Dental age assessment: the applicability of Demirjian's method in south Indian children

The paper concerns the testing of Demirjian's method of age assessment in South Indian children. Since previous studies have shown the inapplicability of Demirjian's method on other populations, an attempt to compile a maturity standard for South Indian children was made. An additional independent indicator of age was employed, namely the skeletal age. The material was 184 South Indian children aged 5 to 15 years and an additional 34 children as the test sample. It was found that Demirjian's method gave an overestimation of 3.04 and 2.82 years in males and females, respectively. The skeletal age was found to differ from the dental and chronologic age. It may be concluded that the accuracy of age estimation based on Demirjian's method is not applicable for the South Indian children. For the population to be tested, it is imperative that individual assessment parameters need to be put forward because of wide ethnic differences.

Peri-operative risk factors for acute lung injury after elective oesophagectomy

Acute lung injury after oesophagectomy is well recognized but the risk factors associated with its development are poorly defined. We analysed retrospectively the effect of a number of pre-, peri- and post-operative risk factors on the development of lung injury in 168 patients after elective oesophagectomy performed at a single centre. The acute respiratory distress syndrome (ARDS) developed in 14.5% of patients and acute lung injury in 23.8%. Mortality in patients developing ARDS was 50% compared with 3.5% in the remainder. Features associated with the development of ARDS included a low pre-operative body mass index, a history of cigarette smoking, the experience of the surgeon, the duration of both the operation and of one-lung ventilation, and the occurrence of a post-operative anastomotic leak. Peri-operative cardiorespiratory instability (measured by peri-operative hypoxaemia, hypotension, fluid and blood requirements and the need for inotropic support) was also associated with ARDS. Acute lung injury after elective oesophagectomy is associated with intraoperative cardiorespiratory instability.

Pretreatment serum VEGF is associated with clinical response and overall survival in advanced melanoma patients treated with ipilimumab

Ipilimumab, an antibody that blocks CTL antigen 4 (CTLA-4), improves overall survival (OS) for patients with metastatic melanoma. Given its role in angiogenesis and immune evasion, serum VEGF levels were evaluated for association with clinical benefit in ipilimumab-treated patients. Sera were collected from 176 patients treated at 3 (n = 98) or 10 mg/kg (n = 68). The VEGF levels before treatment and at induction completion (week 12) were analyzed using the Meso Scale Discovery kit. The association of the levels of VEGF with clinical responses and OS were assessed using the Fisher exact and Kaplan-Meier log-rank tests. VEGF as a continuous variable was associated with OS (P = 0.002). Using 43 pg/mL as the cutoff pretreatment VEGF value defined by maximally selected log-rank statistics, pretreatment VEGF values correlated with clinical benefit at week 24 (P = 0.019; 159 patients evaluable). Pretreatment VEGF ≥ 43 pg/mL was associated with decreased OS (median OS 6.6 vs. 12.9 months, P = 0.006; 7.4 vs. 14.3 months, P = 0.037 for 3 mg/kg; and 6.2 vs. 10.9 months, P = 0.048 for 10 mg/kg). There was no correlation between VEGF changes and clinical outcome. Serum VEGF may be a predictive biomarker for ipilimumab treatment and is worthy of prospective investigation with various forms of immunologic checkpoint blockade.

Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx

OBJECTIVE

The rapid worldwide rise in incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has generated studies confirming this disease as an entity distinct from traditional OPSCC. Based on pathology, surgical studies have revealed prognosticators specific to HPV-positive OPSCC. The current AJCC/UICC staging and pathologic nodal (pN)-classification do not differentiate for survival, demonstrating the need for new, HPV-specific OPSCC staging. The objective of this study was to define a pathologic staging system specific to HPV-positive OPSCC.

METHODS

Data were assembled from a surgically-managed, p16-positive OPSCC cohort (any T, any N, M0) of 704 patients from five cancer centers. Analysis was performed for (a) the AJCC/UICC pathologic staging, (b) newly published clinical staging for non-surgically managed HPV-positive OPSCC, and (c) a novel, pathology-based, "HPVpath" staging system that combines features of the primary tumor and nodal metastases.

RESULTS

A combination of AJCC/UICC pT-classification and pathology-confirmed metastatic node count (⩽4 versus ⩾5) yielded three groups: stages I (pT1-T2, ⩽4 nodes), II (pT1-T2, ⩾5 nodes; pT3-T4, ⩽4 nodes), and III (pT3-T4, ⩾5 nodes), with incrementally worse prognosis (Kaplan-Meier overall survival of 90%, 84% and 48% respectively). Existing AJCC/UICC pathologic staging lacked prognostic definition. Newly published HPV-specific clinical stagings from non-surgically managed patients, although prognostic, showed lower precision for this surgically managed cohort.

