Should routine surgical wound drainage after ventral hernia repair be avoided? A systematic review and meta-analysis

AIMS

To evaluate outcomes of drain use vs. no-drain use during ventral hernia repair.

METHODS

A PRISMA-compliant systematic review was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Studies comparing use of drains with no-drain during ventral hernia repair (primary or incisional) were included. Wound-related complications, operative time, need for mesh removal and early recurrence were the evaluated outcome parameters.

RESULTS

Eight studies reporting a total number of two thousand four hundred and sixty-eight patients (drain group = 1214; no-drain group = 1254) were included. The drain group had a significantly higher rate of surgical site infections (SSI) and longer operative time compared with the no-drain group [odds ratio (OR): 1.63, P = 0.01] and [mean difference (MD): 57.30, P = 0.007], respectively. Overall wound-related complications [OR: 0.95, P = 0.88], seroma formation [OR: 0.66, P = 0.24], haematoma occurrence [OR: 0.78, P = 0.61], mesh removal [OR: 1.32, P = 0.74] and early hernia recurrence [OR: 1.10, P = 0.94] did not differ significantly between the two groups.

CONCLUSION

The available evidence does not seem to support the routine use of surgical drains during primary or incisional ventral hernia repairs. They are associated with increased rates of SSIs and longer total operative time with no significant advantage in terms of wound-related complications.

Vascularised fatty tissue: its role in prevention of the symptoms of Frey syndrome after parotidectomy

We studied 37 consecutive patients who had parotidectomies between 2008 and 2017 and who had vascular fat flaps inserted to replace the excised parotid tissue and prevent Frey syndrome. They were followed up for 1-9 years to check for the relevant symptoms. We studied 17 female and 20 male patients, mean age 52 (range 19-78) years. The flaps took a maximum of 17minutes to dissect. There was no donor site morbidity, the vascular fat flap was stable in all cases for up to nine years, and none of the patients complained of symptoms of Frey syndrome.

Maxillary advancement versus mandibular setback in class III dentofacial deformity: are there any differences in aesthetic outcomes?

A retrospective evaluation of maxillary advancement and mandibular setback in class III patients was performed and their aesthetic outcomes compared. Patients with a sella-nasion-A-point angle (SNA) of 80-84° were selected. Pre- and postoperative lateral cephalograms were obtained for 34 class III patients; these were divided into two groups according to the surgical procedure performed: mandibular setback group (n=17) and maxillary advancement group (n=17). The pre- and postoperative cervical length, lip-chin-throat angle, lower/upper lip thickness, distance from the lower/upper lip to the aesthetic line, soft tissue angle, facial contour angle, and nasolabial angle of the two groups were compared. Significant differences were observed for cervical length (P=0.0003) and sex (P=0.003) when comparing maxillary advancement with mandibular setback. Although the preoperative cervical length was similar in the two groups, it increased significantly after maxillary advancement and decreased after mandibular setback. In this study, the differences in aesthetic outcomes depending on the surgical procedure performed were considered. Some aesthetically important parameters proved to be superior after maxillary advancement when compared to mandibular setback, even with the maxilla in the normal position.

Three-layer reconstruction of lower third nasal defects using forehead flap, reversed nasolabial flap, and auricular cartilage

The reconstruction of a full-thickness defect of the distal third of the nose requires the restoration of all three anatomical layers. A practical method for three-layer reconstruction of the lower third of the nose and the long-term results of this technique are presented herein. A combined reconstruction technique was utilized, including a reverse subcutaneous pedicled nasolabial flap to restore the nasal mucosa, an auricular cartilage graft for structural support, and a forehead flap for cutaneous coverage of the defect. This technique was applied in 21 patients following the full-thickness excision of basal cell carcinoma of the lower part of the nose. All patients (12 male and nine female; mean age 59.8 years) were treated successfully and were satisfied with the aesthetic and functional outcomes. The wound had to be further revised in three cases for the correction of contour or residual deformities; however, no further complications were experienced. One patient had a wound infection and the cartilage had to be removed. The grafting procedure was repeated successfully after resolution of the infection. Donor site morbidity was unremarkable. Combined flaps from the forehead and nasolabial regions with an incorporated auricular cartilage graft can be used to reconstruct full-thickness defects of the lower third of the nose.

Comparative Plaque Removal Efficacy of a New Powered Toothbrush and a Manual Toothbrush

OBJECTIVES

The purpose of this study was to determine the plaque removal effectiveness of a new powered toothbrush and compare it to that of a manual brush.

METHODS

This examiner-blind, randomized study used a cross-over design. Sixty-two (62) qualifying subjects were randomly assigned either to the powered brush (Arm & Hammer Spinbrush™ Truly Radiant™ Clean & Fresh Battery-Powered Toothbrush), or a standard manual toothbrush (ADA Standard Manual Toothbrush) and instructed to brush at home with a standard fluoride toothpaste twice daily for two minutes during a one-week familiarization period. At the end of this period, the subjects returned to the study site. After refraining from oral hygiene for 12-16 hours and from eating and drinking for four hours, plaque was disclosed by rinsing with an erythrosine dye solution and scored using the Rustogi Modification of the Navy Plaque Index (RMNPI). Subjects then brushed under supervision with their assigned toothbrush for two minutes, and plaque was disclosed and rescored. They were then given the alternate toothbrush, and the familiarization routine and evaluation process were repeated. The primary outcome variable was mean whole mouth RMNPI score with additional analyses performed on regional subsets of tooth surfaces.

RESULTS

Within-group analysis showed that both toothbrushes produced statistically significant reductions from the pre-brushing baseline in whole mouth and regional plaque scores (p < 0.01), with respective whole mouth reductions of 40.7% and 24.9% for the powered brush and the manual brush. Between-group analyses showed that the powered brush produced a statistically significantly greater plaque reduction than the manual brush, both whole mouth (63.7%, p < 0.0001) and at all 12 subsets of sites.

