The influence of mouth breathing on skeletal and dental features of splanchnocranium.

OBJECTIVE: This study was performed to investigate changes in dentofacial characteristics associated with mouth breathing (MB) and adenoidectomy. BACKGROUND: MB is considered to be an etiological factor of malocclusion. Adenoidectomy is supposed to have the ability to prevent the development of dentofacial deformities. METHODS: This retrospective study included 123 patients, namely 57 nose breathers, 19 former mouth breathers, who have undergone adenoidectomy, and 47 mouth breathers. The groups were compared according to their skeletal and dental characteristics. The measurements of each individual were obtained from lateral cephalograms and dental casts. The comparison was done using one-way ANOVA, Bonferroni post-hoc, Mann-Whitney U and Kruskal-Wallis tests. The statistically significant difference was defined as p<0.05. RESULTS: The MB group showed an increase in ArGoMe (p=0.02) angle. No difference was found in the sagittal parameters among the groups. Upper dental arch compression was positively correlated with MB(p=0.00), even in adenoidectomy cases (p=0.01). CONCLUSION: MB alters the vertical and transverse growth of the craniofacial complex. It is associated with longer lower anterior facial height and decreased maxillary intermolar distance. However, it does not influence the sagittal parameters. Airway clearance via adenoidectomy promotes the normalization of vertical parameters (Tab. 1, Fig. 2, Ref. 20).

Do we have to reduce the recall period? Validity of a daily physical activity questionnaire (PAQ24) in young active adults.

BACKGROUND: Combining the strengths of physical activity (PA) diaries and questionnaires may be needed to improve the unsatisfying measurement quality of existing PA questionnaires. This study investigated the construct validity of a short PA questionnaire (Physical Activity Questionnaire for 24 h [PAQ24]) with a recall period of one day. METHODS: In this cross-sectional study, participants completed the PAQ24 on seven consecutive days while wearing an accelerometer (GENEActiv). Thereafter, the Global Physical Activity Questionnaire (GPAQ) was completed. Spearman correlation coefficients and Bland-Altman analysis were used to assess construct validity. RESULTS: Overall, 50 active adults (11 women, mean age = 25.1 ± 2.5) participated. Relative agreements between Total PA of PAQ24 and accelerometer were 0.37 ≤ ρ ≤ 0.72 for each day with satisfying agreement on five out of seven days. Weekly relative agreement for Total PA was moderate (ρ = 0.44). Relative agreements between PAQ24 and GPAQ were ρ = 0.43 for Total PA. Daily and weekly absolute agreements were poor indicated by wide limits of agreement. CONCLUSIONS: In contrast to weekly Total PA, the majority of daily results of the PAQ24 showed satisfying construct validity. A short recall period may improve the measurement quality of PA questionnaires, but measurement errors and the costs of multiple administrations must be considered in future studies.

Somatic mutations in kinetochore gene KNSTRN are associated with basal proliferating actinic keratoses and cutaneous squamous cell carcinoma.

BACKGROUND: Mutations in kinetochore gene KNSTRN accelerate the development of cutaneous squamous cell carcinoma (SCC) and may correlate with different histological classifications of actinic keratosis (AKs). OBJECTIVE: To determine KNSTRN gene mutation frequency in healthy skin (HS), actinically damaged skin (ADS), in AKs with different histomorphological gradings and invasive SCCs. METHODS: All samples were histologically evaluated. AK lesions were additionally classified according to their upwards (AK I-III) and downwards (PRO I-III) directed growth pattern. Mutation analyses of all samples were performed using the Sanger method. RESULTS: With one exception, all detected mutations in KNSTRN gene showed an alanine-to-glutamate substitution at codon 40 (p.Ala40Glu). p.Ala40Glu mutation was found in 6.9% (2/29) of HS, in 16.1% (5/31) of ADS, in 18.3% (20/109) of AKs and in 30.0% (9/30) of invasive SCCs. Further stratification of AKs using the common AK classification of Röwert-Huber revealed the p.Ala40Glu mutation in 14.7% (5/43), 13.3% (4/30) and 24.4% (11/45) (AK I, II and III). In contrast, the new PRO classification showed a distribution of 3.6% (1/28) in PRO I, 21.7% (13/60) in PRO II and 28.6% (6/21) in PRO III. Mutation frequency in HS showed significant differences compared to AKs classified as PRO III and invasive SCCs (P < 0.05). In contrast, there were no statistically significant differences between HS and AKs when classified according to Röwert-Huber. CONCLUSIONS: Recurrent somatic mutation p.Ala40Glu in KNSTRN gene is associated with basal proliferating AKs in accordance with invasive SCCs. This supports the impact of basal proliferative pattern in terms of progression.

