Translational Toxicology and Therapeutics: Windows of Developmental Susceptibility in Reproduction and Cancer

Written by leading research scientists, this book integrates current knowledge of toxicology and human health through coverage of environmental toxicants, genetic / epigenetic mechanisms, and carcinogenicity. Read More...

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Evaluation of the CellaVision DM96 Advanced RBC Application for screening and follow-up of malaria infection

Publication date: Available online 8 December 2017
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Lisa Florin, Karel Maelegheer, Astrid Muyldermans, Marjan Van Esbroeck, Eric Nulens, Jan Emmerechts
CellaVision DM96 is a digital cell morphology system for automated classification of white and red blood cells. CellaVision Advanced RBC application (ARBCA) pre-classifies RBC in 21 categories, including parasitized RBC, and allows re-classification by the operator. In this study, the performance of the software for detection of malaria and calculation of parasitemia was evaluated and compared to microscopy (n=40). For CellaVision, both pre- and post-reclassification results were evaluated. Sensitivity was moderate, even post-reclassification (72%), due to low numbers of analyzed RBC and limited resolution of photographs. CellaVision results correlated with microscopy according to Passing-Bablok analysis, with slightly lower values for CellaVision. Within-run, between-run and inter-observer variability were acceptable. The low sensitivity of CellaVision ARBCA precludes its use as a screening technique for malaria. However, due to its good correlation with microscopy and short turn-around-times, it may be useful in follow-up of parasitemia. Larger studies are required to confirm these findings.



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Proinflammatory mediators related to orthodontically induced periapical root resorption in rat mandibular molars

Summary

Objectives

The early phase of orthodontic tooth movement involves acute inflammatory response that may induce bone resorption. The aim of this study was to localize and quantify cells in the periodontium expressing proinflammatory mediators during orthodontically induced periapical root resorption of the rat mandibular molars.

Materials and methods

The levels of proinflammatory cytokines interleukin-1 (IL-1) α and β, tumor necrosis factor-α (TNF-α), inflammatory enzymes cyclooxygenase (COX) 1 and 2, and their product prostaglandin E₂ (PGE₂) in the root resorption site were compared to those in the corresponding area of the untreated periodontal ligament (PDL) of physiologically drifting teeth. Continuous heavy orthodontic force was applied to the mandibular first molar for 8 and 15 days while in occlusion to induce root resorption. Frozen sections including root resorption lacunae were analyzed for the activity of non-specific esterase (NSE) and tartrate-resistant acid phosphatase (TRAP) by enzyme histochemistry and for the expression of IL-1α, IL-1β, TNF-α, COX-1, COX-2, and PGE₂ by immunohistochemistry.

Results

The active root resorption lacunae had significantly more TRAP-positive multinucleated odontoclasts, whereas the number of NSE-positive cells of the monocyte-macrophage lineage did not differ from that in the control PDL. Several types of periodontal cells exhibited a significant increase in the expression of IL-1α, IL-1β, TNF-α, COX-2, and PGE₂ in the root resorption zone, while COX-1 was rarely detected.

Conclusions

These data suggest that proinflammatory mediators expressed in periodontal cells may synergistically promote apical root resorption in response to continuous heavy mechanical force applied to teeth.

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Evidence of secular trend in mandibular pubertal growth

Summary

Background

During puberty, mandibular growth follows a growth curve comparable to somatic growth. This study aimed to review the relationship between mandibular pubertal peak height velocity (PHV) and skeletal age, and to investigate the possibility of a secular trend.

Methods

Retrospective analysis was performed of two historical craniofacial growth studies (Denver Growth Study; observational time: 1943–1965, and Zurich Growth Study; observational time: 1982–1984) of healthy untreated subjects. Two mandibular growth measures (Articulare–Pogonion [Ar–Pg], Condylion–Pogonion [Co–Pg]) were retrieved from cephalograms (n: 990) and corresponding skeletal age based on hand-wrist radiographs. Mandibular growth velocity was related to skeletal age, PHV was established by use of cubic smoothing splines and variability was calculated by bootstrap resampling for every growth study and gender separately.

Results

Sexual dimorphism in mandibular growth was apparent in both cohorts. In subjects of the Denver Growth Study, mandibular PHV occurred at a more advanced skeletal age than in subjects of the Zurich Growth Study. This trend was more pronounced in males, for whom PHV of Co–Pg shifted from 14.4 to 13.8 years and of Ar–Pg from 14.6 to 13.7 years. This tendency was more subtle in females: PHV of Co–Pg shifted from 12.7 to 12.4 years and of Ar–Pg from 12.6 to 11.8 years.

Conclusions

Mandibular growth appears to be subject to a secular trend. When related to skeletal age, this secular trend seems to be more accentuated than the established secular trend for somatic pubertal growth.

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Measurement of forces and moments around the maxillary arch for treatment of a simulated lingual incisor and high canine malocclusion using straight and mushroom archwires in fixed lingual appliances

Summary

Introduction

An Orthodontic SIMulator (OSIM) was used to investigate the propagation of forces and moments around a simulated archform for a gingival displaced canine and lingual displaced lateral incisor using fixed lingual orthodontic appliances.

Methods

In-Ovation L self-ligating lingual brackets were bonded to anatomically shaped teeth on the OSIM, and the teeth were positioned such that a G4 NiTi 0.016" large maxillary mushroom archwire could be ligated in passive position. Each trial consisted of two movements: a 3mm lingual displacement of the 1–2 lateral incisor at 0.2 mm increments, and a 1.5 mm gingival displacement of the 2–3 canine at 0.15 mm increments (n = 50). Anterior brackets were repositioned to accommodate G4 NiTi 0.016" universal straight archwires (n = 50). Tests were completed at 37°C, and force and moment data in all directions was collected for each tooth around the arch at all increments.

Results

In general, the straight archwire produced significantly larger forces and moments at the centre of resistance for teeth of interest than did mushroom archwires. Specifically, the straight archwire produced 2.62 N and 3.81 N more force in the direction of tooth movement on the tooth being moved for a gingival displaced canine and lingual displaced lateral incisor, respectively, as compared to mushroom archwires.

Conclusions

Results from this study suggest that mushroom archwires may provide better mechanics for movement of teeth in the anterior segment when using a round archwire; however, only biomechanical data was considered in this study and there are many factors that need to be considered in treatment planning.

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Efficiency of piezosurgery technique in miniscrew supported en-masse retraction: a single-centre, randomized controlled trial

Abstract

Background

Piezoelectric surgery is a newly introduced technique for rapid tooth movement. However, the efficiency of this technique has not been investigated on en-masse retraction cases yet.

Objective

To investigate the efficiency of piezosurgery technique in accelerating miniscrew supported en-masse retraction and study the biological tissue response. In addition, to show if this technique induces a difference in dental, skeletal and soft tissue changes on lateral cephalograms, and in canine and molar rotations, besides intercanine and intermolar widths on dental casts.

Design, setting, participants

We conducted a randomized, single-centred, parallel-group, controlled trial, requiring upper right and left first premolar extractions on 30 patients above the minimum age of 14 years at the beginning of retraction.

Interventions

Piezosurgery-assisted versus conventional en-masse retraction anchored from miniscrews placed between second premolars and first molars, bilaterally.

Outcomes

The main outcome was the en-masse retraction rate. Secondary outcomes were gingival crevicular fluid (GCF) volume and GCF content of receptor activator of nuclear factor κβ ligand (RANKL), changes regarding cephalometric and dental cast variables, and miniscrew success rates.

Randomization

Accomplished with opaque, sealed envelopes.

Blinding

Applicable for data assessment only.

Recruitment

Commenced in February 2013 and ended in October 2014.

Results

Thirty-one patients were included in the study and divided into 2 groups of piezosurgery (n = 16) and control (n = 15). After 9.3 months of follow-up, no statistically significant difference was observed between groups for neither retraction rates (P = 0.958) nor GCF parameters (P > 0.05). Changes in lateral cephalometric and dental cast variables, and miniscrew success rates did not show significant differences either.

Conclusion

Based on the results of this study, piezosurgery technique was found to be ineffective in accelerating en-masse retraction, and promoting a difference in the studied GCF parameters, skeletal and dental variables.

Registration

The trial was not registered.

Protocol

The full protocol of this PhD thesis study can be accessed from tez.yok.gov.tr.

Funding

This work was supported by Başkent University Research Fund. No conflict of interest was declared.

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Introduction and assessment of orthognathic information clinic

Summary

Background/Objectives

Orthognathic treatment is routine practice to rehabilitate severe malocclusions and dentofacial deformities. Because orthognathic treatment is elective, patient's involvement in deciding whether to proceed with treatment is vital. Interaction and communication between patient and treating team plays a key role in achieving post-treatment satisfaction. To achieve satisfaction, an orthognathic 'information clinic' for prospective orthognathic patients was established at Oral and Maxillofacial Unit, Tampere University Hospital, Finland. 'Information clinic' includes short talks with power-point presentation given by orthodontist, oral hygienist, oral and maxillofacial surgeon, psychologist, and previous patient. Aim of the study was to set up an 'information clinic' and, more specifically, 1. to assess patients' opinions on the 'clinic' during pilot phase (2013–14) and 2. to analyse general statistics during the first 3 years (2013–16).

Methods

During the pilot phase, patient opinions, based on voluntary questionnaire, were obtained from 85 people. General data were collected for the clinics run in 2013–16.

Results

Seventy-two per cent of respondents reported the information provided to help in their decision-making to proceed/not proceed with treatment. Majority considered the information about the surgical aspects and meeting patient who had undergone orthognathic treatment to be the most important part of the clinic. Between March 2013 and 2016, 290 prospective orthognathic patients were invited to 29 'information clinics'. One hundred and ninety-four patients attended, of whom 137 were female and 57 male (age range 15–67 years).

Conclusions

The questionnaire and verbal feedback from the patients was positive; hence, the 'information clinic' is now offered as a routine process to all prospective orthognathic patients in our clinic.

