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OBJECTIVE: To investigate the risk factors for Staphylococcus aureus infective endocarditis (SAIE) and 6-month mortality in patients with S aureus bacteremia (SAB). PATIENTS AND METHODS: This study consisted of patients who were diagnosed as having nosocomial or community-acquired SAB or SAIE between June 1, 2000, and December 31, 2005. Clinical characteristics of patients with SAB were compared with those of patients with SAIE, and predictors of mortality in patients with SAB were analyzed. RESULTS: The median age of the 132 randomly selected patients with SAB and the 66 patients with SAIE was 66 and 68 years, respectively. Univariable analysis showed that unknown origin of SAB, a valvular prosthesis, a pacemaker, persistent fever, and persistent bacteremia were significantly associated with SAIE. In multivariable analysis, unknown origin of SAB (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.9-9.3; P equals .001), a valvular prosthesis (OR, 9.2; 95% CI, 3.2-26.2; P less than .001), persistent fever (OR, 3.1; 95% CI, 1.0-9.0; P equals .04), and persistent bacteremia (OR, 6.8; 95% CI, 2.3-20.2- P equals .001) were independently associated with SAIE. Six- month mortality was 8% in patients with SAB vs 35% in patients with SAIE (OR, 6.5; 95% CI, 2.9- 14.8; P less than .001). In univariable analysis, methicillin- resistant S aureus (OR, 7.2; 95% CI, 1.7 - 29.4; P equals .005) was significantly associated with 6-month mortality in patients with SAB. CONCLUSION: Unknown origin of SAB, a valvular prosthesis, persistent fever, and persistent bacteremia were independently associated with SAIE in patients with SAB. In univariable analysis, methicillin-resistant S aureus was associated with 6-month mortality in patients with SAB. S aureus infective endocarditis had a significantly higher mortality than SAB. The optimal management of SAB and SAIE deserves further study. [ABSTRACT FROM AUTHOR]

Background: This paper reviews the signs and symptoms of recurrent or persistent carpal tunnel syndrome and examines some of the causes of failed primary carpal tunnel release., Methods: A retrospective review of the surgical findings and outcomes of 29 consecutive patients who underwent 30 revision carpal tunnel operations was performed. Patient outcomes were recorded at a minimum of 1 year postoperatively., Results: Thirty hands in 29 consecutive patients underwent a second operation by a single surgeon. The average time interval from the first carpal tunnel release to the revision surgery was 5.7 years. Twenty-three patients experienced recurrent symptoms, and 7 had persistent symptoms. On preoperative examination, 77% demonstrated abductor pollicis brevis muscle weakness, 67% demonstrated a positive Phalen sign, and 63% demonstrated ring finger "sensory splitting." Incomplete release of the transverse carpal ligament and circumferential fibrosis were the most common intraoperative findings, totaling 20 cases each; intact antebrachial fascia (8 cases), volar subluxation of the median nerve (5 cases), compression of the median nerve by palmaris longus (4 cases), flexor tenosynovitis (4 cases), and aberrant anatomy (1 case) were also observed. Nine patients (34%) had complete resolution of symptoms after the revision carpal tunnel release. Fifteen patients (58%) had improvement in symptoms, and 2 patients did not report improvement., Conclusions: We have found the Phalen sign, comparison of the strength of the abductor pollicis brevis muscle, and subjective "splitting" of the ring finger sensation to be the most helpful findings in establishing the diagnosis. Persistent carpal tunnel syndrome is almost always secondary to incomplete division of the transverse carpal ligament., (© 2024 HMP Global. All Rights Reserved. Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of ePlasty or HMP Global, their employees, and affiliates.)

Acute abdominal pain is a very common chief complaint in the pediatric population, accounting for 5-10% of emergency department (ED) visits. Etiology differentiation is determined by complete history and physical examination, basic laboratory studies, and a variety of imaging study options. In this case report, we present an 8-year-old female with an unusual etiology of acute lower abdominal pain. She presented with tachycardia, hypertension, and bilateral lower quadrant abdominal tenderness without peritonitis. Laboratory studies were unremarkable and appendix ultrasound was indeterminate. CT with contrast revealed right ovarian vein thrombosis. Hematology evaluation did not reveal hypercoagulability. She was discharged on rivaroxaban, which was discontinued after a 3 month course and negative follow-up MRI. Ovarian vein thrombosis (OVT) most commonly develops in the peripartum time frame, with an estimated 20%-40% of cases not related to pregnancies. However, patients with nonpregnancy related OVT were determined to be significantly older than patients with pregnancy related OVT. This case report demonstrates the youngest documented case of OVT. This patient was not in the peripartum period and did not have any identifiable risk factors. Given this unprovoked OVT in a pediatric patient, in patients presenting with abdominal pain with unspecified etiology, advanced imaging studies may be helpful in establishing a diagnosis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interest or personal relationships that could have appeared to influence the work reported in this case report., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Growing evidence suggests an association between Mycoplasma infections and the development and progression of prostate cancer (PCa). In this study, we report that chronic and persistent M. hyorhinis infection induced robust TNF-α secretion from PCa cells. TNF-α secreted from M. hyorhinis -infected PCa cells subsequently led to activation of the NF-κB pathway. Chronic M. hyorhinis infection induced gene expression of pro-inflammatory cytokines and chemokines in a NF-κB-dependent manner and promoted cell proliferation, migration, and invasion in PCa cells. The elimination of M. hyorhinis in PCa cells significantly blocked TNF-α secretion, gene expression of cytokines and chemokines, migration, and invasion in PCa cells, suggesting M. hyorhinis -induced TNF-α plays an important role to promote malignant transformation of PCa. Furthermore, second mitochondria-derived activator of caspases (SMAC) mimetics potentiated caspase activation and cell death in M. hyorhinis -infected PCa by antagonizing inhibitor of apoptosis proteins (IAPs) activity. Tissue microarray analysis indicated that TNF-α is co-expressed in M. hyorhinis- infected human patient tissues. Findings from this study advance our understanding of the mycoplasma-oncogenesis process and suggest the potential for new approaches for preventions, diagnosis, and therapeutic approaches against prostate cancers., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Peripheral nerve injuries requiring surgical repair affect over 100,000 individuals in the US annually. Three accepted methods of peripheral repair include end-to-end, end-to-side, and side-to-side neurorrhaphy, each with its own set of indications. While it remains important to understand the specific circumstances in which each method is employed, a deeper understanding of the molecular mechanisms underlying the repair can add to the surgeon's decision-making algorithm when considering each technique, as well as help decide nuances in technique such as the need for making epineurial versus perineurial windows, length and dept of the nerve window, and distance from target muscle. In addition, a thorough knowledge of individual factors that are active in a particular repair can help guide research into adjunct therapies. This paper serves to summarize the similarities and divergences of the three commonly used nerve repair strategies and the scope of molecular mechanisms and signal transduction pathways in nerve regeneration as well as to identify the gaps in knowledge that should be addressed if we are to improve clinical outcomes in our patients.

