Quantification of condylar resorption in temporomandibular joint osteoarthritis

OBJECTIVE

This study was performed to determine the condylar morphologic variation of osteoarthritic (OA) and asymptomatic temporomandibular joints (TMJs) and to determine its correlation with pain intensity and duration.

STUDY DESIGN

Three-dimensional surface models of mandibular condyles were constructed from cone-beam computerized tomography images of 29 female patients with TMJ OA (Research Diagnostic Criteria for Temporomandibular Disorders group III) and 36 female asymptomatic subjects. Shape correspondence was used to localize and quantify the condylar morphology. Statistical analysis was performed with multivariate analysis of covariance analysis, using Hotelling T(2) metric based on covariance matrices, and Pearson correlation.

RESULTS

The OA condylar morphology was statistically significantly different from the asymptomatic condyles (P < .05). Three-dimensional morphologic variation of the OA condyles was significantly correlated with pain intensity and duration.

CONCLUSION

Three-dimensional quantification of condylar morphology revealed profound differences between OA and asymptomatic condyles, and the extent of the resorptive changes paralleled pain severity and duration.

Effects of lip revision surgery in cleft lip/palate patients

The decision for lip revision surgery in patients with repaired cleft lip/palate is based on surgeons' subjective evaluation of lip disability. An objective evaluation would be highly beneficial for the assessment of surgical outcomes. In this study, the effects of lip revision on circumoral movements were objectively quantified. The hypothesis was that lip revision increases scarring and impairment. The study was a non-randomized clinical trial that included patients with cleft lip who had revision, patients with cleft lip who did not, and non-cleft control individuals. Three-dimensional facial movements were measured. Revision patients were measured before and after surgery. Other individuals were measured at similar intervals. Regression models were fit to summary measurements, and changes were modeled. Patients with repaired cleft lip/palate had fewer mean movements than control individuals. Lip revision did not worsen mean movements; however, individual patients' movements varied from 'improvement' to 'no change' to 'worse' relative to those of control individuals.

Long-term stability of adolescent versus adult surgery for treatment of mandibular deficiency

In mandibular deficient patients, mandibular growth is not expected after the adolescent growth spurt, so mandibular advancement surgery is often carried out at 13 years. To test if the long-term stability for younger patients is similar to that for adult patients, the authors compared cephalometric changes from 1-year postsurgery (when changes due to the surgery should be completed) to 5-year follow up. 32 patients who had early mandibular advancement with or without simultaneous maxillary surgery (aged up to 16 for girls and 18 for boys), and 52 patients with similar surgery at older ages were studied. Beyond 1-year postsurgery, the younger patients showed significantly greater change in the horizontal and vertical position of points B and pogonion, the horizontal (but not vertical) position of gonion, and mandibular plane angle. 50% of younger patients had 2-4mm backward movement of Pg and another 25% had >4mm. 15% of older patients had 2-4mm change and none had >4mm. Long-term changes in younger patients who had two-jaw surgery were greater than for mandibular advancement only. Changes in younger groups were greater than for adult groups. Satisfaction with treatment and perception of problems were similar for both groups.

Functional connectivity in the default network during resting state is preserved in a vegetative but not in a brain dead patient

Recent studies on spontaneous fluctuations in the functional MRI blood oxygen level-dependent (BOLD) signal in awake healthy subjects showed the presence of coherent fluctuations among functionally defined neuroanatomical networks. However, the functional significance of these spontaneous BOLD fluctuations remains poorly understood. By means of 3 T functional MRI, we demonstrate absent cortico-thalamic BOLD functional connectivity (i.e. between posterior cingulate/precuneal cortex and medial thalamus), but preserved cortico-cortical connectivity within the default network in a case of vegetative state (VS) studied 2.5 years following cardio-respiratory arrest, as documented by extensive behavioral and paraclinical assessments. In the VS patient, as in age-matched controls, anticorrelations could also be observed between posterior cingulate/precuneus and a previously identified task-positive cortical network. Both correlations and anticorrelations were significantly reduced in VS as compared to controls. A similar approach in a brain dead patient did not show any such long-distance functional connectivity. We conclude that some slow coherent BOLD fluctuations previously identified in healthy awake human brain can be found in alive but unaware patients, and are thus unlikely to be uniquely due to ongoing modifications of conscious thoughts. Future studies are needed to give a full characterization of default network connectivity in the VS patients population.