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An exploratory quality assessment of orthodontic clinical guidelines using the AGREE II instrument

Summary

Objectives

Clinical guidelines act as a means of assisting clinicians in improving the quality of healthcare provided. We aim to assess the quality of currently available international orthodontic guidelines.

Materials and methods

A cross-sectional systematic assessment of orthodontic clinical guidelines was undertaken. A Medline search using the keywords 'guideline', 'orthodontics', and 'dent', and search of specific dental and orthodontic organization websites for orthodontic-related clinical guidelines. Relevant guidelines published between 1999 and 2012 in English were identified. Draft guidelines and endorsements were excluded. The quality of each guideline was evaluated by a single calibrated assessor using the AGREE II instrument. Variation in the quality of guidelines produced by different organizations was also assessed.

Results

Seventeen guidelines were included in this study. Overall, the reporting of scope and purpose (84.31, 95% CI: 70.91–97.72) and clarity of presentation (75.49, 95% CI: 61.68–89.3) domains of the AGREE II instrument were deemed of high quality. Lower scores were obtained for the following domains: rigour of development (52.08, 95% CI: 37.59–66.57), editorial independence (47.06, 95% CI: 20.6–73.51), stakeholder agreement (46.41, 95% CI: 29.66–63.15), and applicability (27.45, 95% CI: 8.26–46.64). There was a noted difference in the individual domain scores of orthodontic guidelines produced by the different organizations.

Conclusions

In relation to the AGREE II instrument, the quality of orthodontic guidelines for use in clinical practice are deemed sub-optimal. Variation in the quality of guidelines produced different organizations is evident.

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The nasopalatine canal, a limiting factor for temporary anchorage devices: a cone beam computed tomography data study

Summary

Objectives

There is only little knowledge on topographical predispositions of the nasopalatine canal as a limiting factor for insertion of mid-palatal temporary anchorage devices (TAD). The purpose of the study was to assess the course of the nasopalatine canal, the adjacent vertical bone quantity, and whether it might differ among vertical facial types, using pre-existing cone beam computed tomography (CBCT) scans.

Material and Methods

Out of a consecutive sample collected from April 2008 to August 2012, only patient data depicting both upper and lower jaw completely were evaluated retrospectively. The linear measurements were taken on the respective midsagittal view perpendicular to the palate at the level of 1st molar/2nd premolar (5/6), 2nd premolar/1st premolar (4/5), and 1st premolar/canine (3/4). Screen-prints were used to measure the inclination of the nasopalatine canal in relation to the maxillary jaw base. Maxillary and mandibular divergence was assessed on rendered lateral cephalograms.

Results

Out of 3869 pre-existing consecutive CBCT scans, data from 398 patients met the inclusion criteria and could be extracted. The mean vertical bone was 4.09 mm at the 5/6 level, 5.22 mm at the 4/5 level, and 3.14 mm at the 3/4 level, respectively. A statistically significant negative correlation exists between jaw divergence and the canal angulation with regard to the maxillary base. A statistically significant negative correlation exists between the canal angulation and vertical bone measurements at the 4/5 and 3/4 levels.

Conclusions

Vertical bone volume is sufficient at 4/5 level for TAD placement, and bares only a small risk for neuro-sensory impairment. Therefore, only in rare cases a CBCT is justified for palatal implant placement. The course of the nasopalatine canal is negatively correlated with the vertical skeletal facial pattern pointing to the fact that in hypodivergent patients a TAD might be placed in a more distal or paramedian region.

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Three-dimensional evaluation of the maxillary arch and palate in unilateral cleft lip and palate subjects using digital dental casts

Summary

Objectives

To assess arch width, palatal surface area, and volume in surgically treated unilateral cleft lip and palate (UCLP) in mixed dentition children in comparison with non-cleft lip and palate (NCLP) children using a 3D laser scanning.

Materials and Methods

38 subjects (Caucasian origin), 5.63–11.9 years of age (mean, 9.33 ± 1.67 years), were included. 19 in each group (UCLP and NCLP). Digital dental casts were obtained using a 3 Shape R700 laser scanner. Intercanine and intermolar widths (cusp and gingival levels), palatal surface area and volume were measured. An independent sample Student's t-test and an ANOVA were undertaken with significance level set as P < 0.05.

Results

Intercanine widths at the cusp (5.60 mm; P < 0.001) and at the gingival level (3.11 mm; P = 0.014), palatal area (141.5 mm²; P = 0.009) and volume (890.7 mm³; P = 0.029) were significantly lower in the UCLP compared to the control group.

Limitations

A smaller part of the subjects was in late mixed dentition phase. To overcome this limitation a matched control group was used. In seven subjects with UCLP, some teeth were missing, which might have had an influence on the dental measurements. However, these subjects could not be excluded because eliminating more severely affected subjects, would have introduced bias.

Conclusions

Three-dimensional evaluation of the maxillary arch and palate highlighted significant differences between UCLP and non-UCLP subjects in mixed dentition phase, suggesting that orthopaedic maxillary expansion is advisable in UCLP.

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Negative effect of malocclusion on the emotional and social well-being of Brazilian adolescents: a population-based study

Summary

Background/objectives

The aesthetic impact of malocclusion can have negative repercussions on quality of life, social interaction, interpersonal relationships, and psychological well-being. The aim of this study was to evaluate the impact of malocclusion on the quality of life of Brazilian adolescents.

Methods

A representative cross-sectional study of 1612 adolescents from Belo Horizonte, Minas Gerais was conducted. The adolescents responded to the Brazilian version of the Child Perception Questionnaire (CPQ_11-14-ISF:16) to assess the impact of the condition on quality of life. Cases of malocclusion were diagnosed using the Dental Aesthetic Index while clinical examination was performed by three calibrated examiners. Data regarding traumatic dental injuries, dental caries, gender, type of school, age and social vulnerability was collected. Data analysis was performed using bivariate and multivariate Poisson regression with robust variance (P < 0.05).

Results

The prevalence of malocclusion was 31.3%. The presence of definite malocclusion (PR = 1.28; CI = 1.13–1.45), severe malocclusion (PR = 1.24; CI = 1.04–1.47) and handicapping malocclusion (PR = 1.55; CI = 1.31–1.84) was associated with a greater negative impact on Emotional Well-Being. The presence of definite malocclusion (PR = 1.18; CI = 1.02–1.36), severe malocclusion (PR = 1.46; CI = 1.21–1.76) and handicapping malocclusion (PR = 1.61; CI = 1.35–1.94) was also associated with a greater negative impact on Social Well-Being.

Conclusions

Adolescents with handicapping malocclusion, where the need for treatment was mandatory, suffered from a greater negative impact on quality of life, with emotional and social aspects most affected.

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The impact of premature birth on the permanent tooth size of incisors and first molars

Summary

Background

Scientific evidence is insufficient to answer the question of whether premature birth causes altered tooth-crown dimensions.

Objective

To evaluate permanent tooth-crown dimensions in prematurely born children and to compare the findings with full-term born controls.

Subjects and Methods

Preterm children of 8–10 years of age were selected from the Swedish Medical Birth Register. One group consisted of 36 extremely preterm children (born before the 29th gestational week); the other group included 37 very preterm children (born during gestational weeks 29–32). The preterm children were compared with 41 matched full-term born children. Clinical examination and study casts were performed on all children. Permanent maxillary and mandibular first molars, central incisors, and laterals were measured with a digital sliding caliper on study casts. The tooth-crowns were measured both mesio-distal and bucco-lingual.

Results

Both the mesio-distal and bucco-lingual measurements in the maxillary and mandibular first molars had a significantly smaller width in the extremely preterm group compared with the full-term group. The central incisors and lower laterals were significantly smaller mesio-distally in the extremely preterm group compared to the full-term group. A reduction in tooth size of 4–9% was found between the extremely preterm group and the full-term group for both boys and girls. The maxillary first molars and mandibular left first molar were also smaller mesio-distally in the extremely preterm group compared to the very preterm group. The results indicate that the more preterm the birth, the smaller the tooth-crown dimensions. Independent of gestational age girls had generally smaller teeth than boys.

Conclusion

Premature birth is associated with reduced tooth-crown dimensions of permanent incisors and first molars.

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Excellent versus unacceptable orthodontic results: influencing factors

Summary

Aim

To retrospectively compare patients with excellent and unacceptable orthodontic treatment results with respect to possible prognostic factors.

Material and methods

All patients, who completed treatment at the Department of Orthodontics of the Justus-Liebig-University Giessen, Germany between 1993 and 2009 with an excellent or unacceptable outcome according to the Ahlgren index. Possibly influencing factors regarding case history, treatment, cephalometrics, and plaster casts were analyzed. Furthermore, PAR index pre- and post-treatment was compared. The explorative statistical analysis was performed using Fishers Exact test, Chi-square test, and Mann–Whitney U-test.

Results

Out of 1653 patients, treatment outcome was excellent in 226 (13.7 per cent) and inacceptable in 56 (3.4 per cent) patients. For the remaining cases, a good or acceptable outcome was assessed. Pretreatment PAR scores showed no difference between the excellent and unacceptable group. The following factors were significantly more common in the unacceptable group: male predominance (P = 0.009), occurrence of general diseases (P = 0.003), habits (P < 0.001), prolonged active appliance treatment duration (P = 0.014), negative cooperation (P < 0.001), denial of recommended appliance or premature removal of appliances (P < 0.001), decreased pretreatment overbite (P = 0.005), and hyperdivergent jaw base relationships (P = 0.005).

Conclusion

Patient cooperation remains the outstanding parameter determining treatment success. A proportionally higher frequency of unacceptable treatment results must be expected in patients with open bite configurations (skeletally, dentally, and functionally).

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Efficiency of piezotome-corticision assisted orthodontics in alleviating mandibular anterior crowding—a randomized clinical trial

Summary

Objectives

The aim of this clinical trial was to investigate the duration of mandibular-crowding alleviation with piezotome-corticision orthodontics compared with conventional orthodontics.