When prescribing low-dose methotrexate, frequent serological testing is recommended in the dermatologic literature, although much of the supporting data is extrapolated from non-dermatologic conditions. We performed a retrospective cohort study to determine the cumulative incidence and timing of low-dose methotrexate-associated serological abnormalities over the first year of therapy, in a pragmatic cohort of patients with dermatologic compared to non-dermatologic diagnoses. Laboratory values recorded included white blood cell count, hemoglobin, platelet count, estimated glomerular filtration rate, alanine aminotransferase, and aspartate aminotransferase. Among 1376 patients, there were no cases of methotrexate-associated grade 4/very severe lab abnormality or fatality. Baseline risk factors associated with moderate-to-severe lab abnormalities included non-dermatologic diagnoses, low hemoglobin, low estimated glomerular filtration rate, and elevated transaminases. The incidence of moderate-to-severe lab abnormalities was 4.4% among all patients, 3.1% among patients with dermatologic diagnoses, and 2.3% among patients with normal baseline lab values. Lab abnormalities led to discontinuation of therapy in 0.8% of patients. Serious changes did not occur in the first two weeks of therapy. We conclude that the cumulative incidence of low-dose methotrexate-associated lab abnormality was lower in patients with dermatologic diagnoses or normal baseline testing and these factors may be used to adjust monitoring practices.

Objectives: To identify factors associated with the decision to provide in-person, hybrid, and remote learning in kindergarten through 12th grade school districts during the 2020-2021 school year., Methods: We performed a retrospective study evaluating school district mode of learning and community coronavirus 2019 (COVID-19) incidence and percentage positivity rates at 3 time points during the pandemic: (1) September 15, 2020 (the beginning of the school year, before Centers for Disease Control and Prevention guidance); (2) November 15, 2020 (midsemester after the release of Centers for Disease Control and Prevention guidance and an increase of COVID-19 cases); and (3) January 15, 2021 (start of the second semester and peak COVID-19 rates). Five states were included in the analysis: Michigan, Missouri, North Carolina, Ohio, and Wisconsin. The primary outcome was mode of learning in elementary, middle, and high schools during 3 time points. The measures included community COVID-19 incidence and percentage positivity rates, school and student demographics, and county size classification of school location., Results: No relationship between mode of learning and community COVID-19 rates was observed. County urban classification of school location was associated with mode of learning with school districts in nonmetropolitan and small metropolitan counties more likely to be in-person., Conclusions: Community COVID-19 rates did not appear to influence the decision of when to provide in-person learning. Further understanding of factors driving the decisions to bring children back into the classroom are needed. Standardizing policies on how schools apply national guidance to local decision-making may decrease disparities in emergent crises., (Copyright © 2022 by the American Academy of Pediatrics.)

