An Overview of the Surgical Correction of Dentofacial Deformity

The correction of severe dentofacial discrepancies involving a combination of orthodontic and surgical therapies (termed ‘orthognathic treatment’) is commonplace. There is an abundance of evidence within this field but it is often inconsistent. This article is an evidence-based overview of such treatments and is aimed at the general dental practitioner. It will cover: the timing of treatment; the indications and risks associated with different surgical osteotomies; the magnitude of surgical movements that can be achieved with these procedures; and the importance of mandibular autorotation when planning treatment. Orthognathic treatment is considered to be the gold standard for comprehensive correction of severe dentofacial discrepancies. It is undertaken by a multidisciplinary team of clinicians involving, but not exclusive to, consultants in orthodontics and oral and maxillofacial surgery in secondary and tertiary medical centres throughout the United Kingdom. Clinical relevance: It is imperative that general dental practitioners have a good understanding of orthognathic treatment in order to recognize when such treatments are indicated, to inform the patient of possible treatment modalities and to be able to discuss associated risks in order to make appropriate referrals. Since treatment timing and magnitude of surgical movements have a profound effect on stability of the treatment result, these must be carefully considered by all clinicians involved in patient care to minimize relapse potential.

Comparison of Academic and Behavioral Performance between Athletes and Non-athletes

The Toronto Charter for Physical Activity (2010) and several national physical activity plans advocate sports participation as an important part of population targeted physical activity for youth. Emerging research evidence also suggests that sports participation during adolescents is linked to significant positive correlations with academic and behavioral performance. The purpose of this study was to compare academic and behavioral performance between male and female public school athletes (Total N=11,139; 38% Female) and non-athletes (Total N=23,891; 52% Female) in a convenient, ethnicity diverse, sample (grades 7-12) from the state of Texas (USA). We examined the passing rates of individual athletes and non-athletes on standardized tests (Texas Assessment of Knowledge and Skills, TAKS) for math, language arts, reading, writing, science, and social studies. We also examined the percentage of athletes and non-athletes for being "at risk," for dropping out of school and for the total average number of disciplinary actions. Chi-Square statistical analyses comparing athletes to non-athletes showed that athletes scored significantly better (p<0.05) on all standardized tests compared to non-athletes (passing rate ranges ranged from 77.1% to 92.9% versus 27.7% to 66.5% respectively). Athletes were at lower risk for dropout compared to non-athletes (35.6% versus 49.24%; p<0.05), and they had fewer disciplinary actions (mean of 0.85 per athletes per year versus 1.23 for non-athletes; ANOVA, p<0.05). Our results support the research findings of others that participation in school sports is positively correlated to better academic and behavioral performances for athletes compared to non-athletes.

PBPK models for the prediction of in vivo performance of oral dosage forms

Drug absorption from the gastrointestinal (GI) tract is a highly complex process dependent upon numerous factors including the physicochemical properties of the drug, characteristics of the formulation and interplay with the underlying physiological properties of the GI tract. The ability to accurately predict oral drug absorption during drug product development is becoming more relevant given the current challenges facing the pharmaceutical industry. Physiologically-based pharmacokinetic (PBPK) modeling provides an approach that enables the plasma concentration-time profiles to be predicted from preclinical in vitro and in vivo data and can thus provide a valuable resource to support decisions at various stages of the drug development process. Whilst there have been quite a few successes with PBPK models identifying key issues in the development of new drugs in vivo, there are still many aspects that need to be addressed in order to maximize the utility of the PBPK models to predict drug absorption, including improving our understanding of conditions in the lower small intestine and colon, taking the influence of disease on GI physiology into account and further exploring the reasons behind population variability. Importantly, there is also a need to create more appropriate in vitro models for testing dosage form performance and to streamline data input from these into the PBPK models. As part of the Oral Biopharmaceutical Tools (OrBiTo) project, this review provides a summary of the current status of PBPK models available. The current challenges in PBPK set-ups for oral drug absorption including the composition of GI luminal contents, transit and hydrodynamics, permeability and intestinal wall metabolism are discussed in detail. Further, the challenges regarding the appropriate integration of results from in vitro models, such as consideration of appropriate integration/estimation of solubility and the complexity of the in vitro release and precipitation data, are also highlighted as important steps to advancing the application of PBPK models in drug development. It is expected that the "innovative" integration of in vitro data from more appropriate in vitro models and the enhancement of the GI physiology component of PBPK models, arising from the OrBiTo project, will lead to a significant enhancement in the ability of PBPK models to successfully predict oral drug absorption and advance their role in preclinical and clinical development, as well as for regulatory applications.

Idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) and electrosensibility (ES) - are they connected?

