Search

Kun Zhang,1 Somayaji Ramamurthy,1 Thomas J Prihoda,2 Maxim S Eckmann1 1Department of Anesthesiology, 2Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA Purpose: The current study was designed to examine the antinociceptive effect of intrathecally administered capsaicin, a transient receptor potential vanilloid 1 receptor agonist, in a rat model of neuropathic pain induced by unilateral sciatic nerve chronic constriction injury. Methods: Male adult Sprague Dawley rats were randomly assigned to six groups, and all rats underwent unilateral sciatic nerve chronic constriction injury. Two weeks after injury, five groups received intrathecal administration of either capsaicin in three different dosing regimens or equal volumes of vehicle. The other group received intrathecal capsaicin on the third day after nerve injury. The antinociceptive effect of capsaicin was assessed by measuring the capsaicin-induced change in thermal and mechanical response thresholds. Results: Capsaicin (150–300 µg/100–200 µL), when administered by fast infusion or chronic infusions at 8 µL/hour or 1 µL/hour, attenuated thermal hyperalgesia as indicated by significantly prolonging paw withdrawal latency to noxious thermal stimulation. The antinociceptive effect of capsaicin was more profound in the injured limb compared to that in the uninjured limb. When capsaicin was administered on the third day after nerve injury, it failed to attenuate thermal hyperalgesia. No significant effect on the mechanical response threshold was observed with intrathecally administered capsaicin. Conclusion: Our data suggest that intrathecal capsaicin could significantly attenuate thermal hyperalgesia, depending on the time when the drug is given after nerve injury, and that the antinociceptive efficacy of intrathecal capsaicin positively correlates with the previously reported dynamic profile of spinal transient receptor potential vanilloid 1 activity after nerve injury. Keywords: hyperalgesia, TRPV1, paw withdrawal latency, paw withdrawal threshold

AIMS: To examine various dimensions of reliability of the Craniomandibular Index, a commonly used instrument for quantifying the severity of signs and symptoms of temporomandibular disorders. METHODS: Classical psychometric theory and generalizability theory were used to assess the reliability of data obtained from a calibration study of examiners participating in a multi-site clinical trial and from a random community sample. RESULTS: The reliability of aggregate scores formed by summing individual binary scored items was high, with intraclass correlations ranging from 0.81 to 0.88. When it was required that examiners recognize and agree upon a specific pattern of signs and symptoms exhibited by a patient, however, reliability dropped dramatically (multivariate kappas ranged from 0.26 to 0.32). A group of practicing examiners also showed limited ability to agree with the pattern of signs and symptoms identified by a 'gold standard' examiner (multivariate kappas ranging from 0.25 to 0.32). Generalizability analysis failed to identify the specific sources of measurement error that played a major role in limiting reliability but demonstrated that generalizability of aggregate scores was very high. CONCLUSION: Methods of classical psychometric theory and generalizability theory support the conclusion that the reliability of aggregate scores is acceptably high. Individual items assessing certain aspects of jaw mobility and joint sounds are measured with poor reliability. Reliability declines when it is defined as the ability of examiners to agree among themselves upon a specific constellation of signs and symptoms or their ability to identify correctly a 'correct' constellation identified by an expert examiner. [ABSTRACT FROM AUTHOR]

INTRODUCTION: This meta-analysis was conducted to systematically review the efficacy and safety of the H-Wave(R) (Electronic Waveform Lab, Inc, Huntington Beach, CA, USA) device and programme as a non-pharmacological analgesic treatment in chronic soft tissue inflammation and neuropathic pain. METHODS: Five studies related to pain relief, reduction in pain medication and increased functionality obtained with the H-Wave device were included in the analysis. Data were analysed using the random effects model, including adjustment to evaluate variability, size of study and bias in effect size. A total of 6535 participants were included in the meta-analysis; there were 8065 participants' outcomes measured due to multiple measurements per participant. RESULTS: The H-Wave device decreased pain ratings across various chronic soft tissue inflammation and neuropathic pain conditions. The mean weighted effect size was 0.59, and the estimated effect size variance was 0.00003 (95% confidence intervals [CI]: 0.580, 0.600). The H-Wave device also decreased the intake of pain medication in patients with various chronic soft tissue inflammation and neuropathic pain conditions. The mean weighted effect size was 0.56, and the estimated effect size variance was 0.000013 (95% CI: 0.553, 0.567). Patient functionality was also improved with use of the H-Wave device. The mean weighted effect size was 0.70, and the estimated effect size variance was 0.00002 (95% CI: 0.691, 0.709). A chi-square test for homogeneous effect sizes found highly significant (P<0.00001) variability, indicating a robust significant effect size for increased functionality relative to both pain relief and reduction in pain medication. There was little to no evidence of any adverse effects associated with the use of the H-Wave device. CONCLUSION: The findings indicate a moderate to strong effect of the H-Wave device in providing pain relief, reducing the requirement for pain medication and increasing functionality. The most robust effect was observed for improved functionality, suggesting that the H-Wave device may facilitate a quicker return to work and other related daily activities. [ABSTRACT FROM AUTHOR]

Context: Early-onset alcoholism differs from late-onset alcoholism by its association with greater serotonergic abnormality and antisocial behaviors. Thus, individuals with early-onset alcoholism may be responsive to treatment with a selective serotonergic agent.Objective: To test the hypothesis that drinking outcomes associated with early vs late-onset alcoholism are differentially improved by the selective 5-HT(3) (serotonin) antagonist ondansetron.Design: Double-blind, randomized, placebo-controlled clinical trial.Settings: University of Texas Health Science Center in Houston (April 1995-June 1998) and University of Texas Health Science Center in San Antonio (July 1998-December 1999).Participants: A total of 321 patients with diagnosed alcoholism (mean age, 40.6 years; 70.5% male; 78.6% white) were enrolled, 271 of whom proceeded to randomization.Interventions: After 1 lead-in week of single-blind placebo, patients were randomly assigned to receive 11 weeks of treatment with ondansetron, 1 microg/kg (n = 67), 4 microg/kg (n = 77), or 16 microg/kg (n = 71) twice per day; or identical placebo (n = 56). All patients also participated in weekly standardized group cognitive behavioral therapy.Main Outcome Measures: Self-reported alcohol consumption (drinks per day, drinks per drinking day, percentage of days abstinent, and total days abstinent per study week); and plasma carbohydrate deficient transferrin (CDT) level, an objective and sensitive marker of transient alcohol consumption.Results: Patients with early-onset alcoholism who received ondansetron (1, 4, and 16 microg/kg twice per day) compared with those who were administered placebo, had fewer drinks per day (1.89, 1.56, and 1.87 vs 3.30; P =.03, P =.01, and P =.02, respectively) and drinks per drinking day (4.75, 4.28, and 5.18 vs 6.90; P =.03, P =.004, and P =.03, respectively). Ondansetron, 4 microg/kg twice per day, was superior to placebo in increasing percentage of days abstinent (70.10 vs 50.20; P =.02) and total days abstinent per study week (6.74 vs 5.92; P =.03). Among patients with early-onset alcoholism, there was a significant difference in the mean log CDT ratio between those who received ondansetron (1 and 4 microg/kg twice per day) compared with those who received the placebo (-0.17 and -0.19 vs 0.12; P =.03 and P =.01, respectively).Conclusion: Our results suggest that ondansetron (particularly the 4 microg/kg twice per day dosage) is an effective treatment for patients with early-onset alcoholism, presumably by ameliorating an underlying serotonergic abnormality. JAMA. 2000;284:963-971 [ABSTRACT FROM AUTHOR]

