Serous cystic neoplasm of the pancreas: a multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas)

OBJECTIVES

Serous cystic neoplasm (SCN) is a cystic neoplasm of the pancreas whose natural history is poorly known. The purpose of the study was to attempt to describe the natural history of SCN, including the specific mortality.

DESIGN

Retrospective multinational study including SCN diagnosed between 1990 and 2014.

RESULTS

2622 patients were included. Seventy-four per cent were women, and median age at diagnosis was 58 years (16-99). Patients presented with non-specific abdominal pain (27%), pancreaticobiliary symptoms (9%), diabetes mellitus (5%), other symptoms (4%) and/or were asymptomatic (61%). Fifty-two per cent of patients were operated on during the first year after diagnosis (median size: 40 mm (2-200)), 9% had resection beyond 1 year of follow-up (3 years (1-20), size at diagnosis: 25 mm (4-140)) and 39% had no surgery (3.6 years (1-23), 25.5 mm (1-200)). Surgical indications were (not exclusive) uncertain diagnosis (60%), symptoms (23%), size increase (12%), large size (6%) and adjacent organ compression (5%). In patients followed beyond 1 year (n=1271), size increased in 37% (growth rate: 4 mm/year), was stable in 57% and decreased in 6%. Three serous cystadenocarcinomas were recorded. Postoperative mortality was 0.6% (n=10), and SCN's related mortality was 0.1% (n=1).

CONCLUSIONS

After a 3-year follow-up, clinical relevant symptoms occurred in a very small proportion of patients and size slowly increased in less than half. Surgical treatment should be proposed only for diagnosis remaining uncertain after complete workup, significant and related symptoms or exceptionally when exists concern with malignancy. This study supports an initial conservative management in the majority of patients with SCN.

TRIAL REGISTRATION NUMBER

IRB 00006477.

Managing Carious Lesions: Consensus Recommendations on Terminology

Variation in the terminology used to describe clinical management of carious lesions has contributed to a lack of clarity in the scientific literature and beyond. In this article, the International Caries Consensus Collaboration presents 1) issues around terminology, a scoping review of current words used in the literature for caries removal techniques, and 2) agreed terms and definitions, explaining how these were decided.Dental cariesis the name of the disease, and thecarious lesionis the consequence and manifestation of the disease-the signs or symptoms of the disease. The termdental caries managementshould be limited to situations involving control of the disease through preventive and noninvasive means at a patient level, whereascarious lesion managementcontrols the disease symptoms at the tooth level. While it is not possible to directly relate the visual appearance of carious lesions' clinical manifestations to the histopathology, we have based the terminology around the clinical consequences of disease (soft, leathery, firm, and hard dentine). Approaches to carious tissue removal are defined: 1)selective removal of carious tissue-includingselective removal to soft dentineandselective removal to firm dentine; 2)stepwise removal-including stage 1,selective removal to soft dentine, and stage 2,selective removal to firm dentine6 to 12 mo later; and 3)nonselective removal to hard dentine-formerly known ascomplete caries removal(technique no longer recommended). Adoption of these terms, around managing dental caries and its sequelae, will facilitate improved understanding and communication among researchers and within dental educators and the wider clinical dentistry community.

Nonrestorative Treatments for Caries: Systematic Review and Network Meta-analysis

