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To produce a guide for dentists and orthodontists to determine orthodontic treatment need in borderline cases (dental health component DHC 3) and to compare views of different panels of judges on treatment need.Prospective, observational study. Photographs of one hundred subjects displaying borderline occlusal traits (DHC3) were collected. Three panels of judges consisting of 25 orthodontists, 25 dentists and 25 lay persons assessed photographs based on orthodontic treatment need on aesthetic grounds.Spearman's correlation coefficient showed no statistical difference between the panels of judges (p 0.001). The judges identified a 'high need' for treatment on aesthetic grounds for those with anterior open bites and reverse overjets. Kappa analysis showed moderate intra-rater agreement for the orthodontic and dental panels of judges (k = 0.47 and 0.45, respectively) and fair agreement (k = 0.26) for the lay panel, highlighting the intrinsic difficulty of assessing borderline malocclusions.There was no statistical difference in the way the orthodontic, dental and lay panels of judges perceived treatment need for DHC 3 cases. Anterior open bites and reverse overjets were predominantly found to be in high need of treatment by all panels of judges. A 'Guide to Borderline Orthodontic Need' (GBON) is proposed consisting of 8 photographs of subjects with borderline occlusal traits (DHC3) determined unambiguously by lay, dental and orthodontic panels as either 'needing' or 'not needing' orthodontic treatment on aesthetic grounds. It is anticipated that this will assist users to make judgments on aesthetic grounds on the need for treatment in borderline cases.

The issue of children dying due to vehicular heatstroke has raised significant concerns of public interest. The advancement of artificial intelligence (AI) technology, particularly in image classification and object detection, could be applied to overcome the current flaws of the vehicular occupant detection devices that often failed to serve as a triggering system to caretakers. In this paper, a technique for child detection with transfer learning is proposed. A real-time child detection system that consisted of a camera as an input medium, a classifier to detect the presence of a child and a triggering system in audio and visual forms was established. The modern convolutional object detector, SSD Mobilenet v1 was trained with Microsoft Common Objects in Context (MS COCO) dataset as a starting point of the training process. The model was then assessed and retrained to possess the ability to classify human into an adult or a child. The accuracy of the model was measured by counting the percentage of pixels labelled correctly per class. Based on the mean Average Precision (mAP), the detection system achieved an overall precision of 0.969 and the experimental results obtained showed a precision of 0.883, giving an error of less than ten percent.

AIM Increased arterial stiffness is associated with progressive renal deterioration and poor clinical outcomes in patients with chronic kidney disease (CKD). Assessment of vascular age as derived from arterial stiffness parameters might be an important clinical marker of cardiovascular risks. The aim of the present study is to evaluate whether the difference (△age) between vascular age and chronological age can predict the risk of reaching dialysis or death in patients with known CKD. METHODS This longitudinal study enrolled 94 male Chinese CKD patients, aged 40-62 years. Vascular age was calculated by brachial-ankle pulse wave velocity, and measured by an ankle-brachial index-form device. The study endpoints were the commencement of renal replacement therapy or death. RESULTS After a stepwise multivariate analysis, △age was associated independently with increased urine protein-to-creatinine ratio (β = 0.32; P = 0.001) and decreased baseline estimated glomerular filtration rate (β = -0.24; P = 0.008). During a median follow-up period of 62 (interquartile range = 55-66) months, the 4-year cumulative incidence of reaching the study endpoint in patients with △age = 0 and △age > 0 year was 4.9% and 25%, respectively (log-rank test, P = 0.009). Multivariate forward Cox regression analysis identified that higher △age (hazard ratio (HR) = 1.05; P = 0.027), lower baseline estimated glomerular filtration rate (HR = 0.93; P

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This study explores the relationship between foreign investors and the dynamics of capital structure. Using a sample of listed firms in Taiwan during the period from 1997 to 2016, our results reveal that firms with higher foreign ownership are less likely to issue debt, indicating that foreign investors serve as a direct substitute for debt by enhancing corporate governance. Moreover, foreign investors help reduce leverage adjustment costs, which in turn increases the speed of adjustment toward target leverage. Overall, this study highlights the important role played by foreign investors in shaping firms’ optimal capital structure decisions and shareholder wealth maximization, and thus provides evidence in supporting a positive view of foreign ownership in emerging markets.