CONCLUSIONS

When evaluated using this single-use clinical model, the Arm & Hammer Spinbrush Truly Radiant Clean & Fresh powered toothbrush was statistically significantly more effective in reducing plaque than the manual toothbrush, both whole mouth and at all regional subsets of tooth surfaces, including difficult-to-reach sites.

Comparative Plaque Removal Efficacy of Three Manual Toothbrushes

OBJECTIVES

The purpose of this study was to determine the safety and plaque-reducing effectiveness of a newly designed manual toothbrush compared to that of a leading marketed toothbrush and a reference standard manual toothbrush control.

METHODS

This examiner-blind, randomized, single-use study used a cross-over design. Sixty-eight qualifying male and female subjects were randomly assigned either an Arm & Hammer™ Truly Radiant™ Deep Clean manual toothbrush (TR), a Colgate® Extra Clean manual toothbrush (C), or an ADA reference standard manual toothbrush (SM) according to one of three computer-generated sequences. Following instruction in the use of their assigned brush, subjects brushed at home with a standard fluoride toothpaste twice daily for two minutes during a one-week familiarization period. At the end of this period, the subjects returned to the study site after refraining from oral hygiene for 12-16 hours and from eating and drinking for four hours. Plaque was disclosed and scored using the Rustogi Modification of the Navy Plaque Index (RMNPI). Subjects brushed under supervision with their assigned toothbrush for two minutes in a room without mirrors and apart from the dental examiner, after which plaque was disclosed and rescored. They were then given one of the alternate toothbrushes according to their assigned sequence, and the familiarization routine and evaluations were repeated until each of the subjects used each of the three brushes. Within-treatment and between-treatment whole mouth RMNPI scores and scores at each of twelve subsets of sites were analyzed using paired t-tests and appropriate ANCOVA models, respectively.

RESULTS

Within-group analyses showed that all three toothbrushes produced statistically significant reductions from the pre-brushing baseline in whole mouth RMNPI scores (p < 0.0001), with respective reductions of 68.2%, 58.3%, and 48.5% for TR, C, and SM. Between-group analyses showed that TR was significantly more effective (p < 0.0001) than C and SM with 16.4% and 40.3% greater reductions in whole mouth scores, respectively. TR also produced statistically significant greater reductions (p < 0.0001) than the other two manual brushes at each of the twelve subsets of sites examined, with the greatest differences at the lingual and gingival sites, especially sites presenting difficulty in access, such as those in the posterior lingual gingival region.

CONCLUSIONS

While all three manual toothbrushes produced significant supragingival plaque reductions with a single use, the Truly Radiant Deep Clean brush was significantly more effective than the Colgate Extra Clean and ADA manual brushes in reducing wholemouth plaque, as well as plaque at all subsets of sites analyzed including difficult-to-reach areas.

Clinical Study to Determine the Stain Removal Effectiveness of a New Dentifrice Formulation

OBJECTIVES

This randomized, prospective clinical trial was conducted to determine the safety and effectiveness of a new whitening dentifrice formulation in comparison to that of both a negative and a positive control dentifrice.

METHODS

Seventy-nine qualifying subjects were randomly assigned to either the new whitening dentifrice (Arm & Hammer® Truly Radiant™ Clean & Fresh Toothpaste), a positive control whitening dentifrice (Crest® 3-D White® Radiant Mint Toothpaste), or a negative control regular dentifrice (Colgate® Cavity Protection Toothpaste). The subjects brushed with their assigned dentifrice for two minutes, twice daily, for five days. Extrinsic tooth stain was assessed using a Modified Lobene Stain Index (MLSI) at baseline and after five days of product use.

RESULTS

All entering subjects completed the study. There were no significant differences (p > 0.05) in stain among the three groups at baseline. The Arm & Hammer Truly Radiant and positive control groups had statistically significant (p < 0.001) mean composite MLSI reduction scores of 13.2% and 7.8%, respectively, from baseline to day five. The negative control dentifrice group was virtually unchanged during this period. Intergroup comparisons showed the Truly Radiant group to have significantly greater stain removal (p < 0.0001) scores than the negative control. The Truly Radiant group also had greater stain removal than the positive control, though the differences were not statistically significant.

CONCLUSIONS

This study demonstrates that five-days' use of Arm & Hammer Truly Radiant Clean & Fresh dentifrice was significantly more effective in stain removal than a regular (non-whitening) dentifrice and comparable in effectiveness to a whitening dentifrice positive control.

Reconstruction of facial soft tissue: comparison between conventional procedures and the facelift technique

We compared the result of replacement using a modified facelift technique with those of other commonly used surgical techniques for the treatment of defects of the soft tissue of the infraorbital and cheek region. We made a retrospective observational study of 86 patients who had defects of the facial soft tissue after excision of malignant tumours. Procedures used for reconstructions included non-vascularised skin grafts, local flaps, facelift technique, and microvascular free flaps, and we evaluated morbidity; duration of hospital stay; the need for, and duration of stay in the intensive care unit (ICU); and functional and aesthetic outcomes. We studied 46 men and 40 women (mean (range) age 71 (8-99) years). We found no significant difference between the methods apart from shorter duration of hospital stay and lower incidence of ectropion in the facelift group. The facelift technique also gave the best aesthetic outcome. However, in defects larger than 60cm², microvascular free tissue transfer was the only choice. The facelift technique is reliable and safe, and gives excellent aesthetic and functional outcomes, but its use is limited to defects smaller than 60cm².