Design

Single-centre, two-arm parallel group randomized controlled trial.

Setting

Orthodontic clinic at the University of Connecticut.

Ethical approval

The study was approved by the Institutional Review Board (IRB # 12-0147-2).

Subjects and methods

Forty-one adult subjects from a single centre with more than 5mm of mandibular anterior crowding were randomly allocated using block randomization into experimental and control groups. The experimental group received a corticision procedure with a piezotome on the labial aspect of the mandibular incisors in conjunction to a self-ligation fixed orthodontic appliance. The control group received the self-ligation fixed orthodontic appliance and no corticision. Same archwire sequence (0.014 inch followed by 0.014 × 0.025 inch copper–nickel–titanium) was followed for both groups. Mandibular study casts taken every 4–5 weeks were used to assess changes in the irregularity index by blinded outcome assessors.

Outcome measures

The time to alignment was calculated in days.

Results

Twenty-nine subjects (16 experimental and 13 control) completed the study. Overall, no significant difference in the time required to correct mandibular crowding with piezotome-corticision assisted (102.1 ± 34.7 days; 95% CI, 83.6 to 120.6) and conventional orthodontics (112 ± 46.2 days; 95% CI, 84–139.9) was observed. No complications with treatment or unintended consequences were observed on any of the subjects.

Limitations

A high attrition rate.

Conclusions

This randomized clinical trial found no evidence that piezotome-corticision assisted orthodontics was more efficient in alleviating mandibular anterior crowding.

Registration

ClinicalTrials.gov, Identifier: NCT02026258.

Funding

Division of Orthodontics, University of Connecticut.

Conflict of Interest

None.

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Effect of fluoride-releasing resin composite in white spot lesions prevention: a single-centre, split-mouth, randomized controlled trial

Abstract

Introduction

The objective of this two-arm split-mouth randomized trial, was to evaluate the ability of fluoride-releasing resin composite to prevent demineralization and white spot lesion (WSL) formation, during orthodontic treatment with fixed appliances.

Methods

Patients needing comprehensive orthodontic treatment were randomly allocated into two groups, according to the half split-mouth technique. This trial examined a total of 300 teeth in each group: the control group, in which brackets were fixed with a non–fluoride-containing adhesive resin; and the intervention group, in which brackets were fixed with a fluoride-containing adhesive resin. Eligibility criteria included Class I malocclusion in the permanent dentition, adequate oral hygiene and no missing teeth, active caries, enamel demineralization, fluorosis staining, or heavy restorations. The primary outcome was the formation of WSLs. Randomization was achieved using a computer-generated random number table; blinding of the patients, assessor, orthodontist and data analysist were achieved. The patients were followed for twelve months, during which time their teeth were checked every three months. To investigate the differences in frequencies and ranks of demineralization and WSL formation between the two groups, odds ratios were computed using mixed modelling (to compensate for the clustered nature of the data) with intervention as a fixed effect and patient as a random effect.

Results

Thirty-four patients (ages, 13–25 years; mean age, 17.6) were randomized into a 1:1 ratio, though four patients dropped out before the start of the treatment. The percentage of the teeth showing the effects of demineralization and WSL formation, increased from 6.3% to 15% for the control group after three and twelve months, respectively, and from 3% to 16.3% for the study group, after three to twelve months, respectively. There were no significant differences between the two groups and no interaction between time and treatment group in the visual inspections (OR 0.79; 95% CI 0.52, 1.21), in DIAGNOdent examinations (OR 0.68; 95% CI 0.43, 1.06), or in photographic images (OR 0.72; 95% CI 0.46, 1.11). No serious harm was observed during the trial.

Limitations

This trial was a single-centre trial, and treatment was carried out by one orthodontist.

Conclusions

Fluoride-containing resin adhesive does not have the desired preventive effect to prevent demineralization and WSL formation, during orthodontic treatment with fixed appliance.

Registration and Protocol

This randomized trial was not registered, and the protocol was not published before patient recruitment.

Funding

The University of Damascus funded this trial.

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Influence of long-term in vivo exposure, debris accumulation and archwire material on friction force among different types of brackets and archwires couples

Summary

Objective

The aim was to assess the influence of long-term in vivo exposure, debris accumulation and archwire material on static and kinetic friction force among different types of brackets and archwires couples.

Material and Methods

Friction testing was performed among four lower incisors' brackets, conventional and self-ligating (SL), coupled with either nickel-titanium or stainless steel archwires, as-received and in vivo exposed in 18 subjects. The friction testing was performed for a sliding distance of 14 mm at a speed of 10 mm/min, with a starting force of 0.2 N. Wear and quantitative assessment of debris accumulation was performed on pictures of brackets obtained using a scanning electron microscope. Non parametric tests were used for statistical analysis.

Results

Only bracket type, but not exposure duration, amount of debris accumulation, archwire material or their manufacturer, was significantly correlated with both static (rho = 0.602, P < 0.001) and kinetic (rho = 0.584, P < 0.001) friction force. Within each bracket type no significant difference was observed between as-received and in vivo exposed brackets for any friction parameter except for the SL brackets in which significantly higher static and kinetic (P = 0.001, at least) friction forces were seen in in vivo exposed SL brackets (164.9 cN and 217.63 cN, respectively) in comparison with as-received SL brackets (19.69 cN and 55.72 cN, respectively).

Limitation

The frictional testing was performed in the dry condition which might have influenced the results.

Conclusion

A significant correlation was seen between friction force and bracket type, while treatment duration, amount of debris accumulation, archwire material or their manufacturer was not significantly correlated to it. Nevertheless, higher friction forces were measured among in vivo aged SL brackets in comparison with as-received ones.

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Comparing the effectiveness profile of pharmacological interventions used for orthodontic pain relief: an arm-based multilevel network meta-analysis of longitudinal data

Summary

Background and objectives

We compare the effectiveness profile of various analgesics used for orthodontic pain relief over a 1-week time period by conducting a longitudinal network meta-analysis (NMA).

Search methods

The MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases were searched till 31st December 2015 to identify the relevant studies. Additional studies were identified by hand searching journals and reference lists. Unpublished literature was also searched.

Selection criteria

Eligible studies were randomized-controlled trials (RCTs) evaluating the effectiveness of pharmacological interventions for pain relief after placement of separator or initial aligning arch wire.

Data collection and analysis

Pain intensity data at 2, 6, 12, 24, 36, 48, 72, 96, and 168 hours was collected. In addition, data were also extracted for potential covariates (age, sex, and procedure). A covariate-adjusted arm-based multilevel random coefficient model was used for evidence synthesis.

Results

Fifteen RCTs (1341 participants; male/females 595, 44.6%/746 55.4%; mean age 17.3 years, SD 4.1) were included. A total of 11 nodes (Acetaminophen, Aspirin, Etoricoxib, Flurbiprofen, Ibuprofen, Lumiracoxib, Meloxicam, Naproxen, Piroxicam, Placebo, and Control) were identified out of which five nodes (Placebo, Ibuprofen, Naproxen, Acetaminophen, and Aspirin) had subnodes (based on timing of administration). Compared to Control, Placebo, Flurbiprofen, Lumiracoxib, and Meloxicam were not significantly effective. Etoricoxib (most effective) and Piroxicam (second most effective) were effective over a long period which lasted up to 96 and 72 hours, respectively. Ibuprofen, Acetaminophen, Naproxen, and Aspirin were effective at 6, 12, and 24 hours. The effectiveness of these analgesics was significantly influenced by the timing of administration. Assessment of heterogeneity, transitivity, inconsistency, and publication bias revealed no major threat to the NMA derived estimates.

Conclusion

Compared to the Control, Placebo was least effective whereas Etoricoxib was the most effective analgesic in reducing orthodontic pain. Administration timing has significant influence on the effectiveness profile of analgesics routinely used for managing orthodontic pain.

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Structural, morphological, compositional, and mechanical changes of palatal implants after use: a retrieval analysis

Summary

Purpose

The aim of this study was to characterize the surface, elemental, and mechanical alterations of orthodontic palatal implants after intraoral aging.

Materials and method

Nineteen consecutively retrieved implants (RET) after orthodontic treatment and three unused implants used as control (CON) were included in this study. Both groups were characterized non-destructively by Stereomicroscopy, Optical Profilometry (Sa, Sq, Sz, Sc), and SEM/EDX analysis and then destructively after metallogaphic preparation employing instrumented indentation testing (HM, E_IT, η_IT, and HV) and SEM/EDX at bone-implant interface.

Results

All retrieved implants showed a loss of gloss with the formation of bone-like formation on the majority of them. However, no differences in surface roughness parameters were identified between macroscopically intact and retrieved regions of implants. The elements precipitated on the surface were O, C, Ca, and P while traces of Na, K, Al, S, Cl, and Mg were also identified. The surface of control sample is characterized by small pits while only Ti and Al traces were identified by EDX analysis. The presence of all the aforementioned elements apart from Ti and Al on the retrieved implants' surface should be appended to the contact of implant with bone and biological fluids while Interfacial analysis revealed a well-formed bone-implant interface. However, no significant differences were found for all mechanical properties tested between RET and CON groups.

Conclusions

The results of this study indicate that retrieved palatal implant surface has undergone morphological and elemental alterations probably associated with the osseointegration process during service. Insertion and functional loading did not affect the mechanical properties of implants tested.

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ICYMI: Short Seller Slams OSI Systems, Sell-Side Makes Some Notable Calls

For the second day in a row, a noted short seller went on the attack as Muddy Waters Research founder Carson Block took aim at OSI Systems, Inc . This comes just one day after Citron Research's Andrew Left took a swipe at HubSpot, Inc .

