Golfers have greater preoperative and equal postoperative function when undergoing total knee arthroplasty compared to non-golfers.

BACKGROUND: Approximately 10% to 20% of patients with joint arthroplasties are golfers. The aim of this study was to assess if being a golfer is associated with functional outcomes, satisfaction or improvement in quality of life (QoL) compared to non-golfers following total knee arthroplasty. METHODS: All patients undergoing primary total knee arthroplasty (TKA) over a one-year period at a single institution were included with one-year postoperative outcomes. Patients were retrospectively followed up to assess if they had been golfers at the time of their surgery. Multivariate linear regression analysis was performed to assess the independent association of preoperative golfing status on postoperative function and health-related outcomes. RESULTS: The study cohort consisted of a total of 514 patients undergoing TKA. This included 223 (43.3%) male patients and 291 (56.7%) female patients, with an overall mean age of 70 (SD 9.5) years. The preoperative Oxford Knee Score (OKS) was significantly higher in golfers when adjusting for confounders (Diff 3.4 [95% CI 1 to 5.8], p = 0.006). There was no difference in postoperative outcomes between golfers and non-golfers. There was however a trend towards a higher Forgotten Joint Score (FJS) in the golfers (difference 9.3, 95% CI - 0.2 to 18.8, p = 0.056). Of the 48 patients who reported being golfers at the time of their surgery, 43 (89.6%) returned to golf and 88.4% of those were satisfied with their involvement in golf following surgery. CONCLUSIONS: Golfers had better preoperative and equal postoperative knee specific function compared to non-golfers. The majority of golfers returned to golf by one year and were satisfied with their involvement in the game. LEVEL OF EVIDENCE: III.

Preoperative morbidity and joint awareness while awaiting hip arthroscopy for femoroacetabular impingement.

PURPOSE: The Forgotten Joint Score (FJS-12) is a valid tool in the evaluation of patients undergoing hip arthroscopy, assessing the unique concept of joint awareness in the setting of a patient's hip pathology. The preoperative burden on patients' mental wellbeing of impaired joint function or symptoms is well established. The purpose of this study was to determine patients' awareness of their hip joint whilst awaiting hip arthroscopy for femoroacetabular impingement, to explore any association between joint awareness and mental health status, and to determine whether this relates to time spent waiting for arthroscopy preoperatively. METHODS: A prospective database of patients undergoing hip arthroscopy between January 2018 and November 2020 was analysed. All patients with a diagnosis of femoroacetabular impingement (FAI) undergoing arthroscopic treatment were included. Questionnaires included the FJS-12, twelve item international hip outcome tool (iHOT-12), EuroQol 5D-5L (EQ-5D-5L) and the Tegner activity score. Pearson's correlation coefficient was used to assess relationships between continuous variables. RESULTS: Preoperative functional outcomes were completed by 81 patients (97.5%) prior to undergoing hip arthroscopy. Median preoperative FJS-12 score was 16.67 (IQR 8.33 - 29.68). Forty-four patients reported any level of anxiety/depression preoperatively (54.3%). Preoperative FJS-12 showed a significant negative correlation with worsening mental health status (r = - 0.359, p <  0.001), and a significant positive correlation with EQ-5D-5L (r = 0.445, p <  0.001). The duration of symptoms or time on the waiting list did not correlate with increased joint awareness or worsened mental health. CONCLUSION: Joint awareness is high when awaiting hip arthroscopy for FAI. Increasing levels of joint awareness correlate with poorer mental health status and poorer quality of life measures, however these parameters do not seem to be associated with increased duration of symptoms prior to surgery or time on the waiting list for surgery.

A systematic review of robotic-assisted unicompartmental knee arthroplasty: prosthesis design and type should be reported.