CONCLUSIONS

Three loco-regional "HPVpath" stages are identifiable for HPV-positive OPSCC, based on a combination of AJCC/UICC primary tumor pT-classification and metastatic node count. A workable, pathologic staging system is feasible to establish prognosis and guide adjuvant therapy decisions in surgically-managed HPV-positive OPSCC.

Dorsal buccal mucosal graft urethroplasty by a ventral sagittal urethrotomy and minimal-access perineal approach for anterior urethral stricture

OBJECTIVE

To present the technique of dorsal buccal mucosal graft urethroplasty through a ventral sagittal urethrotomy and minimal access perineal approach for anterior urethral stricture.

PATIENTS AND METHODS

From July 2001 to December 2002, 12 patients with a long anterior urethral stricture had the anterior urethra reconstructed, using a one-stage urethroplasty with a dorsal onlay buccal mucosal graft through a ventral sagittal urethrotomy. The urethra was approached via a small perineal incision irrespective of the site and length of the stricture. The penis was everted through the perineal wound. No urethral dissection was used on laterally or dorsally, so as not to jeopardize the blood supply.

RESULTS

The mean (range) length of the stricture was 5 (3-16) cm and the follow-up 12 (10-16) months. The results were good in 11 of the 12 patients. One patient developed a stricture at the proximal anastomotic site and required optical internal urethrotomy.

CONCLUSION

Dorsal buccal mucosal graft urethroplasty via a minimal access perineal approach is a simple technique with a good surgical outcome; it does not require urethral dissection and mobilization and hence preserves the blood supply.

Immunologic response to xenogeneic gp100 DNA in melanoma patients: comparison of particle-mediated epidermal delivery with intramuscular injection

PURPOSE

Prior studies show that i.m. injection of xenogeneic orthologues of melanosomal antigens (tyrosinase, gp100) induces CD8(+) T-cell responses to the syngeneic protein. To further define the optimal vaccination strategy, we conducted a pilot clinical trial comparing i.m. injection with particle-mediated epidermal delivery (PMED).

EXPERIMENTAL DESIGN

Human leukocyte antigen (HLA)-A*0201(+) disease-free melanoma patients were randomized to the PMED or i.m. arm, receiving eight vaccinations over 4 months. Patients received 4 microg or 2,000 microg per injection, respectively, of mouse gp100 DNA. Peripheral blood mononuclear cells were collected, cultured with gp100 peptides, and analyzed by tetramer and intracellular cytokine staining for responses to HLA-A*0201-restricted gp100 epitopes [gp100(209-217) (ITDQVPFSV) and gp100(280-288) (YLEPGPVTA)].

RESULTS

Twenty-seven patients with stage IIB-IV melanoma were analyzable for immune response. The only common toxicity was grade 1 injection site reaction in nine patients with no intergroup difference, and one dose-limiting toxicity of acute hypersensitivity occurred in a PMED patient with undiagnosed gold allergy. Four of 27 patients produced gp100 tetramer(+)CD8(+) T cells, all carrying the CCR7(lo)CD45RA(lo) effector-memory phenotype. Five of 27 patients generated IFN-gamma(+)CD8(+) T cells, one who was also tetramer-positive. Overall, vaccination induced a response in 30% of patients, which was not significantly associated with study arm or clinical outcome. However, the PMED group showed a trend toward increased IFN-gamma(+)CD8(+) T-cell generation (P = 0.07).

CONCLUSION

A comparable efficacy and safety profile was shown between the i.m. and PMED arms, despite a significantly decreased dose of DNA used for PMED injection.

Biochar-mediated sequestration of Pb and Cd leads to enhanced productivity in Mentha arvensis

Immobilization of cadmium (Cd) and lead (Pb) along with the alleviation of their phytotoxicity in Mentha arvensis by biochar was examined in this investigation. A greenhouse experiment was executed to evaluate the effect of biochar (BC) amended Cd and Pb spiked soil on their immobilization and uptake, plant growth, photosynthetic attributes (total chlorophyll, photosynthetic rate, transpiration rate, and stomatal activity) and oxidative enzymes (guaiacol peroxidase: POD; catalase: CAT and superoxide dismutase: SOD). In the present study, the photosynthetic attributes showed that BC significantly improved the total chlorophyll, photosynthetic, transpiration rates, and stomatal activity in the plants. The incorporation of BC in soil increase the Pb and Cd tolerance in M. arvensis vis-à-vis improved the biomass yield and nutrient intake. In addition, biochar has also reduced the POD, CAT, and SOD in the plant as well as improved the soil pH and enzymatic activities. Overall, BC immobilized the Cd and Pb in soil by providing the binding site to the metals and reduced the phytotoxicity in M. arvensis. However, large-scale field trials of BC are required for safe cultivation of M. arvensis which is known for its phytopharmaceuticals importance.

