), 93% (95% CI: 92%, 94%) and 87% (95% CI: 82%, 92%), respectively. Substantial differences in study characteristics were found to hinder effective direct comparison of findings. Evidence for the effect of prognostic factors on tooth survival was weak. Based on the data available for meta-analyses, four conditions were found to significantly improve tooth survival. In descending order of influence, the conditions increasing observed proportion of survival were as follows: (i) a crown restoration after RCTx; (ii) tooth having both mesial and distal proximal contacts; (iii) tooth not functioning as an abutment for removable or fixed prosthesis; and (iv) tooth type or specifically non-molar teeth. Statistical heterogeneity was substantial in some cases but its source could not be investigated because of insufficient available information. Conclusions The pooled proportion of teeth surviving over 2–10 years following RCTx ranged between 86% and 93%. Four factors (listed above) were identified as significant prognostic factors with concurrence between all three strands of evidence. [ABSTRACT FROM AUTHOR]

Aims (i) To investigate the effects of study characteristics on the reported success rates of secondary root canal treatment (2°RCT or root canal retreatment); and (ii) to investigate the effects of clinical factors on the success of 2°RCT. Methodology Longitudinal human clinical studies investigating outcome of 2°RCT which were published upto the end of 2006 were identified electronically (MEDLINE and Cochrane database 1966–2006 Dec, week 4). Four journals ( Dental Traumatology, International Endodontic Journal, Journal of Endodontics, Oral Surgery Oral Medicine Oral Pathology Endodontics Radiology), bibliographies of all relevant papers and review articles were hand-searched. Two reviewers (Y-LN, KG) independently assessed and selected the studies based on specified inclusion criteria and extracted the data onto a pre-designed proforma, independently. The criteria were: (i) Clinical studies on 2°RCT; (ii) Stratified analyses available for 2°RCT where 1°RCT data included; (iii) Sample size given and larger than 10; (iv) At least 6-month post-operative review; (v) Success based on clinical and/or radiographic criteria ( strict = absence of apical radiolucency; loose = reduction in size of radiolucency); and (vi) Overall success rate given or could be calculated from the raw data... [ABSTRACT FROM AUTHOR]

Aims (i) To carry out meta-analyses to quantify the influence of the clinical factors on the efficacy of primary root canal treatment and (ii) to identify the best treatment protocol based on the current evidence. Methodology The evidence for the effect of each clinical factor on the success rate (SR) of primary root canal treatment was gathered in three different ways: (i) intuitive synthesis of reported findings from individual studies; (ii) weighted pooled SR by each factor under investigation was estimated using random-effect meta-analysis; (iii) weighted effect of the factor under investigation on SR were estimated and expressed as odds ratio for the dichotomous outcomes (success or failure) using fixed- and random-effects meta-analysis. Statistical heterogeneity amongst the studies was assessed by Cochran’s (Q) test. Potential sources of statistical heterogeneity were investigated by exploring clinical heterogeneity using meta-regression models which included study characteristics in the regression models. Results Out of the clinical factors investigated, pre-operative pulpal and periapical status were most frequently investigated, whilst the intra-operative factors were poorly studied in the 63 studies. Four factors were found to have a significant effect on the primary root canal treatment outcome, although the data heterogeneity was substantial, some of which could be explained by some of the study characteristics. Conclusions Four conditions (pre-operative absence of periapical radiolucency, root filling with no voids, root filling extending to 2 mm within the radiographic apex and satisfactory coronal restoration) were found to improve the outcome of primary root canal treatment significantly. Root canal treatment should therefore aim at achieving and maintaining access to apical anatomy during chemo-mechanical debridement, obturating the canal with densely compacted material to the apical terminus without extrusion into the apical tissues and preventing re-infection with a good quality coronal restoration. [ABSTRACT FROM AUTHOR]