The goal of nonrestorative or non- and microinvasive caries treatment (fluoride- and nonfluoride-based interventions) is to manage the caries disease process at a lesion level and minimize the loss of sound tooth structure. The purpose of this systematic review and network meta-analysis was to summarize the available evidence on nonrestorative treatments for the outcomes of 1) arrest or reversal of noncavitated and cavitated carious lesions on primary and permanent teeth and 2) adverse events. We included parallel and split-mouth randomized controlled trials where patients were followed for any length of time. Studies were identified with MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews. Pairs of reviewers independently conducted the selection of studies, data extraction, risk-of-bias assessments, and assessment of the certainty in the evidence with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Data were synthesized with a random effects model and a frequentist approach. Forty-four trials (48 reports) were eligible, which included 7,378 participants and assessed the effect of 22 interventions in arresting or reversing noncavitated or cavitated carious lesions. Four network meta-analyses suggested that sealants + 5% sodium fluoride (NaF) varnish, resin infiltration + 5% NaF varnish, and 5,000-ppm F (1.1% NaF) toothpaste or gel were the most effective for arresting or reversing noncavitated occlusal, approximal, and noncavitated and cavitated root carious lesions on primary and/or permanent teeth, respectively (low- to moderate-certainty evidence). Study-level data indicated that 5% NaF varnish was the most effective for arresting or reversing noncavitated facial/lingual carious lesions (low certainty) and that 38% silver diamine fluoride solution applied biannually was the most effective for arresting advanced cavitated carious lesions on any coronal surface (moderate to high certainty). Preventing the onset of caries is the ultimate goal of a caries management plan. However, if the disease is present, there is a variety of effective interventions to treat carious lesions nonrestoratively.

Intranasal immunogenicity and adjuvanticity of site-directed mutant derivatives of cholera toxin

Genetically modified derivatives of cholera toxin (CT), harboring a single amino acid substitution in and around the NAD binding cleft of the A subunit, were isolated following site-directed mutagenesis of the ctxA gene. Two mutants of CT, designated CTS106 (with a proline-to-serine change at position 106) and CTK63 (with a serine-to-lysine change at position 63), were found to have substantially reduced ADP-ribosyltransferase activity and toxicity; CTK63 was completely nontoxic in all assays, whereas CTS106 was 10(4) times less toxic than wild-type CT. The mucosal adjuvanticity and immunogenicity of derivatives of CT were assessed by intranasal immunization of mice, with either ovalbumin or fragment C of tetanus toxin as a bystander antigen. Mice immunized with wild-type CT produced both local (immunoglobulin A in mucosal washes) and systemic immune responses to both CT and bystander antigens. CTS106 showed good local and systemic responses to bystander proteins and to itself. Interestingly, mice immunized with the nontoxic derivative of CT, CTK63, generated weak immune responses to the bystander antigens which were similar to those achieved when CT B subunit was used as an adjuvant. In parallel experiments, an equivalent nontoxic mutant of the Escherichia coli heat-labile enterotoxin, LTK63 (with a serine-to-lysine change at position 63), was tested (9). In contrast to CTK63, LTK63 was found to be more immunogenic and a better intranasal adjuvant than recombinant heat-labile enterotoxin B subunit or CTK63. This information, together with data on immunoglobulin subclass responses, suggests that although highly homologous, CT and heat-labile enterotoxin should not be considered biologically identical in terms of their ability to act as intranasal adjuvants.

Osteoarthritis of the knee after ACL reconstruction

One hundred and fourteen knees with deficiency of the anterior cruciate ligament (ACL) which had undergone reconstruction of the ligament using semitendinosus and gracilis were reviewed at a mean of 61 months after operation. Radiological and clinical evaluation was undertaken. A significant correlation was found between the number of meniscectomies performed in acute cases and those undertaken on the chronic knee. There was also significant correlation between meniscectomy and the Fairbank grading of degenerative changes seen on the radiographs. There was no correlation between the clinical results, residual laxity and the development of osteoarthritis. In ACL deficient knees with irreparable meniscal tears, or in which meniscectomy had been undertaken, the development of osteoarthritis seemed independent of the degree of stability, but in such knees with no meniscal tear or meniscal repair, reconstruction appeared to save the menisci and preserve the joint.