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Cardiovascular risk and severity factors in patients admitted to hospital for spontaneous epistaxis

Publication date: Available online 8 December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): N. André, N. Klopp-Dutote, A. Biet-Hornstein, V. Strunski, C. Page
ObjectivesTo assess the role of cardiovascular risk factors, intake of drugs altering hemostasis and severity signs in patients admitted with spontaneous epistaxis.Material and methodsA single-center retrospective study covering a 7-year period in a university hospital center included 205 patients admitted with spontaneous epistaxis. Study variables comprised: cardiovascular risk factors (cardiovascular disease or history of cardiovascular disease with hemorrhagic or thromboembolic risk, high blood pressure, type-2 diabetes, dyslipidemia), intake of drugs altering hemostasis, blood pressure and minimum hemoglobin level during hospital stay. Groups of serious and non-serious epistaxis were distinguished.ResultsThere were no significant inter-group differences for mean age, sex ratio, history of high blood pressure or number of cardiovascular risk factors. Serious epistaxis was associated with significantly lower blood pressure and hemoglobinemia. Number of cardiovascular risk factors correlated with probability of blood transfusion.ConclusionThe real influence of the various study factors, including severity factors, on onset of spontaneous epistaxis remains to be elucidated.



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Impact of allergy on phenotypic and endotypic profiles of nasal polyposis

Publication date: Available online 8 December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): G. Mortuaire, I. Gengler, M. Balden, M. Capron, G. Lefèvre
ObjectivesTo assess the impact of allergy on clinical presentations (phenotypes) and inflammatory patterns (endotypes) of chronic rhinosinusitis with nasal polyps (CRSwNP).MethodsA single-center prospective study was conducted over an 18-month period. Fifty-seven patients with refractory CRSwNP were included. The diagnosis of allergy was based on concordant skin prick tests and symptoms. Phenotypes were determined on symptom severity score, polyp size classification and Lund-Mackay CT staging. Inflammatory endotypes were determined on biomarker analysis (IgE, IgA, IL-5, IL-9, ECP, EDN) in blood and nasal secretions. Eosinophil counts were obtained in blood, nasal secretions and polyps.ResultsPhenotype and endotype profiles were comparable in patients with (n=15) or without (n=42) allergy. Only asthma with high total IgE blood concentration showed association with allergy.ConclusionsThe present results suggest that allergy is not directly involved in the clinical expression and specific inflammatory pathways of CRSwNP. New therapies target inflammation signaling pathways, and identifying accurate blood and tissue biomarkers will be the line of research most likely to improve treatment of CRSwNP.



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RELN signaling modulates glioblastoma growth and substrate-dependent migration

Abstract

Glioblastoma (GBM) represents the most common and most malignant type of primary brain tumor and significantly contributes to cancer morbidity and mortality. Invasion into the healthy brain parenchyma is a major feature of glioblastoma aggressiveness. Reelin (RELN) is a large secreted extracellular matrix glycoprotein that regulates neuronal migration and positioning in the developing brain and sustains functionality in the adult brain. We here show that both RELN and its main downstream effector DAB1 are silenced in glioblastoma as compared to non-neoplastic tissue and mRNA expression is inversely correlated with malignancy grade. Furthermore, RELN expression is positively correlated with patient survival in two large, independent clinically annotated datasets. RELN silencing occurs via promoter hypermethylation as shown by both database mining and bisulfite sequencing of the RELN promoter. Consequently, treatment with 5'-Azacytidine and trichostatin A induced RELN expression in vitro. On the functional level, we found RELN to regulate glioblastoma cell migration both in a DAB1 (tyrosine phosphorylation)-dependent and -independent fashion, depending on the substrate provided. Moreover, stimulation of RELN signaling strongly reduced proliferation in glioblastoma cells. This phenotype depends on DAB1 stimulation by RELN, as a mutant that lacks all RELN induced tyrosine phosphorylation sites (DAB1-5F) failed to induce a growth arrest. Proteomic analyzes revealed that these effects are mediated by a reduction in E2F targets and dephosphorylation of ERK1/2. Taken together, our data establish a relevance of RELN signaling in glioblastoma pathology and thereby might unearth novel, yet unrecognized treatment options. This article is protected by copyright. All rights reserved.

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Dominant role of microglial and macrophage innate immune responses in human ischemic infarcts

Abstract

Inflammatory mechanisms, involving granulocytes, T-cells, B-cells, macrophages and activated microglia, have been suggested to play a pathogenic role in experimental models of stroke and may be targets for therapeutic intervention. However, knowledge on the inflammatory response in human stroke lesions is limited. Here, we performed a quantitative study on the inflammatory reaction in human ischemic infarct lesions. We found increased numbers of T-lymphocytes, mainly CD8⁺ cells, but not of B-lymphocytes. Their number was very low in comparison to that seen in inflammatory diseases of the central nervous system and they did not show signs of activation. Polymorphonuclear leukocytes were present in meninges and less prominently in the perivascular space in early lesions, but their infiltration into the lesioned tissue was sparse with the exception of a single case. Microglia were lost in the necrotic core of fresh lesions, their number was increased in the surrounding penumbra, apparently due to proliferation. Using TMEM119 as a marker for the resident microglia pool, macrophages in lesions were in part derived from the original microglia pool, depending upon the lesion stage. Most microglia and macrophages revealed a pro-inflammatory activation pattern, expressing molecules involved in phagocytosis, oxidative injury, antigen presentation and iron metabolism and had partially lost the expression of P2RY12, an antigen expressed on homeostatic ("resting") microglia in rodents. At later lesion stages, the majority of macrophages showed intermediate activation patterns, expressing pro-inflammatory and anti-inflammatory markers. Microglia in the normal white matter of controls and stroke patients were already partly activated towards a pro-inflammatory phenotype. Our data suggest that the direct contribution of lymphocytes and granulocytes to active tissue injury in human ischemic infarct lesions is limited and that stroke therapy that targets pro-inflammatory microglia and macrophage activation may be effective. This article is protected by copyright. All rights reserved.

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In response to Letter to the Editor entitled ‘Is an endoscopic or a microscopic approach optimal for management of attic cholesteatoma?’

Publication date: Available online 8 December 2017
Source:American Journal of Otolaryngology
Author(s): Giuseppe Magliulo, Giannicola Iannella




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Effect of abutment height on interproximal implant bone level in the early healing: A randomized clinical trial

Abstract

Objective

The aim of this randomized clinical trial was to compare the effect on the interproximal implant bone loss (IBL) of two different heights (1 and 3 mm) of definitive abutments placed at bone level implants with a platform switched design.

Material and methods

Twenty-two patients received forty-four implants (6.5–10 mm length and 3.5–4 mm diameter) to replace at least two adjacent missing teeth, one bridge set to each patient—two implants per bridge. Patients were randomly allocated, and two different abutment heights, 1 and 3 mm using only one abutment height per bridge, were used. Clinical and radiological measurements were performed at 3 and 6 months after surgery. Interproximal bone level changes were compared between treatment groups. The association between IBL and categorical variables (history of periodontitis, smoking, implant location, implant diameter, implant length, insertion torque, width of keratinized mucosa, bone density, gingival biotype and antagonist) was also performed.

Results

At 3 months, implants with a 1-mm abutment had significantly greater IBL (0.83 ± 0.19 mm) compared to implants with a 3-mm abutment (0.14 ± 0.08 mm). At 6 months, a greater IBL was observed at implants with 1-mm abutments compared to implants with 3-mm abutments (0.91 ± 0.19 vs. 0.11 ± 0.09 mm). The analysis of the relation between patient characteristics and clinical variables with IBL revealed no significant differences at any moment except for smoking.

Conclusions

Abutment height is an important factor to maintain interproximal implant bone level in early healing. Short abutments led to a greater interproximal bone loss in comparison with long abutments after 6 months. Other variables except smoking showed no relation with interproximal bone loss in early healing.

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Anti-mumps IgM antibody positive rate with sudden sensorineural hearing loss using second-generation enzyme immunoassay: A retrospective, multi-institutional investigation in Hokkaido, Japan

Publication date: Available online 8 December 2017
Source:Auris Nasus Larynx
Author(s): Atsushi Fukuda, Shinya Morita, Yuji Nakamaru, Kimiko Hoshino, Keishi Fujiwara, Shigeru Akazawa, Tomohiro Sakashita, Nobuyuki Obara, Akihiro Homma
ObjectiveAlthough elevated anti-mumps IgM antibody levels were reported in 5.7%–7.2% of Japanese patients with sudden sensorineural hearing loss (SSNHL), there were several reports of false-positive cases, such as the continually IgM positive case and the IgM positive case in normal adults. To improve specificity, the new enzyme immuno assay (EIA) anti-mumps IgM antibody measurement kit was introduced in December 2009. This study re-examined the frequency of anti-mumps IgM antibody test positivity with SSNHL using the new measurement kit and compared the results with those from a previous report that used old kit.MethodsThis is a retrospective multi-institutional study involving patients diagnosed with SSNHL who exhibited the anti-mumps IgM antibody. We compared the positive rate of anti-mumps IgM antibody and the annual average number of mumps cases per sentinel in Hokkaido between the patients in the present study and patients previously evaluated.ResultsOverall, 100 patients with SSNHL were enrolled. One case (1.0%) was positive for anti-mumps IgM antibody. Of the 69 patients evaluated in the previous study, 5 cases (7.2%) were positive for anti-mumps IgM antibody. The positive rate of the anti-mumps IgM antibody in the present cases was significantly lower than that previously reported (p=0.042). The annual average number of mumps cases per sentinel in Hokkaido of the present and previous surveillance period was 34.47 and 42.77, respectively; no significant difference was seen in these data (p=0.4519).ConclusionThe present study revealed that 1.0% of SSNHL was positive for the anti-mumps IgM antibody using the new EIA-IgM measurement kit. After the introduction of the new EIA-IgM measurement kit, anti-mumps IgM antibody positive rate with SSNHL significantly decreased, indicating that the proportion of asymptomatic mumps among etiology of SSNHL may be lower than those previously reported.



