Preclinic investigations accelerate decision-making, reduce delays in treatment and are highly popular with endocrinology patients and staff

OBJECTIVE

Endocrine diagnosis relies on a thorough history, examination and confirmatory biochemical tests. Previously, in our unit, tests were performed after new patients attended clinic. We proposed that diagnosis and management would be improved if this system was inverted.

DESIGN

Clinicians and chemical pathologists reviewed available guidance and local practice to determine the key tests to confirm or refute most common endocrine disorders. A system was developed for clinicians to categorize new referrals into diagnostic groups: for example, nodular thyroid disease or possible polycystic ovarian syndrome. Standard letters were developed and sent to patients explaining the requirement for tests to be performed prior to first hospital appointment. The letters and requests for investigation sets were standardized for each diagnostic group and generated via a one-click automated method. After one year, clinical outcomes were audited and patients and staff surveyed.

RESULTS

The time from referral to confirming diagnosis and starting treatment was halved: mean 11·8-5·7 weeks (P < 0·001). Acute patients were also discharged from clinic earlier: mean 17 to 10·3 weeks (P < 0·005). Ninety four percent patients surveyed had their tests performed easily prior to attending their appointment. Hundred per cent of patients, 100% of hospital staff and 93% referring general practitioners who responded felt the system improved patient care and should continue.

CONCLUSIONS

Performing investigations prior to new patient appointments is practical, popular with staff and patients and has dramatically improved our referral to treatment statistics by reducing delays prior to diagnosis. This system could be used as a model for other departments.

Precision measurement of the neutron twist-3 matrix element d(2)(n): probing color forces

Double-spin asymmetries and absolute cross sections were measured at large Bjorken x  (0.25≤x≤0.90), in both the deep-inelastic and resonance regions, by scattering longitudinally polarized electrons at beam energies of 4.7 and 5.9 GeV from a transversely and longitudinally polarized (3)He target. In this dedicated experiment, the spin structure function g(2)((3)He) was determined with precision at large x, and the neutron twist-3 matrix element d(2)(n) was measured at ⟨Q(2)⟩ of 3.21 and 4.32  GeV(2)/c(2), with an absolute precision of about 10(-5). Our results are found to be in agreement with lattice QCD calculations and resolve the disagreement found with previous data at ⟨Q(2)⟩=5  GeV(2)/c(2). Combining d(2)(n) and a newly extracted twist-4 matrix element f(2)(n), the average neutron color electric and magnetic forces were extracted and found to be of opposite sign and about 30  MeV/fm in magnitude.

Dentists' perspectives on caries-related treatment decisions

OBJECTIVE

To assess the impact of patient risk status on Colombian dentists' caries related treatment decisions for early to intermediate caries lesions (ICDAS code 2 to 4).

METHODS

A web-based questionnaire assessed dentists' views on the management of early/intermediate lesions. The questionnaire included questions on demographic characteristics, five clinical scenarios with randomised levels of caries risk, and two questions on different clinical and radiographic sets of images with different thresholds of caries.

RESULTS

Questionnaires were completed by 439 dentists. For the two scenarios describing occlusal lesions ICDAS code 2, dentists chose to provide a preventive option in 63% and 60% of the cases. For the approximal lesion ICDAS code 2, 81% of the dentists chose to restore. The main findings of the binary logistic regression analysis for the clinical scenarios suggest that for the ICDAS code 2 occlusal lesions, the odds of a high caries risk patient having restorations is higher than for a low caries risk patient. For the questions describing different clinical thresholds of caries, most dentists would restore at ICDAS code 2 (55%) and for the question showing different radiographic thresholds images, 65% of dentists would intervene operatively at the inner half of enamel. No significant differences with respect to risk were found for these questions with the logistic regression.

CONCLUSION

The results of this study indicate that Colombian dentists have not yet fully adopted non-invasive treatment for early caries lesions.

