[Clinical significance of the Krogh-Poulsen bite test in mandibular dysfunction]

INTRODUCTION

The bite test was initially described as the Krogh-Poulsen test consists of biting a flat and thin wedge placed unilaterally between the molars. Temporomandibular joint (TMJ) pain located on the ipsilateral side is considered as muscular, when on the contralateral side pain signifies a joint problem. Although this test is widely used, no scientific evaluation of its real clinical value has been published.

MATERIAL AND METHOD

A prospective study is conducted in 32 patients exhibiting temporomandibular pain (n=40) at the bite test. The results of the bite test were compared with results of computed tomography of the TMJ. Several criteria are studied: joint space narrowing, retrusion of the mandibular condyle in occlusal position, bony signs of joint degeneration. Chi-square and Student's t test were used for statistical analysis of correlations between clinical findings and radiological abnormalities.

RESULTS

Significant results demonstrated a high degree of radiologically detectable disorders in patients with joint pain as defined by the bite test. All of these patients presented at least one radiological sign of joint disease. There was also a low degree of radiologically detected joint disturbance in patients with muscular pain according to the bite test, 70% of them presenting no radiological abnormality.

DISCUSSION

It is concluded that the bite test is of significant value for evaluation of TMJ disorders and can be useful for the indication of complementary radiological examinations.

Plasmodium falciparum EBA-140 kDa protein peptides that bind to human red blood cells

The erythrocyte-binding antigen 140 (EBA140) sequence was chemically synthesized in 61 20-mer sequential peptides covering the entire 3D7 protein strain, each of which was tested in erythrocyte-binding assays. Peptides 26135, 26144, 26147, 26160, 26170 and 26177 presented high erythrocyte-binding activity, with affinity constants ranging from 350 to 750 nM. Critical erythrocyte-binding residues were determined by competition-binding assays with glycine analogous peptides. Cross-linking assays with SDS-PAGE from high erythrocyte membrane protein binding peptides showed that all these peptides bound specifically to 25, 52 and 75 kDa erythrocyte membrane proteins. The nature of these receptor sites was studied in peptide-binding assays using enzyme-treated erythrocytes, showing that these protein receptors are susceptible to structural changes provoked by enzyme treatment (neuraminidase, trypsin or chymotrypsin). Inhibition invasion assays in 'in vitro' cultures showed that all specific high binding sequences were able to inhibit invasion by 11-69% at 200 microM concentration.

Influence of preapheresis clinical factors on the efficiency of CD34+ cell collection by large-volume apheresis

We evaluated 120 leukapheresis procedures (93 patients), in order to detect clinical factors that influence the efficiency of CD34+ collection using Cobe Spectra trade mark cell separators. Hematocrit was >27% and platelet count >30 000/microl in >95% of patients. Platelet transfusions were given if the postprocedure count was &<20 000/microl. Multiple regression analysis was used to analyze putative factors, and a predictive equation defined by stepwise regression modeling. The mean efficiency was 0.59 (s.d. 0.27). Sex (M>F; P=0.01), the volume processed (inversely; P=0.01) and CD34+ cell count (inversely; P=0.04) were associated with efficiency, whereas hematocrit, platelet or leukocyte count, catheter type and patient weight were not. The effect size for predictive factors was small (R(2)=0.21). Adverse events were limited to hypocalcemia. We conclude that female sex, volume processed and CD34+ cell count adversely influence the efficiency of CD34+ cell leukapheresis. However, the impact of volume and CD34+ cell count is small, and likely to be offset by the influence of these same factors on overall yield. Leukapheresis appears to be safe and efficient for autologous blood and marrow transplantation patients with hematocrit >27% and platelet count >30 000/microl.

Epidemiology of necrotizing ulcerative gingival lesions in adolescents

OBJECTIVE AND BACKGROUND

Relatively little is known about the epidemiology of necrotizing ulcerative gingival lesions (NUG) in adolescent populations. Most studies have comprised special target groups, such as military recruits, HIV patients, or severely malnourished subjects.