Lupus nephritis (LN) is a common and severe organ manifestation of systemic lupus erythematosus (SLE), and is associated with significant patient morbidity and mortality. Autoantibodies and aberrations in lymphocyte subsets have putative roles in the pathogenesis of SLE and LN, and might reflect disease activity and are amenable to immunosuppressive treatments. Anti-DNA is one of the well-studied autoantibodies, which correlates with disease activity and has direct nephritogenic effects on resident renal cells and various glomerular components. Other important autoantibodies in the pathogenesis of LN include anti-C1q, anti-α-actinin and anti-nucleosome antibodies. Changes in naive and memory B cells and plasma cells have been observed in SLE and LN patients. These B cell subsets exert diverse effects during pathogenesis of LN such as production of autoantibodies, secretion of proinflammatory and anti-inflammatory cytokines and presentation of auto-antigens to effector cells. Aberration of T lymphocytes, especially the T-helper subsets, is also highly pertinent in the development of LN. In this context, important T helper subsets include Th1, Th2, Th9, Th17, TReg and follicular T-helper cells. The growing knowledge on these autoantibodies and lymphocyte subset abnormalities will enhance our understanding of SLE and LN, and hence help devise better strategies for disease monitoring and treatment.

Purpose: To compare fixation stability and fixation loss between the Humphrey Field Analyzer (HVF, static fixation target) and the RareBit computer-based perimeter (RBP, kinetic fixation target) during visual field testing. Methods: Fourteen healthy volunteer subjects wore an ASL Mobile Gaze Tracker as they completed HVF 10-2 and RareBit central field tests in a random order. Fixation stability, defined as the average distance from the fixation target to the subject’s gaze location, was calculated using data from the processed video capture. Fixation loss, defined as eye closure or a deviation of >20 degrees from the fixation target, was also measured. All subjects were surveyed regarding test preference. Results: Use of the RBP kinetic target was associated with 18% improved fixation stability compared with the HVF static target (P=0.02). Nine of 14 study subjects demonstrated better fixation with RBP compared with HVF. Subjects demonstrated decreased fixation loss during RBP (0.9 s) compared with HVF (10.0 s) (P=0.002). Eighty-six percent of study subjects preferred RBP over HVF. Conclusions: Use of the RBP kinetic fixation target is associated with consistent fixation stability and decreased fixation loss compared with the HVF static target. This improvement in fixation stability may result from decreased perception interference (Ganzfeld, Troxler, and binocular rivalry effects), and may help account for the greater comfort reported with RBP compared with HVF.

This study designed a compact size 45 mm × 9 mm × 1.6 mm stand-alone dualband inverted-F antenna IFA printed on a low-cost FR4 substrate for dual-network WLAN 2.4/5.2/5.8 GHz and WiMAX 2.5/3.5/5.5 GHz operating bands. To achieve broad 10-dB bandwidth of more than 45% and 31% for the lower and upper operating bands, respectively, the techniques of shorting the open-end of the microstrip feed line to the driven monopole and loading a C-shaped parasitic element with dissimilar arm lengths into the opposite side of the IFA were introduced. Further experimental results also show that the proposed IFA have efficiencies of more than 60% throughout the bands of interest. © 2013 Wiley Periodicals, Inc. Int J RF and Microwave CAE 24:523-528, 2014.

This article proposes a compact 6 × 21 × 0.4 mm3 antenna with dual-band operation that satisfies the wireless local area network. To achieve optimal impedance matching for the lower and upper operating bands, the proposed antenna structure is designed as a quasi-self-complementary QSC type, in which the lower 2.4 GHz operating band is excited through the loop-like structure of the proposed antenna, whereas its self-complementary counterpart rectangular patch structure induces the upper 5.2/5.8 GHz operating band. Further investigation was also conducted by printing the proposed QSC antenna onto a flexible substrate of 0.063 mm in thickness. To cover both operating bands, the proposed flexible antenna was restructured to 20.5 × 8 mm2. The design and initial characteristics of the two proposed antennas were discussed in detail via simulation, and the experimental results showed satisfactory performance of both operating bands. © 2013 Wiley Periodicals, Inc. Int J RF and Microwave CAE 24:298-305, 2014.

We report the first observation of diffractive $J/\psi(\to \mu^+\mu^-)$ production in $\bar pp$ collisions at $\sqrt{s}$=1.8 TeV. Diffractive events are identified by their rapidity gap signature. In a sample of events with two muons of transverse momentum $p_T^{\mu}>2$ GeV/$c$ within the pseudorapidity region $|\eta, Comment: 9 pages, 4 figures, using RevTeX. Submitted to Physical Review Letters