Peripheral Nerve Injuries (PNI) frequently occur secondary to traumatic injuries. Recovery from these injuries can be expectedly poor, especially in proximal injuries. In order to study and improve peripheral nerve regeneration, scientists rely on peripheral nerve models to identify and test therapeutic interventions. In this review, we discuss the best described and most commonly used peripheral nerve models that scientists have and continue to use to study peripheral nerve physiology and function., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Infective endocarditis (IE) remains a severe disease with high mortality. Most studies report on short-term outcome while real world long-term outcome data are scarce. This study reports reinfection rates and mortality data during long-term follow-up., Methods: A total of 270 patients meeting the modified Duke criteria for definite IE admitted to a tertiary care center between July 2000 and June 2007 were analyzed retrospectively. Early reinfection was defined as a new IE episode within 6 months; late reinfection as a new IE episode beyond 6 months follow-up., Results: Median follow-up was 8.5 years. Early reinfection occurred in 10 patients (3.7%), late reinfection in 18 patients (6.7%). Staphylococci (39.7%) were the most frequent causative microorganisms, followed by Streptococci (30.0%) and Enterococci (17.8%). Independent predictors of any reinfection were heart failure (HR 3.02, 95% CI 1.42-6.41), peripheral embolization (HR 4.00, 95% CI 1.58-10.17) and implanted pacemakers (HR 3.43, 95% CI 1.25-9.36). Survival rates were 71.1%, 55.2% and 43.3% at respectively 1-, 5- and 10-years follow-up. Independent predictors for mortality were age (HR 1.03, 95% CI 1.01-1.04), diabetes mellitus (HR 2.24, 95% CI 1.46-3.45), hemodialysis (HR 2.70, 95% CI 1.37-5.29), heart failure (HR 1.64, 95% CI 1.19-2.26), stroke (HR 1.73, 95% CI 1.18-2.52), antimicrobial treatment despite surgical indication (HR 5.53, 95% CI 3.59-8.49) and non-Streptococci causative microorganisms (HR 1.84, 95% CI 1.28-2.64)., Conclusions: Contemporary mortality rates of infective endocarditis remain high, irrespective of reinfection. Heart failure, peripheral embolization and presence of a pacemaker were predictors of reinfection., Competing Interests: Declaration of Competing Interest The authors have no relevant conflict of interest in this manuscript. WP received grants from MSD Belgium, Pfizer Belgium, Astellas Belgium and GSK Belgium. Frans Van de Werf Fund for Clinical Cardiovascular Research. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Despite the relatively recent Department of Veterans Affairs (VA) policy advances in providing care for veterans and their infants during the perinatal period, little information exists regarding access to prenatal care for women veterans. Currently, VA medical centers do not provide onsite pregnancy care for veterans, but pay for care from community obstetricians through the Veterans Choice Program (VCP) and related non-VA care programs. The VCP is subcontracted to two large contractors, Health Net and TriWest, to assist the VA in administering the VCP. To date, no studies have evaluated women's perceived access to prenatal care under the VCP., Objective: The purpose of this study was to understand pregnant veterans' perceived access to community prenatal care through the VCP., Design: The Center for Maternal and Infant Outcomes Research in Translation (COMFORT) study is a longitudinal, prospective multisite observational cohort study of pregnant and postpartum veterans at 15 VA facilities nationwide. Telephone surveys were conducted with women veterans at 20 weeks of pregnancy. We used multivariable logistic regression to examine the odds of receiving care early enough adjusted for these key factors. Measures included perceived access to early prenatal care by race, age, marital status, history of mental health conditions, urban/rural residence, and the VCP contractor (Health Net vs. TriWest)., Results: Overall, 519 women veterans completed the baseline pregnancy survey. A sizeable proportion of participants reported a history of mental health conditions, including depression (56.7%), anxiety disorder (45.5%), and posttraumatic stress disorder (40.5%). White veterans were more likely to report perceived timely access to prenatal care than minority veterans (66% vs. 52%; p = .0038). Veterans receiving care at Health Net facilities were more likely to report receiving prenatal care as early as desired in comparison to veterans at TriWest facilities (adjusted odds ratio, 0.48; 95% CI, 0.32-0.73), whereas veterans with a history of depression were 1.7 times more likely to report perceived delays in desired prenatal care compared with veterans without a history of depression (adjusted odds ratio, 1.65; 95% CI, 1.08-2.53)., Conclusions: We found that nearly one-third of women reported problems receiving early prenatal care as soon as they would have liked. Women with histories of depression and racial minorities may require additional maternity care coordination services to ensure they receive timely prenatal care. Community-based provider networks under the VCP should continue to be expanded so that pregnant veterans are able to access high-quality prenatal care in a timely manner., (Published by Elsevier Inc.)

Therapeutic strategies targeting both cancer cells and associated cells in the tumor microenvironment offer significant promise in cancer therapy. We previously reported that generation 5 (G5) dendrimers conjugated with cyclic-RGD peptides target cells expressing integrin alpha V beta 3. In this study, we report a novel dendrimer conjugate modified to deliver the mammalian target of rapamycin (mTOR) inhibitor, rapamycin. In vitro analyses demonstrated that this drug conjugate, G5-FI-RGD-rapamycin, binds to prostate cancer (PCa) cells and fibroblasts to inhibit mTOR signaling and VEGF expression. In addition, G5-FI-RGD-rapamycin inhibits mTOR signaling in cancer cells more efficiently under proinflammatory conditions compared to free rapamycin. In vivo studies established that G5-FI-RGD-rapamycin significantly inhibits fibroblast-mediated PCa progression and metastasis. Thus, our results suggest the potential of new rapamycin-conjugated multifunctional nanoparticles for PCa therapy., (© 2018 Wiley Periodicals, Inc.)

Patient falls and fall-related injury remain a safety concern. The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) was developed to facilitate early detection of risk for anticipated physiologic falls in adult inpatients. Psychometric properties in acute care settings have not yet been fully established; this study sought to fill that gap. Results indicate that the JHFRAT is reliable, with high sensitivity and negative predictive validity. Specificity and positive predictive validity were lower than expected.

Haldane's Rule and Darwin's Corollary to Haldane's Rule are the observations that heterogametic F1 hybrids are frequently less fit than their homogametic siblings, and that asymmetric results are often obtained from reciprocal hybrid crosses. In Caenorhabditis, Haldane's Rule and Darwin's Corollary have been observed in several hybrid crosses, including crosses of Caenorhabditis briggsae and C. nigoni. Fertile F1 females are obtained from reciprocal crosses. However, F1 males obtained from C. nigoni mothers are sterile and F1 males obtained from C. briggsae die during embryogenesis. We have identified cbr-him-8 as a recessive maternal-effect suppressor of F1 hybrid male-specific lethality in this combination of species. This result implicates epigenetic meiotic silencing in the suppression of F1 male-specific lethality. It is also shown that F1 males bearing a C. briggsae X chromosome are fertile. When crossed to C. briggsae hermaphrodites or F1 females derived from C. briggsae hermaphrodites, viable F2 and backcross (B2) progeny were obtained. Sibling males that possessed a C. nigoni X chromosome were sterile. Therefore, the sterility of F1 males bearing a C. nigoni X chromosome must result from dysgenic interactions between the X chromosome of C. nigoni and the autosomes of C. briggsae. The fertility of F1 males bearing a C. briggsae X chromosome provides an opportunity to identify C. nigoni loci that prevent spermatogenesis, and hence hermaphroditic reproduction, in diplo-X hybrids., (Copyright © 2016 Ragavapuram et al.)

