Transit time flow measurement in off-pump surgery: is it a functional index of the biological graft integrity?

OBJECTIVE: Transit-time flow measurement (TTFM) represents a valid tool in the assessment of the quality of the anastomosis during coronary artery bypass graft (CABG). Nevertheless, a high variability limits its standardized use, lacking univocally accepted cut-off flow values. Our study analyzes TTFM data collected from a study population that underwent off-pump CABG (OP-CABG), with the aim to differentiate into subgroups according to the presence of diabetes mellitus. PATIENTS AND METHODS: Patients referred to the Cardiovascular Unit of S. Michele Hospital (Caserta, Italy) for coronary artery disease (CAD) and underwent OP-CABG between January 2015 and December 2019 were enrolled, and intraoperative TTFMs data were recruited and evaluated. Mean graft flow (MGF) and pulsatility index (PI) values were collected and analyzed. RESULTS: The study population was composed of 342 patients who underwent OP-CABG with TTFM data regarding 824 grafts. Diabetic patients shared a higher cardiovascular risk profile. The TTFM assessment showed better results for the use of the arterial grafts in diabetic patients, especially for those insulin-dependent; conversely, venous grafts showed worse data with lower MGF and higher PI values. In particular, the anastomoses of the saphenous vein graft with marginal obtuse (MO) coronary artery showed worse MGF results in the insulin-dependent rather than normoglycemic subgroup (28.66 vs. 38.44, p=0.003). CONCLUSIONS: Diabetic patients, especially in the insulin-dependent subgroups, have demonstrated lower MGF and higher PI values collected from venous anastomoses with, conversely, inverse results from the arterial one. These results might be correlated to an altered biological adaptability caused by the effects of the diabetic endocrine disorder.

CARL: a LabVIEW 3 computer program for conducting exposure therapy for the treatment of dental injection fear.

This paper describes CARL (Computer Assisted Relaxation Learning), a computerized, exposure-based therapy program for the treatment of dental injection fear. The CARL program operates primarily in two different modes; in vitro, which presents a video-taped exposure hierarchy, and in vivo, which presents scripts for a dentist or hygienist to use while working with a subject. Two additional modes are used to train subjects to use the program and to administer behavioral assessment tests. The program contains five different modules, which function to register a subject, train subjects to use physical and cognitive relaxation techniques, deliver an exposure hierarchy, question subjects about the helpfulness of each of the therapy components, and test for memory effects of anxiolytic medication. Nine subjects have completed the CARL therapy program and 1-yr follow-up as participants in a placebo-controlled clinical trial examining the effects of alprazolam on exposure therapy for dental injection phobia. All nine subjects were able to receive two dental injections, and all reduced their general fear of dental injections. Initial results therefore indicate that the CARL program successfully reduces dental injection fear.

Factors influencing the appropriateness of restorative dental treatment: an epidemiologic perspective.

OBJECTIVES: An epidemiology analysis was performed to identify patient and dentist factors influencing over- and undertreatment of restorative services in a sample of insured adults. METHODS: At baseline, 681 Washington State employees and their spouses, aged 20 to 34 years and residing in the Olympia or Pullman areas, were interviewed by telephone. Oral assessments were conducted to measure personal characteristics, oral disease, and restoration quality. Adults were followed for two years to measure use of restorative services from dental insurance claims. Each adult's baseline and claims data were linked with provider and practice variables collected from the dentist who provided treatment. RESULTS: For overtreatment, 39 percent of adults received one or more replacement restorations in nondecayed teeth with satisfactory fillings at baseline, while 18 percent of adults had one or more restorations placed in teeth with no decay and fillings. An adult's probability of overtreatment was higher if the adult had more fillings at baseline, or if an adult's dentist was younger, had a busy practice, advertised, charged higher fees, had less continuing education, or had a solo practice. For undertreatment, about 16 percent of adults either received no replacement restorations in teeth with unsatisfactory fillings at baseline, or had decayed teeth at baseline that were not filled or crowned. An adult's probability of undertreatment was higher if an adult had less decayed or more missing surfaces at baseline, or if an adult's dentist believed in sharing information with patients, had a busy practice, or reported not placing fillings when radiographic evidence of new caries was present. CONCLUSIONS: A minority of adults aged 20 to 34 experienced potential over- or undertreatment of restorative services, which are influenced by both patient and dentist factors.

Oral hygiene instruction and health risk assessment in dental practice.

We studied oral hygiene instruction given to 109 patients in 19 Washington State dental practices to investigate the extent to which therapists targeted their efforts toward patients with high disease risk. Patients were examined prior to instruction and prophylaxes. Therapists' instructions were tape-recorded and their content analyzed: therapists' expectations were scored. There were no statistically significant associations between patients' initial plaque levels and the process/content of the oral hygiene instructions delivered. On average, therapists spent 9.4 minutes of each prophylaxis session discussing oral hygiene. Therapists were judged more genuine with those patients for whom they had higher expectations of compliance, i.e., those with less plaque and low disease risk. We conclude that dental practitioners were not employing effective risk assessment strategies in selection of patients most in need of intensive instructional efforts.

How effective is oral hygiene instruction? Results after 6 and 24 weeks.