An evaluation of a 2-day sexually transmitted disease (STD) and HIV and AIDS curriculum for primary care providers is presented which compares large scale continuing medical education (CME) conferences with smaller clinic workshop (CW) models with regard to short-term (2-month) and long-term (10-month) program effects on STD and HIV knowledge, attitudes toward risk assessment, and frequency of both STD diagnosis and STD and HIV risk counseling. Data from interventions held in San Antonio, Texas (328 CME; 95 CW) replicate and extend earlier findings from a preliminary intervention, indicating nonsignificant CME-CW differences and dramatic and long-lasting gains from baseline among those with lower knowledge and experience levels preintervention. Similar program effect magnitudes were found for attitude and practice dimensions at 2 months postintervention, with the strongest consistent short and long-term program effects observed for STD and HIV knowledge among service providers. [ABSTRACT FROM AUTHOR]

Objectives: To examine ridge dimensional changes and histologic parameters of healing when ridge preservation (RP) was performed at molar sites using dense polytetrafluoroethylene (dPTFE) membrane alone, without a bone graft., Material and Methods: Eighteen patients had molar extraction and RP using dPTFE membrane alone. Ridge dimensions were measured using two standardized cone beam computerized tomography (CBCT) scans taken within 72 h and 3 months following extraction. Following a 3-month healing period, an implant osteotomy was prepared using a trephine drill and bone cores were collected for histological analysis. Four-arm analyses were performed using data from three previously published study arms of the same research group., Results: There was a significant change in the buccal ridge height between the four groups at all aspects of the socket. Alveolar ridge width reduction at 3 mm from crest for all aspects (mesial, midpoint, distal) of the socket showed statistically significant difference for dPTFE alone group compared to the other three groups. Percentage of vital bone formation (62.10%) was significantly greater in dPTFE alone group compared to the other groups., Conclusions: RP using dPTFE membrane alone in molar sites with intact socket walls showed successful outcomes in maintaining ridge dimensions and in histologic wound healing., (© 2021 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Background: Neonates undergoing congenital heart defect repair require optimized nutritional support in the perioperative period. Utilization of a gastrostomy tube is not infrequent, yet optimal timing for placement is ill-defined. The objective of this study was to identify characteristics of patients whose postoperative course included gastrostomy tube placement to facilitate supplemental tube feeding following neonatal repair of congenital heart defects., Methods: A single-institution, retrospective chart review identified 64 consecutive neonates who underwent cardiac operations from 2012 to 2016. Perioperative variables were evaluated for significance in relation to gastrostomy tube placement., Results: A total of 27 (42%) underwent gastrostomy tube placement. Diagnosis of a genetic syndrome was associated with the likelihood of placement of gastrostomy tube ( P = .032), as were patients with single ventricle physiology ( P = .0013) compared to those felt to be amenable to eventual biventricular repair. Aortic arch reconstruction ( P = .029), as well as the need for delayed sternal closure ( P = .05), was associated with increased frequency of gastrostomy tube placement. Postoperative outcomes including the number of days intubated ( P = .0026) and the presence of significant dysphagia ( P = .0034) were associated with gastrostomy placement. Additionally, genetic syndrome ( P = .003), aortic arch reconstruction ( P = .01), and postoperative intubation duration ( P = .0024) correlated with increased length of stay, where increased length of stay was associated with gastrostomy tube placement ( P = .0004)., Discussion: Patient characteristics that were associated with a high likelihood of eventual gastrostomy placement were identified in this study. Early recognition of such characteristics in future patients may allow for reduced time to gastrostomy tube placement, which in turn may improve perioperative growth and outcomes.

Background: To determine if there is a difference in the amount of shrinkage during healing of free soft tissue autografts (FSTAs) using different surgical techniques-suturing the vestibular flap margin apically to the base of the recipient bed versus leaving the flap margin free and unsutured., Methods: Twenty-eight patients with mucogingival defects requiring FSTAs were recruited and enrolled in the study. Patients were randomized into test and control groups (14 per group) and received ≥1 FSTAs on non-molar mandibular teeth. In the test group the mucosal flap margin was sutured apically to the periosteum at the base of the graft; whereas, the mucosal flap margin in the control group was left free. Graft dimensional measurements were taken at time of surgery, then at 1, 3, and 6 months post-surgery., Results: Thirty-five grafts were performed (15 test, 20 control). All FSTAs experienced vertical shrinkage after 6 months, but there was no significant difference (P = 0.51) in the mean amount of shrinkage after 6 months between the test (23.20% ± 20.88%) and control (21.10% ± 21.88%) groups. There was significantly greater horizontal shrinkage in the test (loss of 7.59% ± 10.20%) compared with the control (small gain of 0.32% ± 4.20%) group (P = 0.01)., Conclusions: The findings suggest that there is similar vertical shrinkage when performing FSTA surgery when the mucosal flap margin is left free and unsutured when compared with leaving the flap margin free., (© 2020 American Academy of Periodontology.)

Objectives: To sequentially study the effectiveness of lithium and divalproex monotherapy and adjunctive therapy with quetiapine or lamotrigine in the acute and continuation treatment of bipolar I or II disorder at any phase of illness and at least mild symptom severity., Methods: From June 2011 to December 2016, patients with bipolar I or II disorder (using DSM-IV diagnostic criteria) and CGI-S (Clinical Global Impression-Severity) ⩾ 3 were randomized to receive lithium or divalproex monotherapy for 2 weeks. Patients who had CGI-S-depression ⩾ 3 for 2 weeks at any time after 2-week monotherapy were randomly assigned to receive quetiapine or lamotrigine, or remaining on monotherapy for a total of 26 weeks., Results: The rates of early termination due to lack of efficacy and side effects and changes in BISS (Bipolar Inventory of Symptoms Scale) and CGI-S total score were not significantly different between lithium and divalproex. The completion rate was significantly higher with adjunctive therapy than with monotherapy. BISS and CGI-S total scores, and their sub-scores were significantly reduced with adjunctive therapy compared to monotherapy. Adjunctive therapy significantly increased survival times compared to monotherapy (hazard ratio = 6.8), and the monotherapy group had a significantly increased risk for not reaching sustained recovery from depression (hazard ratio = 12.7). Patients who did not need the 2nd randomization and remained on monotherapy had a significantly reduced hazard for discontinuation (hazard ratio = 3.8)., Conclusions: The efficacy of lithium and divalproex as monotherapy was modest. Adjunctive lamotrigine and quetiapine to either one was well-tolerated and equally effective in reducing bipolar symptomatology, but adjunctive therapy should be initiated as early as possible when depression symptoms are present., Competing Interests: FUNDING SOURCE This study was supported by the National Institute of Mental Health to (CLB and JRC). The grant number is 1P30MH086045–01A2., (Copyright © 1964–2019 by MedWorks Media Inc, Los Angeles, CA All rights reserved. Printed in the United States.)

The goal of the study was to compare the outcome of immediate single-implant placement in esthetic sites of patients with thick or thin tissue phenotypes. Forty-one patients underwent implant surgery with guided bone regeneration including peri-implant gap and overcontour grafting. A connective tissue graft was added only for patients with a thin tissue phenotype. Twenty-six patients completed the 12-month follow-up examination (thick, n = 14; thin, n = 12). The thick-phenotype group gained 0.01 ± 1.56 mm of midfacial soft tissue height, while the thin-phenotype group lost 0.20 ± 1.14 mm (P = .21). There was no significant difference in buccal plate thickness achieved at time of uncovery, pink and white esthetic scores, radiographic bone levels, and clinical parameters between the two groups. These results suggest that when the suggested treatment protocol is followed, there are no significant differences in the outcomes of immediate implant placement for patients with different soft tissue phenotypes.