Immunotherapy with imiquimod and interferon alfa for metastasized Merkel cell carcinoma

Merkel cell carcinoma (mcc) is a highly aggressive neuroendocrine tumour of the skin. Remission rates are high with chemotherapy in patients with metastasis, but without any improvement in overall survival. We present the case of a 90-year-old woman with facial mcc. After radiation and surgery, the mcc recurred with widespread cutaneous and regional lymph node metastases. The metastases were treated with weekly intralesional injections of 1-2×10(6) IU interferon alfa-2a, accompanied by topical imiquimod 5% cream 3 times weekly. After partial regression, subcutaneous pegylated interferon alfa-2b was added at a dose of 30 μg weekly, which was then increased to 50 μg weekly. At 4 months after the start of immunotherapy, all cutaneous metastases and the intralesionally treated lymph node metastases receded. Interruption or reduction of systemic interferon application resulted in locoregional relapses that were successfully treated with surgery or intralesional interferon injections. The patient remains alive 30 months after initiation of immunotherapy, suggesting that locally metastasized mcc might be able to be controlled with local and systemic immunotherapy.

Clinical Study to Assess the Stain Removal Effectiveness of a Tooth Whitening Regimen with Added Whitening Booster

OBJECTIVE

This randomized, controlled clinical trial was conducted to assess the extrinsic stain reduction achieved by brushing with a whitening dentifrice and powered toothbrush, and to determine whether the addition of a whitening booster paste to this regimen would enhance its stain reducing effectiveness.

METHODS

Sixty qualifying subjects were randomly assigned either to Regimen One, a whitening dentifrice (Arm & Hammer Truly Radiant [TR] toothpaste] and powered toothbrush (Arm & Hammer Truly Radiant [TR] Extra Whitening Spinbrush); Regimen Two, the dentifrice and powered toothbrush with the addition of a whitening booster; or Regimen Three, a negative control (Colgate Cavity Protection toothpaste and an ADA standard manual brush). They were instructed in the use of their assigned products and then brushed unsupervised at home for two minutes, twice daily, for 14 days. Extrinsic tooth stain was assessed at baseline and after two, five, and 14 days using a Modified Lobene Stain Index (MLSI) with Lobene inclusion criteria of ≥ 1.5.

RESULTS

All three treatment groups had statistically significant (p < 0.0001) mean total MLSI reductions from baseline at each time point, in a time-dependent manner. Day 14 reductions were 22.2% for Colgate Cavity Protection, 29.1% for Regimen One, and 34.4% for Regimen Two. Reductions for Regimen One and Regimen Two were significantly greater compared to Regimen Three, the negative control, at each time period (p < 0.01), and those for Regimen Two were significantly greater compared to Regimen One on days 2 and 14 (p < 0.05) and directionally more effective on day 5 (p = 0.0673).

CONCLUSION

The combination of Truly Radiant toothpaste and Truly Radiant Spinbrush provides safe and effective stain removal that can be further enhanced by the addition of the whitening booster.

Extrinsic Stain Removal Effectiveness of a New Whitening Dentifrice

OBJECTIVE

This study was conducted to evaluate the effectiveness of Arm & Hammer (A&H) Truly Radiant Rejuvenating toothpaste in removing extrinsic tooth stain compared to that of a conventional fluoride/silica-containing dentifrice.

METHODS

This was a randomized, examiner-blind, parallel-design study with two groups of subjects who brushed unsupervised with their assigned dentifrice for two minutes, twice daily, for five days. Extrinsic stain was measured on the labial surfaces of the eight incisor teeth by the Modified Lobene Stain Index (MLSI) at baseline and following five days of product use. After balancing for baseline MLSI, beverage and tobacco use, fifty-four healthy adults with existing stain were randomly distributed into two comparable groups: Arm and Hammer Truly Radiant Rejuvenating toothpaste or Colgate Cavity Protection toothpaste (negative control). Within-treatment comparisons between baseline and day five were made using matched-pair t-tests, and between-treatment comparisons of MSLI scores were performed using ANCOVA, with baseline scores as covariates.

RESULTS

Twenty-eight subjects in the Truly Radiant Rejuvenating toothpaste group and twenty-six subjects in the negative control group completed the study. The groups had comparable mean scores at baseline (p > 0.05). The Truly Radiant Rejuvenating toothpaste produced a statistically significant 23.1% total (composite) stain reduction from baseline after five days of product use (p < 0.0001) while the negative control was essentially unchanged (p > 0.05). Between-treatment analysis showed statistically significantly (p < 0.0001) greater stain removal for Truly Radiant Rejuvenating toothpaste compared to the Colgate control following five days of product use. There were no adverse events reported during the study.

CONCLUSION

The A&H Truly Radiant Rejuvenating toothpaste is safe and effective in reducing extrinsic stain compared to a regular toothpaste control.

Evaluation of Nosocomial Infection in Patients at hematology-oncology ward of Dr. Sheikh children's hospital

BACKGROUND

Infections in critical care unit are high, and they are serious hospital problems. Infections acquired during the hospital stay are generally called nosocomial infections, initially known as infections arising after 48 h of hospital admission. The mostfrequent nosocomial infections (urinary, respiratory, gastroenteritis and blood stream infection) were common in patients at hospital.The aim was to study, the current status of nosocomial infection, rate of infection among hospitalized children at hematology-oncology ward of Dr. Sheikh children's hospital, Mashhad, Iran.

MATERIALS AND METHODS

Data were collected from 200 patient's records presented with symptoms of nosocomial infection at hematology-oncology ward of Dr. Sheikh children's hospital from March 2014 to September 2014. Descriptive statistics using percentage was calculated.

RESULTS

Incidence of nosocomial infections inpatients athematology-oncology ward was 31% (62/200). Of which 69.35% (43/62) blood stream infection being the most frequent; followed by 30.64% (19/62) was urinary tract infection (UTI), and the most common blood culture isolate was been Staphylococcus epidermidis 18 (41.86%), andour study showed that large numbers ofnosocomial UTIs causing by Gram‑negative bacteria.

