Exploring Hong Kong nurses' decision-making processes around presenteeism.

BACKGROUND: Presenteeism among nurses is the common behaviour of being physically present at work when one should not be due to personal health and well-being, a stressful work environment, lack of work-life balance, or a sense of professional identity or obligation. AIMS: To explore nurses' decision-making process related to presenteeism in a large Hong Kong public hospital. METHODS: As part of a larger study on nurse presenteeism in Hong Kong, we conducted focus groups with nurses to understand their considerations related to working sick. RESULTS: Eleven major themes emerged from the focus groups, which we grouped into three organizational domains reflecting nurses' decision-making process around presenteeism: consideration for colleagues, organizational factors and professional identity. CONCLUSIONS: Presenteeism was a familiar behaviour among Hong Kong nurses in our study. We found both overlap and divergence with prior presenteeism research in the domains and themes identified. Loyalty to colleagues, written and unwritten rules and professional identity as nurses all seemed to encourage presenteeism among Hong Kong nurses. Organizations seeking to discourage presenteeism should evaluate policies such as sick leave certificates, ensure appropriate coverage for all nurse ranks and address subcultural norms encouraging presenteeism.

Accelerated Skeletal Maturation in Disorders of Retinoic Acid Metabolism: A Case Report and Focused Review of the Literature.

Nutritional excess of vitamin A, a precursor for retinoic acid (RA), causes premature epiphyseal fusion, craniosynostosis, and light-dependent retinopathy. Similarly, homozygous loss-of-function mutations in CYP26B1, one of the major RA-metabolizing enzymes, cause advanced bone age, premature epiphyseal fusion, and craniosynostosis. In this paper, a patient with markedly accelerated skeletal and dental development, retinal scarring, and autism-spectrum disease is presented and the role of retinoic acid in longitudinal bone growth and skeletal maturation is reviewed. Genetic studies were carried out using SNP array and exome sequencing. RA isomers were measured in the patient, family members, and in 18 age-matched healthy children using high-performance liquid chromatography coupled to tandem mass spectrometry. A genomic SNP array identified a novel 8.3 megabase microdeletion on chromosome 10q23.2-23.33. The 79 deleted genes included CYP26A1 and C1, both major RA-metabolizing enzymes. Exome sequencing did not detect any variants that were predicted to be deleterious in the remaining alleles of these genes or other known retinoic acid-metabolizing enzymes. The patient exhibited elevated plasma total RA (16.5 vs. 12.6±1.5 nM, mean±SD, subject vs. controls) and 13-cisRA (10.7 nM vs. 6.1±1.1). The findings support the hypothesis that elevated RA concentrations accelerate bone and dental maturation in humans. CYP26A1 and C1 haploinsufficiency may contribute to the elevated retinoic acid concentrations and clinical findings of the patient, although this phenotype has not been reported in other patients with similar deletions, suggesting that other unknown genetic or environmental factors may also contribute.

Chemodenervation for treatment of limb spasticity following spinal cord injury: a systematic review.

STUDY DESIGN: Systematic review. OBJECTIVES: To systematically review the literature on chemodenervation with botulinum toxin (BoNT) or phenol/alcohol for treatment of limb spasticity following spinal cord injury (SCI). SETTING: British Columbia, Canada. METHODS: EMBASE, MEDLINE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials were searched for English language studies published up until March 2014. Studies were assessed for eligibility and quality by two independent reviewers. RESULTS: No controlled trials were identified. A total of 19 studies were included: 9 involving BoNT and 10 involving phenol/alcohol. Owing to the clinically diverse nature of the studies, meta-analysis was deemed inappropriate. The studies produced level 4 and level 5 evidence that chemodenervation with BoNT or alcohol/phenol can lead to improvement in outcome measurements classified in the body structure and function, as well as activity domains of the International Classification of Functioning, Disability and Health framework. The Modified Ashworth Scale (MAS) was the most commonly used outcome measure. All six studies on BoNT and three of the four studies on phenol/alcohol measuring MAS reported a decrease in at least one point. An improvement in MAS was not always associated with improvement in function. The effect of phenol/alcohol has the potential to last beyond 6 months; study follow-up did not occur beyond this time point. CONCLUSION: Chemodenervation with BoNT or phenol/alcohol may improve spasticity and function in individuals with SCI. However, there is a lack of high-quality evidence and further research is needed to confirm the efficacy of these interventions.