Immunologic responses to xenogeneic tyrosinase DNA vaccine administered by electroporation in patients with malignant melanoma

Background

Prior studies show that intramuscular injection and particle-mediated epidermal delivery of xenogeneic melanosomal antigens (tyrosinase or Tyr, gp100) induce CD8⁺ T cell responses to the syngeneic protein. To further define the optimal vaccination strategy, we conducted a phase I study of in vivo electroporation (EP) of a murine Tyr DNA vaccine (pINGmuTyr) in malignant melanoma patients.

Methods

Human leukocyte antigen (HLA)-A1, A2, A24 or B35 stage IIb-IV melanoma patients received up to five doses of the mouse tyrosinase DNA vaccine by EP every three weeks at dose levels of 0.2 mg, 0.5 mg, or 1.5 mg per injection. Peripheral blood mononuclear cells (PBMC) were collected, cultured with a peptide pool containing eight HLA class I-restricted Tyr-specific T-cell epitopes, and analyzed by HLA-A*0101-restricted tetramers and intracellular cytokine staining (ICS).

Results

Twenty-four patients received ≥1 dose of the pINGmuTyr vaccine; PBMCs from 21 patients who completed all five doses were available for Tyr immune assays. The only common toxicity was grade 1 injection site reaction. Six of 15 patients (40%) in the 1.5 mg dose cohort developed Tyr-reactive CD8⁺ T cell responses following stimulation, defined as a ≥3 standard deviation increase in baseline reactivity by tetramer or ICS assays. No Tyr-reactive CD8⁺ T cell response was detected in the 0.2 mg and 0.5 mg dose cohort patients. Epitope spreading of CD8⁺ T cell response to NY-ESO-1 was observed in one patient with vitiligo. One patient subsequently received ipilimumab and developed an enhanced Tyr-reactive response with polyfunctional cytokine profile. After a median follow-up of 40.9 months, median survival has not been reached.

Conclusions

A regimen of five immunizations with pINGmuTyr administered by EP was found to be safe and resulted in Tyr-reactive immune responses in six of 15 patients at 1.5 mg dose cohort.

Trial registration

ClinicalTrials.gov NCT00471133

Effect of sanguinarine on the transport of essential nutrients in an everted gut sac model: role of Na+,K(+)-ATPase

The effect of the argemone alkaloid, sanguinarine, was studied on the active transport of D-glucose and some of the L-amino acids in everted sacs of the small intestine of rats. Sanguinarine (1.0 mumole) was found to inhibit (61%) the transport of D-glucose, while an alkaloid concentration of 0.1 mumole was ineffective. Both 0.1 and 1.0 mumole of sanguinarine had no effect on the transport of the L-amino acids including aspartic acid, lysine, and tyrosine. Sanguinarine showed a dose dependent inhibition of intestinal and hepatic Na+,K(+)-ATPase in a non-competitive manner. The inhibition of Na+,K(+)-ATPase by sanguinarine may in turn inhibit the active transport of D-glucose which requires a sodium pump.

The effects of lauryl maltoside on the reactivation of several enzymes after treatment with guanidinium chloride

The present study confirms the previous reports that detergents can facilitate the reactivation of guanidinium chloride (GdmCl) denatured rhodanese (Tandon, S. and Horowitz, P. (1986) J. Biol. Chem. 261, 15615-15618; Tandon, S. and Horowitz, P. (1987) J. Biol. Chem. 262, 4486-4491). Here, we report the effect of the detergent, lauryl maltoside, on the reactivation of several enzymes other than rhodanese. For this study we used five different enzymes each having a single polypeptide chain, namely: adenosine deaminase; 3-phosphoglyceric phosphokinase; myokinase; 3 alpha-hydroxysteroid dehydrogenase; and phosphoglucomutase. The regain of enzyme activity was used to monitor refolding. Like rhodanese, these enzymes were denatured in 6 M GdmCl and diluted into a buffer containing various concentrations of lauryl maltoside. The effect of lauryl maltoside on reactivating these proteins depended on the specific enzyme used. For example, in the presence of lauryl maltoside, reactivation of adenosine deaminase increased to 98%, while phosphoglucomutase could not be reactivated significantly. The critical micelle concentration (CMC) of lauryl maltoside was measured under the present experimental conditions using 2-(p-toluidinyl)naphthalene 6-sulfonate (TNS) as an apolar fluorescent probe, and gave a value of 0.085 mg.ml-1 in 10 mM sodium phosphate (pH 7.4). The reactivating effect of lauryl maltoside was not generally related to its CMC. In some cases an induction period was observed before the enzyme attained its steady-state velocity. This might suggest the presence of intermediate(s) in the refolding pathway that could have been stabilized by the detergent. These findings indicate that 'non-denaturing' detergents may be useful for assisting reactivation of enzymes, although the optimum conditions will have to be determined for each individual case.

