Is the risk of chronic pain after total temporomandibular joint replacement independent of its indications? A prospective cohort study.

Chronic pain is a possible long-term complication after alloplastic temporomandibular joint reconstruction (TMJR). This study was developed to evaluate various subjective and objective measurements to determine the presence and degree of TMJ pain in patients treated with TMJR regardless of the indication for the operation. A prospective, single-centre study was performed. Data on 36 patients (56 TMJR) were collected preoperatively and at follow up two to three years postoperatively. The primary outcome variable was subjective TMJ pain (none/mild, moderate/severe) at follow up. The predictor variables were objective pressure pain thresholds (PPTs) at the ipsilateral joint(s) and muscle(s), functional parameters (incisal range of motion, maximum voluntary clenching), subjective oral health-related quality of life (OHRQoL), and demographic and surgical variables. The number of patients with moderate/severe pain decreased from 17 preoperatively to 10 at follow up. Self-reported TMJ pain was significantly reduced in the entire group (p = 0.001). Patients with moderate/severe pain at follow up were more restricted in their OHRQoL but did not differ in PPT and functional parameters from the no/mild pain group. Moderate/severe TMJ pain at follow up was associated with unilateral TMJR and more preoperative pain. This study provides preliminary evidence that despite good pain reduction in most patients, persistent pain after TMJR is common and, in rare cases, may even worsen regardless of the original diagnosis. At follow up there was a close relation between OHRQoL and TMJ pain. TMJ pain after TMJR cannot be confirmed by objective measurement methods (PPTs and functional parameters).

Retrospective study on the pharyngeal airspace in the lateral cephalogram - A mathematical model to predict changes due to bimaxillary orthognathic surgery.

The aim of this study was the development of a statistical model for reliable prediction of Posterior Airway Space (PAS) changes in lateral cephalograms (LCR) of patients after bimaxillary orthognathic surgery. The LCRs of patients who underwent bimaxillary orthognathic surgery were retrospectively analyzed. The anteroposterior dimension of the PAS was measured at three levels in the pre-operative and postoperative LCR: On the nasopharyngeal (SPAS), oropharyngeal (MAS), and hypopharyngeal level (IAS). The data of 139 patients were collected. The following changes of the PAS were measured: in class II patients SPAS: 0.291 mm (SD = 2.570 mm); MAS: 2.444 mm (SD = 2.986 mm); IAS: 0.750 mm (SD = 3.017 mm); in class III patients SPAS: 1.377 mm (SD 3.212 mm); MAS: 0.962 (SD: = 3.135 mm); IAS: 0.370 mm (SD = 3.468 mm). Linear regression analysis showed for class II patients, a significant influence of mandibular movement on MAS (p = 0.049) and a significant effect of maxillary and mandibular movements on SPAS (p = 0.001) and MAS (p = 0.022) in class III patients. The other jaw displacements had no significant impact on the investigated PAS levels. While the presented method does not permit exact prediction of the dimension of the PAS, it is still an easily accessible method of orientation for the surgeon. The surgeon can initiate three-dimensional examinations to provide exact three-dimensional prediction based on this calculation.

A novel serum-free medium for the isolation, expansion and maintenance of stemness and tissue-specific markers of primary human periodontal ligament cells.