AIMS: Robotic-assisted unicompartmental knee arthroplasty (UKA) promises accurate implant placement with the potential of improved survival and functional outcomes. The aim of this study was to present the current evidence for robotic-assisted UKA and describe the outcome in terms of implant positioning, range of movement (ROM), function and survival, and the types of robot and implants that are currently used. MATERIALS AND METHODS: A search of PubMed and Medline was performed in October 2018 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Search terms included "robotic", "knee", and "surgery". The criteria for inclusion was any study describing the use of robotic UKA and reporting implant positioning, ROM, function, and survival for clinical, cadaveric, or dry bone studies. RESULTS: A total of 528 articles were initially identified from the databases and reference lists. Following full text screening, 38 studies that satisfied the inclusion criteria were included. In all, 20 studies reported on implant positioning, 18 on functional outcomes, 16 on survivorship, and six on ROM. The Mako (Stryker, Mahwah, New Jersey) robot was used in 32 studies (84%), the BlueBelt Navio (Blue Belt Technologies, Plymouth, Minnesota) in three (8%), the Sculptor RGA (Stanmore Implants, Borehamwood United Kingdom) in two (5%), and the Acrobot (The Acrobot Co. Ltd., London, United Kingdom) in one study (3%). The most commonly used implant was the Restoris MCK (Stryker). Nine studies (24%) did not report the implant that was used. The pooled survivorship at six years follow-up was 96%. However, when assessing survival according to implant design, survivorship of an inlay (all-polyethylene) tibial implant was 89%, whereas that of an onlay (metal-backed) implant was 97% at six years (odds ratio 3.66, 95% confidence interval 20.7 to 6.46, p < 0.001). CONCLUSION: There is little description of the choice of implant when reporting robotic-assisted UKA, which is essential when assessing survivorship, in the literature. Implant positioning with robotic-assisted UKA is more accurate and more reproducible than that performed manually and may offer better functional outcomes, but whether this translates into improved implant survival in the mid- to longer-term remains to be seen. Cite this article: Bone Joint J 2019;101-B:838-847.

Enhancing oral health via sense of coherence: a cluster-randomized trial.

Sense of coherence (SOC) has been related to oral health behaviors and oral-health-related quality of life (OHRQoL) in observational studies. This cluster-randomized trial aimed to test the effect of an intervention to enhance SOC on OHRQoL in children. Twelve primary schools were randomly allocated to intervention and control groups. The intervention was comprised of 7 sessions over 2 mos, focusing on child participation and empowerment. The first 4 sessions were classroom activities, and the last 3 involved working on healthy school projects. Trained teachers who received a one-day course delivered the intervention. Socio-demographic and clinical data, together with self-reported measures of OHRQoL, SOC, and oral health beliefs, were obtained from 261 total 10- to 12-year-olds (133 in the intervention and 128 in the control groups). Data were collected at baseline, 2 wks after the intervention, and at three-month follow-up. Mixed-effects models indicated that the intervention increased SOC and improved OHRQoL, together with oral health beliefs and gingival health. The findings offer experimental evidence that OHRQoL can be influenced by SOC. SOC may also provide an avenue for oral health promotion (Australian New Zealand Clinical Trials Registry ACTRN12612000547842).

Social aspects of HIV and their relationship to craniofacial problems: workshop 4C.

The oral research community needs an understanding of the social causes, consequences, and costs of disease in relation to oral health. This workshop concluded that HIV infection constitutes a special dental need requiring specific arrangements to facilitate oral care for infected persons. Oral manifestations of HIV infection affect everyday life, but more evidence is needed on the effects of interventions to alleviate these impacts. Other oral health habits add to the burden of HIV/AIDS-associated oral diseases and compete with them for resources. These problems are most acute where the prevalence of HIV is high and resources are scarce. Effective health promotion is therefore important in these areas. Without data on the utility of oral health care in developing countries, practical approaches are guided by societal and multidisciplinary principles. There are also important ethical considerations.

Fulminant hepatitis from herpes simplex virus type 2 in an immunocompetent adult.

Herpes simplex virus (HSV) is regarded as a common viral pathogen that produces a wide variety of diseases. After a primary infection, which usually occurs during childhood and may or may not be clinically evident, the virus establishes a latent infection in the local sensory ganglia and can reactivate throughout the life of the individual. Fulminant hepatic failure (FHF) due to HSV infection is a clinical condition well known in pediatric, immunocompromised, and pregnant patients. It is rare in immunocompetent hosts. We report the case of a 51-year-old man with no significant past medical history who developed FHF with disseminated intravascular coagulopathy and septic shock secondary to HSV infection. The initial diagnosis was made through a frozen section of a needle liver biopsy and the presence of HSV was confirmed in the permanent section with immunohistochemistry. HSV was grown in cell culture from liver tissue obtained through an autopsy.

The relevance of oral health for attenders and non-attenders: a qualitative study.