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Results of a systematic literature review of treatment modalities for jugulotympanic paraganglioma, stratified per Fisch class

Abstract

Objective

Key for successful jugulotympanic paraganglioma management is a personalized approach aiming for the best practice for each individual patient. To this end, a systematic review is performed, evaluating the local control- and complication rates for the different treatment modalities stratified by the broadly accepted Fisch classification.

Design

A systematic literature review according to the PRISMA statement was performed. A detailed overview of individual treatment outcomes per Fisch class is provided.

Main outcome measures

local control, cranial nerve damage, complications, function recovery.

Results

Eighteen studies were selected, resembling 83 patients treated with radiotherapy and 299 with surgery. Excellent local control was found post surgery for class A and B tumours and risk of cranial nerve damage was <1%. For class C1-4 tumours, local control was 80-95% post surgery (84% post radiotherapy) and, cranial nerve damage was found in 71-76% (none post radiotherapy; p < 0.05). There was no difference in treatment outcomes between tumours of different C class. For class C1-4De/Di tumours, local control was 38-86% (98% post radiotherapy; p < 0.05), cranial nerve damage/complication rates were 67-100% (3% post radiotherapy; p < 0.05). C1-4DeDi tumours showed lesser local control and cranial nerve damage rates when compared to C1-4De tumours.

Conclusions

An individual risk is constituted for surgery and radiotherapy, stratified per Fisch class. For class A and B tumours surgery is a suitable treatment option. For class C and D tumours radiotherapy results in lower complication rates and similar or better local control rates when compared to the surgical group.

This article is protected by copyright. All rights reserved.

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Odontoblast-like differentiation and mineral formation of pulpsphere derived cells on human root canal dentin in vitro

The revitalization or regeneration of the dental pulp is a preferable goal in current endodontic research. In this study, human dental pulp cell (DPC) spheres were applied to human root canal samples to evalua...

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Primary intraosseous squamous cell carcinoma of the mandible: locoregional control and survival is significantly reduced if the tumour is more than 4cm in size

To establish the prognostic factors for primary intraosseous squamous cell carcinoma we designed a retrospective study of patients treated in the head and neck department of a tertiary referral centre in China from 2010–2015. We collected clinical, radiological, and histopathological data from 36 patients treated during the given time period, among which 34 were followed up. There were 22 male and 12 female patients, 13 of whom gave a history of smoking tobacco and four who drank alcohol. All 34 patients were treated by segmental mandibulectomy and neck dissection.

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In response to Letter to the Editor entitled ‘Is an endoscopic or a microscopic approach optimal for management of attic cholesteatoma?’

We are grateful to Zhengcai-Lou et al. for having appreciated our study entitled 'Endoscopic versus microscopic approach in attic cholesteatoma surgery [1].

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‘The End of Sitting’ in a public space: observations of spontaneous visitors

Sitting too much has been associated with negative health outcomes. 'The End of Sitting' is a newly developed office landscape that moves away from the traditional chair-desk setup. The landscape aims to reduce s...

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Body mass index had different effects on premenopausal and postmenopausal breast cancer risks: a dose-response meta-analysis with 3,318,796 subjects from 31 cohort studies

There is sufficient evidence supporting a relationship between increased body mass index (BMI) and an increased risk for breast cancer among postmenopausal women. However, most studies have found a decreased r...

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Economic evaluations of ergonomic interventions preventing work-related musculoskeletal disorders: a systematic review of organizational-level interventions

Work-related musculoskeletal disorders (WMSD) represent a major public health problem and economic burden to employers, workers and health insurance systems. This systematic review had two objectives: (1) to a...

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Lexical neutrality in environmental health research: Reflections on the term walkability

Neighbourhood environments have important implications for human health. In this piece, we reflect on the environments and health literature and argue that precise use of language is critical for acknowledging...

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Upper Airway Areas, Volumes and Linear Measurements Determined on CT during Different Phases of Respiration Predict the Presence of Severe Obstructive Sleep Apnea

The objective of this study was to analyze the potential of using low-dose, volumetric computed tomography (CT) during different phases of respiration for identifying patients likely to have severe obstructive sleep apnea (OSA) defined as having a respiratory disturbance index (RDI) of more than 30.

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“Ferrule Comes First. Post Is Second!” Fake News and Alternative Facts? A Systematic Review

Both the role of an endodontic post and the ferrule effect have been discussed for decades. The clinical impact of endodontic posts compared with post-free restoration with or without ferrule support was not systematically reviewed so far. It was assumed that the effect of an endodontic post compared with a post-free restoration can be evaluated only when at the same time a ferrule or no-ferrule situation was clinically compared.

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Effect of Low–surface Tension EDTA Solutions on the Bond Strength of Resin-based Sealer to Young and Old Root Canal Dentin

The purpose of this study was to evaluate the effect of low–surface tension EDTA solutions on the push-out bond strength of resin-based sealer to young and old root canal dentin.

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Impact of Cone-beam Computed Tomography on Treatment Planning for External Cervical Resorption and a Novel Axial Slice–based Classification System

The aim of this study was to compare treatment plans for external cervical resorption (ECR) developed from periapical (PA) radiographs and cone-beam computed tomographic (CBCT) imaging. The secondary aim of this study was to test a new classification system for ECR based on CBCT axial slice analysis.

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Regenerative Endodontic Procedures among Endodontists: A Web-based Survey

The protocols that endodontists implement for regenerative endodontic procedures (REPs) are unknown. The aim of this study was to examine current REP protocols among practicing endodontists in the United States.

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Evaluation of 3 Different Retreatment Techniques in Maxillary Molar Teeth by Using Micro–computed Tomography

Nonsurgical retreatment procedure involves the complete removal of the previous filling material to allow thorough instrumentation, disinfection, and refilling of root canal system. We aimed to determine the residuals of the root-filling material by using 3 different retreatment techniques with the aid of micro–computed tomography.

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The Effects of Irrigants on the Survival of Human Stem Cells of the Apical Papilla, Including Endocyn

Endocyn, a pH-neutral solution of hypochlorous acid and hypochlorite has been developed for use as an endodontic irrigant. The purpose of this study was to evaluate the effect of Endocyn on human periodontal ligament (PDL) fibroblasts, rat osteosarcoma cells (UMR-106), and stem cells of the apical papilla (SCAP) compared with other commonly used endodontic irrigants.

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Survival Rates of Teeth with Primary Endodontic Treatment after Core/Post and Crown Placement

The objective of this study was to determine the effect of delayed placement of the core/post and crown on the outcomes of nonsurgical root canal therapy (NSRCT).

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Efficacy of Ultrasound Doppler Flowmetry in Assessing Pulp Vitality of Traumatized Teeth: A Propensity Score Matching Analysis

This retrospective study aimed to evaluate and compare the efficacy of ultrasound Doppler flowmetry (UDF) with that of electric pulp testing (EPT) in assessing pulp vitality in traumatized teeth.

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Model-Driven Treatment of Childhood Apraxia of Speech: Positive Effects of the Speech Motor Learning Approach

Purpose

The aim of the study was to propose the speech motor learning approach (Van der Merwe, 2011) as a treatment for childhood apraxia of speech and to determine if it will effect positive change in the ability of a 33-month-old child to produce untreated nonwords and words containing treated age-appropriate consonants (Set 1 sounds), untreated age-appropriate consonants (Set 2), and untreated age-inappropriate consonants (Set 3) and also to determine the nature and number of segmental speech errors before and after treatment.

Method

An A-B design with multiple target measures and follow-up was implemented to assess the effects of treatment of Set 1. Effect sizes for whole-word accuracy were determined, and two criterion lines were generated following the conservative dual criterion method. Speech errors were judged perceptually.

Results

Conservative dual criterion analyses indicated no reliable treatment effect due to rising baseline scores. Effect sizes showed significant improvement in whole-word accuracy of untreated nonwords and real words containing age-appropriate treated sounds and real words containing age-appropriate untreated sounds. The number of errors for all three sound sets declined. Sound distortion was the most frequent error type.

Conclusions

Preliminary evidence suggests potentially positive treatment effects. However, rising baseline scores limit causal inference. Replication with more children of different ages is necessary.

Supplemental Materials

http://ift.tt/2ApICzW

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Orbital volume and shape in Treacher Collins syndrome

Orbito-palpebral reconstruction is a challenge in Treacher Collins syndrome (TCS). This study investigates orbital phenotypes in TCS using cephalometry and orbital shape analysis.Eighteen TCS and 52 control patients were included in this study, using the Dr Warehouse database. Orbital cephalometry was based on 20 landmarks, 10 planes, 16 angles, and 22 distances. Orbits were segmented. Registration-based, age-specific mean models were generated using semi-automatic segmentation, and aligned and compared using color-coded distance maps – maximum absolute distance (MAD), Hausdorff distance (HD), and Dice similarly coefficient (DSC).

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Outcome and complications after treatment of facial fractures at different times in polytrauma patients

Finding the correct point of time for operative treatment of facial fractures in multiply injured people remains one of the most important challenges in modern emergency medicine. Findings relating to pathophysiological mechanisms after severe trauma argue against the early operative treatment of non-life-threatening injuries. Our retrospective analysis investigated the effects on complications and outcome of different time points for operative treatment of maxillofacial fractures in multiply injured patients.

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Orthodontic Class II:1 treatment—efficiency and outcome quality of Herbst-multibracket appliance therapy

Abstract

Objectives

The aim of this retrospective investigation was to assess the efficiency and outcome quality of Class II:1 treatment (Tx).

Material and methods

The investigation is based on the evaluation of all Class II:1 patients that ever (1986–2014) started Tx with a Herbst appliance and subsequently a multibracket appliance (MBA) at the study center. Study casts from before Tx, after Herbst-MBA Tx, and (if available) after ≥ 24 months of retention were evaluated using the Peer Assessment Rating (PAR) index, the Ahlgren scale, and standard occlusal variables.