When a patient presents with an implant with the internal threads damaged (or cross-threaded), a definitive restorative challenge may be faced. By having a difference in hardness between an abutment screw and the implant to which it is to be attached, there is potential for internal thread damage to the implant if the opposing threads do not interface properly. As such, the operator must use care when positioning the abutment and engaging the threads to prevent possible misalignment and damage to the internal aspect of the implant body. This article describes such a situation and the action taken to overcome the problem.

Traumatic injuries to anterior teeth in children range from minor chipping to total tooth loss and occur more often in boys than in girls. The treatment of permanent tooth loss in younger patients is complicated by the difficulty of doing restorative procedures which may be influenced by pulpal size, clinical crown height, and a dental profile that is constantly changing. This case report presented a situation involving a 9-year-old boy who had experienced traumatic loss of the maxillary central incisors. Innovative materials coupled with sound principles of removable partial denture design were utilized to fabricate a cast metal removable denture prosthesis to satisfy the esthetic, functional and psychological dental needs of the patient and his parents.

Traumatic injuries to anterior teeth in children range from minor chipping to total tooth loss and occur more often in boys than in girls. The treatment of permanent tooth loss in younger patients is complicated by the difficulty of doing restorative procedures which may be influenced by pulpal size, clinical crown height, and a dental profile which is constantly changing. This case report presented a situation involving a 9-year-old boy who had experienced traumatic loss of the maxillary central incisors. Innovative materials coupled with sound principles of removable partial denture design were utilized to fabricate a cast metal removable denture prosthesis to satisfy the esthetic, functional and psychological dental needs of the patient and his parents.

For many years, flexible resin materials have been available for fabricating removable partial denture (RPD) prostheses. Using a nonrigid material for the major connector or other components of an RPD may be a consideration for certain patients. Except for the promotional literature that has been written for flexible resin dentures, there is very little information available in the dental literature concerning nonrigid RPDs. As a result, the decision to use this treatment option depends on the judgment and experience of the dentist and fabricating laboratory. This article summarizes clinically pertinent information about flexible, nonrigid partial dentures.

The mechanisms that regulate hematopoietic stem cell (HSC) dormancy and self-renewal are well established and are largely dependent on signals emanating from the HSC niche. Recently, we found that prostate cancer (PCa) cells target the HSC niche in mouse bone marrow (BM) during metastasis. Little is known, however, as to how the HSC niche may regulate dormancy in cancer cells. In this study, we investigated the effects of TANK binding kinase 1 (TBK1) on PCa dormancy in the BM niche. We found that binding with niche osteoblasts induces the expression of TBK1 in PCa cells PC3 and C4-2B. Interestingly, TBK1 interacts with mammalian target of rapamycin (mTOR) and inhibits its function. Rapamycin, an mTOR inhibitor, induces cell cycle arrest of PCa cells and enhances chemotherapeutic resistance of PCa cells. As a result, the knockdown of TBK1 decreases PCa stem-like cells and drug resistance in vitro and in vivo. Taken together, these results strongly indicate that TBK1 plays an important role in the dormancy and drug resistance of PCa.

Objective: To examine the associations between sleep duration and emerging inflammatory and endothelial function risk factors in adolescents., Methods: This study included a total of 183 (88 girls) adolescents, aged 13-17 years, without diagnosed sleep-related disorders. White blood cell counts, C-reactive protein (CRP), complement factors 3 and 4, interleukin-6, adiponectin, leptin, inter-cellular adhesion molecule 1, vascular cell adhesion molecule-1, E-selectin, l-selectin, and plasminogen activator inhibitor-1 were measured. Sleep duration and sleep-related disorders were obtained by self-report and moderate-to-vigorous physical activity (MVPA) was objectively measured by accelerometer. Body mass index (BMI) was calculated from measured height and weight., Results: A significant inverse association between sleep duration and CRP (β=-0.17, P=0.024) existed only after controlling for sex, age, and pubertal status. The results did not change when MVPA was included into the model. However, the association of sleep duration with CRP was slightly attenuated when BMI was included in the model, though it remained significant (β=-0.15, P=0.044)., Conclusion: Short sleep duration during adolescence might play an important and independent role in cardiovascular and metabolic diseases through CRP., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Introduction: Signaling pathways responsible for dentin regeneration in a dental pulp are not fully understood. In this study, we determined the effects of the mammalian target of rapamycin (mTor) on the differentiation and mineralization of dental pulp stem cells. We hypothesized that the two known mTor complexes Torc1 and Torc 2 play pivotal roles in the differentiation of odontoblasts and that they modulate deposition of a mineralized extracellular matrix. Therefore, we investigated the effects of Torc1 and Torc 2 signaling on the differentiation and mineralization of stem cells from human exfoliated deciduous teeth (SHED)., Methods: We used Western blot analysis to examine the expression of markers of dental differentiation in SHED (+/-) inhibition of either Torc1 or Torc 2 complex proteins raptor or rictor, respectively. In addition, the deposition of a mineralized matrix was determined under these conditions via alkaline phosphatase and alizarin red staining., Results: Results show that the inhibition of Torc 1, via reduced expression of either raptor or mTor, severely restricts the synthesis of dentin sialoprotein and inhibits deposition of a mineralized matrix. Inhibition of Torc 2, via reduction of rictor, has the opposite effect, enhancing mineralization. This latter effect disappears when both rictor and mTor are inhibited, showing that the Torc 2 effect is Torc 1 dependent., Conclusions: These results strongly suggest an important role for mTor in dental pulp stem cell differentiation and provide evidence that the mechanisms involved in protein synthesis could prove an interesting target for dental pulp tissue engineering., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

In order to create optimum esthetics, function and phonetics in complete denture fabrication, it is necessary to record accurate maxillo-mandibular determinants of occlusion. This requires clinical skill to establish an accurate, verifiable and reproducible vertical dimension of occlusion (VDO) and centric relation (CR). Correct vertical relation depends upon a consideration of several factors, including muscle tone, inter-dental arch space and parallelism of the ridges. Any errors made while taking maxillo-mandibular jaw relation records will result in dentures that are uncomfortable and, possibly, unwearable. The application of a tracing mechanism such as the Gothic arch tracer (a central bearing device) is a demonstrable method of determining centric relation. Intraoral Gothic arch tracers provide the advantage of capturing VDO and CR in an easy-to-use technique for practitioners. Intraoral tracing (Gothic arch tracing) is a preferred method of obtaining consistent positions of the mandible in motion (retrusive, protrusive and lateral) at a comfortable VDO.