Observation of J/ψp Resonances Consistent with Pentaquark States in Λ_{b}^{0}→J/ψK^{-}p Decays

Observations of exotic structures in the J/ψp channel, which we refer to as charmonium-pentaquark states, in Λ_{b}^{0}→J/ψK^{-}p decays are presented. The data sample corresponds to an integrated luminosity of 3 fb^{-1} acquired with the LHCb detector from 7 and 8 TeV pp collisions. An amplitude analysis of the three-body final state reproduces the two-body mass and angular distributions. To obtain a satisfactory fit of the structures seen in the J/ψp mass spectrum, it is necessary to include two Breit-Wigner amplitudes that each describe a resonant state. The significance of each of these resonances is more than 9 standard deviations. One has a mass of 4380±8±29 MeV and a width of 205±18±86 MeV, while the second is narrower, with a mass of 4449.8±1.7±2.5 MeV and a width of 39±5±19 MeV. The preferred J^{P} assignments are of opposite parity, with one state having spin 3/2 and the other 5/2.

Injury of the suprascapular nerve at the spinoglenoid notch. The natural history of infraspinatus atrophy in volleyball players

From 1985 to 1996, we observed 38 cases of isolated atrophy of the infraspinatus muscle in athletes; all were involved in volleyball at a competitive level. There were 20 men and 18 women with a mean age of 26 years (range, 15 to 27). At the time of the first examination, 35 of these athletes had no pain and were treated with exercises to strengthen the external rotators. The remaining three patients underwent surgery because of pain at the posterior aspect of the shoulder. Sixteen of the 35 players treated nonoperatively were reviewed at a mean follow-up of 5.5 years (range, 3 to 10). Thirteen were still involved in volleyball and three had retired symptom-free at the end of their careers. On physical examination, atrophy of the infraspinatus muscle was unchanged in all cases. The patients treated surgically were reviewed at a mean follow-up of 2 years. All of them were able to play volleyball at their preinjury levels, but one had pain at the anterior aspect of the shoulder after strenuous activity. Physical examination showed a notable reduction of the atrophy in one patient. Entrapment of the suprascapular nerve at the spinoglenoid notch is a usually painless syndrome that is frequently observed in volleyball players. Surgical treatment is indicated in the rare cases of painful neuropathies after careful patient selection.

Interaction of enkephalins with oxyradicals

The interaction of enkephalins (leu-enkephalin and met-enkephalin) and other tyrosine amino-terminal peptides with reactive oxygen species has been investigated. All the peptides tested exhibited hydroxyl radical and superoxide anion scavenging ability and the capacity to reduce the rate of lipid peroxidation induced by 2,2'-azobis(2-amidinopropane). The scavenging activity was observed in the 0.1-1 mM concentration range. It has been observed that enkephalins underwent an oxidative modification by Fenton systems. The tyrosine amino-terminal residue was attacked by hydroxyl radical, being converted to dopa. The overall transformation produced opiomelanin pigments. This oxidative process provides evidence of a possible route for opiomelanin synthesis without any enzyme intervention.

Measurement of the ratio of branching fractions B(B[over ¯]^{0}→D^{*+}τ^{-}ν[over ¯]_{τ})/B(B[over ¯]^{0}→D^{*+}μ^{-}ν[over ¯]_{μ})

The branching fraction ratio R(D^{*})≡B(B[over ¯]^{0}→D^{*+}τ^{-}ν[over ¯]_{τ})/B(B[over ¯]^{0}→D^{*+}μ^{-}ν[over ¯]_{μ}) is measured using a sample of proton-proton collision data corresponding to 3.0  fb^{-1} of integrated luminosity recorded by the LHCb experiment during 2011 and 2012. The tau lepton is identified in the decay mode τ^{-}→μ^{-}ν[over ¯]_{μ}ν_{τ}. The semitauonic decay is sensitive to contributions from non-standard-model particles that preferentially couple to the third generation of fermions, in particular, Higgs-like charged scalars. A multidimensional fit to kinematic distributions of the candidate B[over ¯]^{0} decays gives R(D^{*})=0.336±0.027(stat)±0.030(syst). This result, which is the first measurement of this quantity at a hadron collider, is 2.1 standard deviations larger than the value expected from lepton universality in the standard model.