Background: Little evidence is available regarding the benefit of ridge preservation (RP) at molar sites. The primary objective of this three-arm cohort study was to histologically compare the healing outcome between natural healing after molar tooth extraction and two different techniques of RP using freeze-dried bone allograft (FDBA) and a nonresorbable dense polytetrafluoroethylene (dPTFE) membrane, or an absorbable collagen sponge as a barrier., Methods: Seventy-nine patients requiring extraction and delayed implant placement were placed into three groups: extraction alone (control); ridge preserved using FDBA; and either dPTFE (Test1) or collagen sponge (Test2). Bone cores were harvested from implant osteotomies at ≈3 months after extraction for histomorphometric analysis to determine the percentage of vital bone, residual graft, and connective or other tissue. Ridge dimension changes were also evaluated radiographically (cone-beam computed tomography)., Results: The percentage of vital bone was significantly greater in control group compared with Test1 but was not statistically different among other groups. Test2 showed significantly less connective or other tissue than control and Test1. The percentage of residual graft was significantly lower in Test1 compared with Test2. There was no significant correlation between the percentage of vital bone or residual graft and the following parameters: healing time, patient age, gender, buccal plate thickness, or radiographic changes in ridge dimensions., Conclusion: RP at molar sites using FDBA and an absorbable collagen sponge may be a sufficient and economic way to preserve the ridge dimension without interfering with the amount of new bone formation., (© 2019 American Academy of Periodontology.)

There has been ongoing debate and discussion concerning whether the funding source influenced the outcome of research on human health effects from exposure to radiofrequency fields (RF, electromagnetic waves that carry energy as they propagate in air and dense media). In a study of 225 publications, in which we sought to determine a possible association between the funding source(s), quality and outcome in a total of 2,160 genetic damage assessment tests of mammalian cells exposed to RF energy, we made several observations. One finding was that a great majority of researchers had acknowledged government agencies as the funding source (53%, 120 of 225 publications), while a small number of scientists mentioned mobile phone industry as the financial source (9%, 20 of 225 publications). Numerous investigators did not mention the funding source (26%, 58 of 225 publications). Secondly, industry-funded investigations were of better quality and utilized quality control measures, i.e., blind evaluation, adequate description of dosimetry, positive controls and/or sham-exposed controls, compared to those funded by the government. Another observation was that in industry-funded studies, the d values (effect size or standardized mean difference between the cells exposed to RF energy and sham-exposed controls) were consistently lower than in government-funded studies. In addition, compared to government-funded studies, a higher percentage of industry-funded studies reported no difference in genetic damage between RF- and sham-exposed cells (80% for industry-funded studies versus 49% for government-funded studies). Finally, we observed that industry-funded studies were less likely to report an increase in genetic damage in cells exposed to RF energy (10%) compared to government-funded studies (23%). In view of the large difference between the percentage of publications funded by government and industry (53% or 122 of 225 publications for government, compared to 9% or 29 of 225 publications for industry), caution should be used when debating and discussing the above observations. Overall, it is important to include the quality control measures in the investigations, and also mention the funding source in published studies.

Purpose: Ridge preservation limits dimensional changes after tooth extraction. However, it is still unclear if using a membrane may be advantageous over a collagen wound dressing. Therefore, the goal of this report was to evaluate the outcomes of ridge preservation using freeze-dried bone allograft with a collagen wound dressing., Materials and Methods: This study included 21 patients who had one molar extracted, and the site received ridge preservation using freeze-dried bone allograft and a collagen wound dressing (test 2 group). Patients had two standardized cone beam computed tomography (CBCT) scans, taken within 72 hours and 3 months after extraction, to measure changes in ridge height and width, and buccal and lingual plate thicknesses. Changes in keratinized tissue width were recorded. Three-arm analyses were performed using historic data from a previous randomized controlled trial by the same study group, in which 20 molar sites received a collagen wound dressing alone (control) and 20 received ridge preservation with freeze-dried bone allograft and a dense polytetrafluoroethylene membrane (test 1) using the same methodology., Results: There was a statistically significant difference in mean buccal ridge height changes between the control group (2.6 ± 2.06 mm) and test 2 group (1.55 ± 0.93 mm) but no difference in ridge and keratinized tissue width changes between groups. No correlation was found between buccal plate thickness and ridge width change., Conclusion: Freeze-dried bone allograft with collagen wound dressing as a barrier was used successfully for ridge preservation in intact molar extraction sites (< 50% bone loss) and can be considered as a treatment alternative to freeze-dried bone allograft with a dense polytetrafluoroethylene membrane.

Aim: The objectives of this study were to compare (a) esthetic, (b) clinical, (c) radiographic, and (d) patient-centered outcomes following immediate (Type 1) and early implant placement (Type 2)., Material and Methods: Forty-six subjects needing a single extraction (premolar to premolar) were randomly allocated to Type 1 or Type 2 implant placement. One year following permanent restoration, evaluation of (a) Esthetics using soft tissue positions, and the pink and white esthetic scores (PES/WES), (b) Clinical performance using probing depth, modified plaque index, and sulcus bleeding index (c) Radiographic bone level, and (d) Patient satisfaction by means of visual analogue scales (VAS) was recorded., Results: Thirty-five patients completed the one-year examination (Type 1, n = 20; Type 2, n = 15). Type 1 implants lost 1.03 ± 0.24 mm (mean ± SE) of mid-facial soft tissue height while Type 2 implants lost 1.37 ± 0.28 mm (p = 0.17). The papillae height on the mesial and distal was reduced about 1 mm following both procedures. Frequency of clinical acceptability as defined by PES ≥ 6 (Type 1: 55% vs. Type 2 40%), WES ≥ 6 (Type 1: 45% vs. Type 2 27%) was not significantly different between groups (p > 0.05). Clinical and radiographic were indicative of peri-implant health. Patient-centered outcomes failed to demonstrate significant differences between the two cohorts., Conclusion: One year after final restoration, there were no significant differences in esthetic, clinical, radiographic, and patient-centered outcomes following Type 1 and Type 2 implant placement. At one year, patient satisfaction may be achieved irrespective of the two placement protocols., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: Assess construct validity of a low-cost medium-fidelity silicone injection molded model task trainer for endoscopic sinus surgery (ESS) training., Methods: Fellowship-trained rhinologists, otolaryngology attendings, and otolaryngology residents at various levels of training performed sinus endoscopy and seven procedures on the model. Construct validity was evaluated by comparing novice to various levels of experienced performance using a validated checklist., Results: Thirty-two subjects participated in this study. Otolaryngology attendings and postgraduate year (PGY) 3 to 5 otolaryngology residents significantly outperformed PGY 1 to 2 otolaryngology residents on most tasks in the task-specific checklist., Conclusions: This study demonstrated the construct validity of the low-cost medium-fidelity ESS model., Level of Evidence: NA Laryngoscope, 129:1505-1509, 2019., (© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: Inconsistencies in the nomenclature of structures of the frontal sinus have impeded the development of a validated "reference standard" classification system that surgeons can reliably agree upon. The International Frontal Sinus Anatomy Classification (IFAC) system was developed as a consensus document, based on expert opinion, attempting to address this issue. The purposes of this study are to: establish the reliability of the IFAC as a tool for classifying cells in the frontal recess among an international group of rhinologists; and improve communication and teaching of frontal endoscopic sinus surgery (ESS)., Methods: Forty-two computed tomography (CT) scans, each with a marked frontal cell, were reviewed by 15 international fellowship-trained rhinologists. Each marked cell was classified into 1 of 7 categories described in the IFAC, on 2 occasions separated by 2 weeks. Inter- and intrarater reliability were evaluated using Light's kappa (κ), the interclass correlation coefficient (ICC), and simple proportion of agreement., Results: Interrater reliability showed pairwise κ values ranging from 0.7248 to 1.0, with a mean of 0.9162 (SD, 0.0537). The ICC was 0.98. Intrarater reliability showed κ values ranging from 0.8613 to 1.0, with a mean of 0.9407 (SD, 0.0376). The within-rater ICC was 0.98., Conclusion: Among a diverse sample of rhinologists (raters), there was substantial to almost perfect agreement between raters, and among individual raters at different timepoints. The IFAC is a reliable tool for classification of cells in the frontal sinus. Further outcome studies are still needed to determine the validity of the IFAC., (Published 2018. This article is a U.S. government work and is in the public domain in the USA.)

