Horizontal root fractures in posterior teeth without dental trauma: tooth/root distribution and clinical characteristics.

AIM: To describe the clinical characteristics and radiographic findings of horizontal root fractures (HRF) in posterior teeth without a history of dental trauma. METHODOLOGY: A total 24 patients and 31 HRF cases in 28 posterior teeth were collected from 2006 to 2015. Clinical examinations and radiographic imaging were evaluated. Value of confidence intervals of the proportions was calculated for data presentation. RESULTS: The number of males (54%) was similar to females (46%). The patients were predominantly between 50 and 70 years of age (75%). Most HRF cases were found in nonendodontically treated teeth (79%), without crown and bridge restorations (82%), and maxillary molars (54%). Many roots of maxillary molars had developed HRF, and the probability was nearly equal. Fractured teeth usually presented with periodontal and apical bone loss, and most patients (92%) were diagnosed with full mouth chronic periodontitis. Tooth wear was another common clinical feature amongst these patients. CONCLUSIONS: HRF in posterior teeth without dental trauma occurred mainly in patients aged between 50 and 70, in nonendodontically treated teeth, teeth with attrition but without crown and bridge restorations, maxillary molars and with periodontal and periapical bony destruction. Periodontal condition, occlusal wear and patients' age at diagnosis were the possible related factors. HRF in posterior teeth without dental trauma is a diagnostic challenge and even misdiagnosed. A thorough clinical examination, radiographic analysis and recognition of the clinical characteristics are helpful in the early diagnosis and treatment of HRF.

Methods for quantifying Staphylococcus aureus in indoor air.

Staphylococcus aureus has been detected in indoor air and linked to human infection. Quantifying S. aureus by efficient sampling methods followed by appropriate sample storage treatments is essential to characterize the exposure risk of humans. This laboratory study evaluated the effects of sampler type (all-glass impinger (AGI-30), BioSampler, and Andersen one-stage sampler (Andersen 1-STG)), collection fluid (deionized water (DW), phosphate-buffered saline (PBS), and Tween mixture (TM)), and sampling time (3-60 min) on cell recovery. Effects of storage settings on bacterial concentration were also assessed over 48 h. Results showed BioSampler performed better than Andersen 1-STG and AGI-30 (P < 0.05) and TM was superior to PBS and DW (P < 0.05). An increase in sampling time negatively affected the recoveries of cells in PBS of BioSampler and AGI-30 (P < 0.05), whereas cell recoveries in TM were increased at sampling of 6-15 min compared with 3 min. Concentrations of cells collected in PBS were decreased with storage time at 4 and 23 °C (P < 0.05), while cells stored in TM showed stable concentrations at 4 °C (P > 0.05) and increased cell counts at 23 °C (P < 0.05). Overall, sampling by BioSampler with TM followed by sample transportation and storage at 4 °C is recommended.

Spectrally selective antireflection of nanoimprint lithography-formed 3D spherical structures on film coated with a silver layer.

We fabricate moth-eye antireflection (AR) coatings using high-resolution and low-cost UV nanoimprint lithography with polyethylene terphthalate (PET) molds. Several various thicknesses of silver films placed on the moth-eye structure were analyzed for reflectance and transmission. On PET, the conical nanostructured surface arrays had a spatial period length of approximately 250 nm, a diameter of approximately 200 nm, and a height of approximately 160 nm. After them, a silver (Ag) layer of 18 nm is deposited satisfactorily on the PET substrate surface. The never-ending moth-eye formations of the imprinted mold were fabricated by Ni mold electroplating, interference lithography, and replication. We found that an Ag layer of suitable thickness on AR film in the spectrum range that can be seen has high transmittance (Highest value is 72%) while in the infrared spectrum it has high reflectance (At least 60%). For an optical film with a silver coating has been placed on an anti-reflection subwavelength-structured (ASS) surface, such properties, including heat insulation, have obvious applications in windows for homes and vehicles.