BACKGROUND: Low expectations of health mean that oral health becomes a low priority for some people, an appreciation of which would help dentists when a non-attender does come to the surgery. OBJECTIVE: To provide an insight into why oral health is not important to some people and how this attitude might hinder access to dental care. METHOD: In this qualitative study, purposive sampling was used to recruit two groups of participants with sociably visible missing, decayed or broken teeth but apparently differing responses to that status. The data analysis used social systems theory as operationalised by grounded theory techniques. RESULTS: The core category that emerged from the data was that people constructed their own 'margins of the relevance' of oral health. For some people oral health was highly relevant whilst for others it was not very relevant. The degree of relevance of oral health was organised along seven dimensions: the perceived 'normal' state of oral health, the perceived causes of oral health and disease, the degree of trust held in dentistry, perceptions of oral 'health' as a commodity, perceptions of the accessibility of oral health care, perceptions of 'natural' oral health and judgements of character. CONCLUSIONS: If certain aspects of oral health are not relevant, little that is said about those aspects will be meaningful to people. The key is to either emphasize or gently challenge those ideas and beliefs that allow or hinder the margins of relevance.

General health promotion in general dental practice--the involvement of the dental team. Part 1: a review of the evidence of effectiveness of brief public health interventions.

OBJECTIVES: To review the evidence of the effectiveness of dentists, dental teams and other healthcare workers in seven different brief public health interventions that might contribute to Government targets in cancer and circulatory disease. The interventions were: smoking prevention, smoking cessation, advice on alcohol consumption, diet counselling, advice on physical exercise, advice on skin cancer prevention and blood pressure monitoring. METHOD: A series of literature reviews, using a generic systematic approach, were undertaken to investigate the effectiveness of dentists, dental teams and other healthcare workers in each intervention. RESULTS: Apart from smoking cessation and dietary advice, no studies were identified on the effectiveness of dentists or dental teams in the interventions investigated. There is some evidence that dentists and dental teams can be effective in smoking cessation. There is minimal evidence for effectiveness in dietary counselling, and that which exists shows only a transient effect. There is evidence that other healthcare workers can have some effect in all interventions, though the effect in preventing skin cancer is questionable. CONCLUSIONS: Due to the paucity of studies undertaken, there is minimal evidence of effectiveness of dentists and dental teams in any of the seven interventions. However other healthcare workers are effective in most of them. Dentists and dental teams' involvement in such brief general health promotion interventions might contribute to Government targets on cancer and circulatory disease.

Dental and oral lesions in HIV infected patients: a study in Brazil.

AIM: To determine the prevalence of dental and oral lesions, as well as treatment need, in a group of HIV sero-positive Brazilians. In addition, to test the association between oral manifestation of HIV infection and age, sex, mode of transmission and drug therapy. METHOD: All HIV seropositive patients attending a dedicated dental clinic in Recife were invited to participate in the study. They were all examined by one trained and calibrated examiner and interviewed by one trained interviewer. RESULTS: 161 of 204 patients (78.9%) agreed to participate in this study. Most of the participants were male (76%), had acquired HIV sexually (74.5%), and were taking some form of antiretroviral therapy (70.8%). 33.5% had one or more oral manifestation of HIV. Candidiasis was the most common (28.6%), followed by hairy leukoplakia (9.3%), Kaposi sarcoma (2.5%), ulceration (2.5%), herpes simplex (1.2%), papiloma (0.6%), and 4.4% had periodontal disease. Only 1.2% reported xerostomia. There were no differences in the prevalence of oral manifestations of HIV infection between age groups, sexes, modes of transmission and types of drug therapy (P>0.05). The mean DMF-T score was 19 (SD 8) and 78.9% needed some form of dental treatment. CONCLUSIONS: While the prevalence of oral manifestations of HIV/AIDS was low in this sample of HIV seropositive Brazilians, dental status was poor and need for dental treatment was high.

Changes in the prevalence of HIV-associated mucosal disease at a dedicated clinic over 7 years.

OBJECTIVE: To investigate changes in the prevalence of mucosal disease in patients with HIV/AIDS. DESIGN: Retrospective analysis of clinic database. SETTING: An open-access dental clinic dedicated to the dental treatment of patients infected with HIV in London, UK. SUBJECTS: Dental patients attending for routine assessment (check-up). MAIN OUTCOME MEASURES: Prevalence of HIV associated oral lesions, diagnosed in accordance with EC classification criteria, in patients taking and not taking antiretroviral therapies (ARTs). RESULTS: Data were collected at 2789 dental examinations for 1590 patients between 1992 and 1998. More patients taking ART had one or more oral manifestations in the years up to 1996, after which the prevalence fell to a similar level to those not taking medications. The prevalence of mucosal disease in patients not taking ART was relatively constant over time. These trends were observed for oral hairy leukoplakia, pseudomembranous and erythematous candidiasis and Kaposi's sarcoma but not for oral papillomata. CONCLUSIONS: These data provide evidence that decreases in the prevalence of oral disease in people with HIV infection can be attributed to the effectiveness of ART.