Results

In total, 526 Class II:1 patients with a mean pre-Tx age of 14.4 years (range 9.8–44.4) had received Herbst-MBA Tx; 18 patients discontinued Tx before completion. For 240 patients, data from ≥ 24 months of retention were available. The pre-Tx PAR score of 32.4 ± 8.83 was reduced to 8.0 ± 4.51 during Tx. A slight increase to 8.8 ± 5.11 occurred during retention. The percentage of patients which could be assigned to the category "greatly improved" was 62% after Tx and 57% after retention; only 2–3% had to be assigned to the category "worse/no different." The outcome ratings according to the Ahlgren scale revealed 17% excellent, 35% good, 45% satisfactory, and 3% unsuccessful results.

Conclusions

Class II:1 Tx using Herbst-MBA is an efficient approach in orthodontic care. During a mean active Tx period of 2 years, high-quality results can be obtained in the majority of patients.

Clinical relevance

The present investigation is the first to investigate a large unselected cohort of consecutive Herbst-MBA patients to determine representative data on the efficiency and the outcome quality of this Tx approach.

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“Omics” in oral cancer: New approaches for biomarker discovery

Publication date: Available online 8 December 2017
Source:Archives of Oral Biology
Author(s): Vertika Rai, Rashmi Mukherjee, Ananta K. Ghosh, Aurobinda Routray, Chandan Chakraborty
ObjectivesIn this review paper, we explored the application of "omics" approaches in the study of oral cancer (OC). It will provide a better understanding of how "omics" approaches may lead to novel biomarker molecules or molecular signatures with potential value in clinical practice. A future direction of "omics"-driven research in OC is also discussed.MethodsStudies on "omics"-based approaches [genomics/proteomics/transcriptomics/metabolomics] were investigated for differentiating oral squamous cell carcinoma,oral sub-mucous fibrosis, oral leukoplakia, oral lichen planus, oral erythroplakia from normal cases. Electronic databases viz., PubMed, Springer, and Google Scholar were searched.ResultsOne eighty-one studies were included in this review. The review shows that the fields of genomics, transcriptomics, proteomics, and metabolomics-based marker identification have implemented advanced tools to screen early changes in DNA, RNA, protein, and metabolite expression in OC population.ConclusionsIt may be concluded that despite advances in OC therapy, symptomatic presentation occurs at an advanced stage, where various curative treatment options become very limited. A molecular level study is essential for detecting an OC biomarker at an early stage. Modern "Omics" strategies can potentially make a major contribution to meet this need.



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Genetic markers of nasolabial morphology

Publication date: Available online 7 December 2017
Source:Archives of Oral Biology
Author(s): Tarek El-Bialy




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Gongylonema pulchrum infection in the human oral cavity – a case report and literature review

Gongylonema infection is a zoonotic disease occurring throughout the world and is mainly caused by consumption of contaminated water and raw food. Adult Gongylonema worms can exist as parasites in the human body for up to 10 years and cause symptoms of local irritation in the oral cavity, oesophagus, and pharynx. Herein, we report a rare case in which live Gongylonema pulchrum was detected and extracted from the oral cavity of a woman. The pathogen was confirmed as G. pulchrum on the basis of microscopic examination and morphological analysis.

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Quality and readability of internet-based information on halitosis

To evaluate quality and readability of Internet-based information on halitosis.

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Minnesota mom details daughter's death in dentist's office

'Please don't kill me': Cop is cleared of murder after shooting dead sobbing father, 26, as he crawled along a hotel corridor in shocking footage which his family insists shows a 'cold-blooded execution' Muslim 'day of rage' turns deadly as Palestinian is shot dead by Israeli soldiers during violent clashes over Trump's decision to recognize Jerusalem as the capital 14 UN peacekeepers are killed and more than 50 wounded in 'worst attack on United Nations troops in recent history' in Congo Trump heads to Florida town fewer than FIFTEEN miles from Alabama to boost Roy Moore's bid for senate despite his slew of teen harassment and sexual assault allegations Bitcoin plunges 15 per cent to below $14,500 in wild trading after a roller-coaster week that saw the currency hit record highs and fears it is on course to create 'largest financial bubble ever' Nine fraternity brothers are arrested in ... (more)

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Clinical validation study of dried blood spot for determining everolimus concentration in patients with cancer

Abstract

Purpose

Everolimus treatment is seriously hampered by its toxicity profile. As a relationship between everolimus exposure and effectiveness and toxicity has been established, early and ongoing concentration measurement can be key to individualize the dose and optimize treatment outcomes. Dried blood spot (DBS) facilitates sampling at a patients' home and thereby eases dose individualization. The aim of this study is to determine the agreement and predictive performance of DBS compared to whole blood (WB) to measure everolimus concentrations in cancer patients.

Methods

Paired DBS and WB samples were collected in 22 cancer patients treated with everolimus and analyzed using UPLC-MS/MS. Bland-Altman and Passing-Bablok analysis were used to determine method agreement. Limits of clinical relevance were set at a difference of ± 25%, as this would lead to a different dosing advice. Using DBS concentration and Passing-Bablok regression analysis, WB concentrations were predicted.

Results

Samples of 20 patients were suitable for analysis. Bland-Altman analysis showed a mean ratio of everolimus WB to DBS concentrations of 0.90, with 95% of data points within limits of clinical relevance. Passing-Bablok regression of DBS compared to WB revealed no constant bias (intercept 0.02; 95% CI 0.93–1.35) and a small proportional bias (slope 0.89; 95% CI 0.76–0.99). Predicted concentrations showed low bias and imprecision and 90% of samples had an absolute percentage prediction error of < 20%.

Conclusions

DBS is a valid method to determine everolimus concentrations in cancer patients. This can especially be of value for early recognition of over- or underexposure to enable dose adaptations.

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ASBA/SGS First Sleep Coordinator Boot Camp an Overwhelming Success!

December 1-2, marked the first Sleep Coordinator Boot Camp with the American Sleep and Breathing Academy and Sleep Group Solutions working together to bring a two day course geared entirely towards giving staff members the keys to succeed in a dental sleep practice.

Rebecca Layhe brought energy and excitement to the course as she presented to over 40 dental team members. She has worked in the medical field for over 20 years.  She has experience in dental and medical practice management, as well as in medical billing, coding, transcription, and is a medical language specialist. 

The Sleep Group Solutions/ASBA Boot Camp is built around supporting dental team members involved in DSM screening and treatment. The program provides a two-day, hands-on training dedicated to their particular roles in snoring and sleep apnea screening and treatment, as well as oral appliance therapy. The two-day program focuses on patient care, team coordination, case creation and presentation, marketing, insurance billing and collections. For only $295, sending your staff to this course is a no-brainer; the amount of productivity it will bring to your office is priceless. To find out more or how you can register for the next ASBA/Sleep Group Solutions Sleep Coordinator Boot Camp, email skylar@myasba.com.

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Peak Airflow Measurement in Patients With Glottic Insufficiency After Vocal Fold Augmentation

This case series study evaluates changes in peak airflow after vocal fold augmentation among patients with glottic insufficiency.

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Implementing Quality Improvement and Patient Safety in Residency Education

This Viewpoint discusses practical strategies for implementing successful resident-led patient safety and quality improvement initiatives in otolaryngology–head and neck surgery residency education.

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Anesthesia Exposure and Neurotoxicity in Children

This Viewpoint discusses the implications for otolaryngologists of a recent US Food and Drug Administration warning about the association between anesthesia exposure and neurocognitive deficits in children.

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The End of the Road

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Survival Outcomes for T3N0M0 Squamous Cell Carcinoma of the Glottic Larynx

This cohort study defines outcomes in patients with clinical T3N0M0 glottic laryngeal cancer treated with definitive surgical and radiotherapy-based approaches.

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Reporting of Effect Size and Confidence Intervals

This study evaluates the frequency of reporting effect sizes and confidence intervals in the results of analytical studies from JAMA Otolaryngology–Head & Neck Surgery.

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Error in Byline

In the Observation titled "Double Parathyroid Adenomas in Monozygotic Twins," published online September 28, 2017, there was an error in the byline. Where it previously read Brendan R. Stack, it now correctly reads Brendan C. Stack Jr. This article was corrected online.

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Measuring Institutional Quality in Head and Neck Surgery Using Hospital-Level Data

Using data from the National Cancer Database, this study examines the association of negative margin rate and lymph node yield with survival in patients with head and neck squamous cell carcinomas at the hospital level.

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Prognosis of 5-Year Survival of Chemoradiotherapy-Treated Patients With Nasopharyngeal Carcinoma

This cohort study evaluates outcomes data and the American Joint Committee on Cancer staging system to improve the accuracy of the 5-year survival prognosis for patients with nasopharyngeal carcinoma who underwent chemoradiotherapy.

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Nationwide Variation in Rates of Thyroidectomy Among US Medicare Beneficiaries

This cross-sectional analysis of Medicaid data examines variability across US regions for rates of thyroid surgery among Medicaid beneficiaries.

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Extracapsular Dissection vs Superficial Parotidectomy

This study reviews all parotidectomies at a single institution conducted by head and neck surgeons to compare extracapsular dissection with superficial parotidectomy for benign parotid tumors with respect to surgical outcomes and cost-effectiveness.

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Interferon-γ Treatment of Human Laryngotracheal Stenosis–Derived Fibroblasts

This in vitro controlled study assesses whether the helper T cell 1 cytokine interferon-γ inhibits laryngotracheal stenosis–derived fibroblast function in patients undergoing surgical subglottic and tracheal dilation.

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Double Parathyroid Adenomas in Monozygotic Twins

This is a report of a case of primary hyperparathyroidism in a pair of genetically identical individuals.