Research published in 2002 reported limited elder abuse training in U.S. dental hygiene curricula although its importance has increased with an aging population. The aims of this study were to determine the current extent of elder abuse training in U.S. dental hygiene curricula and to explore dental hygiene program directors' perspectives on the topic. A 25-item online survey was distributed to all 361 program directors, coordinators, and/or department chairs of Commission on Dental Accreditation (CODA)-accredited dental hygiene programs via email in August 2017. A response rate of 27.2% (n=98) was achieved. A large percentage of the respondents (83.3%) included elder abuse training in their program curricula; for most (58.7%), one to three curriculum hours were spent on the topic. A large percentage (89%) agreed the topic was at least somewhat important to include, and 29.5% said a personal or professional elder abuse experience influenced the depth of instruction at their program. Various barriers to inclusion were identified. At least 40% of these educators perceived their graduates to be appropriately competent in their ability to recognize elders' oral neglect (63.5%) and general neglect (48.7%) and to document potential signs of elder abuse (43.8%). Lower percentages perceived that their graduates were competent in the areas of communication regarding elder abuse (21.9%) and reporting suspected abuse (32.4%). Despite rising awareness about elder abuse among dental hygienists and widespread incorporation of the subject in dental hygiene curricula, these results suggest that there are still deficiencies in training. To prepare dental hygiene graduates to confidently recognize and respond to elder abuse, educators should seek to overcome barriers by modifying instruction and embracing interprofessional collaboration.

Previous studies demonstrated that global deficiency of eNOS in diabetic mice exacerbated renal lesions and that overexpression of eNOS may protect against tissue injury. Our study revealed for the first time overexpression of eNOS leads to disease progression rather than protection. Transgenic mice selectively expressing eNOS in endothelial cells (eNOSTg) were cross bred with Ins2Akita type-1 (AK) diabetic mice to generate eNOS overexpressing eNOSTg/AK mice. Wild type, eNOSTg, AK and eNOSTg/AK mice were assessed for kidney function and blood glucose levels. Remarkably, overexpressing eNOSTg mice showed evidence of unpredicted glomerular injury with segmental mesangiolysis and occasional microaneurysms. Notably, in eNOSTg/AK mice overexpression of eNOS led to increased glomerular/endothelial injury that was associated with increased superoxide levels and renal dysfunction. Results indicate for the first time that overexpressing eNOS in endothelial cells cannot ameliorate diabetic lesions, but paradoxically leads to progression of nephropathy likely due to eNOS uncoupling and superoxide upsurge. This novel finding has a significant impact on current therapeutic strategies to improve endothelial function and prevent progression of diabetic renal disease. Further, the eNOSTg/AK model developed in this study has significant translational potentials for elucidating the underlying mechanism implicated in the deflected function of eNOS in diabetic nephropathy., (Copyright © 2018 Elsevier Inc. All rights reserved.)

There have been numerous published studies reporting on the extent of genetic damage observed in animal and human cells exposed in vitro and in vivo to non-ionizing radiofrequency fields (RF, electromagnetic waves that carry energy as they propagate in air and dense media). Overall, the data are inconsistent; while some studies have suggested significantly increased damage in cells exposed to RF energy compared to unexposed and/or sham-exposed control cells, others have not. Several variables in exposure conditions used in the experiments might have contributed to the controversy. In this comprehensive review, four specific quality control measures were used to determine the quality of 225 published studies in animal and human cells exposed in vitro and in vivo to RF energy, and the results from 2,160 tests with different sample sizes were analyzed. The four specific quality control measures were as follows: 1. "Blind" collection/analysis of the data to eliminate individual/observer "bias"; 2. Adequate description of "dosimetry" for independent replication/confirmation; 3. Inclusion of "positive controls" to confirm the outcomes; and 4. Inclusion of "sham-exposed controls" which are more appropriate to compare the data with those in RF exposure conditions. In addition, meta-analysis of the genetic damage in cells exposed to RF energy and control cells, thus far available in the RF literature database, was performed to obtain the "d" values, i.e., standardized mean difference between these two types of cells or the effect size. The relationship between d values and the above-mentioned quality control measures was ascertained. In addition, the correlation between the quality control measures and the conclusions reported in the publications (no significant difference between the cells exposed to RF energy and control cells; increased damage in former cells compared to the latter; increased, no significant difference and decreased damage in cells exposed to RF energy in the same experiment; or decreased damage in cells exposed to RF energy) was examined. The overall conclusions were as follows: 1. When all four quality control measures were mentioned in the publication, the d values were smaller compared to those when one or more quality control measures were not mentioned in the investigation; 2. Based on the inclusion of quality control measures, the weighted outcome in cells exposed to RF energy (d values) indicated a very small effect, if any; 3. The number of published studies reporting no significant difference in genetic damage of cells exposed to RF energy, compared to that of control cells, increased with increased number of quality control measures employed in investigations; 4. The number of published studies reporting increased genetic damage in cells exposed to RF energy decreased with increased number of quality control measures; and 5. There was a "bias" towards the publications reporting increased genetic damage in cells exposed to RF energy even with very small sample size. Overall, the results from this study underscore the importance of including quality control measures in investigations so that the resulting data are useful, nationally and internationally, in evaluating "potential" health risks from exposure to RF energy.

To date, there has been a lack of published studies examining the validity of the Health Sciences Reasoning Test (HSRT) to assess critical thinking among dental students. The aim of this study was to examine the construct validity of the HSRT using a novice-expert model consisting of first-year dental students as novices and experienced general dentists as experts. Novice cohort subjects were recruited from all 105 students in the first-year dental school class at the University of Texas Health Science Center at San Antonio during a regularly scheduled course in August 2015. A total of 83 students participated, for a 79% response rate. Thirty individuals personally recruited from the same school's faculty and from private practitioners made up the expert cohort. The results showed that the adjusted mean overall score for the expert cohort (25.31) was significantly higher than that of the novice cohort (22.64) (p=0.04). The expert cohort achieved higher adjusted mean scores in all scales (Induction, Deduction, Analysis, Inference, and Evaluation), with the difference in the Analysis scale being significant (p=0.02). In this study, experienced general dentists achieved significantly better overall scores on the HSRT as compared to first-year dental students, suggesting the instrument was able to measure differences between novice and expert. Further efforts to validate the instrument in a dental education setting and to understand its correlation with strategies and practices aimed at developing critical thinking in dental students are warranted.