Betel quid chewing among Bangladeshi adolescents living in east London.

OBJECTIVES: Ascertain level and predictors of betel quid (pan) chewing in Bangladeshi adolescents. DESIGN: Cross sectional questionnaire study. SETTING: Bangladeshi cultural centres in East London. SAMPLE: Consecutive adolescents attending 4 randomly selected centres. METHOD: Self-completed questionnaire. RESULTS: 204 (70%) of 290 teenagers invited to participate did so. Fifty-eight (28%) chewed pan; 30 (51%) of whom chewed on most days. The median age of first chewing was 9 years. Only 7 (2%) added tobacco to their quids. Pan chewers tended to come from lower socio-economic status families, liked the taste of pan and were less inclined to think that it adversely affected their appearance or that it could cause cancer. CONCLUSIONS: The prevalence of pan chewing was lower than that found among adults reported in earlier studies in the UK. This reduction in the level of pan chewing could be attributed to acculturation. Few teenagers knew about the association between pan chewing and cancer but the widespread concern about the effect of pan chewing on the appearance of their mouth suggests this is a useful health promotion message within common risk/health factor approach.

Predictors of tobacco and alcohol consumption and their relevance to oral cancer control amongst people from minority ethnic communities in the South Thames health region, England.

The purpose of this study was to examine the determinants of the health behaviour of ethnic groups in relation to alcohol and tobacco use. A cross-sectional questionnaire survey was carried out using network sampling amongst community groups in the South Thames region of the United Kingdom. Self-classified ethnic groups were identified: Black-African; Black-Caribbean; Indian; Pakistani; Bangladeshi and Chinese/Vietnamese. A total of 1113 people were recruited in the study. In all of the ethnic groups, men were more likely than women to smoke tobacco. Chewing of pan and tobacco was common in the South Asian communities and alcohol consumption was high among the Black-Caribbean group. Those factors were predicted by education, employment, gender and being born in the UK. It is important to examine the determinants of such risk behaviours in order to aid appropriate targeting of health promotion interventions, particularly those related to cancer control.

Oral examination: a screening tool for HIV infection?

OBJECTIVE: To estimate the predictive values for HIV infection of diagnosis of oral manifestations of the infection. METHOD: Prevalence of oral manifestations was compared in cross sectional blinded clinical examinations of homosexual men attending a genitourinary medicine clinic. Data were extrapolated to populations in England and Wales based on estimates of the prevalence of HIV infection. RESULTS: Data were analysed for 572 HIV infected and non-infected men (312 and 260 respectively). Positive predictive values for erythematous candidiasis, hairy leucoplakia and pseudomembranous candidiasis were greater than 0.96 at the genitourinary medicine clinic and are estimated to be greater than 0.72 among homosexual men in London. CONCLUSIONS: Clinical diagnoses of mucosal lesions alone are poor predictors of HIV infection but are useful when used in conjunction with a social history to establish if there are risk factors for infection.

Is erythematous candidiasis associated with advanced HIV disease?

OBJECTIVES: A multicentre collaborative study by the London HIV and Dentistry Group failed to associate the presence of erythematous candidiasis (EC) with advanced HIV disease. Data from a study of the periodontal health of homosexual men attending a genito-urinary medicine clinic presented an opportunity to investigate social and medical factors related to the presence of EC and mucosal disease. SUBJECTS AND METHODS: 312 men with HIV were examined by a single examiner blinded to HIV status; 22.8% had an indicator condition for AIDS; 37.8% had CD4 lymphocyte counts less than 200 cells mm-3; and 53.8% met the 1993 case definition for AIDS; 59.6% of the men with HIV had oral manifestations of the infection. The most common were: oral hairy leukoplakia, 44.2%; EC, 26.9%; and pseudomembranous candidiasis (PC), 11.5%. RESULTS: Advanced HIV disease was a less powerful predictor of EC than PC. Advanced HIV disease also predicted the presence of hairy leukoplakia and mucosal ulceration. EC was strongly associated with tobacco use. CONCLUSIONS: While methodological differences explain some variation with previous research, these data also suggest that EC and PC may not carry the same prognostic significance and longitudinal studies are required to confirm these findings.

Aetiological factors for oral manifestations of HIV.