INTRODUCTION

The tendency of experiencing unpleasant symptoms in the proximity of working electric devices is called idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF). Evidence about psychophysiological backgrounds of the phenomenon (i.e., detection ability and mechanisms of symptom generation) is not yet conclusive.

METHODS

Participants of the provocation experiment were 29 individuals with self-reported IEI-EMF and 42 control persons. Participants completed questionnaires (symptom expectations, somatosensory amplification - SSAS, modern health worries radiation subscale - MHW-R), and attempted to detect the presence of 50 Hz 0.5 mT magnetic field (MF) directed to their right arm in 20 subsequent 1-min sessions. Heart rate was also recorded and various indices of heart rate variability (HF, LF/HF, SDNN) were calculated.

RESULTS

Using the methodology of the signal detection theory, individuals with IEI-EMF as opposed to the control group showed a higher than random detection performance (d' differed slightly but statistically significantly from zero), and they used a significantly lower criterion (β value) when deciding about the presence of the MF. Detection sessions followed by correct decisions (hits or correct rejections) were characterized by higher HRV (SDNN and HF indices) than periods followed by errors (misses or false alarms). Previous expectations and affiliation to the IEI-EMF group were significant predictors of symptoms reported following exposure. IEI-EMF was closely related to MHW-R and SSAS scores.

CONCLUSION

Detection of MF might be possible for people with IEI-EMF to some extent. Although heightened sensibility to MFs may play a role in the development and/or in the perpetuance of the IEI-EMF phenomenon, symptoms attributed to the MF seem to be mainly of psychogenic origin.

Temperature dependence of Rb 5P fine-structure transfer induced by 4He collisions

Employing ultrafast laser excitation and time-correlated single-photon counting, we have measured the fine-structure transfer between Rb 5P states induced by collisions with 4He buffer gas at temperatures up to 150 °C. The temperature dependence of the binary cross section agrees with earlier measurements. Our data show that the temperature dependence of the three-body rate is about the same as that of the binary rate. The three-body rate can be described as arising from the reduction of the rubidium fine-structure splitting due to nearby helium atoms.

Development of a multidisciplinary, multicampus subspecialty practice in endocrine cancers

OBJECTIVES

Relative to more abundant neoplasms, endocrine cancers have been historically neglected, yet their incidence is increasing. We therefore sought to build interest in endocrine cancers, improve physician experience, and develop innovative approaches to treating patients with these neoplasms.

METHODS

Between 2005 and 2010, we developed a multidisciplinary Endocrine Malignancies Disease Oriented Group involving all 3 Mayo Clinic campuses (Rochester, Minnesota; Jacksonville, Florida; and Scottsdale, Arizona). In response to higher demand at the Rochester campus, we sought to develop a Subspecialty Tumor Group and an Endocrine Malignancies Tumor Clinic within the Division of Medical Oncology.

RESULTS

The intended groups were successfully formed. We experienced difficulty in integration of the Mayo Scottsdale campus resulting from local uncertainty as to whether patient volumes would be sufficient to sustain the effort at that campus and difficulty in developing enthusiasm among clinicians otherwise engaged in a busy clinical practice. But these obstacles were ultimately overcome. In addition, with respect to the newly formed medical oncology subspecialty endocrine malignancies group, appointment volumes quadrupled within the first year and increased 7 times within 2 years. The number of active therapeutic endocrine malignancies clinical trials also increased from 1 in 2005 to 5 in 2009, with all 3 Mayo campuses participating.

CONCLUSIONS

The development of subspecialty tumor groups for uncommon malignancies represents an effective approach to building experience, increasing patient volumes and referrals, and fostering development of increased therapeutic options and clinical trials for patients afflicted with otherwise historically neglected cancers.

A kinetic comparison of back-loading and head-loading in Xhosa women

The purpose of this study was to compare the kinetic responses associated with ground reaction force measurements to both head-loading and back-loading in a group of Xhosa women. Altogether, 16 women were divided into two groups based on their experience of head-loading. They walked over a force plate in three conditions: unloaded or carrying 20 kg in either a backpack or on their head. The most striking finding was that there was no difference in kinetic response to head-loading as a consequence of previous experience. Considering the differences between the load carriage methods, most changes were consistent with increasing load. Head-loading was, however, associated with a shorter contact time, smaller thrust maximum and greater vertical force minimum than back-loading. Both loading conditions differed from unloaded walking for a number of temporal variables associated with the ground contact phase, e.g. vertical impact peak was delayed whilst vertical thrust maximum occurred earlier. STATEMENT OF RELEVANCE: Consideration of the kinetics of head and back load carriage in African women is important from a health and safety perspective, providing an understanding of the mechanical adaptations associated with both forms of load carriage for a group of people for whom such load carriage is a daily necessity.