Physical activity and amyloid-ß plasma and brain levels: results from the Australian Imaging, Biomarkers and Lifestyle Study of Ageing.

Previous studies suggest physical activity improves cognition and lowers Alzheimer's disease (AD) risk. However, key AD pathogenic factors that are thought to be influenced by physical activity, particularly plasma amyloid-ß (Aß) and Aß brain load, have yet to be thoroughly investigated. The objective of this study was to determine if plasma Aß and amyloid brain deposition are associated with physical activity levels, and whether these associations differed between carriers and non-carriers of the apolipoprotein E (APOE) ε4 allele. Five-hundred and forty six cognitively intact participants (aged 60-95 years) from the Australian Imaging, Biomarkers and Lifestyle Study of Ageing (AIBL) were included in these analyses. Habitual physical activity levels were measured using the International Physical Activity Questionnaire (IPAQ). Serum insulin, glucose, cholesterol and plasma Aß levels were measured in fasting blood samples. A subgroup (n=116) underwent (11)C-Pittsburgh compound B (PiB) positron emission tomography (PET) scanning to quantify brain amyloid load. Higher levels of physical activity were associated with higher high density lipoprotein (HDL) (P=0.037), and lower insulin (P<0.001), triglycerides (P=0.019) and Aß1-42/1-40 ratio (P=0.001). After stratification of the cohort based on APOE ε4 allele carriage, it was evident that only non-carriers received the benefit of reduced plasma Aß from physical activity. Conversely, lower levels of PiB SUVR (standardised uptake value ratio) were observed in higher exercising APOE ε4 carriers. Lower plasma Aß1-42/1-40 and brain amyloid was observed in those reporting higher levels of physical activity, consistent with the hypothesis that physical activity may be involved in the modulation of pathogenic changes associated with AD.

Pairing as an instructional strategy to promote soft skills amongst clinical dental students.

Training dentists today is challenging as they are expected to provide a wide range of dental care. In the provision of good dental care, soft skills are equally important as clinical skills. Therefore in dental education the development of soft skills are of prime concern. This study sought to identify the development of soft skills when dental students are paired in their clinical training. In this perception study, four open-ended items were used to elicit students' feedback on the appropriateness of using clinical pairing as an instructional strategy to promote soft skills. The most frequently cited soft skills were teamwork (70%) and communication (25%) skills. However, both negative and positive behaviours were reported. As for critical thinking and problem solving skills, more positive behaviours were reported for abilities such as to explain, analyze, find ideas and alternative solutions, and make decisions. Leadership among peers was not evident as leading without legitimate authority could be a hindrance to its development. If clinical pairing is to be used as an effective instructional strategy to promote soft skills amongst students, clear guidelines need to be developed to prepare students to work in a dental team and the use of appropriate assessment tools can facilitate the development of these soft skills.

Combined photodynamic and low-level laser therapies as an adjunct to nonsurgical treatment of chronic periodontitis.

BACKGROUND AND OBJECTIVE: In recent years, there has been a growing interest in the use of dental lasers for treatment of periodontal diseases. The purpose of this short-term clinical trial was to evaluate the effects of a combination of photodynamic therapy with low-level laser therapy as an adjunct to nonsurgical treatment of chronic periodontitis. MATERIAL AND METHODS: Twenty-four nonsmoking adults with untreated chronic periodontitis were randomly assigned in a split-mouth design to receive scaling and root debridement with or without one course of adjunctive photodynamic therapy and low-level laser therapy within 5 d. Plaque, bleeding on probing, probing depth and gingival recession were recorded at baseline, 1 and 3 mo after the treatment. Gingival crevicular fluid was collected for assay of interleukin-1ß levels at baseline, 1 wk and 1 mo. RESULTS: The test teeth achieved greater reductions in the percentage of sites with bleeding on probing and in mean probing depth at 1 mo compared with the control teeth (p < 0.05). A significant decrease in gingival crevicular fluid volume was observed in both groups at 1 wk (p < 0.001), with a further decrease at 1 mo in the test sites (p < 0.05). The test sites showed a greater reduction of interleukin-1ß levels in gingival crevicular fluid at 1 wk than the control sites (p < 0.05). No significant differences in periodontal parameters were found between the test and control teeth at 3 mo. CONCLUSIONS: The present study suggests that a combined course of photodynamic therapy with low-level laser therapy could be a beneficial adjunct to nonsurgical treatment of chronic periodontitis on a short-term basis. Further studies are required to assess the long-term effectiveness of the combination of photodynamic therapy with low-level laser therapy as an adjunct in nonsurgical treatment of periodontitis.