Oxygen uptake and cardiac performance in obese and normal subjects during exercise

Work capacity and cardiopulmonary performance were studied in a group of 11 young obese subjects (BMI 39.9 kg/m2) and a group of 10 young normal subjects (BMI 22 kg/m2). First of all they underwent an incremental cycle ergometer test up to exhaustion. Subsequently, every subject of the two groups performed a constant work rate test at different work loads to estimate cardiac output (Q) below anaerobic threshold (AT) by a 20-second CO2 rebreathing method. Obese subjects had a significantly lower AT (79 vs. 109 W). The ratio between oxygen uptake and heart rate (VO2/HR) (O2 pulse) was higher in the obese group; nevertheless, this variable became significantly lower if we took into consideration the ratio between O2 pulse and kilogram fat-free body mass or kilogram body weight. Both these observations suggest that their reduced work tolerance is linked with a reduced oxygen supply to the muscles in activity. Q increased in similar ways in obese and normal subjects at the preset work rates. The ratio Q/body surface (cardiac index; CI) that we considered in order to try to minimize the differences in body sizes between the two groups, increased less in response to increasing work rates in our obese subjects than in normal subjects. As a whole, these data appear to be in line with a relatively less efficient cardiac performance during progressive work rates in obese subjects.

A Century of Change towards Prevention and Minimal Intervention in Cariology

Better understanding of dental caries and other oral conditions has guided new strategies to prevent disease and manage its consequences at individual and public health levels. This article discusses advances in prevention and minimal intervention dentistry over the last century by focusing on some milestones within scientific, clinical, and public health arenas, mainly in cariology but also beyond, highlighting current understanding and evidence with future prospects. Dentistry was initially established as a surgical specialty. Dental caries (similar to periodontitis) was considered to be an infectious disease 100 years ago. Its ubiquitous presence and rampant nature-coupled with limited diagnostic tools and therapeutic treatment options-meant that these dental diseases were managed mainly by excising affected tissue. The understanding of the diseases and a change in their prevalence, extent, and severity, with evolutions in operative techniques, technologies, and materials, have enabled a shift from surgical to preventive and minimal intervention dentistry approaches. Future challenges to embrace include continuing the dental profession's move toward a more patient-centered, evidence-based, less invasive management of these diseases, focused on promoting and maintaining oral health in partnership with patients. In parallel, public health needs to continue to, for example, tackle social inequalities in dental health, develop better preventive and management options for existing disease risk groups (e.g., the growing aging population), and the development of reimbursement and health outcome models that facilitate implementation of these evolving strategies. A century ago, almost every treatment involved injections, a drill or scalpel, or a pair of forceps. Today, dentists have more options than ever before available to them. These are supported by evidence, have a minimal intervention focus, and result in better outcomes for patients. The profession's greatest challenge is moving this evidence into practice.

Inflammatory bowel disease in children and adolescents in Italy: data from the pediatric national IBD register (1996-2003)

BACKGROUND

The purpose was to assess in Italy the clinical features at diagnosis of inflammatory bowel disease (IBD) in children.

METHODS

In 1996 an IBD register of disease onset was established on a national scale.

RESULTS

Up to the end of 2003, 1576 cases of pediatric IBD were recorded: 810 (52%) ulcerative colitis (UC), 635 (40%) Crohn's disease (CD), and 131 (8%) indeterminate colitis (IC). In the period 1996-2003 an increase of IBD incidence from 0.89 to 1.39/10(5) inhabitants aged <18 years was observed. IBD was more frequent among children aged between 6 and 12 years (57%) but 20% of patients had onset of the disease under 6 years of age; 28 patients were <1 year of age. Overall, 11% had 1 or more family members with IBD. The mean interval between onset of symptoms and diagnosis was higher in CD (10.1 months) and IC (9 months) versus UC (5.8 months). Extended colitis was the most frequent form in UC and ileocolic involvement the most frequent in CD. Upper intestinal tract involvement was present in 11% of CD patients. IC locations were similar to those of UC. Bloody diarrhea and abdominal pain were the most frequent symptoms in UC and IC, and abdominal pain and diarrhea in CD. Extraintestinal symptoms were more frequent in CD than in UC.