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JAMA Otolaryngology–Head & Neck Surgery

Mission Statement:JAMA Otolaryngology–Head & Neck Surgery provides timely information for physicians and scientists concerned with diseases of the head and neck. Given the diversity of structure and function based in this anatomic region, JAMA Otolaryngology–Head & Neck Surgery publishes clinical, translational, and population health research from an array of disciplines. We place a high priority on strong study designs that accurately identify etiologies, evaluate diagnostic strategies, and distinguish among treatment options and outcomes. Our objectives are to (1) publish original contributions that will enhance the clinician's understanding of otolaryngologic disorders, benefit the care of our patients, and stimulate research in our field; (2) forecast important advances within otolaryngology—head and neck surgery, particularly as they relate to the prevention, diagnosis, and treatment of disease through clinical and translational research, including that of the human genome and novel imaging techniques; (3) address questions of clinical outcomes and cost-effectiveness that result from clinical intervention, which grow in importance as health care providers are increasingly challenged to provide evidence of enhanced survival and quality of life; (4) provide expert reviews of topics that keep our readers current with true advances and also to provide a valuable educational resource for trainees in the several disciplines that treat patients with diseases of the head and neck; (5) serve as a forum for the concerns of otolaryngologists such as socioeconomic, legal, ethical, and medical issues; (6) provide helpful critiques that enable contributing authors to improve their submissions. We encourage a concise presentation of information and employ an abstract format that efficiently assesses validity and relevance from a clinical perspective. This approach promotes succinct yet complete presentation for our readers and electronic information resources. We believe this approach typifies the commitment of JAMA Otolaryngology–Head & Neck Surgery to providing important information that is easily interpreted by its diverse readership.

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What is the appropriate timing for endoscopic and radiographic surveillance following treatment for sinonasal malignancies?

(Source: The Laryngoscope)

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Mendelian randomization: a novel approach for the prediction of adverse drug events and drug repurposing opportunities

Abstract

Identification of unintended drug effects, specifically drug repurposing opportunities and adverse drug events, maximizes the benefit of a drug and protects the health of patients. However, current observational research methods are subject to several biases. These include confounding by indication, reverse causality and missing data. We propose that Mendelian randomization (MR) offers a novel approach for the prediction of unintended drug effects. In particular, we advocate the synthesis of evidence from this method and other approaches, in the spirit of triangulation, to improve causal inferences concerning drug effects. MR addresses some of the limitations associated with the existing methods in this field. Furthermore, it can be applied either before or after approval of the drug, and could therefore prevent the potentially harmful exposure of patients in clinical trials and beyond. The potential of MR as a pharmacovigilance and drug repurposing tool is yet to be realized, and could both help prevent adverse drug events and identify novel indications for existing drugs in the future.

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Association between exposure to second-hand smoke and telomere length: cross-sectional study of 1303 non-smokers

Abstract

Background

Both active smoking and second-hand smoke (SHS) are important risk factors for many age-related diseases. Active smoking is associated with shortened telomere length. However, whether SHS accelerates telomere attrition with age is uncertain. The aim of this study was to examine the association between SHS exposure and shortening by age of leukocyte telomere length among adult non-smokers.

Methods

We undertook a cross-sectional study of the association between self-reported levels of SHS exposure and telomere length shortening per annum on a subgroup of participants from the Scottish Family Health Study. Inclusion was restricted to non-smokers aged ≥ 18 years, who had provided self-reported overall usual SHS exposure (total hours per week) and blood samples for telomere analysis. Linear regression models were used to compare the ratio of telomere repeat copy number to single copy gene number (T/S)by age according to SHS exposure.

Results

Of the 1303 eligible participants, 779 (59.8%) reported no SHS exposure, 495 (38.0%) low exposure (1–19 h per week) and 29 (2.2%) high exposure (≥20 h per week). In the univariate linear regression analyses, relative T/S ratio declined with increasing age in all exposure groups. Telomere length decreased more rapidly with increasing age among those with high exposure to SHS [adjusted coefficient −0.019, 95% confidence interval (CI) −0.031- −0.007) when compared with both those with no exposure to SHS (adjusted coefficient −0.006, 95% CI −0.008- −0.004) (high vs no SHS: P = 0.010) and those with low exposure to SHS (adjusted coefficient −0.005, 95% CI −0.007- −0.003) (high vs low SHS: P = 0.005).

Conclusions

Our findings suggest that high SHS exposure may accelerate normal biological ageing, and support efforts to protect the public from SHS exposure. Further studies on relevant mechanisms should be conducted.

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Body mass index and breast cancer survival: a Mendelian randomization analysis

Abstract

Background

There is increasing evidence that elevated body mass index (BMI) is associated with reduced survival for women with breast cancer. However, the underlying reasons remain unclear. We conducted a Mendelian randomization analysis to investigate a possible causal role of BMI in survival from breast cancer.

Methods

We used individual-level data from six large breast cancer case-cohorts including a total of 36 210 individuals (2475 events) of European ancestry. We created a BMI genetic risk score (GRS) based on genotypes at 94 known BMI-associated genetic variants. Association between the BMI genetic score and breast cancer survival was analysed by Cox regression for each study separately. Study-specific hazard ratios were pooled using fixed-effect meta-analysis.

Results

BMI genetic score was found to be associated with reduced breast cancer-specific survival for estrogen receptor (ER)-positive cases [hazard ratio (HR) = 1.11, per one-unit increment of GRS, 95% confidence interval (CI) 1.01–1.22, P = 0.03). We observed no association for ER-negative cases (HR = 1.00, per one-unit increment of GRS, 95% CI 0.89–1.13, P = 0.95).

Conclusions

Our findings suggest a causal effect of increased BMI on reduced breast cancer survival for ER-positive breast cancer. There is no evidence of a causal effect of higher BMI on survival for ER-negative breast cancer cases.

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A dose-response meta-analysis of chronic arsenic exposure and incident cardiovascular disease

Abstract

Background

Consistent evidence at high levels of water arsenic (≥100 µg/l), and growing evidence at low-moderate levels (<100 µg/l), support a link with cardiovascular disease (CVD). The shape of the dose-response across low-moderate and high levels of arsenic in drinking water is uncertain and critical for risk assessment.

Methods

We conducted a systematic review of general population epidemiological studies of arsenic and incident clinical CVD (all CVD, coronary heart disease (CHD) and stroke) with three or more exposure categories. In a dose-response meta-analysis, we estimated the pooled association between log-transformed water arsenic (log-linear) and restricted cubic splines of log-transformed water arsenic (non-linear) and the relative risk of each CVD endpoint.

Results

Twelve studies (pooled N = 408 945) conducted at high (N = 7) and low-moderate (N = 5) levels of water arsenic met inclusion criteria, and 11 studies were included in the meta-analysis. Compared with 10 µg/l, the estimated pooled relative risks [95% confidence interval (CI)] for 20 µg/l water arsenic, based on a log-linear model, were 1.09 (1.03, 1.14) (N = 2) for CVD incidence, 1.07 (1.01, 1.14) (N = 6) for CVD mortality, 1.11 (1.05, 1.17) (N = 4) for CHD incidence, 1.16 (1.07, 1.26) (N = 6) for CHD mortality, 1.08 (0.99, 1.17) (N = 2) for stroke incidence and 1.06 (0.93, 1.20) (N = 6) for stroke mortality. We found no evidence of non-linearity, although these tests had low statistical power.

Conclusions

Although limited by the small number of studies, this analysis supports quantitatively including CVD in inorganic arsenic risk assessment, and strengthens the evidence for an association between arsenic and CVD across low-moderate to high levels.

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Policies and strategies to facilitate secondary use of research data in the health sciences

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Alcohol consumption in 0.5 million people from 10 diverse regions of China: prevalence, patterns and socio-demographic and health-related correlates

First published online: 1 August 2013, Int J Epidemiol, 2013, doi: http://ift.tt/2yPqHzW

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Anal cancer: different epidemiological and clinical definitions

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HDL-cholesterol levels and risk of age-related macular degeneration: a multiethnic genetic study using Mendelian randomization

Abstract

Background

Dyslipidemia, particularly high-density lipoprotein cholesterol (HDL-C), has recently been implicated in the pathogenesis of age-related macular degeneration (AMD), the leading cause of vision loss. However, epidemiological studies have yielded conflicting results.

Methods

We investigated the causal role of plasma lipid levels in AMD in multiethnic populations comprising 16 144 advanced AMD cases and 17 832 controls of European descent, together with 2219 cases and 5275 controls of Asian descent, using Mendelian randomization in three models. Model 1 is a conventional meta-analysis which does not account for pleiotropy of instrumental variable (IV) effects. Model 2 is a univariate, inverse variance weighted regression analysis that accounts for potential unbalanced pleiotropy using MR-Egger method. Finally, Model 3 is a multivariate regression analysis that addresses pleiotropy by MR-Egger method and by adjusting for effects on other lipid traits.

Results

A 1 standard deviation (SD) higher HDL-cholesterol level was associated with an odds ratio (OR) for AMD of 1.17 (95% confidence interval: 1.07–1.29) in Europeans (P = 6.88 × 10^–4) and of 1.58 (1.24–2.00) in Asians (P = 2.92 × 10^–4) in Model 3. The corresponding OR estimates were 1.30 (1.09–1.55) in Europeans (P = 3.18 × 10^–3) and 1.42 (1.11—1.80) in Asians (P = 4.42 × 10^–3) in Model 1, and 1.21 (1.11–1.31) in Europeans (P = 3.12 × 10^–5) and 1.51 (1.20–1.91) in Asians (P = 7.61 × 10^–4) in Model 2. Conversely, neither LDL-C (Europeans: OR = 0.96, P = 0.272; Asians: OR = 1.02, P = 0.874; Model 3) nor triglyceride levels (Europeans: OR = 0.91, P = 0.102; Asians: OR = 1.06, P = 0.613) were associated with AMD. We also assessed the association between lipid levels and polypoidal choroidal vasculopathy (PCV) in Asians, a subtype of AMD, and found a similar trend for association of PCV with HDL-C levels.

Conclusions

Our study shows that high levels of plasma HDL-C are causally associated with an increased risk for advanced AMD in European and Asian populations, implying that strategies reducing HDL-C levels may be useful to prevent and treat AMD.