A chromatographically purified human TGF-ß1 fraction from virally inactivated platelet lysates.

BACKGROUND AND OBJECTIVES: TGF-ß1 exerts important physiological functions in osteogenesis and chondrogenesis and may be of therapeutic interest. The aim of this work was to develop a scalable purification process of TGF-ß1 from virally inactivated human platelets. STUDY DESIGN AND METHODS: Apheresis platelet concentrates (N=12) were solvent/detergent (S/D) treated (1% TnBP/1% Triton X-45; 31°C) and the resulting platelet lysates were clarified by oil extraction and centrifugation, then chromatographed on an anion-exchange DEAE-Sepharose Fast-Flow column equilibrated in a PBS buffer, pH 7.5. The column was washed to eliminate unbound proteins and the S/D agents. Bound proteins were eluted using a 1 M NaCl-PBS buffer pH 7.5 (DEAE-eluate). The content in TGF-ß1, PDGF-AB, VEGF, IGF-1, EGF, and b-FGF was measured by ELISA. Proteins, lipids, and S/D agents were assessed. Protein profile was determined by SDS-PAGE under reduced or non-reduced conditions. RESULTS: Most proteins, including albumin and immunoglobulins G, A, and M did not bind to the DEAE column as evidenced also by SDS-PAGE. Essentially all PDGF, VEGF, and IGF were in the breakthrough. The DEAE-eluate contained close to 60% of the TGF-ß1 at a mean concentration of about 102 ng/ml, whereas EGF, b-FGF were at about 0.72 and 0.18 ng/ml, respectively. The content in TnBP and Triton X-45 was <2 ppm. CONCLUSION: A fraction enriched in TGF-ß1 can be prepared from virally inactivated human platelet lysates using an easily scale process. Its interest in regenerative medicine and cell therapy will be evaluated in further studies.

Effect of dopants on the soft magnetic properties and high frequency characteristics of FeCoBM (M = Ti, Nb, Hf, and Ta) thin films.

Effect of dopants on the soft magnetic properties and high frequency characteristics of FeCoBM thin films (M = Ti, Nb, Hf, and Ta) have been studied. For (Fe0.55Co0.45)(100-x)B(x) (x = 5-15) thin films, with the increase of B content, the resistivity was increased because B could decrease the crystallinity of the films. The (Fe0.55Co0.45)90B10 thin film showed the optimum properties, where 4piM(s) = 16.1 kG, H(ce) = 64.2 Oe, H(ch) = 13.5 Oe, H(k) = 310 Oe and p = 338 microomega-cm. To reduce the coercivity of the film, the elements M, including Ti, Nb, Hf, and Ta, were selected to substitute for B in the FeCoB films. It was found that (Fe0.55Co0.45)90B6Ti2Nb2 thin film after annealing at a temperature of 200 degrees C for 30 min showed the optimal properties, where 4piM(s) = 15.8 kG, H(ce) = 4.8 Oe, H(ch) = 3.6 Oe, H(k) = 224 Oe and p = 290 microomega-cm. The theoretically calculated ferromagnetic resonance frequency of the developed films can be higher than 5 GHz.

Polymeric gene delivery of ischemia-inducible VEGF significantly attenuates infarct size and apoptosis following myocardial infarct.

The development of clinically beneficial myocardial gene therapy has been slowed by reliance on the use of viral carriers and non-physiologic, constitutive gene expression. To specifically address these issues, we have developed a non-viral gene carrier, water-soluble lipopolymer (WSLP), and an ischemia-inducible plasmid construct expressing vascular endothelial growth factor (VEGF), pRTP801-VEGF, to treat myocardial ischemia and infarction. Rabbits underwent ligation of the circumflex artery followed by injection of (a) an ischemia-inducible VEGF gene construct in a WSLP carrier; (b) a constitutively expressed, or unregulated, SV-VEGF gene construct in a WSLP carrier; (c) WSLP carrier alone; or (d) no injection therapy. Following 4 weeks treatment, ligation alone resulted in infarction of 48+/-7% of the left ventricle. With injection of WSLP carrier alone, 49+/-6% of the left ventricle was infarcted (P=NS). The constitutively expressed gene construct, SV-VEGF, reduced the infarct size to 32+/-7% of the left ventricle (P=0.007). The ischemia-inducible gene construct, RTP801-VEGF, further reduced the infarct size to 13+/-4% of the left ventricle (P<0.001). The use of a non-viral carrier to deliver an ischemia-inducible VEGF construct is effective in the treatment of acutely ischemic myocardium.