We studied the clinical effectiveness of oral hygiene instruction given to 71 "high" plaque patients in 19 Washington State dental practices to determine the extent of plaque reduction. Patients were examined prior to instruction and prophylaxis. Therapist instructions were tape-recorded and content analyzed, and therapists' expectations were scored. Patients were surveyed as to oral health behaviors and general health habit characteristics. Only 20 of 71 (28%) initially "high" plaque patients had reduced mean plaque scores to 1.0 or less at six weeks. An additional 13 percent had deteriorated plaque levels at 24 weeks. We concluded that therapists did not consistently follow principles of effective instruction and often overestimated their effectiveness. Determinants of relapse involve the educational process, the patients' oral status, and patients' life situations.

How fluoridation affects adult dental caries.

Oral assessments conducted to measure caries experience in adults reveal that, on average, each year of exposure to fluoridated water reduced DFS by 0.29 surfaces. Fluoridation appears to have both pre- and post-eruptive benefits.

The multiplicity of dreams: cognitive-affective correlates of lucid, archetypal, and nightmare dreaming.

This preliminary research is the first to compare lucid, nightmare, and archetypal-mythological dreams on dimensions important in previous research on each. A first study of 100 subjects showed all three forms significantly correlated with each other and with estimates of dream recall. In a second study, 41 subjects were selected from the above on the basis of relative specialization in each dream form, with a control group equally high on dream recall. Here, the lucid and archetypal dreamers tended to separate themselves from nightmare sufferers on the basis of high imaginativeness, proclivity to waking mystical experience, spatial/analytic skills, and physical balance. It appears that the intensification of dreaming is expressed positively or negatively, depending on variations in these cognitive dimensions.

A case report: arresting dental caries.

PURPOSE: To arrest dental caries in the dentin in a patient that had been refractory to other attempts at caries control. METHODS: Repeated applications of fluoride varnish (5%, Duraflor, Pharmascience Laboratories, Montreal) in the clinic every three months along with two daily two-minute rinses with sodium fluoride at home. RESULTS: Results over five years are presented. None of the lesions identified five years earlier had been restored. The teeth were monitored with frequent bitewing radiographs and clinical exams; the interproximal decay appears inactive clinically. CONCLUSION: This present case report shows that fluoride varnish may be a good addition to preventive therapy for arresting caries in adult patients in general practice. Surgical intervention may be avoided in patients whose risk has shifted to a lower level.

Establishing research strategies, methodologies and technologies to link genomics and proteomics to seagrass productivity, community metabolism, and ecosystem carbon fluxes.

A complete understanding of the mechanistic basis of marine ecosystem functioning is only possible through integrative and interdisciplinary research. This enables the prediction of change and possibly the mitigation of the consequences of anthropogenic impacts. One major aim of the European Cooperation in Science and Technology (COST) Action ES0609 "Seagrasses productivity. From genes to ecosystem management," is the calibration and synthesis of various methods and the development of innovative techniques and protocols for studying seagrass ecosystems. During 10 days, 20 researchers representing a range of disciplines (molecular biology, physiology, botany, ecology, oceanography, and underwater acoustics) gathered at The Station de Recherches Sous-marines et Océanographiques (STARESO, Corsica) to study together the nearby Posidonia oceanica meadow. STARESO is located in an oligotrophic area classified as "pristine site" where environmental disturbances caused by anthropogenic pressure are exceptionally low. The healthy P. oceanica meadow, which grows in front of the research station, colonizes the sea bottom from the surface to 37 m depth. During the study, genomic and proteomic approaches were integrated with ecophysiological and physical approaches with the aim of understanding changes in seagrass productivity and metabolism at different depths and along daily cycles. In this paper we report details on the approaches utilized and we forecast the potential of the data that will come from this synergistic approach not only for P. oceanica but for seagrasses in general.

Carbonate organo-mineral micro- and ultrastructures in sub-fossil stromatolites: Marion lake, South Australia.

Sub-fossil stromatolites (5000-3000 years old) occur on the marginal flat surrounding Marion Lake (South Australia). A micrite/microsparite crystal fabric characterises these fine-grained, well-laminated stromatolites, which lack trapped grains. The internal lamination is characterised by a sub-millimetric alternation of porous and dense laminae. The microfabric of the laminae is ubiquitously composed of a fine (10-20 µm) peloidal texture, with many thinner aphanitic layers. Aggregates of very fine, low-Mg calcite and aragonite constitute both peloidal and aphanitic micrite, which is coated, respectively, by spherulitic and fringing acicular microspar. Micrite, with a high organic matter content, is formed of coalescing nanospheres grading into small polyhedrons, probably composed mainly of aragonite, with less calcite enriched in Mg, Sr, Na and S. Bacteria-like microfossils and relics of extracellular polymeric substance (EPS) occur abundantly within this micritic framework. The former consist of empty moulds and mineralised bodies of coccoid forms, whereas EPS relics consist of sheet-like or filamentous structures that appear both mineralised and more often still preserved as a C-enriched dehydrated substance that represents the main organic matter component of the deposit. Acicular crystals, which show a prismatic elongate shape, are composed of Mg-depleted aragonite that lacks fossils or organic relicts. Degrading EPS and micro-organisms appear gradually to be replaced and entombed by the nanospherical precipitates, implying the existence of processes of organo-mineralisation within an original syn-sedimentary microbial community. Succeeding micron-scale crystals merge to form isolated or connected micritic aggregates (the peloids), followed by the gradual formation of the acicular crystals as purely inorganic precipitates.