CONCLUSIONS

The IBD incidence in children and adolescents in Italy shows an increasing trend for all 3 pathologies. UC diagnoses exceeded CD.

Defining the Patient Acceptable Symptom State for the HOOS JR and KOOS JR After Primary Total Joint Arthroplasty

BACKGROUND

It is essential to quantify an acceptable outcome after total joint arthroplasty (TJA) in order to understand quality of care. The purpose of this study was to define patient acceptable symptom state (PASS) thresholds for the Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS JR) and the Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) after TJA.

METHODS

A receiver operating characteristic (ROC) curve analysis, leveraging 2-year satisfaction of "moderate improvement" or better as the anchor, was used to establish PASS thresholds among 5,216 patients who underwent primary total hip arthroplasty and 4,036 who underwent primary total knee arthroplasty from 2007 to 2012 with use of an institutional registry. Changes in PASS thresholds were explored by stratifying and recalculating these thresholds by age at the time of surgery (<70 or ≥70 years of age), sex (men or women), body mass index (BMI; <30 or ≥30 kg/m2), and baseline Short Form-36 (SF-36) physical and mental component scores (<50 or ≥50).

RESULTS

The HOOS JR PASS threshold was 76.7 (area under the ROC curve [AUC] = 0.91), which was achieved by 4,334 patients (83.1%). The KOOS JR PASS threshold was 63.7 (AUC = 0.89), which was achieved by 3,461 patients (85.8%). Covariate stratification demonstrated that PASS thresholds were higher in men compared with women, and in those with higher preoperative SF-36 physical and mental scores (≥50) compared with lower SF-36 scores (<50). Results differed between instruments for BMI and age: higher BMI was associated with a lower PASS threshold for the HOOS JR but a higher PASS threshold for the KOOS JR. The HOOS JR PASS threshold was higher in patients who were <70 years of age compared with those who were ≥70 years of age, but was equivalent for the KOOS JR.

CONCLUSIONS

The PASS thresholds for the HOOS JR and KOOS JR at 2 years after TJA were 76.7 and 63.7, respectively. The PASS thresholds were associated with certain preoperative covariates, suggesting that an acceptable symptom state after TJA is influenced by patient-specific factors.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Bowel frequency in healthy children

Bowel frequency was recorded, on a diary sheet basis, in 662 children from six Italian cities. There is a wide interindividual variability, showing a sharp decrease with age; we report the distribution of the percentiles in the different age groups. Among infants, the breast-fed ones pass significantly more stools than the formula-fed.

Test of lepton universality using b+ → K+ℓ+ℓ- decays

A measurement of the ratio of the branching fractions of the B(+) → K(+)μ(+)μ(-) and B(+) → K(+)e(+)e(-) decays is presented using proton-proton collision data, corresponding to an integrated luminosity of 3.0 fb(-1), recorded with the LHCb experiment at center-of-mass energies of 7 and 8 TeV. The value of the ratio of branching fractions for the dilepton invariant mass squared range 1 < q(2) < 6 GeV(2)/c(4) is measured to be 0.745(-0.074)(+0.090)(stat) ± 0.036(syst). This value is the most precise measurement of the ratio of branching fractions to date and is compatible with the standard model prediction within 2.6 standard deviations.

Human intestinal cryptosporidiosis: secretory diarrhea and enterotoxic activity in Caco-2 cells

A cell line model to detect enterotoxic effect was used to test fecal specimens of patients with enteric cryptosporidiosis. Fecal samples were obtained from 11 patients with Cryptosporidium diarrhea, and osmotic gap was determined. Caco-2 cell monolayers grown on filters were mounted in Ussing chambers, and electrical parameters were measured before and after the addition of fecal supernatant. A significant increase in short-circuit current was seen in 9 of 11 specimens. The enterotoxic effect was time- and dose-dependent, saturable, and Cl(-)- and Ca(2+)-dependent. Fecal osmotic gap was consistent with secretory diarrhea in the 9 enterotoxin-positive but not in the 2 enterotoxin-negative samples. In conclusion, a cell line model for studying the pathophysiology of enteric cryptosporidiosis was established. Enterotoxic activity was observed in most patients with enteric cryptosporidiosis and was strictly associated with secretory diarrhea.