Hallux rigidus: a cross-sectional study to evaluate clinical parameters

BACKGROUND

Hallux rigidus (HR) is a common condition with history and physical examination used to help evaluate pathology, grade clinical changes and to inform treatment.

METHOD

A cross-sectional study was undertaken to evaluate the demographics of and clinical parameters encountered in HR. In 110 subjects (180 feet) aged 18-70 years (mean 52 years) a standardized history and physical examination was undertaken. Clinical parameters associated with HR were evaluated. The Foot Health Status Questionnaire (FHSQ) was used to measure health-related quality-of-life dimensions.

RESULTS

Seventy (64%) subjects had bilateral HR and 73 (66%) were female. Mean HR onset was 44 (14-68 years) years and median HR duration 6 years (1-33 years). A history of 1st MTPJ trauma presented in 22% of subjects; 74% of whom had unilateral HR. Eighty-four (47%) feet had pes planus based on a positive Foot Posture Index. A correlation between pes planus and 1st MTPJ pain was found (r=0.84, p=0.05). In 74% of feet, hallux abductus interphalangeus angle (HAI degrees ) was greater than normal (< or =10 degrees ). A correlation between HAI and reduced 1st MTPJ ROM was found (r=0.92, p=0.05). Second toe length was the same as the hallux in 111 feet (62%). A correlation between valgus hallucal rotation and 1st MTP joint pain in HR was found (r=.78, p=.05). A positive relationship was found between 2nd toe length and 1st MTPJ pain (p=0.001<0.05). A correlation between hallucal interphalangeal joint (IPJ) hyperextension and 1st MTPJ pain was found (r=0.78, p=0.01). A positive relationship was found between lesser MTPJ pain and supination at propulsion (p<0.001). There was no evidence of Achilles tendon contracture. The FHSQ results concur with clinical findings.

CONCLUSIONS

HR was associated with female gender, bilateral involvement, older age groups, increased HAI degrees, 2nd toe length similar to hallux, hallucal IPJ hyperextension, lesser MTP joint pain, flat foot and certain gait alterations. HR was not associated with Achilles tendon tightness or footwear. The content validity of clinical parameters of HR needs to be established by formal research prior to their inclusion in a classification of HR.

Selecting forward models for MEG source-reconstruction using model-evidence

We investigated four key aspects of forward models for distributed solutions to the MEG inverse problem: 1) the nature of the cortical mesh constraining sources (derived from an individual's MRI, or inverse-normalised from a template mesh); 2) the use of single-sphere, overlapping spheres, or Boundary Element Model (BEM) head-models; 3) the density of the cortical mesh (3000 vs. 7000 vertices); and 4) whether source orientations were constrained to be normal to that mesh. These were compared within the context of two types of spatial prior on the sources: a single prior corresponding to a standard L2-minimum-norm (MNM) inversion, or multiple sparse priors (MSP). The resulting generative models were compared using a free-energy approximation to the Bayesian model-evidence after fitting multiple epochs of responses to faces or scrambled faces. Statistical tests of the free-energy, across nine participants, showed clear superiority of MSP over MNM models; with the former reconstructing deeper sources. Furthermore, there was 1) no evidence that an individually-defined cortical mesh was superior to an inverse-normalised canonical mesh, but 2) clear evidence that a BEM was superior to spherical head-models, provided individually-defined inner skull and scalp meshes were used. Finally, for MSP models, there was evidence that the combination of 3) higher density cortical meshes and 4) dipoles constrained to be normal to the mesh was superior to lower-density or freely-oriented sources (in contrast to the MNM models, in which free-orientation was optimal). These results have practical implications for MEG source reconstruction, particularly in the context of group studies.