Focus groups are increasingly popular in nursing research. However, proper care and attention are critical to their planning and conduct, particularly those involving nursing staff. This article uses data gleaned from prior research to address the complexities present in clinical settings when conducting focus groups with nurses. Applying their combined experiences of conducting studies with nursing staff, the authors present a data-derived approach to thorough preparation and successful implementation of focus group research, offering a unique contribution to the literature regarding this research strategy.

Objective: To examine the associations between morning cortisol and adiposity in children at baseline and 9-month follow-up., Methods: Participants included 649 (301 males, 348 females) children (9.6 +/- 0.9 years) for the cross-sectional analysis and 316 (153 males, 163 females) for the longitudinal analysis. Body mass index (BMI, kg/m2) was calculated from measured height and weight and waist circumference (WC, cm) was measured at the superior border of the iliac crest. Cortisol was assessed via saliva samples collected on a single morning. Cross-sectional and longitudinal analyses were conducted to examine the relationships between cortisol and adiposity., Results: Approximately 31% were overweight (17.7%) or obese (12.8%). The mean cortisol level was 9.36 +/- 5.64 nmol/L (0.34 +/- 0.20 microg/dL). At baseline, no significant correlations were found between cortisol and BMI or WC (r < 0.07). Baseline cortisol did not correlate with change in BMI z-score (r = -0.03) or WC (r < -0.01) over the follow-up period. When examined by weight status, baseline cortisol was significantly related to changes in WC (r = 0.32) and BMI z-score (r = 0.28) among overweight subjects., Conclusions: A positive relationship was found between morning cortisol and change in WC over 9 months in overweight children. Future studies should examine the association between 24-h cortisol patterns and direct measures of trunk fat.

The stability of a dental prosthesis is its resistance to displacement when it is subjected to functional, horizontal and rotational stresses. For a removable partial denture (RPD), stability depends greatly on overall quality of fit to the supporting teeth and tissues. There are numerous reasons why the fit of a newly fabricated RPD might be compromised, but it is easy for the dentist to determine visually whether vertical movement is excessive. If finger pressure applied to the distal-most tooth on a distal extension denture base results in lifting of the anterior-most indirect retainer, then the RPD is not stable and either an indirect (laboratory processed) or direct (chairside) hard reline should be carried out. In this paper, we discuss factors that might influence the need to do a direct, chairside hard reline at delivery of a newly fabricated distal extension RPD and we recommend techniques.

Traumatic dental injuries are often irreversible, underscoring the need for therapies that protect dental pulp cells and enhance their regeneration. We hypothesized that generation 5 poly amido amine (PAMAM) dendrimers (G5), functionalized with fluorescein isothiocyanate (FL) and αVβ3-specific, cyclic arginine-glycine-aspartic acid (RGD) peptides, will bind to dental pulp cells (DPCs) and modulate their differentiation. Dental pulp cells and mouse odontoblast-like cells (MDPC-23) (±) treated with G5-FL-RGD were analyzed via Western blot, RT-PCR, and quantitative PCR. Transcription of dental differentiation markers was as follows: Dentin matrix protein (DMP-1), dentin sialoprotein (DSPP), and matrix extracellular phosphoglycoprotein (MEPE) as well as vascular endothelial growth factor (VEGF) all increased via the JNK pathway. Long-term G5-RGD treatment of dental pulp cells resulted in enhanced mineralization as examined via Von Kossa assay, suggesting that PAMAM dendrimers conjugated to cyclic RGD peptides can increase the odontogenic potential of these cells.

Chemotherapy-induced peripheral neuropathy (CIPN) remains the principal dose-limiting toxicity of many agents. This systematic review evaluates available CIPN measures and provides rationale for selection of measures in this field. Searches of Medline (1966-2010), CINAHL (1966-2010), Embase (1966-2010), and Cochrane (1988-2010) databases were performed. To be selected, studies had to include (1) subjects receiving peripheral neurotoxic chemotherapy for cancer and (2) a primary purpose of psychometric evaluation of CIPN measures. A modified Quality of Diagnostic Accuracy Studies (QUADAS) tool coded psychometric study quality, with 0-7 score overall possible (higher score indicating better quality). A total of 15 studies qualified for evaluation. Overall studies were of moderate quality, with 10 of 15 receiving a 4-5 QUADAS score. Averaged quality scores for two repeatedly studied measures, Total Neuropathy Score (TNS) versions and Functional Assessment of Cancer-Gynecologic Oncology Group, neurotoxicity (FACT/GOG-Ntx), were 5.4 and 4.5, respectively. Two measures emerged as potentially useful for clinical trials and patient care. The FACT/GOG-Ntx is a subjective measure of CIPN-related quality of life (QoL). TNS clinical versions incorporate both subjective measures and objective examinations of nerve function. However, to improve QUADAS scoring, additional research is needed focusing on other psychometric aspects such as responsiveness of CIPN outcome measures., (© 2010 Peripheral Nerve Society.)