METHODS

A multistage random cluster sampling scheme was used to obtain a sample of 9203 students aged 12-21 years from 98 of a total of 618 high schools in Santiago, Chile. Students were given a clinical oral examination and questionnaire information was obtained on smoking and oral hygiene habits, dental attendance patterns, and diabetic status. The diagnostic criteria for NUG were the presence of necrosis and ulceration of at least one interproximal papillae.

RESULTS

The estimated prevalence of NUG was 6.7% (95% CI = [6.2; 7.3]). A multivariable logistic regression analysis showed that last seeing a dentist more than 1 year ago (OR = 1.60), or never (OR = 1.93), and reporting diabetes (OR = 2.12) showed a significant positive association with the presence of NUG; whereas neither gender nor smoking were important predictors. Students aged 18-21 years were more, albeit statistically insignificantly, likely to have NUG than were younger students (OR = 1.40).

CONCLUSIONS

Our observation that reporting to be diabetic was positively associated with the presence of NUG is interesting, as diabetes has never been addressed as a possible risk factor. As the association between diabetes and periodontitis in adults is thought to relate to impaired function of neutrophils, microangiopathy, and impaired wound healing this finding suggests a significant role of the host response also for the occurrence of NUG.

Predictive value of P53, BCL-2, and BAX in advanced head and neck carcinoma

Because the apoptotic process appears to be involved in the response-to-treatment of chemotherapy and radiotherapy, we investigated the prognostic value of the expression of three apoptosis-associated genes (p53, Bax, and Bcl-2) in tumor biopsies from patients with locally advanced head and neck carcinoma. Using specific monoclonal antibodies, immunohistochemical staining for p53, Bax, and Bcl-2 was performed on tumor material from 43 patients before their scheduled adjuvant chemoradiotherapy. Results indicated that the response to treatment was 83.7% (36 of 43 patients). Bax staining was positive in 8 cases (19.5%), p53 in 19 (47.5%), and Bcl-2 in 4 patients (10.8%). There were no statistically significant correlations between any of the apoptosis genes assayed and the patients' response to treatment or to overall survival. In the univariate statistical analysis, response-to-treatment was the only significant variable (p = 0.013) predictive of survival rate. These results suggest that p53, Bax, and Bcl-2 expression are not significant predictive factors of response to induction treatment in locally advanced head and neck carcinoma and that their routine use as prognostic markers cannot be recommended.

Domestic scorpion control with pyrethroid insecticides in Mexico

Scorpion stings cause more morbidity in Mexico than any other country, leading to about 100 deaths annually. In 1999, the State of Morelos reported nine deaths among 30663 cases of scorpion sting. To replace lindane used for scorpion control, field trials of pyrethroid pesticides were undertaken in Morelos during 1998-2000 at the village of Chalcatzingo (population initially with 2760 inhabitants and 530 houses). Pre-intervention surveys detected scorpions (Scorpiones: Buthidae) of two species in the majority of houses: Centruroides limpidus limpidus Karsch outnumbering Vaejovis mexicanus smithi Koch. Scorpion prevalence was assessed, pre- and post-spray, directly by searching (40 min/house) and by householder reports of sightings inside houses. Pre-intervention perceptions of scorpion abundance were similar for all areas, with sightings in 12-18% of houses, whereas daytime searches detected more infestations in eastern parts of the village (prevalence 17% indoors, 22% outdoors) than in other sectors (9% indoors, 14% outdoors). Pyrethroids were evaluated as residual treatments in separate sectors of Chalcatzingo, with almost complete coverage indoors and peridomestically, using the following four formulations: bifenthrin 10% wettable powder (WP) applied at 50mg a.i./m2, cyfluthrin 10% WP (Solfac 10 WP) at 44-55 mg a.i./m2, deltamethrin 2.5% suspension concentrate (Biothrin 25 SC) at 11 mg a.i./m2 and 5% WP (K-Othrine 50 WP) at 35 mg a.i./m2. Phase 1 compared bifenthrin 10 WP, Solfac 10 WP and Biothrin 25 SC sprayed in December 1998; phase 2 compared Solfac 10 WP and K-Othrine 50 WP sprayed in June and again in December 2000, with follow-up surveys of scorpions one month post-spray and subsequently. Scorpion prevalence was reduced by 64-77% peridomestically one month post-spray and by 83, 46 and 15% in houses sprayed with cyfluthrin WP, bifenthrin WP or deltamethrin SC, respectively. Householder reports of sighting scorpions indoors were 33-85% below pre-intervention levels. Cumulative effects of the three spray-rounds over 3 years reduced scorpion prevalence by approximately 60% in the deltamethrin WP re-sprayed area and by approximately 90% in the cyfluthrin WP re-sprayed area. Householder sightings also fell by 67 and 28% in the cyfluthrin and delta-methrin re-sprayed areas, respectively. Operational efficacy of these products against scorpions at the dosages applied was ranked as cyfluthrin WP > bifenthrin WP > deltamethrin SC > WP. Reported cases of scorpion sting intoxication fell by 17% during this study after having risen by approximately 40% over four previous years.