Patient-reported health outcomes in patients with non-melanoma skin cancer and actinic keratosis: results from a large-scale observational study analysing effects of diagnoses and disease progression.

BACKGROUND: Non-melanoma skin cancer (NMSC) and actinic keratosis (AK) are very common among fair-skinned individuals. A disease continuum from AK to squamous cell carcinoma (SCC) has been frequently postulated. AK and NMSC may influence quality of life (QL) of patients, and it can be suspected that disease progression entails a QL reduction. The purpose of this study was to document QL in patients with NMSC and AK using the health-outcome questionnaire EQ-5D-5L. METHODS: The study was designed as a non-interventional, prospective, cross-sectional study. Patients with AK, SCC, basal cell carcinoma (BCC) or multiple diagnoses were enrolled in this study in 29 dermatological centres across Germany. Patients were asked to complete the EQ-5D-5L (compromising EQ Index and EQ VAS), and the dermatologists provided diagnosis, disease history and treatment data. RESULTS: A total of 1184 patients were enrolled and diagnosed as follows: 73% AK, 49% BCC and 17% SCC. 66% had a single diagnosis, 28% two different diagnoses and 6% three different diagnoses. QL was strongly associated with patients' diagnosis. Patients with a single AK diagnosis had significantly higher mean EQ VAS (78) than patients with BCC (74), SCC (72), and BCC plus SCC (69), P < 0.050. When the effects of disease progression were calculated, patients with AK plus SCC reported significantly less mean EQ VAS (71) than patients with a single AK diagnosis (78), P < 0.011. CONCLUSIONS: While rarely being imminently life-threatening, NMSC and AK have an impact on QL as quantified by the EQ-5D-5L. This impact is associated with diagnosis (AK vs. NMSC) and clinical progression (AK vs. AK plus SCC). Both lead to a clear decline in QL. This shows that disease progression is perceived and judged as detrimental by patients and that AK and NMSC should be diligently treated to preserve and restore QL.

A phase I/II study of KW-2478, an Hsp90 inhibitor, in combination with bortezomib in patients with relapsed/refractory multiple myeloma.

BACKGROUND: KW-2478 is a novel non-ansamycin Hsp90 inhibitor with modest single-agent activity in relapsed/refractory myeloma but which shows synergistic antimyeloma activity with bortezomib (BTZ) in preclinical studies. This study determined the safety, preliminary clinical activity, and pharmacokinetics of KW-2478, an Hsp90 inhibitor, in combination with BTZ in patients with relapsed/refractory multiple myeloma (MM). METHODS: Phase I dose escalation determined the recommended phase II dose (RP2D) of KW-2478 plus BTZ, which was then used during phase II. RESULTS: The maximum tolerated dose was not reached during phase I and the RP2D was KW-2478 175 mg m-2 plus BTZ 1.3 mg m-2 on days 1, 4, 8, and 11 every 3 weeks. In the efficacy evaluable phase I/II population treated at the RP2D (n=79), the objective response rate was 39.2% (95% confidence interval: 28.4-50.9%), clinical benefit rate 51.9% (40.4-63.3%), median progression-free survival 6.7 (5.9-not reached (NR)) months, and median duration of response 5.5 (4.9-NR) months. In the phase I/II safety population (n=95), the most frequently observed treatment-related grade 3/4 adverse events were diarrhoea, fatigue, and neutropenia (each in 7.4% of patients), and nausea and thrombocytopenia (each in 5.3%). CONCLUSIONS: KW-2478 plus BTZ was well tolerated with no apparent overlapping toxicity in patients with relapsed/refractory MM. The antimyeloma activity of KW-2478 in combination with BTZ as scheduled in this trial appeared relatively modest; however, the good tolerability of the combination would support further exploration of alternate dosing schedules and combinations.

Chemical kinetic theory: understanding cell-cycle regulation.