Objective: To evaluate the cross-sectional and longitudinal relationships of morning cortisol with trunk fat and resting blood pressure (BP) in children., Methods: Participants included 72 children aged 4-10 years (mean 7.4 yrs) for the cross-sectional analysis and 58 for the longitudinal analysis. Height, weight, waist circumference, body fat by dual x-ray absorptiometry, and resting BP measures were obtained during a laboratory visit. Saliva samples were collected at home on a single morning and assayed for cortisol., Results: Approximately 21% were overweight (15.3%) or obese (5.6%). Mean morning cortisol was 0.25 +/- 0.12 microg/dL (6.99 +/- 3.46 nmol/L). There were no significant correlations between morning cortisol and any of the measures of fatness (r < -0.17) or BP (r < -0.10) at baseline. Cortisol at baseline was not associated with changes in body size parameters after the 1- and 2-year followup period., Conclusion: Morning cortisol was not associated with body fatness or BP. Future studies should examine the associations between the diurnal cortisol patterns, trunk fat, and BP by collecting samples throughout an entire day.

Purpose: In the acute setting of endocarditis it is very important to assess both the vegetation itself, as well as potential life-threatening complications, in order to decide whether antibiotic therapy will be sufficient or urgent surgery is indicated. A single whole-body scan investigating inflammatory changes could be very helpful to achieve a swift and efficient assessment., Methods: In this study we assessed whether (18)F-FDG can be used to detect and localize peripheral embolism or distant infection. Twenty-four patients with 25 episodes of endocarditis, enrolled between March 2006 and February 2008, underwent (18)F-FDG PET/CT imaging on a dedicated PET/CT scanner., Results: PET/CT imaging revealed a focus of peripheral embolization and/or metastatic infection in 11 episodes (44%). One episode had a positive PET/CT scan result for both embolism and metastatic infection. PET/CT detected seven positive cases (28%) in which there was no clinical suspicion. Valve involvement of endocarditis was seen only in three patients (12%)., Conclusion: PET/CT may be an important diagnostic tool for tracing peripheral embolism and metastatic infection in the acute setting of infective endocarditis, since a PET/CT scan detected a clinically occult focus in nearly one third of episodes.

Stress is a major risk factor for numerous neuropsychiatric diseases. However, susceptibility to stress and the qualitative nature of stress effects on behavior differ markedly among individuals. This is partly because of the moderating influence of genetic factors. Inbred mouse strains provide a relatively stable and restricted range of genetic and environmental variability that is valuable for disentangling gene-stress interactions. Here, we screened a panel of inbred strains for anxiety- and depression-related phenotypes at baseline (trait) and after exposure to repeated restraint. Two strains, DBA/2J and C57BL/6J, differed in trait and restraint-induced anxiety-related behavior (dark/light exploration, elevated plus maze). Gene expression analysis of amygdala, medial prefrontal cortex, and hippocampus revealed divergent expression in DBA/2J and C57BL/6J both at baseline and after repeated restraint. Restraint produced strain-dependent expression alterations in various genes including glutamate receptors (e.g., Grin1, Grik1). To elucidate neuronal correlates of these strain differences, we performed ex vivo analysis of glutamate excitatory neurotransmission in amygdala principal neurons. Repeated restraint augmented amygdala excitatory postsynaptic signaling and altered metaplasticity (temporal summation of NMDA receptor currents) in DBA/2J but not C57BL/6J. Furthermore, we found that the C57BL/6J-like changes in anxiety-related behavior after restraint were absent in null mutants lacking the modulatory NMDA receptor subunit Grin2a, but not the AMPA receptor subunit Gria1. Grin2a null mutants exhibited significant ( approximately 30%) loss of dendritic spines on amygdala principal neurons under nonrestraint conditions. Collectively, our data support a model in which genetic variation in glutamatergic neuroplasticity in corticolimbic circuitry underlies phenotypic variation in responsivity to stress.

Considerable controversy exists in the dental literature regarding cantilevered pontics. This article discusses basic concepts of the cantilever fixed partial denture (CFPD) in which one cantilevered pontic is supported by only one or two abutment teeth. Three primary factors should be considered carefully to optimize the prognosis for a CFPD: abutment selection, control of functional forces, and rigidity/strength of connectors. Abutments should have a root surface area greater than the tooth being replaced and a crown-to-root ratio of 2:3. They also should exhibit minimal mobility and be vital and periodontally sound. Contact on cantilevered pontics should be light in centric position and nonexistent in excursions. CFPDs ideally should be metal or metal-ceramic, and connectors, which are high-stress areas, require bulk for strength. A cantilevered prosthesis may require more consideration and planning than a conventional fixed partial denture, but when kept within the patient's biological limitations and executed properly, can provide a restorative option with many advantages.

Although approximately 50% of nursing home residents fall annually, the surrounding circumstances remain inadequately understood. This study explored nursing staff perspectives of person, environment, and interactive circumstances surrounding nursing home falls. Focus groups were conducted at two nursing homes in the mid-Atlantic region with the highest and lowest fall rates among corporate facilities. Two focus groups were conducted per facility: one with licensed nurses and one with geriatric nursing assistants. Thematic and content analysis revealed three themes and 11 categories. Three categories under the Person theme were Change in Residents' Health Status, Decline in Residents' Abilities, and Residents' Behaviors and Personality Characteristics. There were five Nursing Home Environment categories: Design Safety, Limited Space, Obstacles, Equipment Misuse and Malfunction, and Staff and Organization of Care. Three Interactions Leading to Falls categories were identified: Reasons for Falls, Time of Falls, and High-Risk Activities. Findings highlight interactions between person and environment factors as significant contributors to resident falls., (Copyright 2009, SLACK Incorporated.)

This article reviews factors that must be considered to select the best technique for cleaning a vital tooth prior to cementation of a definitive restoration. The dental literature offers many suggestions with supporting rationales. In cases where provisional cement has been present or contrast powder has been used, some mechanical cleaning (with fine pumice or prophy paste) appears to be justified. The value of soaps or other chemicals is questionable except perhaps as topical disinfectants. Dentists should be aware that a cleansing agent may have a negative or positive effect on bond strength, depending on the adhesive system chosen. It may be necessary to tailor the particular method of tooth cleaning to the cement that is to be used.