The role of histidine in the anemia of folate deficiency

The amino acid histidine is metabolized to glutamic acid in mammalian tissue. Formiminoglutamic acid (FIGLU) is an intermediary in this reaction, and tetrahydrofolic acid is the coenzyme that converts it to glutamic acid. A test for folate deficiency concerns the measurement of urinary FIGLU excretion after a histidine load. It was observed that folate-deficient individuals receiving the histidine for the FIGLU test made hematological response that alleviated the anemia associated with this deficiency. This was unusual in that a biochemical test to determine the deficiency results in a beneficial effect for one aspect of the deficiency. The studies reported in this paper give a metabolic explanation for this phenomenon. Urine was collected for 24 hr from 25 folate-deficient subjects, 10 vitamin B(12)-deficient subjects, and 15 normal controls. Urinary excretion of histidine was a mean of 203 mg with a range of 130-360 mg for the folate-deficient subjects; 51.5 mg with a range of 30-76.6 mg for normal subjects; and 60.0 mg with a range of 32.3-93.0 mg for the vitamin B(12)-deficient subjects. All the folate-deficient subjects subsequently made a hematological response to the histidine administered for the FIGLU test. No hematological response was observed in the vitamin B(12)-deficient individuals. When folic acid was given to folate-deficient subjects who received no histidine, urinary histidine levels returned to normal levels rapidly and this was followed by a hematological response. Others have shown that volunteers fed a histidine-free diet developed anemia. In normal subjects, histidine is excreted much more in the urine than other essential amino acids are. Hemoglobin protein contains 10% histidine. Under normal conditions, dietary histidine can supply sufficient histidine to prevent anemia. When the dietary intake is diminished or the urinary excretion is greatly increased, anemia results. It is concluded that folate deficiency causes histidine depletion through increased urinary excretion of this amino acid. Feeding histidine replenishes tissue levels of histidine, resulting in hemoglobin regeneration. Folic acid administration results in return of histidine to normal urinary levels. Thus, a combination of folic acid histidine would be beneficial for folate deficient individuals.

Effect of acute cigarette smoking, alone or with alcohol, on gastric barrier function in healthy volunteers

BACKGROUND

Smoking is a risk factor for gastroduodenal ulcer and gastric adenocarcinoma. However, the pathophysiological mechanisms induced by acute cigarette smoking in the human gastric mucosa are poorly understood.

AIM

To evaluate the effect of acute cigarette smoking, alone or with alcohol, on the gastric permeability to sucrose, a specific marker of mucosal damage in the stomach.

SUBJECTS AND METHODS

Twenty healthy volunteers (8 smokers/12 non-smokers) were studied. Each fasted subject ingested 500 ml of a 20% sucrose solution and the amount of sucrose excreted in a 5-hour urine collection was measured by gas chromatography Four sucrose permeability tests were carried out: 1. basal, 2. while smoking 5 cigarettes, 3. after drinking 50 ml of a 40 degrees alcoholic beverage, 4. a combination of 2+3.