The purpose of this study was to prospectively evaluate the dimensional bone changes around implants placed immediately with buccal contour augmentation. Patients with hopeless maxillary anterior teeth were treated with extraction, immediate implant placement, and simultaneous buccal contour augmentation. Hard tissue measurements were recorded at the time of implant placement and after 3 months of healing. All implants (N = 18) successfully osseointegrated with a mean buccal bone thickness of 2.94 ± 0.21 mm (mean ± SE) at the implant platform. This was significantly greater compared to previous data on immediate implants placed without contour augmentation (2.32 ± 0.17 mm). Buccal contour augmentation in conjunction with immediate implant placement significantly increased peri-implant buccal bone thickness after 3 months of healing.

Background: Mixed mood states in bipolar disorder are difficult to treat and when present indicate worse illness trajectories. Several medications are US Food and Drug Administration approved to treat mixed episodes; however, the clinical trials have been short term and rarely reported depression response., Methods: We conducted a 5-month open-label trial examining the tolerability and efficacy of iloperidone for bipolar disorder mixed episodes., Results: Mania and depression scores significantly improved over the course of the study for study completers (ie, 60%-68% improvement for manic symptoms and 41%-49% for depression symptoms). Improvements were observed early in the trial and after adjusting for concomitant medication effects. The average daily dose in completers was 15 mg. Thirty-nine percent (12/31) of the eligible sample discontinued early because of adverse effects. The adverse events most commonly associated with withdrawal were increased heart rate/palpitations (n = 5 of 12) and urinary incontinence/intense urge to urinate (n = 3 of 12)., Conclusions: In a subset of patients, iloperidone provides relief for classic manic, depression, and irritability symptoms associated with mixed episodes in a long-term trial. Adverse effect profiles are likely to be a major factor contributing to individualized medication use.

Abstracts: Objective : Given the increase in the incidence of thyroid cancer in the United States, and it's potential public health implications, patient studies assessing ethnic, disparity and health care access are important. In this study, we retrospectively examined the variability in stage of thyroid cancer at presentation and final outcome among Hispanic vs non-Hispanic patients., Method: After obtaining IRB approval, we retrospectively reviewed the medical records of 220 adult patients with papillary thyroid carcinoma(PTC) who were treated at UT Health Science Center San Antonio between1996 and 2013. At disease presentation, patients were staged and risk stratified according to the 2009 American Thyroid Association (ATA) and TNM staging system. Clinical data obtained during the first 6-18 months was used to identify the initial response to therapy and clinical data from the last follow up visit was used to identify the "final" outcome. We examined the effect of insurance and ethnicity on initial response to therapy and final outcome using Chi-square test and one way ANOVA., Result: Our patient population's ATA risk at diagnosis, initial response to therapy and final outcome did not differ by ethnicity (P=0.5, 0.3 &0.4) and insurance coverage(P=0.7, 0.3 & 0.4) ., Conclusion: Insurance coverage and ethnicity may not be independent factors since ethnic minority individuals are more likely to be uninsured.

This study examined whether non-ionizing radiofrequency fields (RF) exposure is capable of inducing poly (ADP-ribose) polymerase-1 (PARP-1) in bone marrow stromal cells (BMSCs) and whether it plays a role in RF-induced adaptive response (AR). Bone marrow stromal cells (BMSCs) were exposed to 900MHz RF at 120μW/cm 2 power flux density for 3h/day for 5days and then challenged with a genotoxic dose of 1.5Gy gamma-radiation (GR). Some cells were also treated with 3-aminobenzamide (3-AB, 2mM final concentration), a potent inhibitor of PARP-1. Un-exposed and sham (SH)-exposed control cells as well as positive control cells exposed to gamma radiation (GR) were included in the experiments. The expression of PARP-1 mRNA and its protein levels as well as single strand breaks in the DNA and the kinetics of their repair were evaluated at several times after exposures. The results indicated the following. (a) Cells exposed to RF alone showed significantly increased PARP-1 mRNA expression and its protein levels compared with those exposed to SH- and GR alone. (b) Treatment of RF-exposed cells with 3-AB had diminished such increase in PARP-1. (c) Cells exposed to RF+GR showed significantly decreased genetic damage as well as faster kinetics of repair compared with those exposed to GR alone. (d) Cells exposed to RF+3-AB+GR showed no such decrease in genetic damage. Thus, the overall date suggested that non-ionizing RF exposure was capable of inducing PARP-1 which has a role in RF-induced AR., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Purpose: This pilot study compared the effectiveness of plaque removal of two manual toothbrushes; a novel toothbrush design and a control reference toothbrush. Methods: Thirty-eight individuals meeting specific criteria consented to participate and were randomly assigned to one of two groups. Subjects were given both study toothbrushes eight days prior to data collection to use on alternate days for two minutes twice daily for familiarization. Subjects refrained from any oral hygiene procedures for twenty-four hours prior to data collection at which time a baseline plaque score was recorded using the O'Leary Plaque Control Record. Following the baseline plaque score recording, timed brushing was supervised by a research assistant, using a split mouth design, followed by a post-brushing plaque score. All plaque scores were recorded by the same examiner blinded to group assignment. Pre- and post-brushing scores were compared using t-tests and analysis of variance (ANOVA) to determine differences. Subjects also completed a qualitative survey on the two brushes. Results: When compared to overall plaque scores, no significant differences were shown between the two brushes or when compared to all interproximal surfaces, all smooth surfaces and left vs. right sides. Both brushes performed better on the left side. The control brush was slightly more effective than the novel brush in the mandible (p=0.0222) and on lingual (p=0.0169) surfaces. Results of the survey showed that the subjects significantly favored the novel brush. Conclusion: Both brushes were effective, although the reference brush was slightly more effective in plaque removal than the novel design brush in the mandible and on lingual surfaces; however, the novel brush was preferred by participants., (Copyright © 2017 The American Dental Hygienists’ Association.)

Background: To date, limited evidence is available specifically evaluating ridge preservation (RP) and implant placement in molar sites. The primary aim of this study is to radiographically compare alveolar ridge changes with and without RP with cone-beam computed tomography (CBCT)., Methods: This parallel, two-arm randomized clinical trial included 40 patients evenly distributed between two treatment groups. After molar extraction, sites were allowed to heal naturally or received RP with freeze-dried bone allograft covered by a non-resorbable dense polytetrafluoroethylene membrane. CBCT scans were taken immediately and 3 months postextraction, and then a dental implant was placed. Width and height measurements were made radiographically., Results: Significantly greater loss in alveolar ridge height was found in molar sites allowed to heal without RP on the buccal aspect of the socket (RP: -1.12 ± 1.60 mm versus no RP: -2.60 ± 2.06 mm, P = 0.01). No significant difference in ridge width loss was found between groups. Two-thirds ridge width reduction was experienced on the buccal aspect in sites without RP, but width loss was evenly distributed between buccal and lingual aspects when RP was performed. Bone grafting at time of placement was required in 25% of implants in the group without RP versus 10% of implants in the RP group., Conclusions: In molar extraction sites without RP, significantly more reduction in ridge height occurred, and the majority of ridge width loss was localized to the buccal aspect. When RP was performed, ridge width loss was not significantly decreased, but the loss was evenly distributed between facial and lingual aspects of the extraction site.