Indicator microbes correlate with pathogenic bacteria, yeasts and helminthes in sand at a subtropical recreational beach site.

AIMS: Research into the relationship between pathogens, faecal indicator microbes and environmental factors in beach sand has been limited, yet vital to the understanding of the microbial relationship between sand and the water column and to the improvement of criteria for better human health protection at beaches. The objectives of this study were to evaluate the presence and distribution of pathogens in various zones of beach sand (subtidal, intertidal and supratidal) and to assess their relationship with environmental parameters and indicator microbes at a non-point source subtropical marine beach. METHODS AND RESULTS: In this exploratory study in subtropical Miami (Florida, USA), beach sand samples were collected and analysed over the course of 6 days for several pathogens, microbial source tracking markers and indicator microbes. An inverse correlation between moisture content and most indicator microbes was found. Significant associations were identified between some indicator microbes and pathogens (such as nematode larvae and yeasts in the genus Candida), which are from classes of microbes that are rarely evaluated in the context of recreational beach use. CONCLUSIONS: Results indicate that indicator microbes may predict the presence of some of the pathogens, in particular helminthes, yeasts and the bacterial pathogen Staphylococcus aureus including methicillin-resistant forms. Indicator microbes may thus be useful for monitoring beach sand and water quality at non-point source beaches. SIGNIFICANCE AND IMPACT OF THE STUDY: The presence of both indicator microbes and pathogens in beach sand provides one possible explanation for human health effects reported at non-point sources beaches.

Environmental and genetic factors affecting the weaning-estrus interval in sows.

We examined the effects of environmental and genetic factors on the weaning-to-estrus interval (WEI) in sows. In order to perform the analyses of the environmental factors, 8104 observations of the 1st to the 6th WEI were carried out, while 6548 observations of the 1st to the 3rd WEI were carried out for the analyses of genetic factors. The environmental model included as fixed effects, herd, genetic line, year and season of birth, as well as the covariates, age of sow at farrowing, litter size at birth and lactation length. Genetic analysis was performed by repeatability and multitrait models. The mean and coefficient of variation for WEI were 7.02 days and 100.6%, respectively. The linear effect of lactation length and the quadratic effect of the age of sow at farrowing affected the WEI. Herd, year and season of farrowing were significant sources of variation for WEI, and there was no influence of genetic line or of litter size at birth. Heritability estimated by the repeatability model was 0.04, while heritabilities obtained by the multitrait model were 0.07, 0.02 and 0.07 for the first three WEI, respectively. Estimates of genetic correlations among the different WEI were of moderate to low magnitude. It was concluded that environmental factors, such as year and season of farrowing, lactation length, age of sow at farrowing and herd, should be considered in the model for best estimation of genetic parameters for this trait. Although with only a small possible genetic gain, selection can be made based on the first WEI.

Genetic and environmental effects on age at first farrowing in sows in southeastern Brazil.

We evaluated genetic and environmental factors affecting age at first farrowing of sows in the Brazilian southeast. For this purpose, 466 observations regarding the age at first farrowing were made for Dalland-C40© animals belonging to two herds. The effects of the environmental factors on this trait were assessed by means of a model that included, as random effects, the influence of the sow's father and mother and, as fixed effects, the influence the year of birth, the herd and the birth season, along with the covariable litter size at birth. The variance components were estimated using the derivative-free restricted maximum likelihood method. The estimated mean was 354.8 ± 25.87 days, with a coefficient of variation of 7.29%. Significant effects on the trait were observed for the herd, the year and the season of birth; but a linear effect of litter size at birth on the age at first farrowing was not observed. The boar did not significantly contribute to the variation occurring among the sows, whereas the sow's mother caused significant variation. The heritability estimate for the age at first farrowing was 0.44 ± 0.15, which is considered high. We concluded that herd effect and year and season of birth should be taken into consideration for an accurate genetic comparison; consequently, the animals should be joined into contemporary groups.