RESULTS

Sucrose excretion increased after alcohol ingestion (40.5 +/- 6.0 mg vs 143.1 +/- 28.9 mg, p = 0.002), but was not modified by acute cigarette smoking (34.4 +/- 5.9 mg). When alcohol and cigarettes were simultaneously consumed, the increase in alcohol-induced sucrose excretion was significantly reduced (73.1 +/- 16.6 mg, p = 0.03). Basal sucrose excretion was similar in smokers and non-smokers. However, in acute cigarette smoking, a decrease in sucrose excretion was observed in smokers (p = 0.02) but not in non-smokers.

CONCLUSIONS

These results indicate that acute cigarette smoking may tighten the gastric mucosa in habitual smokers and this is associated with a smaller increase of gastric permeability induced by alcohol.

[The tuberous breast: a review]

The tuberous breast is one of the most challenging problem in breast surgery. Pediatricians, gynaecologists and plastic surgeons are particularly concerned with the treatment of these young patients. A good assessment of the pathology and a precise knowledge of the surgical procedures are keypoints for a successful treatment. A case report will precede a literature overview of this very complex problem.

The need for continuous immunosuppression with cyclosporin A to maintain an experimental model of uveal melanoma

We investigated the need for continuous immunosuppression to maintain experimental tumours derived from human uveal melanoma cells implanted in the choroid of pigmented rabbits. Two groups of pigmented rabbits immunosuppressed with cyclosporin A (CsA) were implanted with human uveal melanoma cells in the suprachoroidal space. After 5 weeks, CsA was discontinued in group 2. Animals were treated with prophylactic antibiotics and examined weekly for tumour growth, weight and secondary effects; blood urea nitrogen levels were measured every two weeks. Autopsies and histopathological studies were performed after death or euthanasia at the end of week 12. The difference between the groups in the development of ophthalmoscopic tumours was not statistically significant 5 weeks after implantation. Tumours in group 1 grew progressively throughout the experiment, whereas group 2 tumours showed marked regression 3-4 weeks after discontinuing CsA. Tumours in group 1 were significantly larger and had greater mitotic activity and showed more ciliary body, optic nerve and extrascleral invasion than tumours in group 2, which showed massive fibrosis, minimal mitotic activity and marked inflammatory cell infiltration. Continuous immunosuppression with CsA seems to be necessary to maintain tumour growth in this experimental model of uveal melanoma.

Metabolic characteristics of multiparous Angus and Brahman cows grazing in the Chihuahuan Desert

Understanding metabolic differences between breeds of cattle is important when selecting for production in semiarid environments. Spring-calving multiparous Angus and Brahman cows (n = 8/breed) grazing in the Chihuahuan Desert were used to evaluate metabolic hormone status in February (i.e., 3rd trimester of pregnancy), May (i.e., early lactation), and September (i.e., late lactation) 2000. Crude protein in ruminal digesta collected from grazing companion ruminally cannulated cows during these months was 5.6, 6.0, and 10.3%, respectively. Angus cows were heavier (P < 0.01) than Brahman cows across months. Body condition scores among breed groups were 4.4, 3.6, and 4.6 in February, May, and September with Brahman cows tending (P < 0.10) to have greater body condition than Angus cows in May. Brahman cows tended to have greater fecal output per 100 kg BW than Angus cows in February (0.9 > 0.7 +/- 0.1, P < 0.10). Brahman cows had greater serum concentrations of leptin than Angus cows in September (1.8 > 0.70 +/- 0.1 ng/mL; P < 0.05), and serum concentrations of insulin were greater (P < 0.01) in Brahman than Angus cows throughout the study. Brahman cows also had greater (P < 0.01) serum concentrations of glucose during February and May than Angus cows. Serum concentrations of triiodothyronine were greatest (P < 0.01) during September and lowest during February and May in both breed groups and were greater (P < 0.01) in Brahman than in Angus cows in February, May, and September. Pregnancy rate and 205-d adjusted weaning weights were similar (P > or = 0.46) among breed groups. Results suggest that Brahman and Angus cows are sensitive to the seasonal dynamics of forage quality in the Chihuahuan Desert. Brahman cattle appear to have greater concentrations of metabolic hormones and metabolites than Angus cows in this environment, but Angus cows experience greater fluctuations in BW.