Medium-to-long term DEXA analysis of an uncemented (AML) femoral component

We present medium-to-long-term bone mineral density studies assessing bone resorption and remodelling around the cementless femoral component of a total hip arthroplasty (Depuy AML prosthesis). Bone mineral densities were compared with the unoperated side at a time interval of eight years between scans using dual energy X-ray absorptiometry. Initial proximal stress shielding is known but we show that this response continues into the medium to long term in relative terms. We have also found an overall trend for bone mineral density to increase around the prosthesis with the greatest changes occurring distally. The greatest real increase in bone mineral density occurred in Gruen zones 2, 3 and 5 with smaller increases in zones 1, 4, 6 and 7. However, when compared with the contralateral unoperated femur (thus considering systemic changes in bone mineral density), we found these changes only reached statistical significance in Gruen zones 5, 6 and 7.

Bispectral index correlates with regional cerebral blood flow during sleep in distinct cortical and subcortical structures in humans

The relationship between the Bispectral Index (BIS), an EEG-based monitor of anesthesia, and brain activity is still unclear. This study aimed at investigating the relationship between changes in BIS values during natural sleep and regional cerebral blood flow (rCBF) variations, as measured by Positron Emission Tomography (PET). Data were obtained from six young, healthy, right-handed, male volunteers (20-30 years old) using the H2(15)O infusion method. PET scans were performed both during waking and various stages of sleep. BIS values were monitored continuously and recorded during each PET scan. Positive correlations were detected between BIS and rCBF values in dorsolateral prefontal, parietal, anterior and posterior cingulate, precuneal, mesiofrontal, mesiotemporal and insular cortices. These areas belong to a frontoparietal network known to be related to awareness of self conscious sensory perception, attention and memory. BIS values also positively correlated with activity in brainstem and thalami, both structures known to be involved in arousal and wakefulness. These results show that BIS changes associated with physiological sleep depth co-vary with the activity of specific cortical and subcortical areas. The latter are known to modulate arousal, which in turn allows sustained thalamo-cortical enhancement of activity in a specific frontoparietal network known to be related to the content of consciousness. Thus, although mainly derived from frontal EEG, BIS could represent a wider index of cerebral activity.

Cross-sectional study to evaluate radiological parameters in hallux rigidus

BACKGROUND

Hallux rigidus (HR) is a common condition with X-rays used to evaluate its pathology, grade joint changes and to inform treatment.

METHOD

A cross-sectional study was undertaken to evaluate radiological foot parameters in HR. In 110 subjects (180 feet) aged 18-70 years (mean 52 years) standard weight-bearing X-rays were examined using dorsal plantar and lateral views.

RESULTS

Seventy (64%) subjects had bilateral HR and 73 (66%) were female. The mean onset of HR (denoted by first metatarsophalangeal (MTP) joint restriction/pain) was 44 (14-68 years) years and median HR duration was 6 years (1-33 years). Flat or chevron-shaped metatarsal heads presented in 131 (73%) feet and a history of first MTP joint trauma in 22% (74% of whom had unilateral HR). In 74% of feet hallux abductus interphalangeus angle (HAI degrees) was greater than normal (< or =10 degrees). Correlations between first MTP joint narrowing and sclerosis (r=0.76, p=0.01) and increased HAI degrees and first MTP joint narrowing (r=0.34, p=0.01) was found. The mean hallux equinus angle of 11 degrees was outside the normal range (16-18 degrees). Abnormal sesamoid morphology presented in 117 (65%) feet (30% irregular or hypertrophic). Proximal sesamoid displacement was greater than that seen in non-HR. Metatarsus primus elevatus was within normal range (< or =8 mm) in 160 (89%) feet. The first metatarsal was longer than the second metatarsal in 66 (37%) feet although the first metatarsal was longer than the third metatarsal in 131 (73%) feet and may be responsible for altered forefoot function in HR.

CONCLUSIONS

HR was associated with female gender, bilateral involvement, older age groups, flat or chevron-shaped metatarsal head, longer proximal phalanx, increased HAI degrees and a first metatarsal longer than the third metatarsal. For radiological parameters to be considered valid for inclusion in a classification of HR their content validity needs to be established by formal research.

The mechanism of action of a citrus oil blend against Enterococcus faecium and Enterococcus faecalis

AIMS

The aim was to explore the mechanisms by which a blend of orange (Citrus sinensis) : bergamot (Citrus bergamia) (1 : 1 v/v) EO (essential oil) (2% v/v) and its vapour (15 mg l(-1) air) brings about its antimicrobial effect against Enterococcus faecium and Enterococcus faecalis.