CONCLUSION

This study showed blood stream infection and UTI are the common nosocomial infections among patients athematology-oncology ward. Early recognition of infections and short term use of invasive devices along with proper infection control procedures can significantly decrease the incidence of nosocomial infections in patients.

Clinical Effectiveness Evaluation of a New Whitening Dentifrice

OBJECTIVE

This randomized controlled clinical trial was conducted to determine the effectiveness and safety of a new whitening dentifrice.

METHODS

One hundred eighty-two qualifying subjects were randomly assigned to either a whitening dentifrice group (Arm & Hammer Truly Radiant Toothpaste), a negative control dentifrice group (Colgate Cavity Protection Toothpaste), or a positive control dentifrice group (Crest 3-D White Radiant Mint Toothpaste) and were instructed to brush twice daily with their assigned dentifrice for six weeks. Extrinsic tooth stain was assessed using a Modified Lobene Stain Index (MLSI) and tooth shade was assessed using the VITA Classic Shade Guide at baseline and after five days and two, four, and six weeks of dentifrice use. Safety was monitored by clinical examinations and panelist assessment at each evaluation period.

RESULTS

The Arm & Hammer Truly Radiant group showed a statistically significant improvement from baseline in mean composite MLSI and VITA shade at each examination period (p < 0.0001). Significant improvements on day 5 progressively increased with increasing duration of product use. By week 6, there was a 45.4% reduction in stain and a 2.08 improvement in tooth shade. The between-group comparison revealed that Truly Radiant toothpaste was significantly more effective than both the negative and positive control dentifrices for these parameters (p < 0.0001) at each exam time.

CONCLUSION

This study showed that the new dentifrice formulation is safe and effective on stain removal and tooth whitening.

Self-similarity and scaling of thermal shock fractures

The problem of crack pattern formation due to thermal shock loading at the surface of half space is solved numerically using the two-dimensional boundary element method. The results of numerical simulations with 100-200 random simultaneously growing and interacting cracks are used to obtain scaling relations for crack length and spacing. The numerical results predict that such a process of pattern formation with quasistatic crack growth is not stable and at some point the excess energy leads to unstable propagation of one of the longest cracks. This single-crack scenario should be understood in a local sense. There could be other unstable cracks far away that together can form a new pattern. The onset of instability has also been determined from numerical results.

Comparative plaque removal efficacy of two new powered toothbrushes and a manual toothbrush

OBJECTIVE

The purpose of this study was to determine the plaque-reducing effectiveness of two new powered toothbrushes and compare them to a manual toothbrush control.

METHODS

This examiner-blind, randomized study used a crossover design. Sixty-five qualifying male and female subjects were randomly assigned one of the two test powered brushes (Spinbrush Truly Radiant Deep Clean [TRDC] or Spinbrush Truly Radiant Extra Whitening [TREW], Church & Dwight Co., Inc., Princeton, NJ, USA) or an ADA standard manual toothbrush (MT; American Dental Association, Chicago, IL, USA) according to one of three computer-generated sequences. Following instruction in the use of their assigned toothbrush, subjects brushed at home with a standard fluoride toothpaste twice daily for two minutes during a one-week familiarization period. At the end of this period, the subjects returned to the study site after refraining from oral hygiene for 12-16 hours, and from eating, drinking, and smoking for four hours. Plaque was scored using the Rustogi Modification of the Navy Plaque Index. Subjects brushed under supervision with their assigned toothbrush for two minutes, and plaque was rescored. They were then given one of the alternate toothbrushes according to their assigned sequence, and the familiarization routine and evaluation processes were repeated until each of the subjects used each of the three brushes.

RESULTS

Within-group analyses showed that all three toothbrushes produced statistically significant reductions from the pre-brushing baseline in whole mouth and regional plaque scores (p < 0.001), with respective whole mouth reductions of 17.9%, 42.3%, and 38.1% for MT, TRDC, and TREW. Between-group analyses showed that TRDC and TREW were each significantly more effective (p < 0.001) than MT, as each showed at least twice as much of a reduction in whole mouth scores. Both of the powered brushes also produced statistically significantly greater reductions than the manual brush at each of the twelve subsets of sites examined, with the greatest differences at interpoximal sites and sites presenting access difficulty, such as those in the lingual posterior region. Additionally, TRDC produced a statistically significant 11.5% greater reduction than TREW (p = 0.001) in whole mouth plaque scores, and statistically significantly greater reductions in two of the subsets evaluated.

CONCLUSION

Both of the powered brushes tested proved to be safe and significantly more effective than the standard manual control brush in reducing plaque. While the finding that the TRDC was significantly more effective than the TREW in reducing whole mouth plaque and plaque in two subsets demonstrates that small differences in toothbrush design may impact performance, longer-term studies would be needed to assess the extent to which this translates to meaningful clinical outcomes.

Congenital pseudarthrosis of the tibia: the results of an evolving protocol of management

PURPOSE

This retrospective cohort study assesses the outcomes of a protocol of management, based on the recommendations of the European Paediatric Orthopaedic Society (EPOS) multi-centre study, for the management of congenital pseudarthrosis of the tibia.

METHODS

Utilising an incremental protocol of bracing, intramedullary rods and circular frame fixation with or without bone morphogenetic protein-2 (BMP-2), 11 patients had reached skeletal maturity or had follow up of 5 years from radiological union of the pseudarthrosis. Demographic data, deformity parameters before and after treatment, and functional outcome scores were recorded.

RESULTS

Ten of the 11 patients successfully healed and two sustained a refracture. All deformity parameters improved and a mean leg length discrepancy of 2.5 cm (range 0-7.5 cm) existed at the time of the last follow up. Some pseudarthroses healed with deformity correction and rod insertion alone. Six of the 11 patients had a confirmed diagnosis of neurofibromatosis and nine had sustained a fracture before 4 years of age. Refracture was associated with malalignment after healing.