Observation of a Narrow Pentaquark State, P_{c}(4312)^{+}, and of the Two-Peak Structure of the P_{c}(4450)^{+}

A narrow pentaquark state, P_{c}(4312)^{+}, decaying to J/ψp, is discovered with a statistical significance of 7.3σ in a data sample of Λ_{b}^{0}→J/ψpK^{-} decays, which is an order of magnitude larger than that previously analyzed by the LHCb Collaboration. The P_{c}(4450)^{+} pentaquark structure formerly reported by LHCb is confirmed and observed to consist of two narrow overlapping peaks, P_{c}(4440)^{+} and P_{c}(4457)^{+}, where the statistical significance of this two-peak interpretation is 5.4σ. The proximity of the Σ_{c}^{+}D[over ¯]^{0} and Σ_{c}^{+}D[over ¯]^{*0} thresholds to the observed narrow peaks suggests that they play an important role in the dynamics of these states.

Use of ICDAS combined with quantitative light-induced fluorescence as a caries detection method

The purpose of this study was to combine a standardized visually based system, the International Caries Detection and Assessment System (ICDAS), with a sensitive fluorescence-based system, quantitative light-induced fluorescence (QLF), to determine the ability to monitor caries lesion progression. This combination (QLF-I) has the potential to increase the sensitivity of the visual method without compromising specificity. A total of 460 children were enrolled and examined at baseline, 8 months and 12 months by ICDAS and QLF by a single examiner. The examiner repeatability for both methods was comparable, varying between weighted kappa of 0.70 and 0.79. The DMFT score was 6.0 (SD 5.8) at baseline and 6.4 (SD 6.3) at 12 months, and both methods were able to follow the increase in incidence. The QLF-I scored more surfaces at the early ICDAS scores (1 and 2) and score 4. Not all lesions progressed at the same rate, differing by score at baseline and surface type.

Sulfur-containing cyclic ketimines and imino acids. A novel family of endogenous products in the search for a role

Aminoethylcysteine, lanthionine, cystathionine and cystine are mono-deaminated either by L-amino-acid oxidase or by a transaminase exhibiting the properties described for glutamine transaminase. The deaminated products cyclize producing the respective ketimines. Authentic samples of each ketimine were prepared by reacting the appropriate aminothiol compound with bromopyruvate, except cystine ketimine which required the interaction of thiopyruvate with cystine sulfoxide. Reduction of the first three mentioned ketimines with NaBH4 yields the respective derivatives with the saturated rings of thiomorpholine and hexahydrothiazepine. The same reduction is carried out enzymically by a reductase extracted from mammalian tissues. Properties of the members of this family of compounds are described. Gas chromatography followed by mass spectrometry permits the identification of most of these products. HPLC is very useful for the determination of the ketimines by taking advantage of specific absorbance at 380 nm obtained by prior derivatization with phenylisothiocyanate. Adaptation of these and other analytical procedures to biological samples disclosed the presence of most of these compounds in bovine brain and in human urine. By using [35S]lanthionine ketimine as a representative member of the ketimine group, the specific, high-affinity, saturable and reversible binding to bovine brain membranes has been demonstrated. The binding is removed by aminoethylcysteine ketimine and by cystathionine ketimine indicating the occurrence in bovine brain of a common binding site for ketimines. The reduced ketimines are totally ineffective in competing with [35S]lanthionine ketimine. Alltogether these findings are highly indicative for the existence in mammals of a novel class of endogenous sulfur-containing cyclic products provided with a possible neurochemical function to be investigated further.

