How accurate is arthroscopy of the temporomandibular joint? A comparison of findings in patients who had open operations after arthroscopic management failed.

We examined the accuracy of arthroscopy to diagnose disease in the temporomandibular joint (TMJ) and to allocate an appropriate Wilkes' stage. We compared findings made during arthroscopy with those at subsequent open operation in the same patient. Overall, arthroscopy had 87% sensitivity and 99% specificity in diagnosing disease in the TMJ, and it also accurately allocated the Wilkes' stage (sensitivity 94%, specificity 98%).

Outcomes of open temporomandibular joint surgery following failure to improve after arthroscopy: is there an algorithm for success?

We reviewed the results of one surgeon's experience of open surgical management of the temporomandibular joint (TMJ) in patients who fail to respond to arthroscopy and aimed to identify groups of patients that may or may not benefit from the intervention. Over a 7-year period (2005-2012) we retrospectively collected data from the medical notes of patients who underwent discectomy, disc plication, eminectomy, eminoplasty, and adhesiolysis, according to the clinical findings for joint pain, restriction, and locking. A total of 22 patients (71%) reported improvement in pain score and 19 (61%) reported an improvement in mouth opening 12 months postoperatively. Overall, 12 patients (39%) ultimately needed TMJ replacement. This group included 5/6 patients in Wilkes' stage IV and 6/15 in stage V, 5/7 patients with a preoperative pain score of 90-100, and half of those with preoperative mouth opening of 20-29 mm (7/14). Open surgical management of the TMJ can benefit patients despite the previous failure of arthroscopy to manage pain, restriction, and locking. Arthroscopy seems to reduce the percentage of patients that need open TMJ surgery, but also the success of subsequent operations compared with previous studies. TMJ replacement is increasingly being done successfully to treat end-stage disease. These results may be used when obtaining a patient's consent for open TMJ surgery, particularly if they are in the groups considered to have a high risk of subsequently requiring a replacement joint.

Illustrative national scale scenarios of environmental and human health impacts of Carbon Capture and Storage.

Integrated Assessment, and the development of strategies to reduce the impacts of air pollution, has tended to focus only upon the direct emissions from different sources, with the indirect emissions associated with the full life-cycle of a technology often overlooked. Carbon Capture and Storage (CCS) reflects a number of new technologies designed to reduce CO2 emissions, but which may have much broader environmental implications than greenhouse gas emissions. This paper considers a wider range of pollutants from a full life-cycle perspective, illustrating a methodology for assessing environmental impacts using source-apportioned effects based impact factors calculated by the national scale UK Integrated Assessment Model (UKIAM). Contrasting illustrative scenarios for the deployment of CCS towards 2050 are presented which compare the life-cycle effects of air pollutant emissions upon human health and ecosystems of business-as-usual, deployment of CCS and widespread uptake of IGCC for power generation. Together with estimation of the transboundary impacts we discuss the benefits of an effects based approach to such assessments in relation to emissions based techniques.

Expression and analysis of a split premature termination codon in FGG responsible for congenital afibrinogenemia: escape from RNA surveillance mechanisms in transfected cells.

Congenital afibrinogenemia, the most severe form of fibrinogen deficiency, is characterized by the complete absence of fibrinogen. The disease is caused by mutations in 1 of the 3 fibrinogen genes FGG, FGA, and FGB, clustered on the long arm of human chromosome 4. The majority of cases are due to null mutations in the FGA gene although one would expect the 3 genes to be equally implicated. However, most patients studied so far are white, and therefore the identification of causative mutations in non-European families is necessary to establish if this finding holds true in all ethnic groups. In this study, we report the identification of a novel nonsense mutation (Arg134Xaa) in the FGG gene responsible for congenital afibrinogenemia in 10 patients from Lebanon. Expression studies in COS-7 cells demonstrated that the Arg134Xaa codon, which is encoded by adjacent exons (TG-intron 4-A) affected neither mRNA splicing nor stability, but led to the production of an unstable, severely truncated fibrinogen gamma chain that is not incorporated into a functional fibrinogen hexamer.