PURPOSE: Periodontal ligament (PDL) cell cultures are classically maintained in serum-containing media. However, unwanted side-effects of these conditions on cellular and molecular characteristics demand a serum-free alternative. Even though these limitations are well known and efforts for the development of adequate serum-free alternatives have been made, these approaches for replacement remained unsuccessful so far. This study aimed at developing a well-defined, serum-free formulation supporting both isolation from tissue samples and efficient expansion of PDL cells. Here, of particular focus was the perpetuation of tissue-characteristic markers detectable in primary tissues and of stemness features. BASIC PROCEDURES: Primary PDL cell cultures from generally healthy human donors (n = 3) were maintained in basal media N2B27 and E6 together with different concentrations of growth and attachment factors. Cell proliferation was recorded via microscopy and WST assay. Gene expression of RUNX2, Periostin, ALP, CD73, CD90, CD105, CD45, SOX10 and SOX2 was compared to primary PDL explants via qRT-PCR. Immunocytochemistry was performed for anti-CD105, SSEA-3, CD271, HNK1. Serum-containing sDMEM medium served as control. MAIN FINDINGS: N2B27 medium substituted with 25 ng/mL EGF, 25 ng/mL IGF1, 0.5 mg/mL Fetuin plus gelatine coating (designated N2B27-PDLsf) emerged as potent serum-free formulation ensuring adequate culture isolation and expansion. Here, PDL primary tissue signature markers RUNX2 and Periostin remained stable in N2B27-PDLsf compared to controls (229.0-fold ±101.0 and 83.2-fold ±9.6 increase). Additionally, stemness markers ALP and CD105 were significantly upregulated on transcriptional, and CD105 and SOX2 on protein level. PRINCIPAL CONCLUSIONS: This investigation identified a novel serum-free medium for the isolation, and expansion of primary human PDL cells with constantly high proliferation rates. Here, purity and stemness properties are maintained. Thus, N2B27-PDLsf represents a valid replacement for serum-containing media in PDL cultures.

[Comprehensibility of online-based patient education material in ophthalmology]. / Die Lesbarkeit von onlinebasierten Patienteninformationen in der Augenheilkunde.

BACKGROUND: Investigations have shown that the internet as a source of information in medical issues is increasing in importance. For most patients information delivered or supported by hospitals and universities is considered to be the most reliable, however, the comprehensibility of available information is often considered to be wanting. Comprehensibility scores are formulae allowing a quantitative value for the readability of a document to be calculated. OBJECTIVE: The purpose of this study was to assess data by analyzing the comprehensibility of medical information published on the websites of departments for ophthalmology of German university hospitals. We investigated and analyzed medical information dealing with three eye diseases with potentially severe irreversible damage. METHODS: The websites of 32 departments for ophthalmology of German university hospitals were investigated. Information regarding cataracts, glaucoma and retinal detachment (amotio retinae) were identified and analyzed. All information was systematically analyzed regarding comprehensibility by using the analysis program Text-Lab ( http://www.text-lab.de ) by calculation of five readability scores: the Hohenheim comprehensibility index (HVI), the Amstad index, the simple measure of gobbledygook (G-SMOG) index, the Vienna non-fictional text formula (W-STX) and the readability index (LIX). RESULTS: In 59 cases (61.46 %) useful text information from the homepage of the institutions could be detected and analyzed. On average the comprehensibility of the information was identified as being poor (HVI 7.91 ± 3.94, Amstad index 35.45 ± 11.85, Vienna formula 11.19 ± 1.93, G­SMOG 9.77 ± 1.42 and the LIX 54.53 ± 6.67). CONCLUSION: In most of the cases patient information material was written far above the literacy level of the average population. It must be assumed that the presented information is difficult to read for the majority of the patients. A critical evaluation of accessible information material seems to be desirable and available texts should be amended.

[Delayed Infection after Upper Lip Augmentation with Absorbable Hyaluronic Acid Filler]. / Verzögerte Infektion nach Augmentation der Oberlippe mit resorbierbarem Hyaluronsäurefiller.

Since introduction of the first fillers in the 1980s a multitude of substances has been developed and approved for facial contour augmentation and correction of skin defects. Here we present the interesting case of a patient who presented to us with a delayed infection 6 weeks after augmentation of the upper lip with a hyaluronic acid. We observed full convalescence after operative and high-dose antibiotic treatment of the abscesses. Generally speaking, complications after augmentation with resorbable fillers are rare. However, complications might occur even within unexpected time periods and therefore need our special attention.

Limited role of functional differentiation in early diversification of animals.