Coupled waveguide-surface plasmon resonance biosensor with subwavelength grating.

This study develops a coupled waveguide-surface plasmon resonance (CWSPR) biosensor with a subwavelength grating structure for the real-time analysis of biomolecular interactions. In the proposed optical metrology system, normally incident white light is coupled into the waveguide layer through the subwavelength grating structure thereby enhancing the wave vector which excites the surface plasmons on the metal sensing surface. The proposed CWSPR biosensor not only retains the same sensing sensitivity as that of a conventional surface plasmon resonance device, but also yields a sharper dip in the reflectivity spectrum and therefore provides an improved measurement precision. Moreover, the metrology setup overcomes the limitations of the conventional Kretschmann attenuated total reflection approach and is less sensitive to slight variations in the angle of the incident light. The experimental results confirm that the current CWSPR biosensor provides a straightforward yet powerful technique for real-time biomolecular interaction analysis.

Pediatric Oral Electrical Burns: Incidence of Emergency Department Visits in the United States, 1997-2012.

OBJECTIVES: To investigate the epidemiology of emergency department visits for pediatric patients presenting with electrical burns to the mouth. STUDY DESIGN: Cross-sectional analysis of a national database. SETTING: National Electronic Injury Surveillance System Database. SUBJECTS AND METHODS: The Consumer Product Safety Commission's National Electronic Injury Surveillance System database was used to derive a national weighted estimate of emergency department visits for oral electrical burns and was queried for each patient's age, sex, race, local of incidence, disposition, and related consumer product. RESULTS: There were an estimated 1042 emergency department visits for pediatric oral electrical burns from 1997 to 2012, or an average of approximately 65.1 cases per year. A total of 59.6% of patients were male. Nearly half of emergency department visits involved patients <3 years of age, and more than three-fourths of emergency department visits involved patients <5 years of age. A total of 77.2% of patients were examined, treated, and released from the emergency department, while 19.2% were admitted to the hospital. Most injuries involved electrical outlets or receptacles (10.8%), extension cords (18.5%), and electrical wires (21.5%). CONCLUSION: Earlier incidence estimates of pediatric oral electrical burns varied substantially within the literature and varied from small case reports to single-year studies. Our multiyear data analysis provides evidence of decreasing annual incidence when compared with historical estimates for a common but potentially morbid injury among the pediatric population.

Electrophysiological assessments of primitive reflexes in stroke patients.

OBJECTIVE: To evaluate the primitive reflexes by electrophysiological assessments and their correlation with the cognitive and physical functioning of stroke patients. METHODS: Electrophysiological studies of primitive reflexes including jaw jerk, snout reflex, glabellar reflex, and corneomandibular reflexes were performed in 38 stroke patients and 26 normal controls. Cognitive function of patients was assessed by Modified Mini-Mental State (3MS) Examination and logical memory test. The Chinese Functional Independence Scale (CFIS) was used to evaluate the physical functioning and social domains of stroke patients. RESULTS: The presence rate of primitive reflexes was higher in stroke patients than in normal controls. Wave amplitude of snout and corneomandibular reflexes obtained from stroke patients was greater than those from controls. No definite difference in reflex conduction latencies was observed between the two groups. A regression relationship was noted between the wave amplitude of snout reflexes and the 3MS and CFIS scores of stroke patients. CONCLUSION: Primitive reflexes can be measured by electrophysiological assessments. The results may serve as an objective and useful parameter in evaluation of cognition and physical functioning of stroke patients.