Temperature-controlled surface plasmon resonance in VO (2) nanorods

The optical properties of VO(2) nanoparticles formed in an amorphous SiO(2) host by stoichiometric ion implantation of vanadium and oxygen and thermal annealing have been determined and correlated with the particle size and morphology. The results show that that the temperature-controlled semiconductor-to-metal phase transition of the VO(2) nanophase precipitates turns on the classical surface plasmon resonance, with specific features that depend on the size and aspect ratio of the VO(2) particles. This effect improves the optical contrast between the metallic and semiconducting states in the near-IR region of the spectrum as a result of dielectric confinement that is due to the SiO(2) host. A fiber-optic application is demonstrated, as is the ability to control the characteristics of the phase transition by using ion implantation to dope the VO(2) nanoparticles with tungsten or titanium ions.

[Skin necrosis after prophylactic treatment with heparin]

The authors present a case of cutaneous necrosis following local injection of heparin. The physiopathology and the clinical aspect are discussed.

Detection of central pelvic recurrent disease with transvaginal color Doppler ultrasound in women treated for gynecological malignancy

OBJECTIVE

To evaluate color Doppler characteristics of small recurrent tumors detected within the central pelvis in follow-up patients treated for gynecological malignancy.

PATIENTS AND METHODS

A prospective study was performed on 340 patients who were being monitored following treatment for gynecological malignancies. A selected group of 27 patients, with small pelvic masses located in the central region of the pelvis, underwent a color Doppler examination. A subjective assessment of the vascularization (vascular score), the lowest resistance index (RI), the highest peak velocity (PSV) and the highest time averaged maximum velocity (TAMXV) of the vessels detected within the lesion were analyzed.

RESULTS

In 16 patients the pelvic mass was found to be benign while in 11 patients a malignant recurrence was diagnosed. Gray-scale examination could not differentiate between benign and malignant lesions. The color score of tumor recurrences was significantly higher in comparison to that in benign lesions (color score 3 in 54% vs. 0%, P < 0.005). The malignant lesions showed significantly lower mean values of RI and significantly higher mean values of PSV and TAMXV when compared with benign lesions (0.39 +/- 0.09 vs. 0.81 +/- 0.22, P < 0.0001; 19.3 +/- 4.7 vs. 10.5 +/- 5.6 cm/s, P < 0.0001; 8.9 +/- 3.7 vs. 4.3 +/- 2.7 cm/s, P < 0.005).

CONCLUSIONS

Color Doppler analysis added to transvaginal gray-scale ultrasonography seems to be a helpful tool in the diagnosis of recurrent tumors in the central region of the pelvis.

Relationships of metabolic hormones and serum glucose to growth and reproductive development in performance-tested Angus, Brangus, and Brahman bulls

Understanding mechanisms that regulate growth and reproduction are important for improving selection strategies in cattle. In this study, Angus, Brangus, and Brahman bulls (n = 7 per breed) of similar age were selected from a group of 65 weanlings. Bulls were evaluated after weaning (i.e., approximately 6 mo of age) for 112 d for serum concentrations of metabolic hormones and glucose, growth, and reproductive traits. Performance data and blood sera were collected on d 0, 28, 56, 84, and 112. Sera were also collected in periods from d 50 to 59 (56D) and 103 to 112 (112D). Angus bulls were heavier (P < 0.05) throughout the study than Brahman bulls and were heavier than Brangus bulls on d 56, 84, and 112. Initial and final BW for Angus, Brangus, and Brahman bulls were 292.7, 260.6, and 230.4 and 468.3, 435.6, and 350.7 +/- 12 kg, respectively. Conversely, Brahman bulls had greater hip height (P < 0.05) than Brangus, and Brangus were taller (P < 0.05) than Angus. Angus bulls had the greatest (P < 0.05) scrotal circumference (SC) and Brahman bulls the least. Mean SC across days was 31.5, 29.7, and 25.0 +/- 0.6 cm for the three respective breeds. Serum testosterone was greater (P < 0.01) in Angus and Brangus bulls (10.0 and 8.9 +/- 1.4 ng/mL) than in Brahman bulls (4.0 +/- 1.4 ng/mL) throughout the study. After d 112, 100, 86, and 57% of the Angus, Brangus, and Brahman bulls passed a breeding soundness exam (P = 0.51). Serum concentrations of IGF-I and leptin were greater (P < or = 0.06) in Angus bulls on d 56, 84, and 112 than in Brangus and Brahman bulls. Serum concentrations of GH (P < 0.08) and glucose (P < 0.03) were greater in Brangus bulls than in Angus or Brahman bulls throughout the study. Prediction analyses suggested that serum concentrations of leptin could be used to predict (P < or = 0.08) BW and SC (R2 > 0.82) in the 56D and 112D periods among these breeds. Leptin was also useful in predicting (P < or = 0.09) serum concentrations of GH and testosterone in the 112D period (R2 > 0.32). Residual correlation analyses with the effect of breed removed suggested that leptin was correlated (r > or => 0.53, P < 0.05) with both SC and serum testosterone. Angus and Brahman cattle differ in phenotype, level of adiposity, and rate of sexual development. Data herein suggest that these characteristics could be due to varying mechanisms by which metabolic hormones such as leptin, GH, and(or) IGF-I are regulated.