Background: A Spanish language rating scale which assesses the range of bipolar disorder symptoms is needed. There are rating scales commonly used, however they do not address commonly expressed symptoms associated with bipolar disorder and have varied rating systems. There are also few comparisons of symptom severity between Spanish and English speaking patients, due to limitations in available rating scales., Methods: We conducted psychometric assessment of the Spanish language Bipolar Inventory of Symptoms Scale (BISS) (N=71) for persons with bipolar disorder, which assesses 5 domains: mania, depression, irritability, anxiety and psychosis. The Spanish BISS scores were then compared to the MADRS (Montgomery Asberg Depression Rating Scale) and the YMRS (Young Mania Rating Scale) as well as to BISS scores in an English speaking sample (N=102) with bipolar disorder from the same geographic locations., Results: Chronbach's alphas for the Spanish BISS ranged from 0.6 to 0.93, with the psychosis domain displaying lower reliability. Correlations with the MADRS and YMRS were good and ranged from 0.70 to 0.88. The BISS differentiated well across mood states in English and Spanish versions, with mood state differentiated well using subscales and domains. For the irritability and anxiety domains, Spanish speaking participants had higher scores than English speakers across mood states. Females showed differences in symptom profiles compared to males., Limitations: The sample sizes in the Spanish speaking manic group were small. The Spanish BISS, tested here primarily in patients of Mexican ancestry, may require revision in other Spanish language populations., Conclusions: The Spanish BISS, a Spanish language symptom rating scale for bipolar disorder, demonstrates good reliability and validity. Clinical assessment in anxiety and irritability domains is particularly relevant in a Spanish speaking sample. Consistent with prior research, females report higher depression, irritability and anxiety scores irrespective of language spoken., (Copyright © 2016. Published by Elsevier B.V.)

The aim of this study was to compare the learning preferences of millennial dental hygiene students (born between 1982 and 2002) in the U.S. with the teaching methods used by their non-millennial instructors. Cross-sectional surveys were developed with 21-item, five-point Likert scales to examine students' preferences for and faculty use of lecture, collaborative activities, technology, independent work, and group discussion. Surveys were emailed to U.S. dental hygiene program directors in September 2015. The respondents totaled 800 students and 343 faculty members-approximately 5% of all dental hygiene students and 6.8% of all dental hygiene faculty members in the U.S. The results showed that the responding faculty members (88.7%) used case studies more than the students (61.2%) preferred and that the students (71.4%) preferred games when learning more than the faculty members (57.2%) used them (p<0.0001). Student respondents (82.1%) preferred handouts for lecture more than did the faculty respondents (58.8%; p<0.0001). Faculty respondents expected students to read before class 39.3% more than student respondents read (p<0.0001). Student respondents preferred study guides for exams 39.2% more than the faculty respondents provided them (p<0.0001). Participating faculty members (84.0%) had students work in groups more than these students preferred (57.8%), and 92% of these faculty members used group activities in class (p<0.0001). The responses of the millennial dental hygiene students in this study were consistent with previous research on millennial traits. This study found areas of disagreement between students and faculty members on the use of case studies, study guides, and group work. Although these students stated they preferred lecture over group work, trends in education stress using active learning over lecture.

Purpose: To examine the extent of genetic damage, assessed from deoxyribonucleic acid (DNA) double-strand breaks (DSBs) and micronuclei (MN) in peripheral blood mononuclear cells obtained from individuals repeatedly exposed to 7T Magnetic Resonance Imaging (MRI)., Materials and Methods: The study protocol was approved by the local ethics committee. Informed consent was obtained from 22 healthy, non-smoking, non-alcoholic male individuals, who had never undergone radio-/chemo-therapy, scintigraphy, and had not undergone X-ray examination one year prior blood withdrawal. Eleven participants were repeatedly exposed to 7T and 3T MRI while working with/around scanners or frequently participating as 7T and lower field MRI research subjects (mean age 34±7years). The other half was never exposed to 7T or lower field MRI and served as controls (mean age 33±9years). The damage in lymphocytes was assessed using anti-γH2AX immunofluorescence staining of DNA DSBs and by quantification of MN. Isolated cells were further exposed in vitro to 7T MRI either alone or in the presence of the DNA damaging drug etoposide, to determine if there is any additional combined effect. The kinetics of DNA damage repair were examined., Results: The mean base-level of γH2AX foci/cell and incidence of MN between repeatedly exposed and control group were not significantly different (P=0.618 and P=0.535, respectively). The additional in vitro exposure of cells to 7T MRI had no significant impact on MN frequencies and γH2AX foci at 1, 20 and 72h after exposure., Conclusion: Frequently repeated 7T MRI exposure did not result in a detectable increase in genotoxicity indices and alterations of DNA repair kinetics., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this investigation was to compare the accuracy of facial models fabricated using facial moulage impression methods to the three-dimensional printed (3DP) fabrication methods using soft tissue images obtained from cone beam computed tomography (CBCT) and 3D stereophotogrammetry (3D-SPG) scans., Materials and Methods: A reference phantom model was fabricated using a 3D-SPG image of a human control form with ten fiducial markers placed on common anthropometric landmarks. This image was converted into the investigation control phantom model (CPM) using 3DP methods. The CPM was attached to a camera tripod for ease of image capture. Three CBCT and three 3D-SPG images of the CPM were captured. The DICOM and STL files from the three 3dMD and three CBCT were imported to the 3DP, and six testing models were made. Reversible hydrocolloid and dental stone were used to make three facial moulages of the CPM, and the impressions/casts were poured in type IV gypsum dental stone. A coordinate measuring machine (CMM) was used to measure the distances between each of the ten fiducial markers. Each measurement was made using one point as a static reference to the other nine points. The same measuring procedures were accomplished on all specimens. All measurements were compared between specimens and the control. The data were analyzed using ANOVA and Tukey pairwise comparison of the raters, methods, and fiducial markers., Results: The ANOVA multiple comparisons showed significant difference among the three methods (p < 0.05). Further, the interaction of methods versus fiducial markers also showed significant difference (p < 0.05). The CBCT and facial moulage method showed the greatest accuracy., Conclusions: 3DP models fabricated using 3D-SPG showed statistical difference in comparison to the models fabricated using the traditional method of facial moulage and 3DP models fabricated from CBCT imaging. 3DP models fabricated using 3D-SPG were less accurate than the CPM and models fabricated using facial moulage and CBCT imaging techniques., (© 2015 by the American College of Prosthodontists.)

Purpose: The purpose of this study was to examine the knowledge, attitude and practice behaviors of dental hygienists' providing oral health care to pregnant women., Methods: Data was collected from an anonymous electronic survey administered to all Michigan Dental Hygiene Association (MDHA) members (n=1,047). The survey asked questions which assessed dental hygienists knowledge, behaviors and attitudes when providing oral care to pregnant patients. Statistical analysis was conducted correlating years in practice and years since dental hygiene degree with survey questions to identify any correlations., Results: The response rate was 14.4% (n=150). Results indicated that regardless of years of experience, or level of degree, the majority of the respondents surveyed (64%) desired more education about caring for a pregnant patient. Ninety percent of respondents reported willingness to provide care for pregnant women, and 85% indicated they or their employers agreed to accept referrals to treat pregnant women. Respondents' knowledge indicated the following treatments could be provided throughout pregnancy: Prophylaxis (95.8%), emergency care (92.7%), periodontal treatment (76.3%) and restorative care (61.5%). One question. "dental hygiene services should only be provided during the second trimester," was written in the negative, with a disagree rate of 85.6% indicated a high level of knowledge about this topic., Conclusion: Dental hygienists are in a position to use current findings, protocols and practice guidelines to provide preventive oral health care and advocate for the pregnant patient. This study found continuing education regarding oral health care and pregnancy was desired by many dental hygienists., (Copyright © 2016 The American Dental Hygienists’ Association.)