Measurement of form-factor-independent observables in the decay B0→K(*0)μ(+)μ(-)

We present a measurement of form-factor-independent angular observables in the decay B(0)→K*(892)(0)μ(+)μ(-). The analysis is based on a data sample corresponding to an integrated luminosity of 1.0 fb(-1), collected by the LHCb experiment in pp collisions at a center-of-mass energy of 7 TeV. Four observables are measured in six bins of the dimuon invariant mass squared q² in the range 0.1<q²<19.0 GeV²/c(4). Agreement with recent theoretical predictions of the standard model is found for 23 of the 24 measurements. A local discrepancy, corresponding to 3.7 Gaussian standard deviations is observed in one q² bin for one of the observables. Considering the 24 measurements as independent, the probability to observe such a discrepancy, or larger, in one is 0.5%.

Late multifocal gliomas in adolescents previously treated for acute lymphoblastic leukemia

Three of 37 adolescents in long-term remission from childhood acute lymphoblastic leukemia (ALL) developed malignant multifocal gliomas several years after completing treatment that included central nervous system (CNS) prophylaxis with radiation (RT) and intrathecal methotrexate (IT-MTX). No recurrence of the leukemia was evident when the CNS tumors were discovered. Seventeen other similar cases have been recorded. The occurrence of second malignancies is reviewed in the context of this development and of the oncogenic effects of radiation. It is probable that prolonged exposure to IT-MTX may have had a synergistic effect with radiation in contributing to the unusual incidence of glial tumors in these patients.

Identification of caries risk factors in toddlers

The purpose of this study was to identify risk factors to predict caries progression in toddlers in primary-healthcare settings for the cost-effective targeting of preventive and referral strategies. We examined 329 children (26 ± 6 mos old) twice, one year apart, in Indiana, USA. A 107-item structured interview was used to collect information from the primary caregiver and child on factors/beliefs/perceptions/behaviors that could affect caries development, transmission of bacteria, medical-dental health, and access to care. Bacterial levels, gingivitis, dental plaque, and caries experience were assessed. Multiple-variable logistic regression models of caries progression toward cavitation included family caries experience, transmission-related behaviors, dietary factors, health beliefs, and lower income, but differed in selected predictors/predictive power by race/ethnicity. Addition of clinical variables did not significantly improve the prediction.

Monitoring of sound and carious surfaces under sealants over 44 months

Although there is strong evidence for the effectiveness of sealants, one major barrier in sealant utilization is the concern of sealing over active caries lesions. This study evaluated detection and monitoring of caries lesions through a clear sealant over 44 mo. Sixty-four 7- to 10-year-old children with at least 2 permanent molars with International Caries Detection and Assessment System (ICDAS) scores 0-4 (and caries less than halfway through the dentin, radiographically) were examined with ICDAS, DIAGNOdent, and quantitative light-induced fluorescence (QLF) before sealant placement and 1, 12, 24, and 44 mo (except QLF) after. Bitewing radiographs were taken yearly. DIAGNOdent and QLF were able to distinguish between baseline ICDAS before and after sealant placement. There was no significant evidence of ICDAS progression at 12 mo, but there was small evidence of minor increases at 24 and 44 mo (14% and 14%, respectively) with only 2% ICDAS ≥ 5. Additionally, there was little evidence of radiographic progression (at 12 mo = 1%, 24 mo = 3%, and 44 mo = 9%). Sealant retention rates were excellent at 12 mo = 89%, 24 mo = 78%, and 44 mo = 70%. The small risk of sealant repair increased significantly as baseline ICDAS, DIAGNOdent, and QLF values increased. However, regardless of lesion severity, sealants were 100% effective at 12 mo and 98% effective over 44 mo in managing occlusal surfaces at ICDAS 0-4 (i.e., only 4 of 228 teeth progressed to ICDAS ≥ 5 associated with sealants in need of repair and none to halfway or more through the dentin, radiographically). This study suggests that occlusal surfaces without frank cavitation (ICDAS 0-4) that are sealed with a clear sealant can be monitored with ICDAS, QLF, or DIAGNOdent, which may aid in predicting the need for sealant repair.