CONCLUSION

This method of treatment provides a successful stepwise protocol for the management of this complex disorder, avoiding the use of aggressive limb reconstruction techniques at a young age in some cases. Level of evidenceCase series Level IV.

Comparative plaque removal efficacy of a new children's powered toothbrush and a manual toothbrush

OBJECTIVE

The purpose of this study was to determine the plaque removal effectiveness of a new children's powered toothbrush and compare it to that of a manual brush.

METHODS

This examiner-blind, randomized study used a cross-over design. One-hundred and five qualifying male and female subjects (52 ages 8-12 and 53 ages 13-17) were randomly assigned either the powered brush (Spinbrush GLOBRUSH) or a manual toothbrush (Oral-B Indicator 30 Compact Soft Toothbrush) and instructed to brush at home with a standard fluoride toothpaste twice daily for two minutes during a one-week familiarization period. At the end of this period, the subjects returned to the study site after refraining from oral hygiene for twenty-four hours and from eating and drinking for four hours. Plaque was scored using the Rustogi Modification of the Navy Plaque Index, subjects brushed under supervision with their assigned toothbrush for two minutes, and plaque was rescored. They were then given the alternate toothbrush and the familiarization routine and evaluation process were repeated.

RESULTS

Within-group analysis showed that both toothbrushes produced statistically significant reductions from the pre-brushing baseline in whole mouth and regional plaque scores (p < 0.0001), with respective whole mouth reductions of 73.3% and 61.8% for the powered brush and the manual brush. Between-group analyses showed that the powered brush produced a statistically significantly greater plaque reduction than the manual brush, both whole mouth (12.8%, p < 0.0001) and at all subset sites, including difficult-to-reach areas such as the posterior lingual gingival region (74.9% greater plaque reduction, p < 0.0001).

CONCLUSION

The Spinbrush GLOBRUSH was significantly more effective in reducing plaque than the manual toothbrush when evaluated using this single-use clinical model.

Bone graft scintigraphy. A new diagnostic tool to assess perfusion during surgery

AIM

To evaluate a scintigraphic tool for intraoperative assessment of vascularized bone graft perfusion before and after transplantation.

PATIENTS, METHODS

This pilot study included three patients scheduled for surgical segmental mandibulectomy followed by reconstruction with a vascularized iliac bone graft. A continuous (99m)Tc-pertechnetate infusion was applied selectively arterial into the blood vessel supplying the respective graft before osteotomy as well as after transplantation. Perfusion was analysed by scintigrams acquired using the intraoperative camera systems declipseSPECT and Sentinella. Results were compared qualitatively.

RESULTS

Before harvesting the graft, intraoperative scintigraphy revealed a clearly delineated area of the iliac crest with a relatively homogenous pertechnetate distribution representing good perfusion. After osteotomy, transplantation to the mandibula and re-anastomosis of the nutrient vessels, scintigraphy in all patients showed a moderately inhomogenous distribution pattern of the pertechnetate indicating an adequate perfusion of the bone transplant through the arterial anastomosis.

CONCLUSION

Intraoperative assessment of bone graft perfusion is possible with the imaging systems Sentinella as well as with declipseSPECT using a continuous intra-arterial infusion of 99mTc-pertechnetate.

Effectiveness of a new dentifrice with baking soda and peroxide in removing extrinsic stain and whitening teeth

OBJECTIVE

The primary purpose of this randomized, controlled, six-week clinical trial was to determine the effectiveness and safety of a new whitening dentifrice in removing extrinsic tooth stain and whitening teeth. An additional two-week exploratory study was conducted to determine whether the whitening or stain-prevention activity of the dentifrice would persist following cessation of use.

METHODS

In the first study (Phase I), one-hundred and forty-six qualifying subjects were randomly assigned to either a sodium bicarbonate whitening dentifrice group (Arm & Hammer Advance White Extreme Whitening Baking Soda and Peroxide Toothpaste) or a silica-based negative control dentifrice group, and brushed twice daily with their assigned dentifrice for six weeks. Tooth shade on the labial surfaces of the eight incisors was assessed using a Vita Classic shade guide, and extrinsic tooth stain was scored using a Modified Lobene Stain Index (MLSI) at baseline, week 4, and week 6. In Phase II (after the week 6 examination), volunteers from the Arm & Hammer whitening dentifrice group were randomly assigned to continue using the whitening dentifrice or to use the negative control dentifrice twice daily for two weeks. The six-week shade and stain index scores served as the baseline for this exploratory phase and were rescored after two weeks.

RESULTS

The whitening dentifrice group had statistically significant (p < 0.0001) mean shade score reductions of 1.82 and 2.57 from baseline to weeks 4 and 6, respectively. For the same periods, the negative control dentifrice group was virtually unchanged from baseline. For tooth stain, the MLSI total mean scores for the whitening dentifrice group showed statistically significant (p < 0.0001) decreases from baseline of 1.42 (41.6%) and 2.11 (61.6%) at weeks 4 and 6, respectively. In contrast, the negative control dentifrice group had a MLSI reduction of 0.07 at week 4 and a 0.06 increase at week 6. Between-group analyses using baseline-adjusted ANCOVA showed the whitening dentifrice to be statistically significantly more effective (p < 0.0001) than the negative control for shade and tooth stain reductions for all index comparisons. Compared to the six-week (baseline) scores, subjects who continued to use the whitening dentifrice for the additional two weeks experienced statistically significant (p < 0.0001) further mean reductions of 0.88 in shade score and 0.46 in MLSI score, while subjects who switched to the negative control dentifrice experienced smaller, statistically significant (p < 0.05) reductions of 0.34 in shade score and 0.13 in total MLSI score.