We report a measurement of the strong coupling constant, ${\ensuremath{\alpha}}_{s}({M}_{Z})$, extracted from inclusive jet production in $p\overline{p}$ collisions at $\sqrt{s}\phantom{\rule{0ex}{0ex}}=\phantom{\rule{0ex}{0ex}}1800\mathrm{GeV}$. The QCD prediction for the evolution of ${\ensuremath{\alpha}}_{s}$ with jet transverse energy ${E}_{T}$ is tested over the range $40l{E}_{T}l450\mathrm{GeV}$ using ${E}_{T}$ for the renormalization scale. The data show good agreement with QCD in the region below 250 GeV. The value of ${\ensuremath{\alpha}}_{s}$ at the mass of the ${Z}^{0}$ boson averaged over the range $40l{E}_{T}l250\mathrm{GeV}$ is found to be ${\ensuremath{\alpha}}_{s}({M}_{Z})\phantom{\rule{0ex}{0ex}}=\phantom{\rule{0ex}{0ex}}0.1178\ifmmode\pm\else\textpm\fi{}0.0001(\mathrm{stat}{)}_{\ensuremath{-}0.0095}^{+0.0081}(\mathrm{expt}.\mathrm{syst})$. The associated theoretical uncertainties are mainly due to the choice of renormalization scale $({+6%}{\ensuremath{-}4%})$ and input parton distribution functions $(5%)$.

Objective To characterize the phenotypes of Dent disease in Chinese children and their heterozygous mothers and to establish genetic diagnoses. Study design Using a modified protocol, we screened 1288 individuals with proteinuria. A diagnosis of Dent disease was established in 19 boys from 16 families by the presence of loss of function/deleterious mutations in CLCN5 or OCRL1 . We also analyzed 16 available patients' mothers and examined their pregnancy records. Results We detected 14 loss of function/deleterious mutations of CLCN5 in 15 boys and 2 mutations of OCRL1 in 4 boys. Of the patients, 16 of 19 had been wrongly diagnosed with other diseases and 11 of 19 had incorrect or unnecessary treatment. None of the patients, but 6 of 14 mothers, had nephrocalcinosis or nephrolithiasis at diagnosis. Of the patients, 8 of 14 with Dent disease 1 were large for gestational age (>90th percentile); 8 of 15 (53.3%) had rickets. We also present predicted structural changes for 4 mutant proteins. Conclusions Pediatric Dent disease often is misdiagnosed; genetic testing achieves a correct diagnosis. Nephrocalcinosis or nephrolithiasis may not be sensitive diagnostic criteria. We identified 10 novel mutations in CLCN5 and OCRL1 . The possibility that altered CLCN5 function could affect fetal growth and a possible link between a high rate of rickets and low calcium intake are discussed.

Background Pseudoachalasia is a rare diagnosis manifested by clinical and physiologic symptoms of achalasia, with alternative etiology for outflow obstruction. While malignancy is a frequent cause of pseudoachalasia, prior surgical intervention especially surgery involving the esophagogastric junction, may result in a misdiagnosis of achalasia. Case presentation We present a case of a 70 year-old male with dysphagia and weight loss after undergoing a Billroth I and Nissen fundoplication several decades ago. His preoperative studies suggested achalasia and he was therefore referred for an endoscopic myotomy. However, careful interpretation of all the data and intra-operative findings revealed a classic mechanical and functional obstruction requiring takedown of his prior wrap. Conclusions Individualized interpretation of preoperative studies in the setting of prior foregut surgery is critical to appropriate diagnosis and intervention. This case highlights the significance of endoscopic findings and features of high-resolution manometry specific to pseudoachalasia, which contrasts with classical features of achalasia.

Immunoglobulin A nephropathy (IgAN) is a worldwide disease characterized by the presence of galactose-deficient IgA1 deposits in the glomerular mesangium. A kidney biopsy for diagnosis is required. Here, we measured two miRNAs (let-7b and miR-148b), previously identified as regulators of the O-glycosylation process of IgA1, in serum samples from patients with IgAN and healthy blood donors (controls) recruited in an international multicenter study. Two predictive models, based on these miRNAs, were developed and the diagnostic accuracy of the combined biomarkers was assessed by the area under the receiver operating characteristic (ROC) curve (AUC) carried out in three steps. In a training study, the combined miRNAs were able to discriminate between 100 patients with IgAN and 119 controls (AUC, 0.82). A validation study confirmed the model in an independent cohort of 145 patients with IgAN and 64 controls (AUC, 0.78). Finally, in a test study, the combined biomarkers were able to discriminate patients with IgAN from 105 patients affected by other forms of primary glomerulonephritis, supporting the specificity (AUC, 0.76). Using the same study design, we also performed two subgroup analyses (one for Caucasians and one for East Asians) and found that race-specific models were the best fit to distinguish IgAN patients from controls. Thus, serum levels of the combined miRNA biomarker, let-7b and miR-148b, appears to be a novel, reliable, and noninvasive test to predict the probability of having IgAN.