Zoledronic acid does not reduce MRI erosive progression in PsA but may suppress bone oedema: the Zoledronic Acid in Psoriatic Arthritis (ZAPA) Study

BACKGROUND

The effect of zoledronic acid (ZA) on articular bone in patients with psoriatic arthritis (PsA) was investigated using MRI.

METHODS

Patients with erosive PsA were randomised to receive 3-monthly infusions of ZA or placebo for 1 year. An additional 'tests alone' group received no infusions. Clinical assessments and MRI scans were performed at baseline and 1 year.

RESULTS

Paired 1.5T MRI scans were available in 22 patients including 6 who received ZA and 16 who did not (non-ZA = 6 placebo + 10 'tests alone' patients). The Disease Activity Score (28 swollen and tender joints, C reactive protein fell over 12 months to a greater degree in patients on ZA than in non-ZA patients (-1.6 vs -0.3, p=0.023). The MRI bone oedema score decreased in the ZA group (15.5 to 8.5) but increased in the non-ZA group (14.0 to 18.0) (p= 0.0056) with regression of bone oedema at 13.5% of sites in ZA patients vs 1.3% in non-ZA patients (p = 0.0073) and progression in 1.3% of sites in ZA patients vs 6.9% in non-ZA patients (p = 0.072). There was no difference between groups in change in MRI erosion score.

CONCLUSIONS

In this pilot study ZA reduced the progression of MRI bone oedema, indicating probable suppression of osteitis concordant with reduction in clinical measures of disease activity.

Subjective perceptions of load carriage on the head and back in Xhosa women

The purpose of this study was to compare the subjective perceptual responses to both head-loading and back-loading in a group of Xhosa women. Thirty two women were divided into three groups based on their experience of head-loading and walked on a treadmill on two occasions, head-loading and back-loading, at a self selected walking speed for 4 min with a variety of loads until pain or discomfort caused the test to be terminated or a load of 70% body mass was successfully carried. After each workload there was a 1 min rest period during which the women indicated feelings of pain or discomfort in particular areas of the body via visual analogue scales. At the end of each test the women were asked to complete further questionnaires relating to pain and discomfort and on completion of the second test were also asked to compare the two loading conditions. Finally the women were interviewed to establish their history of load carriage and associated pain and discomfort. The data indicate that whilst back-loading was generally associated with more areas of discomfort than head-loading, the pain and discomfort in the neck associated with head-loading was the predominant factor in the termination of tests and that this was independent of head-loading experience. This early termination meant that, on average, the women could carry greater loads on their backs than on their heads. The study suggests that further work needs to be carried out to establish viable alternatives to head-loading for rural dwellers in Africa.

222 SPECIES SPECIFICITY OF PORCINE SPERM MOTILITY REDUCTION BY A HIGH MOLECULAR WEIGHT FRACTION OF OVIDUCTAL FLUID

The significance of sperm motility with respect to fertilization is widely recognized and used as a criterion to assess the quality of ejaculates. Observations of sperm behavior in the oviductal isthmus of several species have shown that their motility is suppressed in this physiological environment because the spermatozoa bind to the oviductal epithelial cells, forming a sperm reservoir prior to ovulation (Hunter 1981 J. Reprod. Fertil. 63, 109–117; Hunter and Wilmut 1984 Reprod. Nutr. Dev. 24, 597–608). Once the spermatozoa are released from the reservoir, they progress toward the ampullar region to reach the oocyte, and an increase in motility at this point could, potentially, be crucial. It has been demonstrated that a soluble fraction of oviductal epithelial cell apical plasma membrane proteins (sAPM) suppresses sperm motility and enhances sperm survival (Holt et al. 2005 Reprod. Fertil. Dev. 17, 683–692; Satake et al. 2006 J. Exp. Biol. 209, 1560–1572). However, few studies to date have investigated the influence of oviductal fluid (OF), the natural medium into which spermatozoa are released from the reservoir, on sperm motility. Consequently, this study aimed to determine the effects of different soluble fractions of OF on sperm motility and the species specificity of such effects. OF from pigs and cows was collected and selectively filtered to obtain two different fractions with molecular weights higher or lower than 100 kD. Diluted semen samples from 14 different boars were exposed to bicarbonate/CO2 (to stimulate maximum motility) in the presence or absence of OF fractions. Sperm trajectories were measured using a Hobson Sperm Tracker (Hobson Tracker, Ltd., Sheffield, UK) and analyzed by PATN analysis as described previously to identify subpopulations of high and low motility spermatozoa (Abaigar et al. 1999 Biol. Reprod. 60, 32–41; Satake et al. 2006). The results showed that neither of the bovine OF fractions affected the proportions of the fast linear boar sperm subpopulation in the samples, which was similar to that of the control. However, when the high molecular weight fraction of porcine OF was used, a significant suppression of the fast linear sperm subpopulation was observed (P ≤ 0.05). These data support the hypothesis that species-specific, high molecular weight components in OF are involved in the suppression of sperm motility. Further studies are required to confirm the significance of this finding, although it may not be unreasonable to speculate that the OF, in addition to other sperm selection mechanisms, acts to protect oocytes against fertilization by poor quality spermatozoa (Okada et al. 1986 J. Submicrosc. Cytol. 18, 233–247). In fact, similar results demonstrating that oviductal fluid decreases sperm motility have been obtained in cow (Grippo et al. 1995 J. Reprod. Fertil. 105, 57–64) and rabbit (Overstreet and Cooper 1979 J. Reprod. Fertil. 55, 53–59). This work was supported by MEC and FEDER (PR2006-0506 and AGL2006-03495).