Aims The aims of this study were (i) to conduct a comprehensive systematic review of the literature on the outcome of primary (initial or first time) root canal treatment; (ii) to investigate the influence of some study characteristics on the estimated pooled success rates. Methodology Longitudinal clinical studies investigating outcome of primary root canal treatment, published up to the end of 2002, were identified electronically (MEDLINE and Cochrane database 1966–2002 December, week 4). Four journals (International Endodontic Journal, Journal of Endodontics, Oral Surgery Oral Medicine Oral Pathology Endodontics Radiology and Dental Traumatology & Endodontics), bibliographies of all relevant papers and review articles were hand-searched. Three reviewers (Y-LN, SR and KG) independently assessed, selected the studies based on specified inclusion criteria, and extracted the data onto a pre-designed proforma. The study inclusion criteria were: longitudinal clinical studies investigating root canal treatment outcome; only primary root canal treatment carried out on the teeth studied; sample size given; at least 6-month postoperative review; success based on clinical and/or radiographic criteria (strict, absence of apical radiolucency; loose, reduction in size of radiolucency); overall success rate given or could be calculated from the raw data. The findings by individual study were summarized and the pooled success rates by each potential influencing factor were calculated for this part of the study. Results Of the 119 articles identified, 63 studies published from 1922 to 2002, fulfilling the inclusion criteria were selected for the review: six were randomized trials, seven were cohort studies and 48 were retrospective studies. The reported mean success rates ranged from 31% to 96% based on strict criteria or from 60% to 100% based on loose criteria, with substantial heterogeneity in the estimates of pooled success rates. Apart from the radiographic criteria of success, none of the other study characteristics could explain this heterogeneity. Twenty-four factors (patient and operative) had been investigated in various combinations in the studies reviewed. The influence of preoperative pulpal and periapical status of the teeth on treatment outcome were most frequently explored, but the influence of treatment technique was poorly investigated. Conclusions The estimated weighted pooled success rates of treatments completed at least 1 year prior to review, ranged between 68% and 85% when strict criteria were used. The reported success rates had not improved over the last four (or five) decades. The quality of evidence for treatment factors affecting primary root canal treatment outcome is sub-optimal; there was substantial variation in the study–designs. It would be desirable to standardize aspects of study–design, data recording and presentation format of outcome data in the much needed future outcome studies. [ABSTRACT FROM AUTHOR]

Background Currently there is no consensus on the optimal method to measure the severity of dyspepsia symptoms in clinical trials. Aim To validate the 7-point Global Overall Symptom scale. Methods The Global Overall Symptom scale uses a 7-point Likert scale ranging from 1 = no problem to 7 = a very severe problem. Validation was performed in two randomized-controlled trials ( n = 1121 and 512). Construct validity: Global Overall Symptom was compared with the Quality of Life in Reflux And Dyspepsia, Gastrointestinal Symptom Rating Scale, Reflux Disease Questionnaire and 10 specific symptoms using Spearman correlation coefficients. Test–retest reliability: The Intraclass Correlation Coefficient was calculated for patients with stable dyspepsia defined by no change in Overall Treatment Effect score over two visits. Responsiveness: effect size and standardized response mean were also calculated. Results Construct validity: Change in Global Overall Symptom score correlated significantly with Quality of Life for Reflux And Dyspepsia, Gastrointestinal Symptom Rating Scale, Reflux Disease Questionnaire and specific symptoms (all P < 0.0002). Reliability: The Intraclass Correlation Coefficient was 0.62 ( n = 205) and 0.42 ( n = 270). Responsiveness: There was a positive correlation between change in Global Overall Symptom and change in symptom severity. The effect size and standardized response mean were 1.1 and 2.1, respectively. Conclusion The Global Overall Symptom scale is a simple, valid outcome measure for dyspepsia treatment trials. [ABSTRACT FROM AUTHOR]

This paper presents the design, implementation, and deployment of the DISCOVER Web-based computational collaboratory. Its primary goal is to bring large distributed simulations to the scientists'/engineers' desktop by providing collaborative Web-based portals for monitoring, interaction and control. DISCOVER supports a three-tier architecture composed of detachable thin-clients at the front-end, a network of interaction servers in the middle, and a control network of sensors, actuators, and interaction agents at the back-end. The interaction servers enable clients to connect and collaboratively interact with registered applications using a browser. The application control network enables sensors and actuators to be encapsulated within, and directly deployed with the computational objects. The application interaction gateway manages overall interaction. It uses Java Native Interface to create Java proxies that mirror computational objects and allow them to be directly accessed at the interaction server. Security and authentication are provided using customizable access control lists and SSL-based secure servers. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aim: To compare the maturation of oligodendrocytes from the dysmyelinating mutant twitcher mouse, an authentic model for Krabbe's leukodystrophy, with that of control cells in tissue culture. Methods: Quantitative assessment was achieved by image analysis of oligodendrocytes after immunofluorescent staining with anti-galactocerebroside anti- body at intervals in vitro in twitcher mice and controls (over 10 000 cells analysed in total). Results: Monitoring geometrical parameters such as the membrane sheet area and the total process length per cell allowed a classical pattern of normal development to be recognised. At early stages in vitro, oligodendrocytes with small cell bodies and few short processes predominated. Subsequently, cells showed numerous long processes, connected in a highly branched network. Finally, membrane expansions developed along the processes, often forming a large sheet around the cell body. Logistic modelling demonstrated a highly significant difference in the proportion of mature sheet-bearing cells between twitcher mice and controls (p < 0.001), and also in the pattern of changes over time in these proportions (p < 0.001). The difference between twitcher mice and controls was apparent as early as 10 days in vitro. Conclusion: This new approach permits the identification of the morphological consequences of aberrant biochemistry in the cells targeted by the mutation, long before the disease is expressed in vivo (usually at 20-30 days). [ABSTRACT FROM AUTHOR]