Background and Objectives Enterococci are part of the normal flora of the gastrointestinal tract. They can cause enteric peritonitis, which is a serious complication of peritoneal dialysis (PD). However, the clinical course and outcome of PD-related Enterococcus peritonitis remains unclear. Methods We reviewed all Enterococcus peritonitis episodes occurring in our dialysis unit from 1995 to 2009. Results During the study period, 1421 episodes of peritonitis were recorded. Of 29 episodes (2.0%) that were attributable to single-organism Enterococcus, 12 episodes were caused by E. faecalis; 9, by E. faecium; and the remaining 8, by other Enterococcus species. The overall rate of ampicillin resistance was 41.4%. Recent use of antibiotics was associated with the development of ampicillin-resistant Enterococcus (ARE) peritonitis (hazard ratio: 12.53; p = 0.04). The primary response rate of Enterococcus peritonitis was significantly higher than that of Escherichia coli peritonitis (89.7% vs. 69.9%, p = 0.038), but the primary response rate was not significantly lower for ARE peritonitis than for ampicillin-susceptible Enterococcus (ASE) peritonitis (83.3% vs. 94.1%, p = 0.553). However, significantly more patients with ARE had received vancomycin (83.3% vs. 23.5%, p = 0.003), with a longer mean duration of vancomycin treatment (11.8 ± 6.9 days vs. 3.7 ± 6.8 days, p = 0.005). Conclusions Recent use of antibiotics was a risk factor for the development of ARE peritonitis. Outcomes in ASE and ARE peritonitis were similar, but vancomycin was required during treatment for ARE peritonitis, in turn possibly predisposing the patients to infections caused by vancomycin-resistant organisms.

Aim: The authors recently showed that advanced glycation end-products (AGE) in the form of glycated albumin (GA) upregulated renal tubular expression of interleukin (IL)-8 and soluble intercellular adhesion molecule-1 (sICAM-1), but not other important cytokines known to mediate diabetic nephropathy. This implies that other molecules such as the carbonyl intermediates of AGE or other modified protein lysine-albumin may participate in diabetic tubular injury. Methods: Human proximal tubular epithelial cells (PTEC) were growth-arrested and exposed to methylglyoxal (MG), MG-bovine serum albumin (BSA)-AGE, carboxymethyllysine (CML)-BSA, AGE-BSA or BSA with or without prior addition of rosiglitazone that was previously shown to attenuate the pro-inflammatory effect of GA alone. Results: MG-BSA-AGE and AGE-BSA upregulated tubular expression of connective tissue growth factor (CTGF), transforming growth factor (TGF)-β, and vascular endothelial growth factor (VEGF), whereas CML-BSA stimulated expression of IL-6, CCL-2, CTGF, TGF-β and VEGF. These AGE compounds also activated nuclear factor (NF)-κB and their effects were attenuated by pre-incubation with anti-RAGE antibody. MG and BSA did not affect the expression of any of these molecules. Rosiglitazone did not affect the in vitro biological effects of MG, MG-BSA-AGE, AGE-BSA or CML-BSA on PTEC. Conclusion: AGE exhibit differential inflammatory and fibrotic effects on PTEC via RAGE activation and NF-κB signal transduction. Rosiglitazone had no effect on these responses. Further investigations on compounds that nullify the downstream effects of these AGE are warranted.

Background. One-third to half of IgA nephropathy (IgAN) patients have raised serum IgA levels. Decreased clearance of IgA/IgA complex has been observed in IgAN patients. FCAR codes for IgA-specific receptor and plays an important role in IgA metabolism. Previous small sample-sized studies reported controversial findings in its association with IgAN. Methods. We re-sequenced the FCAR in 107 IgAN patients and 112 controls. Association of � 27T/C and their haplotypes were performed in 606 patients versus 606 controls, its two independent subsets: 293 single patients with family members and 313 cases versus 606 controls. Functional impact of � 27T>C and their haplotypes were analyzed by bioinformatics, allelic differential expression and luciferase activity assays. Cell surface FCAR density between � 27T/C heterozygous patients and � 27T/T homozygous controls was assessed by flow cytometry. Results. � 27T>C, on the consensus TATA box of transcription factor-binding motif in the putative promoter of the gene was the only variation identified in all coding, splice-site and known protein-binding sequence in resequencing. � 27C and its haplotype were associated with IgAN (P ¼ 0.0034/0.0013, 0.0099/0.0054, 0.0129/0.0076 and 0.00039/0.00014 in 606 cases versus 606 controls, family-based study, 313 cases versus 606 controls and meta-analysis, respectively). Bioinformatics predicted 2 bp binding changes by � 27C. Allelic differential expression and luciferase activity assays showed a reduced expression/ activity by the associated haplotype/allele (P < 0.001). � 27T/C heterozygous patients had a lower receptor density on cell surface compared to � 27T/T homozygous controls (P < 0.001). Conclusions. Our results provide evidence for genetic variation at the putative promoter region of FCAR conferring susceptibility to IgAN, suggesting � 27C and its haplotype may be causative for the susceptibility among the Chinese Han population.