Progress of a cell through its reproductive cycle of DNA synthesis and division is governed by a complex network of biochemical reactions controlling the activities of both M-phase- and S-phase-promoting factors. Standard chemical kinetic theory provides a disciplined method for expressing the molecular biologists' diagrams and intuition in precise mathematical form, so that qualitative and quantitative implications of our 'working models' can be derived and compared with experiment.

The influence of different illumination parameters on protoporphyrin IX induced cell death in squamous cell carcinoma cells.

BACKGROUND: Topical photodynamic therapy (PDT) is a highly effective therapy especially for extended cancerized fields of the skin. Whenever extended fields are treated pain management is advisable. Light source mediated pain management can be performed by reducing fluence rates, as long as this does not compromise efficacy. METHODS: Two squamous cell carcinoma cell lines (A431 and SCC-13) were subjected to in vitro PDT using two different ALA concentrations and synthesis intervals and protoporphyrin IX (PpIX) synthesis was assessed. Two total light doses (6 J/cm2 and 37 J/cm2) were applied at three different fluence rates and cell viability was measured using the MTS-test. RESULTS: Both cell lines synthetized PpIX at different kinetics. A431 cells produced a maximum 28.6 nmol/l PpIX, while SCC-13 reached only a production of 8.7 nmol/l. Illumination reduced cell viability depending on PpIX content and light dose. When a lower light dose (6 J/cm2) was applied, only the combination with the highest PpIX content was effective in A431 cells and no effect could be detected in SCC-13 cells. With a light dose of 37 J/cm2, lower PpIX amounts became effective in A431 and cell death could be induced in SCC-13 cells. Light fluence rate had no differential effect in this setup. CONCLUSIONS: In both, A431 and SCC-13 cells, total light dose is a key factor for photodynamic efficacy. Additionally, our results hint towards a threshold concentration of PpIX upon which a drastic loss of viability occurs. Light fluence rate in the analyzed range is not a limiting factor of photodynamic cytotoxicity. This may allow for the clinical implementation of low fluence rate protocols for pain management without compromising efficacy.

Kinetic analysis of a molecular model of the budding yeast cell cycle.

The molecular machinery of cell cycle control is known in more detail for budding yeast, Saccharomyces cerevisiae, than for any other eukaryotic organism. In recent years, many elegant experiments on budding yeast have dissected the roles of cyclin molecules (Cln1-3 and Clb1-6) in coordinating the events of DNA synthesis, bud emergence, spindle formation, nuclear division, and cell separation. These experimental clues suggest a mechanism for the principal molecular interactions controlling cyclin synthesis and degradation. Using standard techniques of biochemical kinetics, we convert the mechanism into a set of differential equations, which describe the time courses of three major classes of cyclin-dependent kinase activities. Model in hand, we examine the molecular events controlling "Start" (the commitment step to a new round of chromosome replication, bud formation, and mitosis) and "Finish" (the transition from metaphase to anaphase, when sister chromatids are pulled apart and the bud separates from the mother cell) in wild-type cells and 50 mutants. The model accounts for many details of the physiology, biochemistry, and genetics of cell cycle control in budding yeast.

Designing and evaluating Brain Powered Games for cognitive training and rehabilitation in at-risk African children.

BACKGROUND: Valid, reliable, accessible, and cost-effective computer-training approaches can be important components in scaling up educational support across resource-poor settings, such as sub-Saharan Africa. The goal of the current study was to develop a computer-based training platform, the Michigan State University Games for Entertainment and Learning laboratory's Brain Powered Games (BPG) package that would be suitable for use with at-risk children within a rural Ugandan context and then complete an initial field trial of that package. METHODS: After game development was completed with the use of local stimuli and sounds to match the context of the games as closely as possible to the rural Ugandan setting, an initial field study was completed with 33 children (mean age = 8.55 ± 2.29 years, range 6-12 years of age) with HIV in rural Uganda. The Test of Variables of Attention (TOVA), CogState computer battery, and the Non-Verbal Index from the Kaufman Assessment Battery for Children, 2nd edition (KABC-II) were chosen as the outcome measures for pre- and post-intervention testing. The children received approximately 45 min of BPG training several days per week for 2 months (24 sessions). RESULTS: Although some improvements in test scores were evident prior to BPG training, following training, children demonstrated clinically significant changes (significant repeated-measures outcomes with moderate to large effect sizes) on specific TOVA and CogState measures reflecting processing speed, attention, visual-motor coordination, maze learning, and problem solving. CONCLUSIONS: Results provide preliminary support for the acceptability, feasibility, and neurocognitive benefit of BPG and its utility as a model platform for computerized cognitive training in cross-cultural low-resource settings.