Clinical and laboratory evaluation of the safety of a bioartificial liver assist device for potential transmission of porcine endogenous retrovirus

BACKGROUND

The potential risk of transmission of porcine endogenous retroviruses (PERV) from xenogeneic donors into humans has been widely debated. Because we were involved in a phase I/II clinical trial using a bioartificial liver support system (BLSS), we proceeded to evaluate the biosafety of this device.

MATERIALS AND METHODS

The system being evaluated contains primary porcine hepatocytes freshly isolated from pathogen-free, purpose-raised herd. Isolated hepatocytes were installed in the shell, which is separated by a semipermeable membrane (100-kD nominal cutoff) from the lumen through which the patients' whole blood is circulated. Both before and at defined intervals posthemoperfusion, patients' blood was obtained for screening. Additionally, effluent collected from a clinical bioreactor was analyzed. The presence of viral particles was estimated by reverse transcriptase-polymerase chain reaction (RT-PCR) and RT assays. For the detection of pig genomic and mitochondrial DNA, sequence-specific PCR (SS-PCR) was used. Finally, the presence of infectious viral particles in the samples was ascertained by exposure to the PERV-susceptible human cell line HEK-293.

RESULTS

PERV transcripts, RT activity, and infectious PERV particles were not detected in the luminal effluent of a bioreactor. Culture supernatant from untreated control or mitogen-treated porcine hepatocytes (cleared of cellular debris) also failed to infect HEK-293 cell lines. Finally, RT-PCR, SS-PCR, and PERV-specific RT assay detected no PERV infection in the blood samples obtained from five study patients both before and at various times post-hemoperfusion.

CONCLUSION

Although longer patient follow-up is required and mandated to unequivocally establish the biosafety of this device and related bioartificial organ systems, these analyses support the conclusion that when used under standard operational conditions, the BLSS is safe.

Assessing the economic return of specializing in orthodontics or oral and maxillofacial surgery

BACKGROUND

The authors determined the economic returns from an educational investment in the specialties of orthodontics and oral an maxillofacial surgery. They also addressed problems found in previous studies.

METHODS

The marginal return for specializing in orthodontics or oral and maxillofacial surgery was determined using net present value and internal rate of return, or IRR, with the income of the general dentist serving as the common opportunity cost. Extreme scenario, threshold and one-way sensitivity analyses were used to account for variation in the data.

RESULTS

The median group of orthodontists broke even 5.9 years after specialty training and had a working lifetime net return of $271,536 above that of general dentists; the IRR for them was 10.36 percent. The median group of oral and maxillofacial surgeons broke even 2.3 years after training and had a working lifetime net return of $587,563 above that of general dentists; the IRR for them was 25.30 percent.

CONCLUSIONS

Under the most likely conditions, the authors found a positive economic return to dentists in both specialties from their additional dental training.

PRACTICE IMPLICATIONS

The positive financial returns brought by specialization indicate that the demand for additional dental education should continue within an environment of increased educational investment costs.