The origin of most animal phyla and classes during the Cambrian explosion has been hypothesized to represent an 'early burst' of evolutionary exploration of functional ecological possibilities. However, the ecological history of marine animals has yet to be fully quantified, preventing an assessment of the early-burst model for functional ecology. Here we use ecological assignments for 18,621 marine animal genera to assess the relative timing of functional differentiation versus taxonomic diversification from the Cambrian to the present day. We find that functional diversity increased more slowly than would be expected given the history of taxonomic diversity. Contrary to previous inferences of rapid ecological differentiation from the early appearances of all well-fossilized phyla and classes, explicit coding of functional characteristics demonstrates that Cambrian genera occupied comparatively few modes of life. Functional diversity increased in the Ordovician and, especially, during the recoveries from the end-Permian and end-Cretaceous mass extinctions. Permanent shifts in the relationship between functional and taxonomic diversity following the era-bounding extinctions indicates a critical role for these biotic crises in coupling taxonomic and functional diversity.

Wash-out of ambient air contaminations for breath measurements.

In breath analysis, ambient air contaminations are ubiquitous and difficult to eliminate. This study was designed to investigate the reduction of ambient air background by a lung wash-out with synthetic air. The reduction of the initial ambient air volatile organic compound (VOC) intensity was investigated in the breath of 20 volunteers inhaling synthetic air via a sealed full face mask in comparison to inhaling ambient air. Over a period of 30 minutes, breath analysis was conducted using ion mobility spectrometry coupled to a multi-capillary column. A total of 68 VOCs were identified for inhaling ambient air or inhaling synthetic air. By treatment with synthetic air, 39 VOCs decreased in intensity, whereas 29 increased in comparison to inhaling ambient air. In total, seven VOCs were significantly reduced (P-value < 0.05). A complete wash-out of VOCs in this setting was not observed, whereby a statistically significant reduction up to 65% as for terpinolene was achieved. Our setting successfully demonstrated a reduction of ambient air contaminations from the airways by a lung wash-out with synthetic air.

Typical patterns of bone involvement in whole-body MRI of patients with chronic recurrent multifocal osteomyelitis (CRMO).

PURPOSE: The diagnosis of CRMO often involves a long patient history. We evaluated the spectrum of bone involvement in whole-body magnetic resonance imaging (WB-MRI) and assessed its potential contribution to a more rapid diagnosis. MATERIALS AND METHODS: WB-MRI (1.5 T, coronal STIR sequences) in 53 children and adolescents (mean age 11 years, 4.8 - 15.1) with histologically (n = 37) or clinically (n = 16) confirmed CRMO were retrospectively reviewed by two experienced pediatric radiologists. RESULTS: WB-MRI revealed multifocal lesions in all but one patients. Only 26 of them had presented with multifocal complaints. We detected 1 - 27 geographic lesions/patient (mean 9.7). 510 of 513 lesions were significantly hyperintense compared to normal bone marrow. The pelvis, lower extremities, shoulders and spine were most frequently involved. 40 patients (75 %) had bilateral symmetrical involvement of bones. Most of the lesions were located in tubular bones, in 87 % adjacent to one or both sides of a growth plate. 32 % of lesions showed periosteal involvement. Of 456 affected bones, 33 (7.2 %) were deformed, 6 (18 %) were vertebra plana. CONCLUSION: In the absence of more specific diagnostic criteria, WB-MRI can, in synopsis with clinical findings, substantially contribute to a rapid diagnosis of CRMO. It discovers the typical pattern of multifocal and bilateral bone involvement more often than has been reported for targeted MRI. It readily reveals the characteristic proximity of lesions to growth plates, the sacroiliac joint and triradiate cartilage and helps to uncover asymptomatic spinal complications.

Exploring cut-off values for large waist circumference in older adults: a new methodological approach.