Objective: The aim of the current study was to assess the implementation of AS in the management of early PC within a typical urology department and determine the impact of the NICE guidelines on this. Materials and methods: Three cohorts of 100 patients diagnosed with PC were identified. Patient computer records and hospital notes were used to collect data on diagnosis and management details for each individual. Management strategies were then assessed and compliance with several key NICE guideline recommendations determined. Results: For low risk disease, 92% were offered active surveillance (AS) in 2006, 92% in 2007 and 93% in 2008. Of these 41% of patients in 2006 elected for AS, 61% in 2007 and 72% in 2008. For intermediate risk disease the percentages offered AS were 77% in 2006, 96% in 2007 and 84% in 2008. Of these patients 27%, 38% and 29% of patients elected for AS respectively. Conclusion: This study demonstrates that many of the recommendations made were already in practise prior to its publication. It also highlights an increase in the number of men electing for AS and that this trend preceded the guidelines. This increased uptake however, appears limited to low risk disease suggesting better patient awareness.

BRE binds to the cytoplasmic domains of tumor necrosis factor receptor-1 and Fas, and in cell lines can attenuate death receptor-initiated apoptosis by inhibiting t-BID-induced activation of the mitochondrial apoptotic pathway. Overexpression of BRE by transfection can also attenuate intrinsic apoptosis and promote growth of the transfected Lewis lung carcinoma line in mice. There is, however, a complete lack of in vivo data about the protein. Here, we report that by using our BRE-specific monoclonal antibody on the immunohistochemistry of 123 specimens of human hepatocellular carcinoma (HCC), significant differences in BRE expression levels between the paired tumoral and non-tumoral regions (P

An association of bullous pemphigoid with neurological disorders has been reported. The objectives of this study were to review the clinical characteristics of patients with bullous pemphigoid and compare the association between bullous pemphigoid and various neurological disorders and comorbidities.This was a retrospective case-control study involving 43 patients with bullous pemphigoid and 43 age-, sex- and ethnicity-matched controls.There was a statistically significant association between bullous pemphigoid and neurological disorders [Odds Ratio (OR) = 3.5, 95% Confidence Interval (CI) 1.3 to 9.2, p=0.011 and adjusted OR=3.5, 95% CI 1.2-10.3, p=0.026], in particular for dementia (p=0.002). Although stroke was more common among patients with bullous pemphigoid, this association was not statistically significant with OR of 1.9 (95% CI 0.7 to 5.2) and adjusted OR of 2.1 (95% CI 0.6 to 7.2). Similarly both ischaemic stroke (OR 1.5, 95% CI 0.5 to 4.2) and haemorrhagic stroke (OR 1.5, 95% CI 0.2 to 9.7) were more common. Other neurological disorders more common among patients with bullous pemphigoid were Parkinson's disease and epilepsy. Dyslipidaemia was significantly less common among patients with bullous pemphigoid (OR 0.4, 95% CI 0.1 to 0.9, p=0.033).A combination of an inflammatory process, prothrombotic state and endothelial activation leads to an increased frequency of neurological disorders among patients with bullous pemphigoid. Thus, a holistic approach to patient care, including screening for dementia and control of comorbidities, should be practised as bullous pemphigoid affects more than just the skin.

Background Previously, a large proportion of the genetic components predisposing individuals to IgA nephropathy (IgAN) have been unidentified. Familial IgAN is enriched with genetic variations predisposing individuals to the disease. Whole exome sequencing is an effective way to explore disease-causing genes and gene variants. Methods We performed exome sequencing on the probands from each of ten IgAN families, and on one of the unaffected member from 7 of the families. Sanger sequencing, bioinformatics and co-segregation analysis were performed for all available family members to detect deleterious genetic variation. The relatedness of the families was tested by haplotype analyses. Results Six deleterious variants in 4 genes were observed to be associated with IgA nephropathy by co-segregating with the disease phenotypes in study families. MYCT1 p.Asp22Glufs*34 was associated with IgAN by co-segregating with its phenotypes in families 2, 7, and 9; DEFA4 p.Ala8Pro, p.Ala8Val, c.172 + 1G>T co-segregated in families 1, 2, and 3; ZNF543 p.Pro226Ala co-segregated in families 3, 5, and 6 and CARD8 p.Val98Lysfs*26 co-segregated in families 7 and 8. Among these genes, MYCT1, CARD8 and ZNF543 are novel. Our haplotype analyses showed that families in which the same variation(s) were co-segregating with IgAN were unrelated, except for DEFA4. Of the families carrying DEFA4, families 2 and 3 were possibly related, but not family 1, indicating that common genes/variations in these families were not due to the same founder. Interfamilial sharing of different co-segregating genes was also observed, demonstrating the polygenic nature of this disease. Conclusions We discovered 6 deleterious variants in 4 genes associated with familial IgAN. These genes are good candidate genes that appear to be causally related to IgAN and warrant further study.