JLab measurement of the 4He charge form factor at large momentum transfers

The charge form factor of 4He has been extracted in the range 29  fm(-2) ≤ Q2 ≤ 77  fm(-2) from elastic electron scattering, detecting 4He recoil nuclei and electrons in coincidence with the high resolution spectrometers of the Hall A Facility of Jefferson Lab. The measurements have uncovered a second diffraction minimum for the form factor, which was predicted in the Q2 range of this experiment. The data are in qualitative agreement with theoretical calculations based on realistic interactions and accurate methods to solve the few-body problem.

Quantitative light-induced fluorescence to measure enamel remineralization in vitro

The aim of this study was to compare the ability of quantitative light-induced fluorescence (QLF) and surface microhardness (SMH) to measure the remineralization of enamel subsurface lesions, using a pH-cycling model including treatment with 0-ppm, 550-ppm or 1,100-ppm sodium fluoride (NaF) dentifrices.

METHODS

Subsurface lesions were created in human enamel specimens (n = 36) and exposed to a remineralization pH-cycling model for 14 days. The pH-cycling model was performed in an automated system where specimens were subjected to a demineralizing solution for 20 min and treatment for 1 min and were then remineralized for 7 h 39 min, 3 times daily. The treatments consisted of 3 NaF, silica-containing dentifrices (0 ppm F; 550 ppm F; 1,100 ppm F). The outcome variables were: change from baseline in surface hardness and percentage change from baseline in fluorescence. An ANCOVA explored differences between different treatment groups (at the p < 0.05 level). Associations between QLF and SMH were evaluated using Spearman's correlation coefficient.

RESULTS

The percentage SMH changes were 14.9 ± 2.1%, 56.6 ± 9.6% and 103.9 ± 14.6% for the 0-, 550- and 1,100-ppm F dentifrices, respectively. The percentage fluorescence changes were 15.6 ± 7.1%, 59.8 ± 11.9% and 85 ± 13.2%, respectively. The differences between all pairwise comparisons were statistically significant for both methods (p = 0.001). QLF correlated with SMH (r = 0.67).

CONCLUSIONS

Both the SMH and QLF methods demonstrated a significant F dose response for toothpaste in this in vitro remineralization model, and both methods were able to distinguish treatments with different F levels.

Beyond UV radiation: a skin under challenge

Since ancient times, human beings have been trying to protect their skin against the adverse effects of the sun. From the first mineral sunscreens used by Egyptians, to the current more sophisticated ultraviolet (UVA/UVB) organic sunscreens, progress has been made in terms of sun protection and deeper knowledge of skin physiology has been acquired in the process. The solar spectrum is composed of radiations of various wavelengths having specific, as well as overlapping effects on skin. UVB is mainly responsible for sunburn and DNA dimer formation that can lead to mutation. UVA generates oxidative reactions affecting DNA, proteins and lipids, and is also immunosuppressive. Recently, visible light and infrared radiation (IR) have been associated with oxidative damage and IR has been additionally linked to adverse heat effects on skin. Numerous other extrinsic factors, related to environment and lifestyle, also affect the appearance of skin, precipitating ageing. New molecular mechanisms linking sun and environmental factors to skin ageing have been identified: IR affects mitochondrial integrity and specific heat receptors also mediate some of its effects, tryptophan is a chromophore for UVB, and the aryl hydrocarbon receptor (AhR) is activated by light and xenobiotics to alter skin physiology. Integrating all these new elements is changing the way we think about skin extrinsic ageing. Is UVA/UVB sunscreen protection still enough for our skin?

Growth modulation index as metric of clinical benefit assessment among advanced soft tissue sarcoma patients receiving trabectedin as a salvage therapy

BACKGROUND

The growth modulation index (GMI) is the ratio of time to progression with the nth line (TTP(n)) of therapy to the TTP(n)(-1) with the n-1th line. GMI >1.33 is considered as a sign of activity in phase II trials.

PATIENTS AND METHODS

This retrospective analysis evaluated the concordance between the GMI and the efficacy outcomes in 279 patients with advanced soft tissue sarcoma (ASTS) treated with trabectedin 1.5 mg/m² (24-h infusion every 3 weeks) in four phase II trials.