BACKGROUND: There is an ongoing debate about the applicability of current criteria for large waist circumference (WC) in older adults. OBJECTIVES: Our aim was to explore cut-off values for large WC in adults aged 70 years and older, using previously used and new methods. DESIGN: Prospective cohort study. PARTICIPANTS: Data of 1049 participants of the Longitudinal Aging Study Amsterdam (LASA) (1995-1996), aged 70-88y, were used. MEASUREMENTS: Measured BMI and WC, and self-reported mobility limitations. RESULTS: Linear regression analyses showed that the values of WC corresponding to BMI of 25kg/m2 and 30kg/m2 were higher than the current cut-offs. Cut-offs found in men were 97 and 110cm, whereas 88 and 98cm represented the cut-offs in women. Areas under the Receiver Operating Characteristic (ROC) curves showed that the accuracy to predict mobility limitations improved when the higher cut-offs were applied. Spline regression curves showed that the relationship of WC with mobility limitations was U-shaped in men, while in women, the risk for mobility limitations increased gradually with increasing WC. However, at the level of current cut-off values for WC the odds for mobility limitations were not increased. CONCLUSION: Based on results of extensive analyses, this study suggests that the cut-offs for large WC should be higher when applied to older adults. The association of WC with other negative health outcomes needs to be investigated to establish the final cut-points.

Homologs of the yeast Sec complex subunits Sec62p and Sec63p are abundant proteins in dog pancreas microsomes.

Cotranslational protein transport into dog pancreas microsomes involves the Sec61p complex plus a luminal heat shock protein 70. Posttranslational protein transport into the yeast endoplasmic reticulum (ER) involves the so-called Sec complex in the membrane, comprising a similar Sec61p subcomplex, the putative signal peptide receptor subcomplex, and the heat shock protein 40-type subunit, Sec63p, plus a luminal heat shock protein 70. Recently, human homologs of yeast proteins Sec62p and Sec63p were discovered. Here we determined the concentrations of these two membrane proteins in dog pancreas microsomes and observed that the canine homologs of yeast proteins Sec62p and Sec63p are abundant proteins, present in almost equimolar concentrations as compared with Sec61alphap monomers. Furthermore, we detected fractions of these two proteins in association with each other as well as with the Sec61p complex. The J domain of the human Sec63p was shown to interact with immunoglobulin heavy chain binding protein. Thus, the membrane of the mammalian ER contains components, known from the posttranslationally operating protein translocase in yeast. We suggest that these components are required for efficient cotranslational protein transport into the mammalian ER as well as for other transport processes.

Prenatal diagnosis of a congenital bladder diverticulum. Case report and benefits of prenatal diagnosis.

A case of congenital bladder diverticulum diagnosed at 37 weeks of gestation (measured from the first day after the last day of the last menstrual period) is reported. Delivery took place 24 h later. A postnatal urologic work-up confirmed the diagnosis of asymptomatic congenital bladder diverticulum. The infant underwent laparotomic surgery at the age of 6 months, with an extravesical diverticulectomy and ureteral reimplantation. There were no complications. This is the first case reported in the literature of a prenatal diagnosis of a congenital bladder diverticulum. This new aspect allows early management and avoidance of the diagnostic meanders to which the discovery of a pelvic mass might lead, as well as the complications that can follow bladder diverticula.

[Septic shock during the immediate post-partum period revealing a liver abscess in a woman with Crohn's disease]. / Choc septique au cours du post-partum immédiat révélant un abcès du foie chez une femme atteinte de maladie de Crohn.

Liver abscess is a rare complication of Crohn's disease. We report one case in a 27 year-old woman, presenting as a sepsis after delivery. Crohn's disease was quiescent at presentation. Pregnancy was the only predisposing condition. An intestinal fistula was diagnosed by ultrasonography. The patient was treated by antibiotics, bowel resection and surgical drainage of the abscess.

Detection of hepatitis C virus RNA (HCV RNA) in amniotic fluid: a prospective study.