METHODS AND RESULTS

Cells were exposed to the blend in oil or vapour form in a sealed unit. Membrane permeability was measured using an NPN assay and intra and extracellular ATP concentrations were assessed using luminescence. Assays using 3,3-dipropylthiacarbocyanine and carboxyfluorescein diacetate succinimidyl ester measured membrane potential and intracellular pH changes. TEM images of treated cells indicate morphological differences and show the possible uptake of the EO into the cell. After cells were exposed to EO or vapour, cell permeability increased by x2 and x40 respectively. A decrease of 1.5 in intracellular pH, 20 a.u. in membrane potential and 18 pmol mg(-1) protein of intracellular ATP occurred.

CONCLUSIONS

The EO blend affects the cell membrane and cell homeostasis resulting in inhibition of growth or cell death.

SIGNIFICANCE AND IMPACT OF THE STUDY

Understanding the mechanisms by which EOs bring about their antibacterial effect could lead to an alternative to chemical-based bactericides for use against Enterococcus sp.

Genetic variability of the SNPforID 52-plex identification-SNP panel in Central West Colombia

A set of autosomal single nucleotide polymorphism (SNP) loci was analyzed using the 52-plex assay previously described by Sanchez et al. [J.J. Sanchez, C. Phillips, C. Borsting, K. Balogh, M. Bogus, M. Fondevila, C.D. Harrison, E. Musgrave-Brown, A. Salas, D. Syndercombe-Court, P.M. Schneider, A. Carracedo, N. Morling, A multiplex assay with 52 single nucleotide polymorphisms for human identification, Electrophoresis 27 (2006) 1713-1724] in 140 samples of unrelated individuals born in the Colombian regions of, Risaralda, Caldas, Quindio, Antioquia, Tolima and Valle, and 164 samples of unrelated individuals with declared Native American ancestry from Colombia. Allele frequencies and statistical parameters of forensic interest are presented for the 52 SNPs. All loci were in agreement with Hardy-Weinberg equilibrium while comparisons with population samples of Argentina, Portugal, Spain, Mozambique, and Taiwan revealed significant differences in allele frequency distributions.

Quantum interference of magnetic edge channels activated by intersubband optical transitions in magnetically confined quantum wires

We investigate the photoresistance of a magnetically confined quantum wire in which microwave-coupled edge channels interfere at two pinning sites in the fashion of a Mach-Zehnder interferometer. The conductance is strongly enhanced by microwave power at B = 0 and develops a complex series of oscillations when the magnetic confinement increases. Both results are quantitatively explained by the activation of forward scattering in a multimode magnetically confined quantum wire. By varying the strength of the magnetic confinement we are able to tune the phase of electrons in the arms of the interferometer. Quantum interferences which develop between pinning sites explain the oscillations of the conductance as a function of the magnetic field. A fit of the data gives the distance between pinning sites as 11 µm. This result suggests that quantum coherence is conserved over a distance three times longer than the electron mean free path.

The mtDNA ancestry of admixed Colombian populations

A total of 185 individuals from Colombia were sequenced for the first hypervariable region (HVS-I) of the mitochondrial DNA (mtDNA) genome, and a subset of these individuals were additionally genotyped for the second hypervariable segment (HVS-II). These individuals were collected according to their "self-reported ethnicity" in Colombia, comprising "Mestizos," "Mulatos," and "Afro-Colombians." We used databases containing more than 4,300 Native American lineages, 6,800 Africans, and 15,600 Europeans for population comparisons and phylogeographic inferences. We observe that Mulatos and Afro-Colombians have a dominant African mtDNA component, whereas Mestizos carry predominantly Native American haplotypes. All the populations analyzed have high diversity indices and there are no signatures of dramatic genetic drift episodes. Central and South America are the main candidate source populations of the Colombian Native American lineages, whereas west-central, southwest, and southeast Africa are the main original mtDNA sources for the African Colombian mtDNAs. We found that our results differ from those obtained in other studies for the same "population groups" in terms of haplogroup frequencies. This observation leads us to conclude that (i) self-reported ancestry is not a reliable proxy to indicate an individual's "ethnicity" in Colombia, (ii) our results do not support the use of outmoded race descriptions (Mestizos, Mulatos, etc.) mainly because these labels do not correspond to any genetically homogeneous population group, and (iii) studies relying on these terms to describe the population group of the individual, which then treat them as genetically homogeneous, carry a high risk of type I error (false positives) in medical studies in this country and of misinterpretation of the frequency of observed variation in forensic casework.