Aim: The objective of the study was to compare (i) esthetic, (ii) clinical and (iii) patient-centered outcomes following immediate (Type 1) and early implant placement (Type 2)., Material and Methods: Thirty-eight subjects needing a single extraction (premolar to premolar) were randomly allocated to Type 1 or Type 2 implant placement. Three months following permanent crown insertion, evaluation of (i) esthetic outcomes using soft tissue positions, and the pink and white esthetic scores (PES/WES), (ii) clinical performance using probing pocket depth (PPD), modified plaque index (mPI) and modified sulcus bleeding index (mSBI) around each implant and (iii) patient satisfaction by means of a questionnaire using a visual analogue scale (VAS) was performed., Results: Thirty-two patients completed the 3-month follow-up examination (Type 1, n = 17; Type 2, n = 15) with a 100% implant survival rate. Type 1 implants lost 0.54 ± 0.18 mm of mid-facial soft tissue height, while Type 2 implants lost 0.47 ± 0.31 mm (P > 0.05). The papillae height on the mesial and distal was reduced about 1 mm following both procedures. The PES/WES following Type 1 implant placement amounted to 13.7 ± 0.6 and 12.5 ± 0.7 in the Type 2 group (P > 0.05). PPD, mPI and mSBI were low in both groups (P > 0.05). Patient-centered outcomes failed to demonstrate any statistical difference between the two cohorts., Conclusion: Three months following final crown delivery, there were no significant differences in esthetic, clinical and patient-centered outcomes following Type 1 and Type 2 implant placement. On the short term, one may achieve good optimal esthetic and clinical results irrespective of these two placement protocols. These results need to be confirmed on the long term., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The purpose of this study was to compare extraoral panoramic bitewings (BWs) to intraoral photostimulable phosphor (PSP) plate BWs for the detection of proximal surface caries and to establish if there was any difference between extraoral BWs, intraoral BWs and panoramic radiographs in visualizing open posterior interproximal contacts., Methods: Extraoral panoramic and intraoral BW images were acquired on each of 20 patients, resulting in 489 total non-restored, readable surfaces that were evaluated by 4 observers. The ANOVA analysis to determine diagnostic variability between and within each subject was utilized. The surfaces included in the study extended from the distal of each canine to the last posterior contact in each arch with non-readable proximal surfaces excluded (i.e.surfaces where over half the enamel layer was overlapped or where those surfaces were not visible in one or both modalities)., Results: The statistical analysis indicated that the overall mean area under the receiver operating characteristic curves across all observers for the intraoral BWs and extraoral panoramic BWs were 0.832 and 0.827, respectively, and the difference of 0.005 was not significant at p = 0.7781. The percentage of non-readable proximal surfaces across the three modalities was 4.1% for intraoral BWs, 18.3% for extraoral panoramic BWs and 51.5% for the standard panoramic images., Conclusions: The investigators concluded there was no significant difference in posterior proximal surface caries detection between the modalities. Extraoral panoramic BWs were much better than panoramic radiographs in visualizing open posterior interproximal contacts, 81.7% vs 48.5%, but below the 95.9% value for intraoral BWs.

Adult male ICR mice were exposed to continuous wave 900MHz radiofrequency fields (RF) at 1.6mW/cm(2) power intensity (whole body average specific absorption rate of 0.731W/kg) for 4 hour/day for 15 days. At the end of exposure, each mouse was caged with 3 mature virgin female mice for mating. After 7 days, each male mouse was transferred to a fresh cage and mated with a second batch of 3 females. This process was repeated for a total of 4 consecutive weeks. Sham exposed male mice and those subjected to an acute 2Gy γ-irradiation (GR) were handled similarly and used as un-exposed and positive controls, respectively. All females were sacrificed on the 18th day of gestation and presumptive mating and, the contents in their uteri were examined. The overall observations during the 4 weeks of mating indicated that the un-exposed female mice mated to RF-exposed male mice showed no significant differences in the percentage of pregnancies, total implants, live implants and dead implants when compared with those mated with sham-exposed mice. In contrast, female mice mated with GR-exposed males showed a consistent pattern of significant differences in the above indices in each and all 4 weeks of mating. Thus, the data indicated an absence of mutagenic potential of RF exposure in the germ cells of male mice., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Purpose: Although milled titanium may be used as a substructure in fixed and implant prosthodontics, the application of the veneering porcelain presents particular challenges compared to traditional alloys. To address these challenges, some Ti ceramic systems incorporate the application of a bonding agent prior to the opaque layer. Vita Titankeramik's bonding agent is available as a powder, paste, and spray-on formulation. We examined the effect of these three application methods on the bond strength., Materials and Methods: Four titanium bars were milled from each of 11 wafers cut from grade II Ti using the Kavo Everest milling unit and a custom-designed milling toolpath. An experienced technician prepared the 25 × 3 × 0.5 mm(3) metal bars and applied bonding agent using one of three application methods, and then applied opaque, dentin, and enamel porcelains according to manufacturer's instructions to a 8 × 3 × 1 mm(3) porcelain. A control group received no bonding agent prior to porcelain application. The four groups (n = 11) were blindly tested for differences in bond strength using a universal testing machine in a three-point bend test configuration, based on ISO 9693-1:2012., Results: The average (SD) bond strengths for the control, powder, paste, and spray-on groups, respectively, were: 24.8 (2.6), 24.6 (2.6), 25.3 (4.0), and 24.1 (3.9) MPa. One-way ANOVA and Tukey's multiple comparison tests were performed between all groups. There were no statistically significant differences among groups (p = 0.951)., Conclusion: Titanium-porcelain bond strength was not affected by the use of a bonding agent or its application method when tested by ISO 9693-1 standard., (© 2014 by the American College of Prosthodontists.)