Purpose: The shortage of full-time dental school faculty along with a slow steady increase in student enrollment is not a new phenomenon. The purpose of this study was to determine who is teaching undergraduate prosthodontics in US dental schools-what percent are full-time faculty; what percent are prosthodontists; and what percent are board-certified prosthodontists-to allow schools to make a real-time comparison of the composition of instructors they have teaching prosthodontics to the apparent status quo., Materials and Methods: A short, ten-question survey was sent via e-mail to representatives at the 55 undergraduate US dental schools. A cover letter explained the nature of the study and requested participation and electronic return of the survey. Three weeks after the initial request, an aggressive follow-up was conducted to schools that had not returned the survey. Answers were converted to percentages to compensate for differences between schools with many or few instructors. Schools were also grouped by location to see if regional differences exist., Results: Thirty-eight (69%) of the surveys were completed and returned. In general, the division between full-time and part-time instructors is about 50%. More removable prosthodontic instructors (60%) than fixed instructors (44%) are prosthodontists, and only a small percentage of the total (18% removable and 15% fixed) have completed board certification. The South and Midwest had the highest percentage of prosthodontists involved in teaching; the South had the highest percentage with specialty board certification., Conclusion: This study indicated that only a few schools are fortunate enough to have sufficient full-time, specialty-trained faculty available for complete coverage of all undergraduate prosthodontic courses and clinics. The information presented serves as a baseline for future comparison to see if the percentage of full-time and/or specialty-certified prosthodontic faculty changes.

This is a report of a unique finding in a preclinical laboratory that may be a potential dental school health hazard. Visual inspection (conducted in April 2008 by a preclinical crown and bridge course coordinator) of typodonts used by second-year students at the University of Mississippi School of Dentistry found that fourteen out of thirty-nine had black spots on the undersurface of the cheek shroud and/or plastic gingiva. The spots were cultured by the Medical Center's Department of Microbiology and described only as being mold/fungus typical of that which frequently grows in warm, moist, southern environments. Although indoor molds are common, about 5 percent of the general population will develop some type of mild allergic airway problem from molds over their lifetime. Mold on typodonts is unsightly, indicates failure of students to recognize the value of cleanliness in the dental environment, and may be a potential health hazard for some individuals. Cleaning and drying procedures for typodonts were implemented. The transfer of items between students and instructors during preclinical courses provides many opportunities for the spread of potentially harmful microorganisms/viruses. As a minimal level of personal protection, it is suggested that instructors wear disposable gloves and face masks and exercise hand washing between handling student instruments and typodonts. This problem has not been previously mentioned in the literature and merits further investigation/discussion.

Data about predictors of embolism in patients with infective endocarditis (IE) are conflicting. This study aimed to investigate clinical and transoesophageal echocardiography (TEE) characteristics in predicting embolism and six-month mortality. In this observational cohort study, 216 patients with definite left-sided IE, according to the modified Duke criteria, were prospectively recruited. All patients underwent TEE. 'Any embolism' was defined as embolism before or after initiation of antimicrobial therapy; 'new embolism' included embolism after initiation of antimicrobial therapy. Sixty-two of 216 patients (29%) experienced any embolism. New embolism occurred in 12 patients (6%), 7 of which were postoperative. Factors significantly associated with any embolism were community origin of IE and the etiologic microorganism, in particular staphylococci and nonviridans streptococci. Vegetation length >10 mm showed a trend towards association with new embolism and a mobile vegetation was predictive for new embolism. Six-month mortality was 24% (52/216). In multivariable analysis, age, vegetation length >10 mm, Staphylococcus aureus, and the type of treatment predicted mortality. Multiple emboli showed a trend towards association with death. In conclusion, any embolism occurred in over a fourth of patients. A mobile vegetation was significantly associated with new embolism, and vegetation length >10 mm tended to be associated with new embolism. Vegetation length >10 mm predicted six-month mortality, and multiple emboli showed a trend towards association with death.

Most dental procedures are accomplished while the patient is partially or totally supine; as a result, all restorative patients have the potential to ingest or aspirate a dental item. The principle of nonmaleficence dictates the use of preventive practices (rubber dam, ligatures, throat pack) when possible; even so, accidents happen and one has to assume the worst when a dental item disappears. Knowing what to do can be extremely important, both medically and legally. The first order of business is ensuring that the airway is not compromised and advising the patient of the problem. Immediate referral (with escort) to a medical facility for appropriate radiographs and determination of required medical action is mandatory, regardless of how well the patient looks. According to the literature, all aspirated foreign objects and approximately one-third of ingested items require the patient to be hospitalized. Proper documentation also is important to reduce liability in the event of litigation.

Because the microbiology and patient population of infective endocarditis (IE) have evolved, the traditional definition of nosocomial IE may require revision. The question of whether this definition should be extended to 6 months after discharge was explored, and a high rate of episodes with nosocomial pathogens (coagulase-negative staphylococci) and a low rate of episodes with community pathogens (streptococci) in the extended nosocomial group were found. Therefore, modification of the traditional definition is proposed, distinguishing between early (as traditionally described) and late nosocomial IE (IE in association with a significant invasive procedure performed during a hospitalization between 8 weeks and 6 months before the onset of symptoms).