RESULTS

One hundred and forty-two (51%) patients received one prior line and 137 ≥ 2 lines. The median TTP(n) was 2.8 months (range 0.2-26.8), whereas the median TTP(n)(-1) was 4.0 months (0.3-79.5). The median GMI was 0.6 (0.0-14.4). Overall, 177 patients (63%) had a GMI <1; 21 (8%) a GMI equal to 1-1.33 and 81 (29%) a GMI >1.33, which correlated with the median overall survival in those patients (9.1, 13.9 and 23.8 months, respectively, P = 0.0005). A high concordance rate between the GMI and response rate (P < 0.0001) and progression-free survival (PFS, P < 0.0001) was observed. Good performance status (PS) was the only factor associated with GMI >1.33 (PS = 0; P < 0.04).

CONCLUSIONS

A high GMI was associated with favorable efficacy outcomes in patients treated with trabectedin. Further research is needed to assess GMI as an indicator in this setting.

Antioxidant and anti-inflammatory effects of a hypoglycemic fraction from Cucurbita ficifolia Bouché in streptozotocin-induced diabetes mice

Type 2 diabetes is characterized by oxidative stress and a chronic low-grade inflammatory state, which also play roles in the pathogenesis of this disease and the accompanying vascular complications by increasing the production of free radicals and pro-inflammatory cytokines. Cucurbita ficifolia Bouché (C. ficifolia) is an edible Mexican plant whose hypoglycemic activity has been demonstrated in several experimental and clinical conditions. Recently, D-chiro-inositol has been proposed as the compound responsible for the hypoglycemic effects; however, the antioxidant and anti-inflammatory potential of this plant has not yet been explored. The aim of this research is to study the influence of a hypoglycemic, D-chiro-inositol-containing fraction from the C. ficifolia fruit (AP-Fraction) on biomarkers of oxidative stress, as well as on the inflammatory cytokines in streptozotocin-induced diabetes. The AP-Fraction obtained from the mature fruit of C. ficifolia contained 3.31 mg of D-chiro-inositol/g of AP-Fraction. The AP-Fraction was administrated daily by gavage to normal mice for 15 days as a preventive treatment. Then these animals were given streptozotocin, and the treatments were continued for an additional 33 days. Pioglitazone was used as a hypoglycemic drug for comparison. Administration of the AP-Fraction significantly increased glutathione (GSH) and decreased malondialdehyde (MDA) in the liver without significantly affecting the levels in other tissues. The AP-Fraction reduced TNF-α and increased IL-6 and IFN-γ in serum. Interestingly, the AP-Fraction also increased IL-10, an anti-inflammatory cytokine. These results suggest that C. ficifolia might be used as an alternative medication for the control of diabetes mellitus and that it has antioxidant and anti-inflammatory properties in addition to its hypoglycemic activity.

SU-E-I-78: Neuromelanin in the Subthalamic Nucleus of Patients with Parkinson's Disease: An Electron Spin Resonance Spectroscopy Study

PURPOSE

Parkinson disease and related syndromes are associated directly with the concentrations of neuromelanin, iron and other heavy metals, and nowadays it is discussed the possible protective role of neuromelanin by the sequester redox active iron ions, reducing the formation of free hydroxyl radicals and therefore inactivating the iron ions that induce oxidative stress. The aim of this work is to study the concentration ratios between iron ions and neuromelanin in subthalamic nucleus of patients with Parkinson's disease (PD) using Electron Spin Resonance (ESR).

METHODS

Necropsy samples of subthalamic nucleus from eight human brains were studied: three non-affected by any neurodegenerative disease and five with Parkinson's disease. The samples were stored in formaldehyde and washed with a solution of 0.01 molar of ethylenediaminetetraacetic acid. ESR experiments were development in a JEOL FA-200 X-Band spectrometer at different temperatures between -170° C to room temperature. The relative concentrations of each species were estimated from the double integral values of the fitted spectra.