Toward using delta13C of ecosystem respiration to monitor canopy physiology in complex terrain

In 2005 and 2006, air samples were collected at the base of a Douglas-fir watershed to monitor seasonal changes in the delta13CO2 of ecosystem respiration (delta13C(ER)). The goals of this study were to determine whether variations in delta13C(ER) correlated with environmental variables and could be used to predict expected variations in canopy-average stomatal conductance (Gs). Changes in delta13C(ER) correlated weakly with changes in vapor pressure deficit (VPD) measured 0 and 3-7 days earlier and significantly with soil matric potential (psi(m)) (P value <0.02) measured on the same day. Midday G (s) was estimated using sapflow measurements (heat-dissipation method) at four plots located at different elevations within the watershed. Values of midday Gs from 0 and 3-7 days earlier were correlated with delta13C(ER), with the 5-day lag being significant (P value <0.05). To examine direct relationships between delta13C(ER) and recent Gs, we used models relating isotope discrimination to stomatal conductance and photosynthetic capacity at the leaf level to estimate values of stomatal conductance ("Gs-I") that would be expected if respired CO2 were derived entirely from recent photosynthate. We compared these values with estimates of Gs using direct measurement of transpiration at multiple locations in the watershed. Considering that the approach based on isotopes considers only the effect of photosynthetic discrimination on delta13C(ER), the magnitude and range in the two values were surprisingly similar. We conclude that: (1) delta13C(ER) is sensitive to variations in weather, and (2) delta13C(ER) potentially could be used to directly monitor average, basin-wide variations in Gs in complex terrain if further research improves understanding of how delta13C(ER) is influenced by post-assimilation fractionation processes.

Prediction of periodontal pathology around third molars using linear mixed effects modeling

OBJECTIVE

To compare the random intercept multilevel model with other linear mixed effects models in an assessment of the effect of quadrant-, jaw-, and person level covariates on probing depth of asymptomatic third molars.

BASIC RESEARCH DESIGN

Five different covariance models were considered: 1) the random intercept multilevel 2) multi-level with unequal jaw variance 3) multi-level with unequal tooth variance 4) multi-level with unequal jaw and side variance and 5) the general linear model for correlated data with unstructured covariance matrix.

PARTICIPANTS

235 subjects with all four third molars erupted were included. Fifty-one percent were female and 75% Caucasian. The average age was 29.1 years (sd = 7.0).

RESULTS

The extended multi-level with unequal residual variance was the best fit to the data. Likelihood ratio tests in a stepdown selection approach resulted in a final model for mean probing depth that included one statistically significant three-way interaction (age x gingival inflammation x gender), two statistically significant two-way interactions (jaw x gingival inflammation and jaw x gender) and one significant main effect (ethnicity).

CONCLUSIONS

Linear mixed effects modeling is a powerful tool for the analysis of correlated dental data. However, no one covariance structure is appropriate for all purposes.

[Brain imaging of reflection on self]

Precise brain regions are activated when a subject gives a judgment on himself. Those are the medial parietal cortex, essentially related to episodic memory processing, and the ventromedial prefrontal cortex, recruited for evaluating the personal valence of an information. These regions are not activated in Alzheimer's disease. The decrease of awareness for own deficits in a patient with Alzheimer's disease would depend on a reduction of episodic memory capacities and a worsening of judgment for self significance.