CONCLUSION

The Arm & Hammer whitening dentifrice tested in this study is effective for removing extrinsic tooth stain and whitening teeth. While the results also suggest that this dentifrice may have stain-prevention activity that persists following cessation of product use, such activity would need to be confirmed with further studies.

Enhancement of plaque removal by baking soda toothpastes from less accessible areas in the dentition

OBJECTIVE

To determine if baking soda toothpastes are relatively more effective than non-baking soda toothpastes in promoting plaque removal from less accessible sites in the dentition.

METHODS

Several single-brushing comparisons of baking soda and non-baking soda toothpastes for their overall ability to remove plaque have been published. In this study, individual comparisons of these published data, comparing the plaque removal performance of baking soda and non-baking soda toothpastes at various sites in the dentition, were examined to see if there were any site-dependant performance trends. The site-specific single-brushing data were then combined and analyzed in two ways. Meta-analyses of the clinical studies were performed to compare baking soda's relative plaque removal advantage at various sites in the mouth using paired t-testing at p <0.05. Also, plaque index reductions at various sites due to brushing with baking soda toothpastes were graphically compared with plaque index reductions due to brushing with non-baking soda dentifrices. The percent relative plaque removal advantage for baking soda toothpastes at various sites were plotted against the reduction in plaque index due to brushing with non-baking soda toothpastes.

RESULTS

Individual comparisons showed that brushing with the toothpastes containing baking soda generally removed significantly more plaque from each site than brushing with toothpastes without baking soda. The relative efficacy advantage for baking soda toothpastes was consistently higher at sites where the non-baking soda toothpastes removed less plaque. Meta-analytical comparisons confirmed baking soda toothpastes to be relatively more effective in enhancing plaque removal from sites where less plaque was removed compared to brushing with non-baking soda toothpastes (p < 0.05). Graphically, the baking soda toothpastes' relative plaque removal advantage could be seen to increase hyperbolically with decreasing plaque removal by the non-baking soda toothpastes with which they were compared. We presuppose that the reason less plaque is removed by non-baking soda toothpastes at some sites than others is that these sites are less accessible to the toothbrush.

CONCLUSION

These results show that baking soda toothpastes are relatively more effective in enhancing plaque removal from harder-to-reach areas of the dentition (p <0.05), i.e., from lingual than facial surfaces, from posterior than anterior areas, and from proximal than mid-surface sites.

Effectiveness of a baking soda toothpaste delivering calcium and phosphate in reducing dentinal hypersensitivity

OBJECTIVE

The purpose of this controlled clinical trial was to determine the effectiveness and safety of a single-phase dentifrice that delivers calcium, phosphate, and fluoride to the tooth surface (Arm & Hammer Enamel Care for Sensitive Teeth toothpaste, United Kingdom) in reducing dentinal hypersensitivity.

METHODS

Two-hundred and eight qualifying subjects were randomly assigned to either the Enamel Care dentifrice group or a control dentifrice group, and brushed twice daily with their assigned dentifrice for eight weeks. Pain/discomfort in response to a thermal stimulus was assessed at baseline, week 4, and week 8 using a Visual Analogue Scale (VAS; primary outcome variable) and the Schiff Thermal Sensitivity Scale (STSS; secondary outcome variable). After eight weeks, volunteers from the Enamel Care group were switched to the control dentifrice and participated in a second eight-week study to determine the degree of persistence of pain reduction.

RESULTS

Both groups had statistically significant VAS score reductions from baseline at weeks 4 and 8, with mean VAS scores in the Enamel Care group decreasing by 45.6% at week 4 and 61.1% at week 8 (p < 0.0001). Enamel Care was statistically significantly more effective than the control at weeks 4 and 8, with respective mean VAS reductions of 63% (p < 0.0001) and 33% (p = 0.0004) greater than the control. Consistent with the VAS score results, the Enamel Care group had respective statistically significant STSS score reductions of 77% and 58% greater than the control group (p < 0.0001). The reductions in dentinal hypersensitivity seen in the Enamel Care group at week 8 persisted for an additional eight weeks, during which the subjects discontinued use of Enamel Care and brushed with the control dentifrice.

CONCLUSION

Enamel Care for Sensitive Teeth toothpaste (United Kingdom) is an effective dentifrice for the management of dentinal hypersensitivity, and its efficacy persists for a least eight weeks following discontinued product use.

Spatial registration of digital brain atlases based on fuzzy set theory

We present a semiautomatic method based on fuzzy set theory for adjusting a computerized brain atlas to magnetic resonance images (MRIs) of the human cerebral cortex. The atlas was registered to three-dimensional MRI data sets of 10 healthy volunteers. After a global matching using the external contour of the brain, several local procedures were performed regarding selected primary furrows and cytoarchitectonic areas. The final transformation matrix was calculated with respect to these anatomical structures and to their local matrices. Evaluation revealed an increase in accuracy as expressed by a reduction of the visible mismatch with respect to the registration of cortical and subcortical brain structures.

[A case of Leber's neuroretinitis]

BACKGROUND

Described in 1916 by Theodore Leber, this rare syndrome characterized by low visual acuity, papillary edema, and a macular star (dry exsudates) occurs classically in the 30 to 40 year age range but also as frequently in children. The visual prognosis is excellent. An infectious cause is found in almost all cases. Case report A 34-year-old man consulted for declining visual acuity of the right eye which began suddenly without pain and was preceded by a flu-like syndrome lasting two weeks. Visual acuity on the right side was 2/10 P6, there was optic disk edema associated with dry macular exsudate (macular star) and a paleness of the posterior pole progressing to the periphery and readily visualized on the angiography, and a central scotome, but no dyschromatopsy. The left eye was strictly normal. Laboratory tests showed an erythrocyte sedimentation rate at 45, C reactive protein at 61, normal red cell count and minimal transaminase elevation. Spinal tap showed: 3 elements/mm(3), protein 0.28g/l, 18% gammaglobulins. Serology tests were negative. Brain imaging was normal.