RESULTS

For all samples, ESR spectra showed to be composed of three different signals following the Curie's law. One signal was attributed to high-spin ferric ions (g∼ 4.3) in rhomboedric symmetry, Cu(II) ions (close to g=2.0) and neuromelanin (g∼ 2.01). The ferric ions concentration ratio between patients and controls was 3.0±0.2. The same ratio for neuromelanine was 0.24±0.06.

CONCLUSIONS

Our preliminary results indicated a significant increment of iron concentration in PD samples which agrees with previous histochemical and biochemical reports. This finding and the clear reduction of neuromelanin concentration in PD samples suggest the possible role of neuromelanin as iron ions storage.

Measurement of the neutron radius of 208Pb through parity violation in electron scattering

We report the first measurement of the parity-violating asymmetry A(PV) in the elastic scattering of polarized electrons from 208Pb. A(PV) is sensitive to the radius of the neutron distribution (R(n)). The result A(PV)=0.656±0.060(stat)±0.014(syst) ppm corresponds to a difference between the radii of the neutron and proton distributions R(n)-R(p)=0.33(-0.18)(+0.16) fm and provides the first electroweak observation of the neutron skin which is expected in a heavy, neutron-rich nucleus.

Dental fluorosis, dental caries, and quality of life factors among schoolchildren in a Colombian fluorotic area

OBJECTIVE

To assess dental fluorosis, dental caries and quality of life factors associated with dental fluorosis among schoolchildren living in a Colombian endemic dental fluorosis area.

METHOD

110 12-year olds were visually examined for dental caries (ICDAS) and dental fluorosis (TF) and a self-administered quality of life and fluorosis questionnaire was applied.

RESULTS

The prevalence of dental fluorosis reached 100% in this sample with most children falling within the TF 3 severity category. Varying degrees of severity were observed as follows for TF 1 to 6: 1%, 16%, 62%, 16%, 4%, 2%. The prevalence of caries experience (DF-S2) was 54%. The DF-S2 mean was 4.4 (sd 4.3). The principal contributor to the DF-S2 outcome was the decayed component. When initial caries lesions were included (ICDAS-scores 1-3) the mean DF-S1,2 increased to 10 (sd 5.1). The association between fluorosis and dental caries was not statistically significant (p > 0.05). Children not only detected the presence of something abnormal in their teeth but also reported feeling embarrassed, and worried due to their dental appearance. Almost 60% of the children reported avoiding smiling because of their teeth's appearance.

CONCLUSIONS

The high prevalence of dental fluorosis and dental caries combined with the schoolchildren's negative perception about their dental health reflects the need to propose effective dental public health policies to regulate multiple exposures to fluoride at an early age, and to improve health outcomes in a highly vulnerable population.

Infiltrating/sealing proximal caries lesions: a 3-year randomized clinical trial

This randomized split-mouth controlled clinical trial aimed at assessing the therapeutic effects of infiltration vs. sealing for controlling caries progression on proximal surfaces. Out of 90 adult students/patients assessed at university clinics and agreeing to participate, 39, each with 3 proximal lesions identified radiographically around the enamel-dentin junction to the outer third of the dentin, were included. Lesions were randomly allocated for treatment to test-A (Infiltration: ICON-pre-product; DMG), test-B (Sealing: Prime-Bond-NT; Dentsply), or control-C (Placebo). Primary outcome after 1, 2, and 3 yrs of radiographically observed lesion progression was assessed by an independent examiner blinded to groups, using pair-wise and digital-subtraction readings. No adverse events occurred. In 37 participants assessed after 3 yrs, 10 lesions (A-4; B-2; C-4) progressed deep into dentin and needed operative treatment. The 3-year therapeutic effect, based on pair-wise radiographic readings between infiltration and placebo, was 37.8% (95% CI: 20.5-55.2%) and that between sealing and placebo was 29.7% (95% CI: 20.2-35.0%). One-year follow-up digital-subtraction readings showed significant differences in lesion progression between infiltration and placebo (P = 0.0012) and between sealing and placebo (P = 0.0269). The study showed that infiltration and sealing are significantly better than placebo treatment for controlling caries progression on proximal lesions. No significant difference was seen between infiltration and sealing (ClinicalTrials.gov number NCT01417832).