Resolving relationship tests that show ambiguous STR results using autosomal SNPs as supplementary markers

When using a standard battery of STRs for relationship testing a small proportion of analyses can give ambiguous results - where the claimed relationship cannot be confirmed by a high enough paternity index or excluded with fully incompatible genotypes. The majority of such cases arise from unknowingly testing a brother of the true father and observing only a small number of exclusions that can each be interpreted as one- or two-step mutations. Although adding extra STRs might resolve a proportion of cases, there are few properly validated extra STRs available, while the commonly added hypervariable SE33 locus is four times more mutable than average, increasing the risk of ambiguous results. We have found SNPs in large multiplexes are much more informative for both low initial probabilities or ambiguous exclusions and at the same time provide a more reliable genotyping approach for the highly degraded DNA encountered in many identification cases. Eight relationship cases are outlined where the addition of SNP data resolved analyses that had remained ambiguous even with extended STR typing. In addition we have made simulations to ascertain the frequency of failing to obtain exclusions or conclusive probabilities of paternity with different marker sets when a brother of the true father is tested. Results indicate that SNPs are statistically more efficient than STRs in resolving cases that distinguish first-degree relatives in deficient pedigrees.

Case report: identification of skeletal remains using short-amplicon marker analysis of severely degraded DNA extracted from a decomposed and charred femur

Applying two extraction protocols to isolate DNA from a charred femur recovered after a major forest fire, a range of established and recently developed forensic marker sets that included mini-STRs and SNPs were used to type the sample and confirm identity by comparison to a claimed daughter of the deceased. Identification of the remains suggested that the individual had been dead for 10 years and the DNA was therefore likely to be severely degraded from the combined effects of decomposition and exposure to very high temperatures. We used new marker sets specifically developed to analyze degraded DNA comprising both reduced-length amplicon STR sets and autosomal SNP multiplexes, giving an opportunity to assess the ability of each approach to successfully type highly degraded material from a challenging case. The results also suggest a modified ancient DNA extraction procedure offers improved typing success from degraded skeletal material.

Intrinsic brain activity in altered states of consciousness: how conscious is the default mode of brain function?

Spontaneous brain activity has recently received increasing interest in the neuroimaging community. However, the value of resting-state studies to a better understanding of brain-behavior relationships has been challenged. That altered states of consciousness are a privileged way to study the relationships between spontaneous brain activity and behavior is proposed, and common resting-state brain activity features observed in various states of altered consciousness are reviewed. Early positron emission tomography studies showed that states of extremely low or high brain activity are often associated with unconsciousness. However, this relationship is not absolute, and the precise link between global brain metabolism and awareness remains yet difficult to assert. In contrast, voxel-based analyses identified a systematic impairment of associative frontoparieto-cingulate areas in altered states of consciousness, such as sleep, anesthesia, coma, vegetative state, epileptic loss of consciousness, and somnambulism. In parallel, recent functional magnetic resonance imaging studies have identified structured patterns of slow neuronal oscillations in the resting human brain. Similar coherent blood oxygen level-dependent (BOLD) systemwide patterns can also be found, in particular in the default-mode network, in several states of unconsciousness, such as coma, anesthesia, and slow-wave sleep. The latter results suggest that slow coherent spontaneous BOLD fluctuations cannot be exclusively a reflection of conscious mental activity, but may reflect default brain connectivity shaping brain areas of most likely interactions in a way that transcends levels of consciousness, and whose functional significance remains largely in the dark.

Intrinsic brain activity in altered states of consciousness: how conscious is the default mode of brain function?

Spontaneous brain activity has recently received increasing interest in the neuroimaging community. However, the value of resting-state studies to a better understanding of brain-behavior relationships has been challenged. That altered states of consciousness are a privileged way to study the relationships between spontaneous brain activity and behavior is proposed, and common resting-state brain activity features observed in various states of altered consciousness are reviewed. Early positron emission tomography studies showed that states of extremely low or high brain activity are often associated with unconsciousness. However, this relationship is not absolute, and the precise link between global brain metabolism and awareness remains yet difficult to assert. In contrast, voxel-based analyses identified a systematic impairment of associative frontoparieto-cingulate areas in altered states of consciousness, such as sleep, anesthesia, coma, vegetative state, epileptic loss of consciousness, and somnambulism. In parallel, recent functional magnetic resonance imaging studies have identified structured patterns of slow neuronal oscillations in the resting human brain. Similar coherent blood oxygen level-dependent (BOLD) systemwide patterns can also be found, in particular in the default-mode network, in several states of unconsciousness, such as coma, anesthesia, and slow-wave sleep. The latter results suggest that slow coherent spontaneous BOLD fluctuations cannot be exclusively a reflection of conscious mental activity, but may reflect default brain connectivity shaping brain areas of most likely interactions in a way that transcends levels of consciousness, and whose functional significance remains largely in the dark.