The kinetic evolution in velocity space of a minority suprathermal electron population that is undergoing the anomalous Doppler instability (ADI) is investigated using the results from fully nonlinear numerical simulations that self-consistently evolve particles and fields in a plasma. Electron trajectories in phase space during different stages of the ADI are captured, and are analysed in relation to the characteristics of the excited electric fields and of the overall distribution of particles. For some electrons, trapping and mirroring effects are observed during the saturation phase. A relationship between the second order moments of the perpendicular electron distribution function and time is established, and is used to investigate the range of applicability of analytical approximations drawn from classical theory, that involve a quasilinear wave-driven diffusion operator.

An analytical methodology is developed to study the pollutant dispersion in a turbulent wind flow over a two-dimensional hill with a small slope. As in a typical boundary layer problem, the flow domain is divided into an inner and an outer region: the inviscid outer region is further subdivided into an upper and a middle layer while the viscous inner region is subdivided into a shear stress and an inner surface layer. Based on the Reynolds-averaged Navier-Stokes equations and the continuity equations, closed form analytical solutions of the stream functions and velocities are readily obtained for all regions in the domain. The velocity information is then imported into the diffusion equation, and the pollutant concentration distribution is readily solved. For reasons of turbulent shear, a variational method with adjustments to the streamline coordinate system is used to obtain an accurate solution of the pollutant concentration. Results show that when the source is located in the upper layer, the concentrations decrease with distance along the upwind side of the hill and tend to reach a constant value rapidly near the hilltop. Similar results are observed when the source is located in the middle layer. However, due to the reduction of wind speed in the middle layer, the concentrations become saturated at a later upslope position as compared to the source in the upper layer. This methodology is shown to be able to provide a quick and accurate estimate of local pollutant patterns and can be applied to any flow field provided that the streamlines can be specified through the velocities.

Cheung GSP, Lai SCN, Ng RPY. Fate of vital pulps beneath a metal-ceramic crown or a bridge retainer. International Endodontic Journal, 38, 521–530, 2005. Aim To investigate the incidence of and factors associated with pulpal necrosis in vital teeth restored with metal-ceramic crowns (CMCs) or crowned as part of a fixed‐fixed bridge. Methodology Patients who had a CMC or bridge retainer (BR) placed on a tooth with no previous history of root canal treatment from 1981 to 1989 were retrieved from computer records. The collated patients were randomly selected and their clinical records examined. Those who satisfied the inclusion criteria were contacted and offered a review. After clinical examination, long-cone paralleling periapical radiographs were taken of the selected teeth, which were then assessed by two precalibrated operators to ascertain the pulpal status. Factors that might contribute to loss of pulp vitality and the tooth type were also recorded. The collected data were analysed statistically using the chi-square test and subject to Bonferroni adjustment where indicated. Results The numbers of preoperatively vital teeth in the CMC and BR groups were 122 and 77, and the mean observation periods were 169 ± 25 (SD) and 187 ± 23 months, respectively. In the CMC group, 19 failed cases (15.6%) were due to an endodontic reason; total number of failures was 34. In the BR group, 25 (32.5%) showed signs of pulpal necrosis; a significant association with maxillary anterior teeth was noted. The survival rates for pulp vitality were 84.4% (CMC) and 70.8% (BR) after 10 years, and 81.2% (SC) and 66.2% (BR) after 15 years. The difference between the two groups was significant. Conclusion The survival of the vital pulp in teeth restored with a single-unit CMC was significantly higher than those serving as an abutment of a fixed‐ fixed bridge. Maxillary anterior teeth used as bridge abutments had a higher rate of pulpal necrosis than any other tooth types.