Holmium laser core-through urethrotomy for traumatic obliterative strictures of urethra: Initial experience

OBJECTIVES

To determine the safety and efficacy of holmium laser core-through urethrotomy (HolCTU) for the treatment of post-traumatic obliterative stricture of the urethra.

METHODS

From June 2002 to March 2003, 29 men underwent the core-through procedure. All the patients had obliterative strictures of the bulbomembranous urethra. The length of the stricture was 2.5 cm or less, with good alignment between the two urethral ends. The holmium laser was used to vaporize the obliterative fibrotic tissue. The procedure was guided by a metal sound introduced through the suprapubic tract. Catheter removal and voiding cystourethrography were done at 6 weeks after the procedure and urethroscopy 1 month after catheter removal.

RESULTS

At a mean follow-up of 15 months (range 10 to 19), the results were excellent in 19 (65.51%) of 29 patients. Nine (31.03%) had acceptable results; these patients failed to maintain good flow after HolCTU and required internal urethrotomy/endoscopic dilation once or twice for stabilization (maximal flow rate 15 mL/s or greater). Failure was seen in 1 patient (3.44%) who had recurrent obstruction despite repeated internal urethrotomy and finally required formal transpubic urethroplasty. The mean operating time was 40 minutes (range 30 to 90), with mean hospital stay of 8 hours (range 6 to 48). No perioperative complications occurred, except in 1 patient who developed small extravasation of fluid locally. All the patients were continent, and potency status was unaffected by HolCTU.

CONCLUSIONS

HolCTU is a safe and simple treatment for obliterative urethral strictures. The procedure is less morbid than open repair with a slightly greater failure rate.

Experimental Investigations into Electrochemical Spark Machining of Composites

Reports have indicated the poor performance of the conventional type of cutting tools during machining of composites. In this paper electrochemical spark machining (ECSM) for the cutting and drilling of holes in the composites is being proposed. The feasibility of using ECSM for composites was first ascertained. Then, kevlar-fiber-epoxy and glass-fiber-epoxy composites as work material, copper as tool material, and an aqueous solution of NaCl as electrolyte were used. It has been concluded that the ECSM is a viable solution for cutting of Fiber Reinforced Plastics (FRP). For achieving desired accuracy, surface finish, and economics of the process, the machining parameters should be optimized.

Blood loss estimation in epistaxis scenarios

Thirty-two members of staff from the Ear, Nose and Throat Department at Warrington General Hospital were asked to estimate blood loss in commonly encountered epistaxis scenarios. Results showed that once the measured volume was above 100 ml, visual estimation became grossly inaccurate. Comparison of medical and non-medical staff showed under-estimation was more marked in the non-medical group. Comparison of doctors versus nurses showed no difference in estimation, and no difference was found between grades of staff.

Embryonic stem cells: An alternative approach to developmental toxicity testing

Stem cells in the body have a unique ability to renew themselves and give rise to more specialized cell types having functional commitments. Under specified growth conditions, these cell types remain unspecialized but can be triggered to become specific cell type of the body such as heart, nerve, or skin cells. This ability of embryonic stem cells for directed differentiation makes it a prominent candidate as a screening tool in revealing safer and better drugs. In addition, genetic variations and birth defects caused by mutations and teratogens affecting early human development could also be studied on this basis. Moreover, replacement of animal testing is needed because it involves ethical, legal, and cost issues. Thus, there is a strong requirement for validated and reliable, if achievable, human stem cell-based developmental assays for pharmacological and toxicological screening.

The global network on dental education: a new vision for IFDEA

The advent of globalization has changed our perspectives radically. It presents increased understanding of world affairs, new challenges and exciting opportunities. The inequitable distribution and use of finite energy resources and global warming are just two examples of challenges that can only be addressed by concerted international collaboration. Globalization has become an increasingly important influence on dentistry and dental education. The International Federation for Dental Educators and Associations (IFDEA) welcomes the challenges it now faces as a player in a complex multifaceted global community. This report addresses the new circumstances in which IFDEA must operate, taking account of the recommendations made by other working groups. The report reviews the background and evolution of IFDEA and describes the extensive developments that have taken place in IFDEA over the past year with the introductions of a new Constitution and Bylaws overseen by a newly established Board of Directors. These were the consequence of a new mission, goals and objectives for IFDEA. An expanded organization is planned using http://www.IFDEA.org as the primary instrument to facilitate the exchange of knowledge, programmes and expertise between colleagues and federated associations throughout the world, thereby promoting higher standards in oral health through education in low-, middle- and high-income countries of the world. Such aspirations are modified by the reality and enormity of poverty-related global ill health.