RESULTS

Corticosteroid flashes for three days were initiated and the patient was seen again two weeks later with clear clinical improvement. Visual acuity was 6/10 P2 with considerable resorption of the edema.

DISCUSSION

This case is a typical illustration of acute Leber's neuroretinititis, probably caused by viral infection. The cerebrospinal fluid tests and brain imaging ruled out multiple sclerosis, and serology tests for syphilis, tuberculosis, Lyme disease and possible parasite infection were negative.

CONCLUSION

Acute lever's neuroretinitis is an uncommon condition which must be distinguished from inflammatory optic neuropathy, particularly in multiple sclerosis which has a very different prognosis and clinical course.

Application of risk assessment and decision analysis to the evaluation, ranking and selection of environmental remediation alternatives

A single framework integrating risk assessment and decision analysis methods for evaluating, ranking and selecting preferred remediation alternatives at a contaminated site was developed and demonstrated. The methodology used relies on stakeholder inputs throughout the entire process and employs those inputs to combine the results of multiple risk assessments to arrive at a total impact for each remediation alternative. The total impact values allow the ranking of the alternatives, which in turn, serves as the basis for deliberations among the stakeholders in order to identify the preferred alternative. Six major risk or impact categories were considered in the evaluation of the alternatives: human health and safety, environmental protection, life cycle cost, socio-economics, cultural, archeological and historical resources, and programmatic assumptions.

Comparison of in vitro and in vivo human skin responses to consumer products and ingredients with a range of irritancy potential

Human skin equivalent cultures were investigated as possible pre-clinical skin irritation screens to aid safety assessments for chemicals and product formulations, and to facilitate design of safe and efficient human studies. In vitro responses in human skin equivalent cultures were compared directly to in vivo human skin responses from historic or concurrent skin tests for representative chemicals and products, including surfactants, cosmetics, antiperspirants, and deodorants. The in vivo data consisted of visual scores (i.e., erythema and edema) from skin-patch tests and diary accounts of skin irritation from product-use studies. In the in vitro studies, cornified, air-interfaced human skin cultures (EpiDerm) were evaluated using methods designed to parallel human clinical protocols with topical dosing of neat or diluted test substances to the stratum corneum surface of the skin cultures. The in vitro endpoints have previously been shown to be relevant to human skin irritation in vivo, including the MTT metabolism assay of cell viability, enzyme release (lactate dehydrogenase and aspartate aminotransferase), and inflammatory cytokine expression (Interleukin-1alpha). For surfactants, dose-response curves of MTT cell-viability data clearly distinguished strongly-irritating from milder surfactants and rank-ordered irritancy potential in a manner similar to repeat-application (3x), patch-test results. For the antiperspirant and deodorant products, all the in vitro endpoints correlated well with consumer-reported irritation (r, 0.75-0.94), with Interleukin-1alpha (IL-1alpha) release, showing the greatest capacity to distinguish irritancy over a broad range. IL-1alpha release also showed the best prediction of human skin scores from 14-day cumulative irritancy tests of cosmetic products. These results confirm the potential value of cornified human skin cultures as in vitro pre-clinical screens for prediction of human skin irritation responses. A preliminary report of these results has been published.

Structural aberrations of chromosome 6 in three uterine smooth muscle tumors

Clonal karyotypic alterations of chromosome 6 in three uterine smooth muscle tumors are reported. In all cases an apparently identical breakpoint on the short arm of chromosome 6 was found. Two cases displayed the histologic features of cell-rich myomas with severe nuclear atypia but no clear evidence for malignancy. The remaining case was a primary uterine leiomyosarcoma of an 80-year-old patient showing an apparently balanced reciprocal chromosomal translocation, t(1;6)(p32-33;p21.3), as the sole karyotypic abnormality. This type of aberration has not been reported before in leiomyosarcomas. Because of the nuclear atypia in the other myomas with a breakpoint involving the short arm of chromosome 6 we feel that this cytogenetically recognizable but rare subgroup of uterine smooth muscle tumors warrants a careful clinical follow-up.

Effects of snake venom phospholipase A2 toxins (beta-bungarotoxin, notexin) and enzymes (Naja naja atra, Naja nigricollis) on aminophospholipid asymmetry in rat cerebrocortical synaptosomes

The effects of snake venom phospholipase A2 (PLA2) toxins (beta-bungarotoxin, notexin) and PLA2 enzymes (Naja nigricollis, Naja naja atra) on aminophospholipid asymmetry in rat cerebrocortical synaptic plasma membranes (SPM) were examined. Incubation of intact synaptosomes with 2 mM 2,4,6-trinitrobenzene sulfonic acid (TNBS) for 40 min, under non-penetrating conditions, followed by SPM isolation, allowed us to calculate the percentage of phosphatidylethanolamine (PE) and phosphatidylserine (PS) in the outer leaflet of the SPM, while incubation with disrupted synaptosomes provided total labeling values with the difference representing labeling of the inner leaflet. We found that 30% of the PE and 2% of the PS were in the outer leaflet, with 54% of the PE and 80% of the PS in the inner leaflet; 16% of the PE and 18% of the PS was inaccessible to TNBS. PLA2 toxins and enzymes increased in a concentration-dependent manner the percentage of PS and, to a lesser extent, the percentage of PE in the outer leaflet of the SPM, due to a redistribution from the inner to the outer leaflet. There was no correlation between the PLA2 enzymatic activities and the increased percentage of PS in the outer leaflet of the SPM induced by the PLA2 toxins and enzymes. Alteration of aminophospholipid asymmetry does not explain the greater presynaptic specificity and potencies of the PLA2 toxins as compared to the PLA2 enzymes, but may be associated with the increased acetylcholine release from synaptosomes induced by both the toxins and enzymes.