Dissemination and evaluation of the ASAS/EULAR recommendations for the management of ankylosing spondylitis: results of a study among 1507 rheumatologists

Background:

Ten ASAS/EULAR recommendations for the management of ankylosing spondylitis (AS) were published in 2006.

Objectives:

(a) To disseminate and (b) to evaluate conceptual agreement with, and (c) application of, these recommendations as well as (d) potential barriers to the application.

Methods:

A questionnaire was sent to rheumatologists in 10 countries. It included (a) the text of the recommendations; (b) rheumatologists’ demographic variables; (c) two numerical rating scales from 1 to 10 for each recommendation: conceptual agreement with, and application of, the recommendation (10 indicates maximal agreement and maximal application); and (d) a list of potential barriers to the application of the recommendation. Statistical analysis included descriptive and multivariate analyses.

Results:

7206 questionnaires were sent out; 1507 (21%) were returned. Of the 1507 answering rheumatologists, 62% were men, mean (SD) age 49 (9) years, and 34% had an academic position. Conceptual agreement with the recommendations was high (mean (SD) for all recommendations 8.9 (0.9)). Self-reported application was also high (8.2 (1.0)). The difference between agreement and application varied across recommendations and countries. The most pronounced discrepancies were reported for use of anti-tumour necrosis factor drugs in a few countries, with funding as the most commonly reported barrier for application of this recommendation.

Conclusion:

This large project has helped the dissemination of the ASAS/EULAR recommendations for the management of AS and shows that conceptual agreement with the recommendations is very high. The project also highlights inequalities in access to healthcare for European citizens with AS.

The Emerging Risk Factors Collaboration: analysis of individual data on lipid, inflammatory and other markers in over 1.1 million participants in 104 prospective studies of cardiovascular diseases

Many long-term prospective studies have reported on associations of cardiovascular diseases with circulating lipid markers and/or inflammatory markers. Studies have not, however, generally been designed to provide reliable estimates under different circumstances and to correct for within-person variability. The Emerging Risk Factors Collaboration has established a central database on over 1.1 million participants from 104 prospective population-based studies, in which subsets have information on lipid and inflammatory markers, other characteristics, as well as major cardiovascular morbidity and cause-specific mortality. Information on repeat measurements on relevant characteristics has been collected in approximately 340,000 participants to enable estimation of and correction for within-person variability. Re-analysis of individual data will yield up to approximately 69,000 incident fatal or nonfatal first ever major cardiovascular outcomes recorded during about 11.7 million person years at risk. The primary analyses will involve age-specific regression models in people without known baseline cardiovascular disease in relation to fatal or nonfatal first ever coronary heart disease outcomes. This initiative will characterize more precisely and in greater detail than has previously been possible the shape and strength of the age- and sex-specific associations of several lipid and inflammatory markers with incident coronary heart disease outcomes (and, secondarily, with other incident cardiovascular outcomes) under a wide range of circumstances. It will, therefore, help to determine to what extent such associations are independent from possible confounding factors and to what extent such markers (separately and in combination) provide incremental predictive value.

Hemodynamic cerebral correlates of sleep spindles during human non-rapid eye movement sleep

In humans, some evidence suggests that there are two different types of spindles during sleep, which differ by their scalp topography and possibly some aspects of their regulation. To test for the existence of two different spindle types, we characterized the activity associated with slow (11-13 Hz) and fast (13-15 Hz) spindles, identified as discrete events during non-rapid eye movement sleep, in non-sleep-deprived human volunteers, using simultaneous electroencephalography and functional MRI. An activation pattern common to both spindle types involved the thalami, paralimbic areas (anterior cingulate and insular cortices), and superior temporal gyri. No thalamic difference was detected in the direct comparison between slow and fast spindles although some thalamic areas were preferentially activated in relation to either spindle type. Beyond the common activation pattern, the increases in cortical activity differed significantly between the two spindle types. Slow spindles were associated with increased activity in the superior frontal gyrus. In contrast, fast spindles recruited a set of cortical regions involved in sensorimotor processing, as well as the mesial frontal cortex and hippocampus. The recruitment of partially segregated cortical networks for slow and fast spindles further supports the existence of two spindle types during human non-rapid eye movement sleep, with potentially different functional significance.