A simple model of circadian rhythms based on dimerization and proteolysis of PER and TIM.

Many organisms display rhythms of physiology and behavior that are entrained to the 24-h cycle of light and darkness prevailing on Earth. Under constant conditions of illumination and temperature, these internal biological rhythms persist with a period close to 1 day ("circadian"), but it is usually not exactly 24h. Recent discoveries have uncovered stunning similarities among the molecular circuitries of circadian clocks in mice, fruit flies, and bread molds. A consensus picture is coming into focus around two proteins (called PER and TIM in fruit flies), which dimerize and then inhibit transcription of their own genes. Although this picture seems to confirm a venerable model of circadian rhythms based on time-delayed negative feedback, we suggest that just as crucial to the circadian oscillator is a positive feedback loop based on stabilization of PER upon dimerization. These ideas can be expressed in simple mathematical form (phase plane portraits), and the model accounts naturally for several hallmarks of circadian rhythms, including temperature compensation and the per(L) mutant phenotype. In addition, the model suggests how an endogenous circadian oscillator could have evolved from a more primitive, light-activated switch.

Electrochemiluminescence of ruthenium (II) tris(bipyridine) encapsulated in sol-gel glasses

The electrogenerated chemiluminescence (ECL) of Ru(bpy)3 2+ and tripropylamine, tributylamine, triethylamine, trimethylamine, or sodium oxalate encapsulated within sol-gel-derived silica monoliths have been investigated using an immobilized ultramicroelectrode assembly. The major purpose of this study was to investigate the role of the reductant on the magnitude and stability of the ECL in this solid host matrix. For gel-entrapped Ru(bpy)3 2-/tertiary amines, the shape and intensity of the ECL-potential curves were highly dependent on scan rate. At 10 mV/s, the ECL intensity was ca. 6-fold higher relative to that observed at 500 mV/s. When the ECL acquired at low scan rates was normalized by that obtained in solution under similar conditions, a value of 0.03-0.06 was obtained. In direct contrast, the ECL of the Ru(bpy)3 2+-oxalate system showed little dependence on scan rate, and the ECL was ca. 65-75% of that measured in solution. These differences can be attributed to differences in rotational and translational mobility between the reductants (amines vs oxalate) trapped in this porous solid host For both systems, the ECL was found to be stable upon continuous oxidation or upon drying the gels in a high-humidity environment for over 10 days.

Quantitative characterization of mass lesions on digitized mammograms for computer-assisted diagnosis.

RATIONALE AND OBJECTIVES: To investigate features for discriminating benign from malignant mammographic findings by using computer-aided diagnosis (CAD) and to test the accuracy of CAD interpretations of mass lesions. METHODS: Fifty-five sequential, mammographically detected mass lesions, referred for biopsy, were digitized for computerized reevaluation with a CAD system. Quantitative features that characterize spiculation were automatically extracted by the CAD system. Data generated by 271 known retrospective cases were used to set reference values indicating the range for malignant and benign lesions. After conventional interpretation of the 55 prospective cases, they were evaluated a second time by the radiologist using the extracted features and the reference ranges. In addition, a pattern-recognition scheme based on the extracted features was used to classify the prospective cases. Accuracy of interpretation with and without the CAD system was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: Sensitivity of the CAD diagnosis for the prospective cases improved from 92% to 100%. Specificity improved significantly from 26.7% to 66.7%. This was accompanied by a significant increase in the accuracy of diagnosis from 56.4% to 81.8% and in the positive predictive value from 51.1% to 71.4%. The Az for the CAD ROC curve significantly increased from 0.73 to 0.90. The performance of the classification scheme was slightly lower than that of the radiologists' interpretation with the CAD system. CONCLUSIONS: Use of the CAD system significantly improved the accuracy of diagnosis. The findings suggest that the classification scheme may improve the radiologist's ability to differentiate benign from malignant mass lesions in the interpretation of mammograms.