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RE: Anal cancer: different epidemiological and clinical definitions

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Misconceptions on the use of MR-Egger regression and the evaluation of the InSIDE assumption

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A note on the use of Egger regression in Mendelian randomization studies

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Exposure to perchlorate, nitrate and thiocyanate, and prevalence of diabetes mellitus

Abstract

Background

It is known that perchlorate, nitrate and thiocyanate have the property of inhibiting sodium iodide symporter. Animal studies have suggested that these compounds, especially perchlorate, might also interfere with insulin secretion. However, the association between their exposure and diabetes risk is largely unknown in humans.

Methods

Among 11 443 participants (mean age 42.3 years) from the National Health and Nutritional Examination Survey 2001–14, urinary perchlorate, nitrate and thiocyanate were measured by using ion chromatography coupled with electrospray tandem mass spectrometry. Diabetes was defined as self-reported doctor diagnosis, use of oral hypoglycaemic medication or insulin, fasting plasma glucose ≥ 126 mg/dl or glycated haemoglobin A1c (HbA1c) ≥ 6.5%.

Results

The median (interquartile range) levels of urinary perchlorate, nitrate and thiocyanate were 3.32 (1.84, 5.70) μg/l, 46.4 (27.9, 72.0) mg/l and 1.23 (0.59, 2.78) mg/l, respectively. Higher levels of urinary perchlorate were associated with elevated levels of fasting glucose, HbA1c, insulin and homeostatic model assessment of insulin resistance (all P_trend < 0.001). After multivariate adjustment including urinary creatinine, smoking status and body mass index (BMI), higher urinary perchlorate, but not nitrate or thiocyanate, was associated with an increased prevalence of diabetes mellitus. Comparing extreme quintiles, the odds ratio (95% confidence interval) of diabetes was 1.53 (1.21, 1.93; P_trend < 0.001) for perchlorate, 1.01 (0.77, 1.32; P_trend = 0.44) for nitrate and 0.98 (0.73, 1.31; P_trend = 0.64) for thiocyanate. When urinary perchlorate, nitrate and thiocyanate were further mutually adjusted, the results did not materially change. Similar results were observed when analyses were stratified by smoking status, as well as by age, gender, kidney function and BMI.

Conclusions

Higher urinary perchlorate levels are associated with an increased prevalence of diabetes mellitus, independent of traditional risk factors. Future prospective studies are needed to confirm these findings.

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Pancreatic cancer incidence rises also in Italy

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Physical activity, mediating factors and risk of colon cancer: insights into adiposity and circulating biomarkers from the EPIC cohort

Abstract

Background

There is convincing evidence that high physical activity lowers the risk of colon cancer; however, the underlying biological mechanisms remain largely unknown. We aimed to determine the extent to which body fatness and biomarkers of various biologically plausible pathways account for the association between physical activity and colon cancer.

Methods

We conducted a nested case-control study in a cohort of 519 978 men and women aged 25 to 70 years followed from 1992 to 2003. A total of 713 incident colon cancer cases were matched, using risk-set sampling, to 713 controls on age, sex, study centre, fasting status and hormonal therapy use. The amount of total physical activity during the past year was expressed in metabolic equivalent of task [MET]-h/week. Anthropometric measurements and blood samples were collected at study baseline.

Results

High physical activity was associated with a lower risk of colon cancer: relative risk ≥91 MET-h/week vs <91 MET-h/week = 0.75 [95% confidence interval (CI): 0.57 to 0.96]. In mediation analyses, this association was accounted for by waist circumference: proportion explained effect (PEE) = 17%; CI: 4% to 52%; and the biomarkers soluble leptin receptor (sOB-R): PEE = 15%; 95% CI: 1% to 50% and 5-hydroxyvitamin D (25[OH]D): PEE = 30%; 95% CI: 12% to 88%. In combination, these factors explained 45% (95% CI: 20% to 125%) of the association. Beyond waist circumference, sOB-R and 25[OH]D additionally explained 10% (95% CI: 1%; 56%) and 23% (95% CI: 6%; 111%) of the association, respectively.

Conclusions

Promoting physical activity, particularly outdoors, and maintaining metabolic health and adequate vitamin D levels could represent a promising strategy for colon cancer prevention.

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Impact of adding hand-washing and water disinfection promotion to oral cholera vaccination on diarrhoea-associated hospitalization in Dhaka, Bangladesh: evidence from a cluster randomized control trial

Abstract

Background

Information on the impact of hygiene interventions on severe outcomes is limited. As a pre-specified secondary outcome of a cluster-randomized controlled trial among >400 000 low-income residents in Dhaka, Bangladesh, we examined the impact of cholera vaccination plus a behaviour change intervention on diarrhoea-associated hospitalization.

Methods

Ninety neighbourhood clusters were randomly allocated into three areas: cholera-vaccine-only; vaccine-plus-behaviour-change (promotion of hand-washing with soap plus drinking water chlorination); and control. Study follow-up continued for 2 years after intervention began. We calculated cluster-adjusted diarrhoea-associated hospitalization rates using data we collected from nearby hospitals, and 6-monthly census data of all trial households.

Results

A total of 429 995 people contributed 500 700 person-years of data (average follow-up 1.13 years). Vaccine coverage was 58% at the start of analysis but continued to drop due to population migration. In the vaccine-plus-behaviour-change area, water plus soap was present at 45% of hand-washing stations; 4% of households had detectable chlorine in stored drinking water. Hospitalization rates were similar across the study areas [events/1000 person-years, 95% confidence interval (CI), cholera-vaccine-only: 9.4 (95% CI: 8.3–10.6); vaccine-plus-behaviour-change: 9.6 (95% CI: 8.3–11.1); control: 9.7 (95% CI: 8.3–11.6)]. Cholera cases accounted for 7% of total number of diarrhoea-associated hospitalizations.

Conclusions

Neither cholera vaccination alone nor cholera vaccination combined with behaviour-change intervention efforts measurably reduced diarrhoea-associated hospitalization in this highly mobile population, during a time when cholera accounted for a small fraction of diarrhoea episodes. Affordable community-level interventions that prevent infection from multiple pathogens by reliably separating faeces from the environment, food and water, with minimal behavioural demands on impoverished communities, remain an important area for research.

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Declining exposures to lead and cadmium contribute to explaining the reduction of cardiovascular mortality in the US population, 1988–2004

Abstract

Background

Lead and cadmium exposures have markedly declined in the USA following the implementation of large-scale public health policies and could have contributed to the unexplained decline in cardiovascular mortality in US adults. We evaluated the potential contribution of lead and cadmium exposure reductions to explain decreasing cardiovascular mortality trends occurring in the USA from 1988–94 to 1999–2004.

Methods

Prospective study in 15 421 adults ≥40 years old who had participated in the National Health and Nutrition Examination Survey 1988–94 or 1999–2004. We estimated the amount of change in cardiovascular mortality over time that can be independently attributed to the intermediate pathway of changes in blood lead and urine cadmium concentrations.

Results

There was a 42.0% decrease in blood lead and a 31.0% decrease in urine cadmium concentrations. The cardiovascular mortality rate ratio [95% confidence intervals (CIs)] associated with a doubling of metal levels was 1.19 (1.07, 1.31) for blood lead and 1.20 (1.09, 1.32) for urine cadmium. The absolute reduction in cardiovascular deaths comparing 1999–2004 to 1988–94 was 230.7 deaths/100 000 person-years, in models adjusted for traditional cardiovascular risk factors. Among these avoided deaths, 52.0 (95% CI 8.4, 96.7) and 19.4 (4.3, 36.4) deaths/100 000 person-years were attributable to changes in lead and cadmium, respectively.

Conclusions

Environmental declines in lead and cadmium exposures were associated with reductions in cardiovascular mortality in US adults. Given the fact that lead and cadmium remain associated with cardiovascular disease at relatively low levels of exposure, prevention strategies that further minimize exposure to lead and cadmium may be needed.

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Domain-specific physical activity and sedentary behaviour in relation to colon and rectal cancer risk: a systematic review and meta-analysis

Abstract

Background

Physical activity is associated with reduced risk of colorectal cancer, but most epidemiological studies have focused on occupational and recreational physical activity. The evidence for other domains of activity, and for sedentary behaviour, is limited.

Methods

Medline, Embase and Web of Science were searched from inception to December 2015 for studies examining domain-specific physical activity or sedentary behaviour and the risk of colon and/or rectal cancer. We extracted maximally adjusted relative risks (RRs) except when RRs not adjusted for body mass index, were also presented. We used random-effects meta-analysis to compute pooled RRs comparing the highest versus the lowest level of exposure. We used meta-regression to assess sources of heterogeneity in estimates.

Results

We identified 17 cohort and 21 case-control studies, of which 17 had occupational data, 23 had recreational data, three each had data on transport and household physical activity domains, and 6 studies had data on occupational sedentary behaviour. The pooled relative risks (RRs) for colon cancer were 0.74 (95% confidence interval (CI): 0.67, 0.82) for occupational activity, 0.80 (95% CI: 0.71, 0.89) for recreational activity, 0.66 (95% CI: 0.45, 0.98) for transport-related physical activity, 0.85 (95% CI: 0.71, 1.02) for household physical activity, and 1.44 (95% CI: 1.28, 1.62) for occupational sedentary behaviour. For rectal cancer, the pooled RRs were 0.88 (95% CI: 0.79, 0.98) for occupational activity, 0.87 (95% CI: 0.75, 1.01) for recreational activity, 0.88 (95% CI: 0.70, 1.12) for transport-related physical activity, 1.01 (95% CI: 0.80, 1.27) for household physical activity, and 1.02 (95% CI: 0.82, 1.28) for occupational sedentary behaviour.

Conclusions

In addition to increasing occupational and recreational physical activity, promoting physical activity during transport and reducing sedentary behaviour in the workplace may also be useful colorectal cancer prevention strategies.

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