Iatrogenic subcutaneous emphysema after dental treatment.

Subcutaneous emphysema as a complication of a dental procedure is uncommon. When it does occur, it can result in significant and sometimes alarming cervicofacial swelling. Management in most cases involves close observation while awaiting spontaneous resolution. However, in some cases the swelling can progress to cause serious complications and even death. Even though such complications are more commonly seen by our dental and oromaxillofacial surgery colleagues, otolaryngologists should be aware of this condition since we are often asked to consult in these cases. We describe the case of a 13-year-old girl who presented to the emergency department of our institution with an unusually dramatic acute-onset cervicofacial swelling after she had undergone a dental procedure earlier in the day. Computed tomography revealed subcutaneous emphysema. The patient was admitted to the hospital for close observation, and within 24 hours her condition had improved significantly. Shortly after discharge, she experienced a complete recovery. We review the clinical presentation, physical examination findings, diagnostic workup, and management of this complication.

Early mechanical complications of a multidirectional mobile-bearing total knee replacement.

Between April 2004 and July 2007, we performed 241 primary total knee replacements in 204 patients using the e.motion posterior cruciate-retaining, multidirectional mobile-bearing prosthesis. Of these, 100 were carried out using an image-free navigation system, and the remaining 141 with the conventional technique. We conducted a retrospective study from the prospectively collected data of these patients to assess the early results of this new mobile-bearing design. At a mean follow-up of 49 months (32 to 71), 18 knees (7.5%) had mechanical complications of which 13 required revision. Three of these had a peri-prosthetic fracture, and were removed from the study. The indication for revision in the remaining ten was loosening of the femoral component in two, tibiofemoral dislocation in three, disassociation of the polyethylene liner in four, and a broken polyethyene liner in one. There were eight further mechanically unstable knees which presented with recurrent disassociation of the polyethylene liner. There was no significant difference in the incidence of mechanical instability between the navigation-assisted procedures (8 of 99, 8.1%) and the conventionally implanted knees (10 of 139, 7.2%). In our view, the relatively high rate of mechanical complications and revision within 30 months precludes the further use of new design of knee replacement.

Non-viral delivery of interleukin-2 and soluble Flk-1 inhibits metastatic and primary tumor growth in renal cell carcinoma.

Treatments for renal cell carcinoma, while promising, are still limited by toxicity and cost. In the hopes of finding a novel compound or combination, we developed a plasmid containing the genes for interleukin-2 (IL-2) and soluble vascular endothelial growth factor receptor 2 (msFlk1). The plasmid, p2CMVIL2/msFlk1, demonstrated similar in vitro transgene expression of IL-2 or msFlk1 compared to their single-agent counterparts. Subcutaneous tumor growth was significantly inhibited in the p2CMVIL2/msFlk1 group when delivered locally by the non-viral water soluble polymer, WSLP and exhibited a 50% increase in survival over glucose and single-agent controls. In vivo experimentation demonstrated that WSLP/msFlk1 decreased microvessel density in pCMVmsFlk1 and p2CMVIL2/msFlk1 treated groups. Furthermore, tumor-infiltrating lymphocytes expressing CD45RO and CD68 were increased within the tumor microenvironment upon p2CMVIL2/msFlk1 treatment. To determine the effects of p2CMVIL2/msFlk1 in an experimental RENCA lung metastases model, therapeutic DNA was delivered systemically following complexation with the angiogenic endothelial-targeting polymer PEI-g-PEG-RGD. The p2CMVIL2/msFlk1 treatment significantly reduced metastases by 56% over single-agent therapy and increased survival proportions by 50% over all groups. Our work clearly demonstrates that non-viral delivery of p2CMVIL2/msFlk1 can inhibit RENCA growth in a synergistic manner and may represent a new treatment for renal carcinoma.