BACKGROUND/AIMS: Mother-to-infant transmission of hepatitis C virus (HCV) has been reported, but the transmission route is unknown. The aim of our study was to detect HCV RNA in amniotic fluid of pregnant women seropositive for HCV. METHODS: Twenty-two HCV seropositive women were included in the study (median age: 39 years). An amniocentesis was performed in all patients during the 4th month of pregnancy. Sixteen women also tested positive for HCV RNA in serum. The range of HCV RNA titers was 0.3 to 15.1x10(6) Eq/ml (Quantiplex HCV RNA 2.0 Assay, Chiron Diagnostics). Of these 16 viremic patients, four had an anterior placenta, ten had a posterior placenta and the position of the placenta was not determined in two cases. PCR (Amplicor HCV, Roche Diagnostics) was used to detect HCV RNA in the amniotic fluid. We also studied 11 HCV seronegative women as a control group. RESULTS: In the viremic group (n = 16), HCV RNA was detected once in amniotic fluid. The positive specimen was collected from a patient with an HCV RNA serum value equal to 1.1x10(6) Eq/ml. The placenta was in an anterior position. A PCR inhibitor was detected in one case. No HCV RNA was detected in the amniotic fluid of six seropositive non-viremic patients, nor in the control group. Serum HCV RNA was negative in the ten children tested. The woman whose amniotic fluid contained HCV RNA was the mother of one of them. CONCLUSIONS: HCV RNA detection in amniotic fluid is rarely positive. The anterior position of the placenta in the only positive detection cannot rule out contamination of the amniotic fluid during the transplacental amniocentesis.

Unexpected inherited chromosomal translocation during prenatal diagnosis for maternal age: risk for a nondetectable karyotype imbalance in offspring.

An unexpected t(1;19) translocation is described in a fetus. Inherited from the mother, this translocation was found during the course of a normal prenatal diagnosis made for maternal age. The very short length of chromosomal translocated segments and their labelling pattern made high-resolution cytogenetic methods and fluorescence in situ hybridization techniques necessary for the correct identification of this karyotype rearrangement, both in mother and fetus. Different modes of meiotic segregation, leading to potential erroneous prenatal diagnoses, are discussed.

[Ambulatory management during the transformation process--a survey of physicians in new German districts]. / Ambulante Versorgung während des Transformationsprozesses--eine Befragung von Arzten in den neuen Bundesländern.

The transformation of the health care system in the former GDR is demonstrated empirically on the basis of postal surveys conducted in 1990/91 with reference to the following spheres: 1. Routine problems. In diagnosis and therapy, the central problem was that the equipment required was often either lacking or defective. 2. Social perception. Female doctors regarded themselves as more understanding, progressive, sensitive, and friendly than their male colleagues. 3. Dynamics of transformation. The percentage of doctors with a practice of their own increased from 1990 to 1991 from 4.2 to 61.4%. 4. Reasons for starting a private practice. For male doctors the motives of greater latitudes in defining working hours and work routines as well as long-term expectations of increasing income were significantly more important than for female doctors. 5. Initial problems. Three aspects proved to be the most significant: too little time for family, work load too high, accounting problems. 6. Job satisfaction. In the course of time, the greatest increase in satisfaction was found to be related to possibilities of advanced professional training and income. A significant trend toward decreasing satisfaction was noted for dimensions such as work load, relationship between work and leisure, as well as secretarial work and accounting.

Predictive value of Doppler umbilical artery velocimetry in a low risk population with normal fetal biometry. A prospective study of 2016 women.