Aim To investigate the probability of and factors influencing tooth survival following primary or secondary root canal treatment. Methodology This prospective study involved annual follow-up of up to 4 years of primary (759 teeth, 572 patients) or secondary (858 teeth, 642 patients) root canal treatment in an Eastman cohort. Informed consent was obtained from the patients. Pre-, intra- and post-operative data were collected prospectively on customised proforma. Information about extraction of the root treated tooth was reported by the patient, the referring dentist or extracted from the patient's hospital medical records. The timing and reasons for extraction were recorded. Tooth survival was estimated and prognostic factors investigated using Cox regression. Clustering effects within patients were adjusted in all models using robust standard error. Results The 4-year tooth survival after primary root canal treatment (95.4%) or secondary root canal treatment (95.3%) were similar. Fourteen prognostic factors were identified. Significant patient factors included: History of diabetes and systemic steroid therapy. Significant pre-operative factors included: narrow periodontal probing depth; pain; discharging sinus; cervical root resorption; and iatrogenic perforation (for retreatment cases only). Significant intra-operative factors included: iatrogenic perforation; patency at apical terminus; and extrusion of root fillings. Significant post-operative restorative factors included: Presence of cast restoration or temporary restoration; presence of cast post & core; proximal contacts with both mesial and distal adjacent teeth; and terminal location of the tooth. The presence of pre-operative pain had a profound effect on tooth loss within the first 22 months after treatment (HR = 3.1; P = 0.001) with a lesser effect beyond 22 months (HR = 2.4; P = 0.01). Patency at the apical terminus reduced tooth loss (HR = 0.3; P < 0.01) within the first 22 months after treatment but had no significant effect on tooth survival beyond 22 months. Extrusion of gutta-percha root filling did not have any effect on tooth survival (HR = 1.1; P = 0.2) within the first 22 months but significantly increased the hazard of tooth loss beyond 22 months (HR = 3.0; P = 0.003). Conclusions The 4-year tooth survival following primary or secondary root canal treatment was 95%; with fourteen prognostic factors common to both. [ABSTRACT FROM AUTHOR]

Aims To assess the success rates of secondary root canal treatment (2oRCT) and identify factors influencing outcome. Methodology Longitudinal clinical studies investigating outcome of 2oRCT were identified by electronic (medline) and hand searches. Inclusion criteria were data on: number of samples, those successful and definition of success. Two reviewers independently assessed the studies and extracted the data onto a proforma. The pooled weighted success rates by each potential prognostic factor were estimated using the binomial random effect model (MLwiN version 2.02) whilst their pooled effects (expressed as odds ratio) on success rates were estimated using fixed and random effects meta-analysis with DerSimonean and Laird's methods (Stata version 9.2). Meta-regression models were used to explore potential sources of statistical heterogeneity. Study characteristics considered in the meta-regression analyses were: decade of publication, study-specific criteria for success (radiographic, combined radiographic & clinical), unit of outcome measure (tooth and root), duration after treatment when assessing success (at least 4 years or shorter), geographic location of the study (North American, Scandinavian and other countries), and qualification of the operator (undergraduate students, postgraduate students, general dental practitioners, specialist or mixed group). Results Of the 41 studies identified, 18 studies published between 1921 and 2005 were included. The majority of studies were retrospective ( n = 13) and only five prospective. The pooled weighted success rate of 2oRCT judged by complete healing was 77.6% (95% CI 73.2%, 81.4%) and by incomplete healing, 77.4% (95% CI 64.1%, 86.7%). The success rates were similar by ‘year of publication’ and ‘country of study’. Eighteen clinical factors were investigated in various combinations in previous studies. The most frequently investigated were ‘periapical status’ ( n = 13), ‘size of lesion’ ( n = 7), ‘culture results prior to RF’ ( n = 5), and ‘apical extent of root filling (RF)’ ( n = 4). The effect of different aspects of previous treatment and re-treatment technique has been poorly tested. Conclusions The pooled weighted estimated success rate of 2oRCT was 77%, which was significantly ( P ≤ 0.001) influenced by the presence and size of pre-operative periapical lesion. The effects of existing canal content, procedural error and re-treatment technique were poorly investigated. [ABSTRACT FROM AUTHOR]