Statement of Problem: Surgical guides aid in accurately placing dental implants to achieve a predictable restorative outcome. Which surgical guide fabrication technique results in the most accurately fitting surgical guide is unknown., Purpose: The purpose of this investigation was to determine the internal fit of dental implant surgical guides on dentate and edentulous ridges by using implant surgical guides fabricated from conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) techniques., Material and Methods: Eighty surgical guides were fabricated from conventional and CAD/CAM techniques; half were designed from Kennedy Class 2 (K2) casts, and half were designed from Kennedy Class 3 (K3) casts. Conventional surgical guides were fabricated from acrylic resin. The CAD/CAM surgical guides were scanned by using cone beam computed tomography (CBCT) or an optical scan (OS). The guides were printed with stereolithography (SL) or 3-dimensional digital printing (3DP). All surgical guides were cemented to their respective design casts, sectioned, and measured at standardized locations. A 2-way ANOVA and the post hoc Fisher least square difference t test was performed (α=.05)., Results: The 2-way ANOVA indicated that the difference between surgical guide groups and Kennedy class was statistically significant (P<.05) and the interaction between groups and Kennedy class was statistically significant (P<.05). The OS/3DP CAD/CAM guide was the best-fitting cast for the K2 cast group, and the conventional guide was the best-fitting guide for the K3 group., Conclusions: Conventionally fabricated and OS surgical guides have greater accuracy of fit than CBCT scanned surgical guides., (Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Background: ADAMTS 13, sP-Selectin and HSP27 have been investigated as potential prognostic markers in patients with hemorrhagic shock., Methods: This study was part of a double-blind, randomized, parallel-group, controlled trial and included seventeen trauma patients presented to ED with severe hemorrhagic. The sera for testing were collected from these patients at the time of admission. Investigators and laboratory personnel performing testing were blinded to the patients' identity and clinical course., Results: The prognostic value of ADAMTS13, sP-Selectin, and HSP27 was compared to prognostic value of systolic blood pressure (SBP), base deficit estimation (BD), heart rate (HR), shock index (SI) and tissue oxygen saturation (StO2) by constructing the receiver operation characteristics (ROC). The area under the curve (AUC) of the ROC for HSP27 (0.92) was greater than for SBP (0.45), BD (0.89), HR (0.61), SI (0.45) and StO2 (0.46). AUC for sP-Selectin (0.86) and for ADAMTS13 antigen (0.74) were comparable with BD one, but greater than for the rest of currently used tests., Conclusion: Serum concentrations of ADAMTS13, HSP27 and sP-Selectin measured during the admission, appear to be comparable to or better than SBP, BD, SI, HR and StO2 in predicting MODS and death after hemorrhage from trauma. These potential new markers deserve further investigation., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Rifapentine is highly protein bound in blood, but the free, unbound drug is the microbiologically active fraction. In this exploratory study, we characterized the free plasma fraction of rifapentine in 41 patients with tuberculosis. We found a lower total rifapentine concentration but significantly higher free rifapentine levels in African patients of black race compared to non-Africans. These data support larger pharmacokinetic/pharmacodynamic studies to confirm these findings and assess free rifapentine in relation to microbiological and clinical outcomes., (Copyright © 2014, American Society for Microbiology. All Rights Reserved.)

While there are studies postulating a model of synergism between human papillomavirus (HPV) and herpes simplex virus (HSV) in cervical carcinogenesis, the frequency of anal herpes as well as its association with anal squamous intraepithelial lesions (ASILs) has been understudied in men. This study evaluates the frequency of HSV changes in anal Pap smears and its association with ASILs in a high-risk population. A computerized search for specimens associated with anal cytology that had positive findings of HSV was performed. The electronic medical records were examined for past diagnosis of herpes, HSV serology prior to or after cytology, and if the patient received treatment after cytologic diagnosis of HSV. Of the 470 anal Pap smears (Thin-prep) examined, seven had cellular changes consistent with HSV infection. All patients were asymptomatic human immunodeficiency virus (HIV) positive males with no prior HSV serology tests. Two patients had prior diagnoses of HSV infection. Cytologic abnormalities were identified in 86% ranging from atypical squamous cells of undetermined significance to high grade squamous intraepithelial lesion. Three patients were treated after the HSV cytologic diagnosis. The frequency of HSV changes in anal Pap smear is low (1.48%), but the presence of concomitant cytologic abnormalities is high (86%). While our findings suggest the possible role of HSV as a HPV co-factor in ASILs, larger studies are needed to support this. Identification of HSV infection on anal Pap smear is important for institution of patient treatment and subsequent reduction of transmission., (Copyright © 2014 Wiley Periodicals, Inc.)

Background: In a phase 3, randomized clinical trial (PREVENT TB) of 8053 people with latent tuberculosis infection, 12 once-weekly doses of rifapentine and isoniazid had good efficacy and tolerability. Children received higher rifapentine milligram per kilogram doses than adults. In the present pharmacokinetic study (a component of the PREVENT TB trial), rifapentine exposure was compared between children and adults., Methods: Rifapentine doses in children ranged from 300 to 900 mg, and adults received 900 mg. Children who could not swallow tablets received crushed tablets. Sparse pharmacokinetic sampling was performed with 1 rifapentine concentration at 24 hours after drug administration (C24). Rifapentine area under concentration-time curve (AUC) was estimated from a nonlinear, mixed effects regression model (NLME)., Results: There were 80 children (age: median, 4.5 years; range, 2-11 years) and 77 adults (age: median, 40 years; all ≥18 years) in the study. The geometric mean rifapentine milligram per kilogram dose was greater in children than in adults (children, 23 mg/kg; adults, 11 mg/kg). Rifapentine geometric mean AUC and C24 were 1.3-fold greater in children (all children combined) than in adults. Children who swallowed whole tablets had 1.3-fold higher geometric mean AUC than children who received crushed tablets, and children who swallowed whole tablets had a 1.6-fold higher geometric mean AUC than adults. The higher rifapentine doses in children were well tolerated. To obtain rifapentine exposures comparable in children to adults, dosing algorithms modeled by NLME were developed., Conclusions: A 2-fold greater rifapentine dose for all children resulted in a 1.3-fold higher AUC compared to adults administered a standard dose. Use of higher weight-adjusted rifapentine doses for young children are warranted to achieve systemic exposures that are associated with successful treatment of latent tuberculosis infection in adults., (Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society 2014. This work is written by US Government employees and is in the public domain in the US.)

There is widespread concern among the general public regarding the ever increasing use of mobile phones. The concern is mainly because the antenna which transmits nonionizing radiofrequency fields is held close to the head during use and thus might cause brain cancer. By far, the largest epidemiological study was conducted by the INTER-PHONE study group and the results were published in 2011. The author's conclusions were (i) no increased risk of meningioma and glioma in mobile phone users and (ii) there were suggestions of an increased risk for glioma at the highest exposure levels but, bias and error prevented a causal interpretation. We have carefully examined all of the odd ratios presented in the INTERPHONE study publication: our results showed 24.3% decreased and 0.7% increased risk for meningioma and 22.1% decreased and 6.6% increased risk for glioma. Hence, we hypothesize that the overwhelming evidence for the decreased risk for both diseases may be due to the induction of 'adaptive response' which is well-documented in scientific literature.

Objectives: Latent tuberculosis infection and tuberculosis disease are prevalent worldwide. However, antimycobacterial rifamycins have drug interactions with many antiretroviral drugs. We evaluated the effect of rifapentine on the pharmacokinetic properties of raltegravir., Methods: In this open-label, fixed-sequence, three-period study, 21 healthy volunteers were given: raltegravir alone (400 mg every 12 h for 4 days) on days 1-4 of Period 1; rifapentine (900 mg once weekly for 3 weeks) on days 1, 8 and 15 of Period 2 and raltegravir (400 mg every 12 h for 4 days) on days 12-15 of Period 2; and rifapentine (600 mg once daily for 10 scheduled doses) on days 1, 4-8 and 11-14 of Period 3 and raltegravir (400 mg every 12 h for 4 days) on days 11-14 of Period 3. Plasma raltegravir concentrations were measured. ClinicalTrials.gov database: NCT00809718., Results: In 16 subjects who completed the study, coadministration of raltegravir with rifapentine (900 mg once weekly; Period 2) compared with raltegravir alone resulted in the geometric mean of the raltegravir AUC from 0 to 12 h (AUC0-12) being increased by 71%; the peak concentration increased by 89% and the trough concentration decreased by 12%. Coadministration of raltegravir with rifapentine in Period 3 did not change the geometric mean of the raltegravir AUC0-12 or the peak concentration, but it decreased the trough concentration by 41%. Raltegravir coadministered with rifapentine was generally well tolerated., Conclusions: The increased raltegravir exposure observed with once-weekly rifapentine was safe and tolerable. Once-weekly rifapentine can be used with raltegravir to treat latent tuberculosis infection in patients who are infected with HIV.