This study examined the influence of exercise intensity upon the cortisol response of the hypothalamic-pituitary-adrenal (HPA) axis. Specifically, we examined exercise at intensities of 40, 60, and 80% maximal oxygen uptake (VO2max) in an attempt to determine the intensity necessary to provoke an increase in circulating cortisol. Twelve active moderately trained men performed 30 min of exercise at intensities of 40, 60, and 80% of their VO2max, as well as a 30-min resting-control session involving no exercise on separate days. Confounding factors such as time of day--circadian rhythms, prior diet--activity patterns, psychological stress, and levels of exercise training were controlled. Cortisol and ACTH were assessed in blood collected immediately before (pre-) and after (post-) each experimental session. Statistical analysis involved repeated measures analysis of variance and Tukey post-hoc testing. The percent change in cortisol from pre- to post-sampling at each session was: resting-control, 40, 60, and 80% sessions (mean+/-SD) =-6.6+/-3.5%, +5.7+/-11.0%, +39.9+/-11.8%, and +83.1+/-18.5%, respectively. The 60% and 80% intensity magnitude of change was significantly greater than in the other sessions, as well as from one to another. The ACTH responses mirrored those of cortisol, but only the 80% exercise provoked a significant (p<0.05) increase pre- to post-exercise. The calculated changes in plasma volume for the resting-control, 40%, 60%, and 80% sessions were: +2.2+/-3.0%, -9.9+/-5.0%, -15.6+/-3.5%, and -17.2+/-3.3%, respectively. Collectively, the cortisol findings support the view that moderate to high intensity exercise provokes increases in circulating cortisol levels. These increases seem due to a combination of hemoconcentration and HPA axis stimulus (ACTH). In contrast, low intensity exercise (40%) does not result in significant increases in cortisol levels, but, once corrections for plasma volume reduction occurred and circadian factors were examined, low intensity exercise actually resulted in a reduction in circulating cortisol levels.

The incidence of methicillin-resistant Staphylococcus aureus (MRSA) infective endocarditis (IE) is increasing. This study compared clinical characteristics and mortality in patients with methicillin-sensitive S. aureus (MSSA) IE versus MRSA IE, based on a prospectively collected series of 72 consecutive patients with definite S. aureus IE according to the modified Duke criteria between June 2000 and December 2006. Sixteen of 72 IE patients (22%) were caused by MRSA. Nosocomial origin, surgical site infection, surgery in the previous 6 months, the presence of a catheter and persistent bacteremia were significantly associated with MRSA. MSSA patients had significantly more unknown origin of bacteremia and experienced a significantly higher rate of major embolism than MRSA patients. MSSA patients underwent more frequently combined surgical and antimicrobial therapy, and MRSA patients were treated more frequently with antimicrobial therapy due to a contraindication to surgery. The 6-month mortality was higher in patients with MRSA than MSSA. In the MSSA group treated with antimicrobial therapy without an indication to surgery, all patients survived, and in the combined surgical and antimicrobial group 29% died. The mortality in MRSA patients was lowest if combined surgical and antimicrobial therapy was performed. Both in MSSA and MRSA patients with antimicrobial therapy due to a contraindication to surgery, the mortality was extremely high. These data suggest that in S. aureus IE patients with a nosocomial origin, the presence of a catheter or recent surgery, initial therapy should include antimicrobial agents active against MRSA. Antimicrobial therapy alone with close monitoring of the therapeutic effect and signs of complicated course is an acceptable approach in selected patients with MSSA IE. Denial of surgery because of local or general factors in patients that meet criteria for surgical intervention in acute IE is prognostically ominous.

Background: The optimal timing of cardiac operations in patients with infective endocarditis continues to be debated. This observational study analyzed the profile and outcome of patients with active infective endocarditis undergoing operations., Methods: Between June 2000 and June 2006, 95 surgically treated patients with definite infective endocarditis by the modified Duke criteria were included., Results: Fifty-eight patients were operated on within the first 7 days after diagnosis of infective endocarditis and 37 at more than 7 days after diagnosis up to immediately after completion of antibiotic treatment. Staphylococci predominated and were significantly associated with embolism, abscess, and septic shock. The most frequent indication for operation was severe regurgitation with heart failure. The 6-month mortality was 15%. Early operation showed a trend towards increased mortality vs late operation. In univariable analysis, factors associated with 6-month mortality included staphylococci and septic shock. Multivariable analysis revealed that septic shock predicted 6-month mortality. Despite early operation in patients experiencing septic shock, 57% died. No patients without heart failure died after undergoing (early or late) procedures for severe regurgitation., Conclusions: The prognosis in surgically treated patients was determined by the occurrence of septic shock. The outcome in patients who underwent late operations was favorable compared with the early group. This difference was probably not due to the timing of the surgical intervention but to the severity of infective endocarditis. In patients with severe regurgitation without heart failure, early operation may offer benefit in length of hospitalization and prevention of development of new heart failure.

This study analyzed the profile and outcome of surgically versus medically treated patients with prosthetic valve infective endocarditis (PVE). From 2000 to 2006, 80 patients >16 years of age (median 71) with definite PVE according to modified Duke criteria were included. The medically treated group was separated into deliberately conservative and perforce conservative treatments, the latter group including patients with contraindications to a cardiosurgical intervention. The most frequent causative micro-organisms were staphylococci. Forty-six percent of patients were surgically treated, 34% had deliberately conservative treatment, and 20% had perforce conservative treatment. Six-month mortality was 29%; 27% of surgically treated patients died, 4% deliberately conservatively patients died, and 75% perforce conservatively treated patients died. Septic shock, multiorgan failure, and type of treatment were significantly associated with death in univariable analysis. Multivariable analysis revealed that type of treatment (perforce conservative) and septic shock predicted death in patients with PVE. Survival was most favorable in deliberately conservatively treated patients, including PVE due to Staphylococcus aureus. In conclusion, there remains a role for watchful waiting in patients with PVE without evidence of major complications. Moreover, patients with uncomplicated S. aureus PVE can be treated successfully without cardiac surgery. Conversely, patients with major complicated PVE should preferentially undergo surgery. Predictors of mortality in patients with PVE included septic shock and perforce conservative treatment.