Intraoral Spitz naevus: a case report

Intraoral occurrences of Spitz naevus are very rare, there being only one previously documented case in the literature. Here is reported a case of a young male who presented with a pigmented lesion of the upper labial mucosa which had the clinical appearance of a simple naevus. Excision biopsy confirmed this to be a Spitz naevus. This lesion shares histopathological similarities with malignant melanoma. Spitz naevus is a benign lesion, but malignant transformation has been reported and close monitoring is recommended.

MC044h, a phase II trial of sorafenib in patients (pts) with metastatic neuroendocrine tumors (NET): A Phase II Consortium (P2C) study

4504

Background: Treatment options for metastatic NET, including islet cell carcinoma (ICC) and carcinoid tumor (CT), are limited. These tumors frequently express vascular endothelial growth factor receptor-2 (VEGFR-2) and platelet derived growth factor receptor receptor-β (PDGFR-β). Sorafenib, a small-molecule inhibitor of the VEGFR-2 and PDGFR-β tyrosine kinase domains, is a rational targeted therapy to evaluate in NET. Methods: Eligibility criteria included: ECOG PS = 2, = 1 prior chemotherapy, good organ function and signed informed consent. Prior interferon and prior or concurrent octreotide at a stable dose were allowed. Pts unable to take oral medications, with uncontrolled hypertension or with symptomatic coronary artery disease were excluded. Pts received sorafenib 400 mg po BID. Primary endpoint was response by RECIST in two cohorts (ie, CT and ICC) using separate 2-stage phase II designs. Results: 93 pts were enrolled: (50 CT, 43 ICC). For pts evaluable for the primary endpoint, 4 of 41 (10%) CT pts and 4 of 41 (10%) ICC pts had a PR. There were 3 minor responses (MR = 20–29% decrease in sum of target lesion diameters) in CT pts and 9 MRs in ICC pts for PR+MR rate of 17% for CT pts and 32% for ICC pts. For pts evaluable, 6-month progression-free survival was observed in 8/20 CT and 14/23 ICC pts. Grade 3–4 toxicity occurred in 43% of pts, with skin (20%), GI (7%) and fatigue (9%) most common. Translational studies from tumor tissue will be presented. Conclusions: Sorafenib at 400 mg po BID has modest activity in metastatic neuroendocrine tumors, with frequent grade = 3 toxicity. Supported by NOI CM6225.

No significant financial relationships to disclose.

Activation and isomerization of n-butane on sulfated zirconia model systems—an integrated study across the materials and pressure gaps

Butane activation has been studied using three types of sulfated zirconia materials, single crystalline epitaxial films, nanocrystalline films, and powders. A surface phase diagram of zirconia in interaction with SO(3) and water was established by DFT calculations, which was verified by LEED investigations on single-crystalline films and by IR spectroscopy on powders. At high sulfate surface densities a pyrosulfate species is the prevailing structure in the dehydrated state; if such species are absent, the materials are inactive. Theory and experiment show that the pyrosulfate can react with butane to give butene, H(2)O and SO(2), hence butane can be activated via oxidative dehydrogenation. This reaction occurred on all investigated materials; however, isomerization could only be proven for powders. Transient and equilibrium adsorption measurements in a wide pressure and temperature range (isobars measured via UPS on nanocrystalline films, microcalorimetry and temporal analysis of products measurements on powders) show weak and reversible interaction of butane with a majority of sites but reactive interaction with <5 micromol g(-1) sites. Consistently, the catalysts could be poisoned by adding sodium to the surface in a ratio S/Na = 35. Future research will have to clarify what distinguishes these few sites.