Cervical myelopathy induced by pseudogout in ligamentum flavum and retro-odontoid mass: a case report.

STUDY DESIGN: Retrospective case study. OBJECTIVES: Report a rare case of cervical myelopathy induced by calcium pyrophosphate dehydrate (CPPD) deposition in multiple cervical levels. SETTING: An area teaching hospital in Taiwan. METHOD: A patient with cervical myelopathy was evaluated by computerized tomography (CT) scan and magnetic resonance (MR) image. CPPD deposition known as pseudogout was diagnosed and approved by a polarized microscope. RESULT: A prominent hypertrophy of ligmentum flavum and a retro-odontoid bulging mass induced cord compression were found in CT scan and MR image. CPPD deposition was confirmed by the histological examinations in the ligamentum flavum at the spinal levels of C3-C6. After decompression surgery of spine and comprehensive rehabilitation, the patient's neurological symptoms subsided and her neurological functions improved leading to a good prognosis. CONCLUSION: CPPD deposition in cervical spine occurring at multiple levels is rare. Image studies with CT scan and MR are complementary in the diagnosis of CPPD-induced myelopathy. Surgical decompression is always required and expected to have a good outcome.

Nonoperative techniques for scar management and revision.

Facial plastic surgeons are frequently called upon to manage facial scars, whether iatrogenic or traumatic. Numerous treatment modalities are available for scar management depending upon scar characteristics, age, and patient expectations. The focus of this article is to review commonly used nonsurgical methods of scar revision. These include topical applications (silicone, vitamin E, pressure dressing, herbal extracts), intralesional medication (steroids, antimitotics), soft tissue augmentation (collagen, fat), laser applications (585-nm flashlamp-pumped pulsed dye, CO(2)), cryotherapy, and make-up camouflage. Nonsurgical modalities can be used as prophylactic prevention of adverse scar formation, as definitive treatment, as intervening therapy until further surgical repair can be made, or as adjunctive treatment following surgical scar revision.

Hemodialysis clearance of metronidazole and its metabolites.

Metronidazole is now being used with increasing frequency for various infectious conditions in patients with renal failure. It is commonly administered to septic patients who have developed acute renal failure requiring hemodialysis. The hemodialysis clearances of metronidazole and its metabolites were evaluated in nine renal failure patients on maintenance hemodialysis. The mean +/- standard deviation clearance and the extraction ratio were 106.9 +/- 16.3 ml/min and 0.65 +/- 0.08, respectively, when regenerated cellulose dialysis membrane was used. The clearance and the extraction ratio with the use of cuprophan membrane were 72.1 +/- 17.3 ml/min and 0.44 +/- 0.12, respectively. The clearances and extraction ratios for the metabolites were similar to those of the parent drug. For both metronidazole and the hydroxy metabolite, the clearance and the extraction ratio demonstrated a statistically significant difference between the regenerated cellulose membrane and the cuprophan membrane. In summary, metronidazole and its metabolites were found to be highly dialyzable with different clearances depending on the specific type of membrane used. However, owing to the relatively wide therapeutic index of the drug, dosage supplementation may be necessary only in seriously ill patients to ensure therapeutic effect.

Plasma clearance, biodistribution and therapeutic properties of mitoxantrone encapsulated in conventional and sterically stabilized liposomes after intravenous administration in BDF1 mice.