A water-soluble conjugate (1) with intact carboxyl groups was prepared by addition of poly(ethylene glycol) thiol (MPEG-SH) regiospecifically to the exo vinyl group of bilirubin. (1)H and (13)C NMR and absorbance spectroscopy in CDCl(3) and DMSO-d(6) confirmed the assigned structure and showed that pegylation did not disrupt the hydrogen-bonded ridge-tile conformation of the pigment moiety. Aqueous solutions of 1 were optically clear, but NMR signals were seen only from the MPEG portion and none from the tetrapyrrole, consistent with dissolved assemblies containing aggregated bilirubin cores within mobile polyether chains. On alkalinization (pH >12), signals from the pigment moiety reappeared. Titrimetric measurements on 1 in water showed the pK(a)'s of the two carboxyl groups to be similar (average 6.42). Control studies with pegylated half-esters of succinic, suberic, brassylic, thapsic, and 1,20-eicosanedioic acid showed that pegylation per se has little, if any, effect on carboxyl ionization. However, aggregation increases the apparent pK(a) by approximately 1-2 units. The molecularity of bilirubin in solution was further characterized by ultracentrifugation. Over the pH range 8.5-10 in buffer, bilirubin formed multimers with aggregation numbers ranging from approximately 2-7. Bilirubin is monomeric in DMSO or CHCl(3) at approximately 2 x 10(-)(5) M, but aggregation occurred when the CHCl(3) was contaminated with trace adventitious (perhaps lipoidal) impurities. These observations show that aggregation increases the pK(a)'s of aliphatic carboxylic acids relative to their monomer values in water. They are consistent with earlier (13)C NMR-based estimates of approximately 4.2 and approximately 4.9 for the aqueous pK(a)'s of bilirubin and similar studies of bilirubin in micellar bile-salt solutions. Together with earlier work, they confirm that the pK(a)'s of bilirubin are about normal for aliphatic carboxyls and suggest that the high (>7.5) values occasionally reported, including those based on CHCl(3) partitioning, are artifacts of aggregation or technique.

Using a Rapid Visco Analyser (HVA), It was revealed that 2 alkalizing agents (Na 2 CO 3 and NaOH) had a far larger effect on pasting properties of nonwaxy starches (wheat, corn, rice) compared with their effect on waxy starches (waxy carn and waxy rice). It was hypothestsed that the alkalizing agents have a greater propensity to attack the amorphons regions of the nonwaxy starch granales, thereby causing increased leaching of amylose molecules and possibly also some hydrolysis of starch chains. As a result, the HVA pasting proflie of a conwaxy starch. In the presence of alkall, was drastically altered in one that more closely resembled that of its waxy counterpart without added alkali.

Using differential scanning calorimetry and pulsed nuclear magnetic resopance (NMR). It was found that the presence of Na 2 CO 3 and NaOH retarded retrogradation of aged starch (wheat, corn, waxy corn, rice, and waxy rice) gels during storage at 4 °C. At the same level of addition (based on a fixed starch/water ratio), the effect of NaOH was observed to be more pronounced than that of Na 2 CO 3 . Kinetic studies using pulsed NMR showed a progressive reduction In rate of starch retrogradation with increasing concentration of alkali (ap to a level of 1 g/100 starch).

Objective Supplemental glutamine (Gln) has been demonstrated to improve the immunologic response and reduce mortality in rodents with sepsis. However, the effects of Gln on gut-associated lymphoid tissue function after infection and sepsis are not clear. We investigated the effects of Gln-supplemented diets before sepsis, Gln-enriched total parenteral nutrition (TPN) after sepsis, or both on the intestinal immunity in rats with gut-derived sepsis. Methods Male Wistar rats were assigned to control and four experimental groups. The control and experimental groups 1 and 2 were fed a semi-purified diet; in experimental groups 3 and 4, part of the casein in the diets was replaced with Gln. After feeding rats the respective diets for 10 d, sepsis was induced by cecal ligation and puncture (CLP) in the experimental groups, whereas the control group underwent a sham operation; at the same time, the internal jugular vein of all rats was cannulated. All rats were maintained on TPN for 3 d. The control group and groups 1 and 3 were infused with conventional TPN, and groups 2 and 4 were given a TPN solution supplemented with Gln, which provided 25% of total amino acid nitrogen. All rats were killed 3 d after the sham operation or CLP. Intestinal immunoglobin A levels, total lymphocyte yields, and lymphocyte subpopulations in Peyer's patches were analyzed. Results Total Peyer's patch lymphocyte numbers were significantly higher in the Gln-supplemented groups than in the control group. Distributions of CD3+ and CD4+ in group 1 were significantly lower than those in the control group, whereas no differences were observed among the control and Gln-supplemented groups. Plasma immunoglobulin A levels were higher in the Gln-supplemented groups than the control group and group 1. Intestinal immunoglobulin A levels were significantly higher in groups 2 and 4 than in the control group and group 1. Conclusions Preventive use of a Gln-supplemented enteral diet before CLP or intravenous Gln supplementation after CLP have similar effects in promoting proliferation of total lymphocyte in gut-associated lymphoid tissue, enhancing IgA secretion, and maintaining T-lymphocyte populations in Peyer's patches. Gln administered before and after CLP did not seem to have a synergistic effect on enhancing mucosal immunity in rats with gut-derived sepsis.