The use of an interactive software program for quantitative characterization of microcalcifications on digitized film-screen mammograms.

RATIONALE AND OBJECTIVES: Mammography is relatively nonspecific for the early detection of breast cancer. This study evaluates the accuracy of mammographic interpretation using quantitative features characterizing microcalcifications, which are extracted by a computerized system. METHODS: A computer-aided diagnosis (CAD) system enabling digitization of film-screen mammograms and automatic feature extraction was developed. A classification scheme (discriminant analysis) based on these features was constructed and trained on 217 cases with known pathology. The diagnostic performance of the classification scheme was tested against the radiologist's conventional interpretation on 45 additional cases of microcalcifications, each analyzed independently by four radiologists. RESULTS: The sensitivity of the CAD system analysis (95.7%) was significantly better than that of conventional interpretation (84.8%). The positive predictive value of interpretation increased significantly, as did the area under the receiver operating characteristic curve. CONCLUSIONS: This classification scheme for microcalcifications, based on quantitative features characterizing the lesion, significantly improved the accuracy of mammographic interpretation.

A stochastic, molecular model of the fission yeast cell cycle: role of the nucleocytoplasmic ratio in cycle time regulation.

We propose a stochastic version of a recently published, deterministic model of the molecular mechanism regulating the mitotic cell cycle of fission yeast, Schizosaccharomyces pombe. Stochasticity is introduced in two ways: (i) by considering the known asymmetry of cell division, which produces daughter cells of slightly different sizes; and (ii) by assuming that the nuclear volumes of the two newborn cells may also differ. In this model, the accumulation of cyclins in the nucleus is proportional to the ratio of cytoplasmic to nuclear volumes. We have simulated the cell-cycle statistics of populations of wild-type cells and of wee1(-) mutant cells. Our results are consistent with well known experimental observations.

Modeling M-phase control in Xenopus oocyte extracts: the surveillance mechanism for unreplicated DNA.

Alternating phases of DNA synthesis and mitosis, during the first 12 cell divisions of frog embryos, are driven by autonomous cytoplasmic oscillations of M-phase promoting factor (MPF). Cell-free extracts of frog eggs provide a convenient preparation for studying the molecular machinery that generates MPF oscillations and the surveillance mechanism that normally prevents entry into mitosis until chromosomal DNA is fully replicated. Early experiments suggested that unreplicated DNA blocks MPF activity by inducing phosphorylation of a crucial tyrosine residue, but recent evidence implicates a stoichiometric inhibitor (an MPF binding protein) as the 'braking' agent. Using a realistic mathematical model of the mitotic control system in frog egg extracts, we suggest that both tyrosine phosphorylation and a stoichiometric inhibitors are involved in the block of MPF by unreplicated DNA. Both pathways operate by raising the cyclin threshold for MPF activation. As a bonus, in the process of analyzing these experiments, we obtain more direct and reliable estimates of the rate constants in the model.

Mathematical model of the fission yeast cell cycle with checkpoint controls at the G1/S, G2/M and metaphase/anaphase transitions.

All events of the fission yeast cell cycle can be orchestrated by fluctuations of a single cyclin-dependent protein kinase, the Cdc13/Cdc2 heterodimer. The G1/S transition is controlled by interactions of Cdc13/Cdc2 and its stoichiometric inhibitor, Rum1. The G2/M transition is regulated by a kinase-phosphatase pair, Wee1 and Cdc25, which determine the phosphorylation state of the Tyr-15 residue of Cdc2. The meta/anaphase transition is controlled by interactions between Cdc13/Cdc2 and the anaphase promoting complex, which labels Cdc13 subunits for proteolysis. We construct a mathematical model of fission yeast growth and division that encompasses all three crucial checkpoint controls. By numerical simulations we show that the model is consistent with a broad selection of cell cycle mutants, and we predict the phenotypes of several multiple-mutant strains that have not yet been constructed.

Optimizing parameters for computer-aided diagnosis of microcalcifications at mammography.