Baseline brain activity fluctuations predict somatosensory perception in humans

In perceptual experiments, within-individual fluctuations in perception are observed across multiple presentations of the same stimuli, a phenomenon that remains only partially understood. Here, by means of thulium-yttrium/aluminum-garnet laser and event-related functional MRI, we tested whether variability in perception of identical stimuli relates to differences in prestimulus, baseline brain activity. Results indicate a positive relationship between conscious perception of low-intensity somatosensory stimuli and immediately preceding levels of baseline activity in medial thalamus and the lateral frontoparietal network, respectively, which are thought to relate to vigilance and "external monitoring." Conversely, there was a negative correlation between subsequent reporting of conscious perception and baseline activity in a set of regions encompassing posterior cingulate/precuneus and temporoparietal cortices, possibly relating to introspection and self-oriented processes. At nociceptive levels of stimulation, pain-intensity ratings positively correlated with baseline fluctuations in anterior cingulate cortex in an area known to be involved in the affective dimension of pain. These results suggest that baseline brain-activity fluctuations may profoundly modify our conscious perception of the external world.

Facial altered sensation and sensory impairment after orthognathic surgery

The aim of this study was to determine whether impairment of sensory functions after trigeminal nerve injury differs in severity among patients who report qualitatively different altered sensations. Data were obtained from 184 patients. Before and at 1, 3 and 6 months after orthognathic surgery, patients were grouped as having no altered sensation, negative sensations only (hypoaesthetic), mixed sensations (negative+active), or active sensations only (paraesthetic or dysaesthetic). Bias-free estimates of contact detection and two-point discrimination were obtained to assess, via ANOVA, whether patients in the four groups exhibited different levels of sensory impairment. Impairment in contact detection and two-point discrimination was found to differ significantly among the groups at 6 months but not at 1 month. At 6 months, patients who reported negative sensations only exhibited the greatest impairment, on average, in contact detection; in contrast, patients who reported mixed sensations exhibited the greatest impairment in two-point discrimination. The least residual impairment at 6 months was observed in patients who reported no altered sensation. It is recommended that clinical judgments regarding nerve injury-associated sensory dysfunction should not be based on threshold testing results without consideration of patients' subjective reports of altered sensation.

Cortisol regulates eel (Anguilla anguilla) aquaporin 3 (AQP3) mRNA expression levels in gill

Previous studies in eel (Anguilla anguilla) gill have shown that the expression of the aquaporin 3 (AQP3) water and small solute channel is dramatically decreased (mRNA abundance decreased by up to 97%) when these euryhaline fish are acclimated from freshwater (FW) to seawater (SW). However, AQP3 mRNA expression levels in the intestine following SW-acclimation do not change. The SW-acclimating corticosteroid hormone, cortisol has previously been shown to regulate the expression of aquaporins (particularly AQP1) in eel osmoregulatory tissues in a tissue-specific and isoform-specific fashion. AQP1 is up-regulated in intestine and oesophagus, but down-regulated in kidney, following SW-acclimation in these fish. This study extends knowledge of the regulation of aquaporin expression by cortisol in the eel and shows that elevated levels of this hormone down-regulate AQP3 mRNA expression in the gill in a similar manner to SW-acclimation. However, the smaller magnitude of the changes in branchial AQP3 expression induced by cortisol-infusion (around a 60% decrease), in comparison to those occurring following SW-acclimation, suggest that other factors must also contribute to AQP3 down-regulation. In a similar fashion to the regulation of AQP1 by cortisol, changes in AQP3 expression following hormone infusion appear to be tissue-specific, as little effect was seen on the level of AQP3 expression in the intestine. Again the apparent lack of change in intestinal AQP3 expression following cortisol-infusion mimicked the invariant level of intestinal AQP3 mRNA abundance following SW-acclimation.