Mitoxantrone can be efficiently loaded into large unilamellar vesicles using a transmembrane pH gradient. Release studies indicate that these drug-loaded carriers are highly stable and even after dissipation of the residual pH gradient retain more than 85% of encapsulated mitoxantrone following dialysis at 37 degrees C for 5 days. In murine studies we have compared the plasma clearance and biodistribution of both mitoxantrone and liposomal lipid following intravenous administration of free drug or mitoxantrone encapsulated in either conventional or sterically stabilized liposomes. In contrast to the rapid blood clearance observed for free mitoxantrone, both liposomal systems provided extended circulation lifetimes, with over 90% of the drug present 1 h after administration and 15-30% remaining at 24 h. In agreement with previous reports, longer plasma half-lives were observed for sterically stabilized liposomes than for conventional systems. In addition, a strong correlation between drug and carrier biodistribution was seen, with uptake occurring mainly in the liver and spleen and paralleling plasma clearance. This would suggest that tissue disposition reflects that of drug-loaded liposomes rather than the individual components. Liposomal encapsulation also significantly reduced mitoxantrone toxicity, allowing administration of higher, more efficacious drug doses. In a murine L1210 tumour model, for example, no long-term survivors were seen in animal groups treated with free drug, whereas at the maximum therapeutic dose of liposomal mitoxantrone survival rates of 40% were observed.

Ventilatory and mouth occlusion pressure responses to hypercapnia in chronic tetraplegia.

OBJECTIVE: To compare the ventilatory response to hypercapnia and the mouth occlusion pressure measured at 0.1 second following inspiration (P0.1) in hypercapnia between chronic tetraplegic and normal subjects. DESIGN: A case-control study with an uneven sample size for the study of clinical disorders. SETTING: Patients were recruited from the outpatient clinic of a rehabilitation department. PARTICIPANTS: Seven normal men and 9 men with tetraplegia who had cervical cord injuries (C5-C8), with a mean injury duration of 9.7 yrs. INTERVENTIONS: Pulmonary function tests were performed during resting, whereas minute ventilation (VE) and P0.1 were measured during CO2 rebreathing. RESULTS: The maximal voluntary ventilation (MVV), vital capacity (VC), and maximal respiratory muscle strength in the tetraplegic subjects were significantly less than in the normal subjects. Both the ventilatory and P0.1 responses to hypercapnia were significantly reduced in tetraplegic as compared with normal subjects, but the reductions were eliminated by normalizing with maximal ventilatory performance (MVV or VC) and maximal inspiratory muscle strength (PImax), respectively. CONCLUSIONS: Chronic tetraplegic persons have diminished ventilatory and P0.1 responses to hypercapnia. Respiratory muscle weakness may be a primary factor contributing to the diminished ventilatory response observed in these patients.

Abdominal weight and inspiratory resistance: their immediate effects on inspiratory muscle functions during maximal voluntary breathing in chronic tetraplegic patients.

OBJECTIVE: To study the immediate effects of maximal voluntary (MV) breathing, with and without abdominal weight (AW) or inspiratory resistance (IR), on inspiratory muscle functions in chronic tetraplegic patients. DESIGN: A crossover trial design. SETTING: Rehabilitation department of a university hospital. PARTICIPANTS: Nine tetraplegic men injured at the C4 to T1 levels, with a mean duration of injury of 72.8 months. INTERVENTIONS: Each subject performed MV breathing without and with AW load (AWMV breathing) and IR load (IRMV breathing) separately. MAIN OUTCOME MEASURES: Electromyographic (EMG) activity of the inspiratory muscles, mouth pressure, inspiratory flow, and inspiratory volume. RESULTS: AWMV breathing evoked greater diaphragmatic EMG activity, inspiratory flow, and inspiratory volume than did IRMV breathing, although the increase of diaphragmatic EMG activity was not statistically significant. Conversely, IRMV breathing produced greater sternocleidomastoid EMG activity and negative mouth pressure than did AWMV breathing. Both AWMV and IRMV breathing evoked greater inspiratory muscle EMG activity than did MV breathing. CONCLUSION: AW and IR loads have differential immediate effects on the inspiratory muscle functions during MV breathing in patients with chronic tetraplegia, suggesting that these two breathing maneuvers may have dissimilar mechanisms of training in such patients. The muscle EMG activity evoked during MV breathing with AW or IR is greater than that without a mechanical load, implying that mechanically loaded training in tetraplegic patients results in load compensatory adjustments via their respiratory motor output to improve respiratory function.