OBJECTIVES: Describe the oral diseases in HIV-infected individuals in London, UK and identify social and medical factors related to the presence of specific oral diseases. DESIGN: Dental clinics. SUBJECTS: Consecutive sample of 456 patients with HIV infection. METHODS: Social and medical history and clinical examinations. Univariate and logistic regression analysis. OUTCOMES: Presence of HIV-associated oral disease. RESULTS: 80% of patients with AIDS and 50% of patients with HIV had a specific oral disease. The most common diseases were hairy leukoplakia (30%), erythematous candidiasis (24%), pseudomembranous candidiasis (14%), angular chielitis (6%), necrotising periodontal disease (8%) and non-recurrent ulceration (6%). CONCLUSIONS: The presence of erythematous candidiasis was not related to advanced HIV disease. Pseudo-membranous candidiasis, hairy leukoplakia and mucosal ulceration were significantly associated with advanced HIV disease. Smoking was also identified as a strong aetiological factor in oral diseases. Longitudinal studies are required to further explore the prognostic significance of oral diseases in HIV infection.

Analysis of DNA aneuploidy and c-myc oncoprotein content of canine plasma cell tumors using flow cytometry.

To derive a method for determining malignant potential of plasma cell tumors, a retrospective analysis of the DNA ploidy and relative p62c-myc oncoprotein content using bivariate flow cytometry was performed on 23 formalin-fixed, paraffin-embedded tissues from 23 dogs. The samples included one tissue each from 17 males and six females 2 to 16 years of age (mean = 7.5 years). Twelve breeds were represented, including three Cocker Spaniels, three Golden Retrievers, and five of mixed breed. Ten of the samples were histologically classified as malignant-plasma cell tumors, and ten specimens were classified as benign. Three samples of plasmacytic inflammation, from two Cocker Spaniels and one Shih Tsu, were included as controls. The ploidy and relative c-myc content data obtained were compared with the histologic grade. A significant difference in ploidy was found between benign and malignant tumors (P < or = 0.05). Five of nine malignant plasma cell tumors were aneuploid; the remainder were diploid (4/9) or tetraploid (1/9). Only one of the benign plasmacytomas was aneuploid (1/10), whereas six were diploid (6/10), and three were tetraploid (3/10). All of the controls were diploid (3/32). When relative amounts of p62c-myc from malignant and benign tumors were compared by flow cytometry, a greater significant difference was established (P < or = 0.01) than bu using aneuploidy alone. Relative values of p62c-myc content ranged from 219 to 553 units in 8/10 malignant plasma cell tumors and from 86 to 392 units in 3/10 benign plasmacytomas.(ABSTRACT TRUNCATED AT 250 WORDS)

Healing after dental extractions in men with HIV infection.

To determine the incidence of delayed healing after dental extractions in men with HIV infection, a retrospective audit was conducted of all extractions performed in a dedicated dental clinic over a 26-month period. The incidence of delayed healing in patients with HIV was compared with the incidence in those patients without HIV. Eighty men with HIV had 163 teeth extracted, which resulted in five dry sockets (3.01%). Thirty-six men thought not to have HIV had 70 extractions and three dry sockets (4.28%). All three dry sockets in the control group occurred in men who had tested negative for HIV antibodies in the year before their extraction. There were no other incidents of delayed healing. These findings contrast with other reports since they reveal no increase in delayed healing after extractions in men with HIV and do not support recommendations that prophylactic antimicrobials are required for extractions in this group of patients.

Pulmonary meningioma. Report of a case with electron microscopic and immunohistochemical findings.

A pulmonary meningioma was removed from a 55-year-old woman. She had no evidence of a cranial meningioma after a 3-year follow-up period. Results of immunohistochemical and electron microscopic studies of the tumor were similar to those for cranial meningiomas. The literature on this subject was reviewed and a possible origin for these tumors in the lung is discussed.

The pathologist's examination of the "lumpectomy"--the pathologists' view of surgical margins.

Despite the widespread conservative management of breast cancer, the pathologists' examination of these specimens is far from uniform. Pathologists sample margins differently, and even disagree on what constitutes a positive margin. This variability in the pathologic examination of the lumpectomy creates tremendous problems in analyzing the existing literature on the importance of positive margins. Herein is a discussion of the available data on the significance of margin assessment. We furthermore suggest a practical approach to examining margins with an emphasis on a functional orientation of the specimen with respect to the nipple. Only by adopting a uniform system of margin assessment can we begin to critically evaluate the importance of positive margins in segmental resections of the breast.

Cystic hepatocellular carcinoma: CT findings.

Although hepatic lesions can be well characterized by noninvasive imaging modalities, findings are often nonspecific. Considerable diagnostic differential exists even for cystic hepatic lesions. We describe a highly unusual case of multifocal, multilocular cystic hepatocellular carcinoma.