The treatment of atypical pneumonia, subsequently termed severe acute respiratory syndrome (SARS), is controversial, and the efficacy of corticosteroid therapy is unknown. We have evaluated the clinical and radiographic outcomes of 72 patients with probable SARS (median age 37 years, 30 M), who received ribavirin and different steroid regimens in two regional hospitals. Chest radiographs were scored according to the percentage of lung field involved. Seventeen patients initially received pulse steroid (PS) (methylprednisolone > or =500 mg/day) and 55 patients initially received nonpulse steroid (NPS) (methylprednisolone

To evaluate the relationship among chest radiographs, oxygen supplementation requirement, and treatment response in severe acute respiratory syndrome (SARS).Forty patients (20 women, 20 men; mean age, 42.90 years +/- 14.01 [SD]; median age, 41.5 years; age range, 25-82 years) with SARS were evaluated. Daily chest radiographs were graded according to percentage of lung involvement during 20.15 days +/- 5.56 (median, 20 days; range, 14-38 days). Times between symptoms and treatment and time to reach maximal radiographic score from admission and treatment day were determined. Daily oxygen saturation (Sao2) and oxygen supplementation including mechanically assisted ventilation were recorded. Treatment response was defined as good, fair, and poor. Patterns of radiographic opacity at admission and at maximal radiographic score were noted. Differences in radiographic and clinical parameters with respect to oxygen supplementation and treatment response were respectively evaluated with Mann-Whitney and Kruskal-Wallis tests.Larger maximal radiographic scores, lower Sao2 at maximal radiographic change, longer time from treatment to maximal radiographic score (P.01), and diffuse consolidation at maximal radiographic score were associated with oxygen supplementation. Parameters that influenced treatment response were time from symptom onset to treatment day (P =.003), time from admission to treatment day (P.001), time to maximal radiographic score from treatment day (P =.001), maximal radiographic score (P =.009), Sao2 at maximal radiographic score (P =.13), and treatment radiographic score (P =.03). Fair responders had shorter time between admission and treatment than did either good (P.001) or poor responders (P =.002) and shorter time between symptoms and treatment (P.001) and lower treatment radiographic score (P =.012) than did good responders. Good (82%), poor (36%), and fair (33%) responders developed maximal chest radiographic scores within 4 days of treatment (P =.008). Radiographic patterns at both admission and maximal radiographic score did not influence treatment response.There are significant relationships among radiographic parameters, oxygen supplementation, and treatment response, and these relationships appear to be clinically useful in the treatment of SARS.

Despite the development of new modalities, cyclophosphamide (CYC) remains the preferred initial treatment for severe proliferative lupus nephritis. Controversies continue about the best route, dosage, and duration of CYC treatment. For recalcitrant disease, new immunosuppressive and immunomodulating agents, immunoablative high dose CYC, nucleoside analogues, apheresis, and the biological response modifiers can be considered., published_or_final_version

Previous reports have shown that arginine (Arg) enhances phagocytic activity of macrophages and is required for macrophage-mediated toxicity toward tumor cells. Few studies have addressed the importance of Arg supplementation on macrophage and neutrophil function after infection and sepsis. This study examined the effect of Arg-supplemented diets before and Arg-enriched total parenteral nutrition (TPN) after sepsis or both on the phagocytic activity of peritoneal macrophages and blood polymorphonuclear cells in rats with gut-derived sepsis.Male Wistar rats were assigned to 4 groups. Groups 1 and 2 were fed a semipurified diet, while groups 3 and 4 had part of the casein replaced with 2% of total calories as Arg. After the experimental diets were administered for 10 days, sepsis was induced by cecal ligation and puncture (CLP); at the same time, an internal jugular vein was cannulated. All rats were maintained on TPN for 3 days. Groups 1 and 3 were infused with conventional TPN, while groups 2 and 4 were supplemented with Arg, replacing 10% of total amino acids in the TPN solution. Survival rates were recorded for 3 days after CLP, and all surviving rats were killed 3 days after CLP to examine their immune responses.Aerobic and anaerobic bacteria colony counts in peritoneal lavage fluid were significantly reduced, and the phagocytic activity of peritoneal macrophages was enhanced in groups 3 and 4 but not in the other 2 groups. There were no significant differences in the phagocytic activities of blood polymorphonuclear cells and survival rates among the 4 groups.Enteral Arg supplementation before sepsis significantly enhanced peritoneal macrophage phagocytic activity and reduced total bacterial counts in peritoneal lavage fluid. Arg administered before and after CLP seemed to have a synergistic effect on enhancing phagocytic activity and on bacterial clearance. However, IV Arg administration after CLP had no favorable effects on phagocytic activity or survival rates in rats with gut-derived sepsis.