RATIONALE AND OBJECTIVES: The purpose of this study was to optimize selection of the mammographic features most useful in discriminating benign from malignant clustered microcalcifications. MATERIALS AND METHODS: The computer-aided diagnosis (CAD) system automatically extracted from digitized mammograms 13 quantitative features characterizing microcalcification clusters. Archival cases (n = 134; patient age range, 31-77 years; mean age, 56.8 years) with known histopathologic results (79 malignant, 55 benign) were selected. Three radiologists at three facilities independently analyzed the microcalcifications by using the CAD system. Stepwise discriminant analysis selected the features best discriminating benign from malignant microcalcifications. A classification scheme was constructed on the basis of these optimized features, and its performance was evaluated by using receiver operating characteristic (ROC) analysis. RESULTS: Six of the 13 variables extracted by the CAD system were selected by stepwise determinant analysis for generating the classification scheme, which yielded an ROC curve with an area (Az) of 0.98, specificity of 83.64%, positive predictive value of 89.53%, and accuracy of 91.79% for 98% sensitivity. When patient age was an additional variable, the scheme's performance improved, but this was not statistically significant (Az = 0.98). The ROC curve of the classifier (without age as an additional variable) yielded a high Az of 0.96 for patients younger than 50 years and an even higher (P < .02) Az of 0.99 for those 50 years or older. CONCLUSION: Stepwise discriminant analysis optimized performance of a classification scheme for microcalcifications by selecting six optimized features. Scheme performance was significantly (P < .02) higher for women 50 years or older, but the addition of patient age as a variable did not produce a statistically significant increase in performance.

Analysis of clustered microcalcifications by using a single numeric classifier extracted from mammographic digital images.

RATIONALE AND OBJECTIVES: The authors prospectively tested the performance of a single numeric classifier constructed from a discriminative analysis classification system based on automatic computer-extracted quantitative features of clustered microcalcifications. MATERIALS AND METHODS: Mammographically detected clustered microcalcifications in patients who had been referred for biopsy were digitized at 600 dpi with an 8-bit gray scale. A software program was developed to extract features automatically from digitized images to describe the clustered microcalcifications quantitatively. The significance of these features was evaluated by using the Wilcoxon test, the Welch modified two-sample t test, and the two-sample Kolmogorov-Smirnov test. A discriminant analysis pattern recognition system was constructed to generate a single numeric classifier for each case, based on the extracted features. This system was trained on 137 archival known reference cases and its performance tested on 24 unknown prospective cases. The results were evaluated by using receiver operating characteristic analysis. RESULTS: Thirty-seven extracted parameters demonstrated a statistically significant difference between the values for the benign and for the malignant lesions. Seven independent factors were selected to construct the classifier and to evaluate the unknown prospective cases. The area under the receiver operating characteristic curve for the prospective cases was 0.88. CONCLUSION: A pattern recognition classifier based on quantitative features for clustered microcalcifications at screen-film mammography was found to perform satisfactorily. The software may be of value in the interpretation of mammographically detected microcalcifications.

Moran repair for inguinal hernias.

A total of 1282 inguinal hernia repairs were performed between September 1989 and June 1994 using polypropylene mesh inserted in the preperitoneal space to reinforce a two-layer transversalis fascia technique. There was a recurrence rate of 0.4 per cent with a minimal follow-up of 14 months. All the operations were performed as outpatient surgery, under local anesthesia or general anesthesia, with immediate ambulating home and early return to normal activities and work. Complications were minimal, with no mortality.

Profunda femoris revascularization in limb salvage.

A retrospective study of 282 profunda femoris artery reconstructions between 1971 and 1981 with follow-up at least two years in 212 (75.1%) is presented. Arteriographic evaluation was performed in 92 cases. Stages III and IV were the indication for revascularization in 86% of cases. An inflow correction was necessary in 60.3% of profunda reconstructions. Factors that bear on the success or failure of profundaplasty were evaluated. These were aorto-iliac inflow, the extent of disease in the profunda femoris artery, the run-off in the distal popliteal-tibial system and the extent of the ischemic lesion. Of the failures most were due to established gangrene, obstructions throughout the whole length of the profunda or patients with a poor popliteal-tibial run-off system. The cumulative limb salvage at two years was 86.8% in limbs subjected to inflow correction procedure and profundaplasty but only in 56.5% of repair of the profunda alone. In the majority of the below-knee amputations after profundaplasty, repair of the profunda was used to lower the level of amputation from above knee to below the knee. Profundaplasty is worth considering even in those patients who cannot be offered other revascularization surgery.