Inhibitory effect of EDTA.Ca2+ on the hydrolysis of synaptosomal phospholipids by phospholipase A2 toxins and enzymes

Phospholipases A2 (PLA2) are Ca2(+)-dependent enzymes that are inhibited by EDTA; this inhibition would be expected to be reversed by restoring the Ca2+ concentration. By examining the hydrolysis of synaptosomal phospholipids by PLA2 enzymes, Naja naja atra and Naja nigricollis, and by toxins with PLA2 activity, beta-bungarotoxin (beta-BuTX) and notexin, we demonstrated a novel inhibitory action of EDTA manifested in the presence of excess Ca2+. We postulate the formation of an EDTA.Ca2+ complex which inhibits PLA2 activity in a concentration-dependent manner. Synaptosomes in which phospholipids are hydrolyzed by PLA2 have membranal damage expressed by increased acetylcholine (ACh) release and decreased osmotic activity. Addition of EDTA.Ca2+, which inhibits phospholipid hydrolysis, also reversed the PLA2 effect on ACh release, but not its effect on osmotic activity. The inhibition of PLA2 was observed on membranal phospholipids as well as on an artificial substrate of phospholipid-Triton mixed micelles. Moreover, we found that another enzyme, lactate dehydrogenase, was also inhibited. Our results indicate a non-specific inhibition exerted on the enzyme rather than on the substrate.

Phospholipid hydrolysis and loss of membrane integrity following treatment of rat brain synaptosomes with beta-bungarotoxin, notexin, and Naja naja atra and Naja nigricollis phospholipase A2

The effects of the phospholipase A2 (PLA2) toxins, beta-bungarotoxin and notexin, and the PLA2 enzymes from Naja naja atra and Naja nigricollis snake venoms on the plasma membrane integrity of synaptosomes were examined. Synaptosomes were isolated from rat brain cerebral cortex, corpus striatum and hippocampus. Osmotic activity, lactate dehydrogenase leakage, and leakage of 2-deoxy-D-(1-3H)-glucose-6-phosphate were monitored (37 degrees C, 10-120 min) following incubation with 0.5, 5 and 50 nM concentrations of toxins and enzymes. Damage to the synaptosomal plasma membrane was time and concentration but not tissue dependent. The potencies of the treatments were as follows: N. n. atra PLA2 greater than or equal to N. nigricollis PLA2 greater than notexin greater than beta-bungarotoxin. Chelation of Ca2+ with 5 mM EDTA completely inhibited plasma membrane disruption caused by beta-bungarotoxin and N. n. atra PLA2. One mg/ml of bovine serum albumin also blocked the disruptive action of N. n. atra PLA2, while 8 mg/ml was required to antagonize beta-bungarotoxin. A correlation between phospholipid hydrolysis and loss of membrane integrity was also observed. The generation of phospholipid hydrolytic products may be critical in the permeabilization of synaptic plasma membranes by these toxins and enzymes, however, they do not explain the presynaptic specificity and potency of beta-bungarotoxin and notexin.

Do chemical modifications dissociate between the enzymatic and pharmacological activities of beta bungarotoxin and notexin?

We have measured enzymatic, hemolytic and anticoagulant activities, lethal potencies and effects on contractions of the phrenic nerve-diaphragm preparation, by chemically modified derivatives of beta bungarotoxin (beta BuTX) and notexin, two presynaptically acting toxins which have PLA2 activity. The following chemical modifications of beta BuTX were tested: alkylation and methylation of histidine 48, alkylation of tryptophan 19, sulfonylation of tyrosine 68, oxidation of methionines 6 and 8, semicarbazide addition under varied conditions to carboxyl groups, varied extents of carbamylation or trinitrophenylation of lysines and guanidination of all lysines with or without trinitrophenylation of the N-terminal asparagine. Only the histidine, tryptophan and tyrosine residues were modified in notexin. The results obtained were compared with those previously obtained using chemically modified derivatives of Naja nigricollis and Naja naja atra PLA2 enzymes which do not have a specific presynaptic site of action. The results with oxidized methionine and lysine-modified derivatives of beta BuTX are supportive of the suggestions of others that the N-terminal region and basic residues away from the enzymatic active region contribute towards the beta type presynaptic neurotoxicity of the PLA2 toxins. Using modified derivatives of beta BuTX and notexin, the dissociations between enzymatic activities and pharmacological properties were not as marked as previously observed with N. nigricollis and N. n. atra PLA2; nevertheless, several dissociations were noted. We conclude that, just as with non-presynaptically acting PLA2 enzymes, some pharmacological actions of presynaptically acting PLA2 toxins may occur independently of phospholipid hydrolysis.

beta-Bungarotoxin-induced phospholipid hydrolysis in rat brain synaptosomes: effect of replacement of calcium by strontium

We tested whether, upon substitution of Ca2+ by Sr2+ in a medium containing beta-bungarotoxin, sufficient Ca2+ remained bound to the tissue to support phospholipid hydrolysis in rat brain synaptosomes. The phrenic nerve--diaphragm preparation could not be used, since replacement of Ca2+ by Sr2+ prolonged time to block of indirectly evoked contractions; however, no phospholipid hydrolysis could be detected (either in the presence of Ca2+ or Sr2+), due to the small amounts of presynaptic terminals. Following initial exposure of synaptosomes to a Ca2+ containing medium and then removal of Ca2+, incubation with beta-bungarotoxin (1 or 10 micrograms/ml) caused significant phospholipid hydrolysis whether or not Sr2+ was present. Therefore, conclusions as to whether phospholipase A2 activity is required for presynaptic actions of beta-bungarotoxin cannot be derived from studies in which Sr2+ is used to inhibit enzymatic activity.