OBJECTIVE: To assess the predictive value of Doppler umbilical artery velocimetry in a low-risk population with normal fetal biometry. STUDY DESIGN: Multicenter prospective study in 17 hospitals with prenatal clinics in France. Two thousand sixteen women who, before 28 weeks gestation were defined as at low risk after routine consultation and after ultrasound. Doppler umbilical artery velocimetry was performed between 28 and 34 weeks gestation. Confounding factors were used to perform multivariate regression. RESULTS: 1903 cases were analysed and 192 (10.1%) had an abnormal Doppler Resistance Index (RI). The abnormal Doppler group contained a significantly higher frequency of severe and moderate small for gestational age infants (SGA), both severe and moderate with a sensitivity of 25.5 and 18.8% respectively. There was no difference in hypertensive disorders or criteria of fetal distress. Mean birth weight was very significantly lower in the abnormal group (162 g). Birth weight was very significantly linked to RI after taking into account confounding variables in the multiple linear regression model (continuous relationship). After multiple logistic regression, the odds ratio associated with an abnormal Doppler result, adjusted for all the confounding factors, was 2.3 (95% CI 1.5-3.7) for moderate SGA and 3.5 (95% CI of 1.8-7.1) for severe SGA. CONCLUSION: Low umbilical Doppler RI is predictive with moderate or severe SGA in a low-risk population with normal fetal biometry, even when the information generally available in clinical practice and ultrasound parameters are taken into account. There is a continuous relationship between RI and birthweight. This predictive value cannot, however, lead to an improvement in neonatal health unless effective measures to prevent SGA exist and umbilical Doppler should not be used in low-risk population on a routine basis.

Determination of chorionicity in twin gestations by high-frequency abdominal ultrasonography: counting the layers of the dividing membrane.

OBJECTIVE: Our aim was to determine whether chorionicity in twin gestations can be diagnosed by use of high-frequency ultrasonography to count the layers of intraamniotic membrane. STUDY DESIGN: This prospective study of 66 twin pregnancies between 13 and 38 weeks' gestation used transabdominal ultrasonography at 10 MHz. The pregnancy was classified as monochorionic when two layers were counted and as dichorionic when three or four layers were counted. The findings of the examiner, who had no other information about chorionicity, were compared with those of the histopathologic examination of the placenta. RESULTS: Ultrasonography allowed chorionicity to be determined correctly in 60 of 63 cases (95%; 100% in the second trimester and 92% in the third. The predictive value for dichorionicity was 100% (48/48) and the sensitivity 94% (48/51). The 12 monochorionic diamniotic pregnancies in which the membrane was visualized were all correctly diagnosed. In a thirteenth case, with severe oligohydramnios, the membrane could not be seen. Two patients were lost to follow-up. In 95% of the cases (63/66) only one examination was required to diagnose chorionicity. Intraobserver variability was 0% (0/26). Interobserver variability, tested by photographs, was 3% (2/65). CONCLUSIONS: This technique should be the first-line method for determining chorionicity in the second and third trimesters because it is the most effective. Its excellent reproducibility may be attributable to the use of high-frequency ultrasonography.

[Comparative value of transverse abdominal diameter and fetal abdominal perimeter. 3844 biometric examinations]. / Intérêts comparés du diamètre abdominal transverse et du périmètre abdominal foetal. A propos de 3,844 examens biométriques.

OBJECTIVE: Assess charts of abdominal size as they are used in a routine ultrasound screening, on a non selected population with 5 operators, to compare the interest of transverse abdominal diameter (TAD) with abdominal circumference (AC). METHOD: Retrospective study, in the department of Antenatal Diagnosis of the Centre Médico-Chirurgical et Obstétrical between September 1991 and August 1994. MAIN OUTCOME MEASURES: Abdominal biometry and gestational age to characterize the prenatal trophicity. Neonatal weight and gestational age at birth to characterize neonatal trophicity. RESULTS: Between 32 and 36 weeks, the TAD charts detected only one SGA (small for gestational age) out of 10. However, the AC sensitivity was 54.5% with a specificity of 94%. In the same period, the TAD charts suspect LGA (large for gestational age) for one exam out of two. The charts of AC have about the same performance to detect LGA and SGA. CONCLUSION: For a routine ultrasound screening between 32 and 36 weeks gestational age, the AC charts have to be preferred to TAD charts.