Breast and ovarian cancer risk perception after prophylactic salpingo-oophorectomy due to an inherited mutation in the BRCA1 or BRCA2 gene.

It is often recommended that women who carry a mutation in the BRCA1 or BRCA2 gene have their ovaries and fallopian tubes removed to reduce their risk of gynecologic cancer. The aim of this study was to evaluate women's perception of their risk of breast and ovarian cancer before and after prophylactic salpingo-oophorectomy. We surveyed 127 women who carry a BRCA1 or BRCA2 mutation and who underwent prophylactic salpingo-oophorectomy at the University Health Network, Toronto. Subjects were asked to estimate their risks of breast and ovarian cancer before and after surgery. Their perceived risks of cancers were then compared with published risks, based on their mutation status. BRCA1 carriers estimated their risk of breast cancer risk to be, on average, 69% before surgery and 41% after surgery. They estimated their risk of ovarian cancer to be 55% before surgery and 11% after surgery. BRCA2 carriers estimated their risk of breast cancer to be 69% prior to surgery and 45% after surgery and their perceived risk of ovarian cancer to be 43% before surgery and 8% after surgery. Compared with published risk figures, the perceived risk of ovarian cancer before prophylactic salpingo-oophorectomy was overestimated by 47% of BRCA1 mutation carriers and by 61% of BRCA2 mutation carriers. Most women who have undergone genetic counseling and subsequently choose prophylactic salpingo-oophorectomy accurately perceive their risk of breast cancer. However, in this study, many women overestimated their risk of ovarian cancer, particularly women who carry a BRCA2 mutation.

Carcass and meat quality traits of wild boar (Sus scrofas. L.) with 2n=36 karyotype compared to those of phenotypically similar crossbreeds (2n=37 and 2n=38) raised under same farming conditions. 1. Carcass quantity and meat dressing.

The aim of this study was to compare wild boar (chromosomal number 2n=36) to phenotypically similar animals of 2n=37 and 2n=38 chromosomes (crossbreeds) with respect to live weight, carcass yield, meat yield, fat and weight of inner organs. All animals were born and raised on the same farm and slaughtered at 39 weeks. The final live weight of wild boar 2n=36 was significantly lower (47.2kg) as compared to crossbreeds (80.0kg). Animals 2n=36 had more carcass yields (65.5%) than 2n=37 karyotype (64.9%) and 2n=38 (64.4%). Wild boar had the highest yields for the cuts with bones and boneless cuts compared to crossbreeds. Therefore, variations in karyotype are accompanied by differences in some carcass quantitative traits, i.e., 2n=36 grow and fatten slower than crossbreeds 2n=37 and 2n=38.

Rosai-Dorfman disease of the testis: an unusual entity that mimics testicular malignancy.

A 47 year old Chinese man with diabetes mellitus and previously treated pulmonary tuberculosis presented with painless right testicular enlargement of 1 month's duration. He underwent an orchidectomy for presumed testicular neoplasm corroborated clinicoradiologically. Histological examination of the testicular mass revealed an inflammatory lesion comprising lymphocytes, plasma cells and sheets of pale staining histiocytes, some containing lymphocytes within their ample cytoplasm, suggestive of emperipolesis. S100 immunohistochemistry stained the histiocytes, while ultrastructural examination confirmed emperipolesis. A diagnosis of Rosai-Dorfman disease was made, an exceedingly rare testicular lesion. Clinicoradiological findings mimicked a neoplasm, while the inflammatory histological appearances with occasionally discerned multinucleated cells raised the possibility of xanthogranulomatous orchitis. Tuberculous orchitis was excluded through negative Ziehl-Neelsen stains and PCR for mycobacterium, while seminoma, which sometimes features a predominant inflammatory component obscuring neoplastic cells, was excluded by absent immunostaining for placental alkaline phosphatase and CD117.

Genetic diversity in wild (Sus scrofa scrofa) and domestic (Sus scrofa domestica) pigs and their hybrids based on polymorphism of a fragment of the D-loop region in the mitochondrial DNA.

We examined the variation in mitochondrial DNA by sequencing the D-loop region in wild and domestic (large-white breed) pigs, in hybrids between domestic and wild pigs, and in Monteiro pigs. A D-loop fragment of approximately 330 bp was amplified by PCR. Sequencing of DNA amplicons identified haplotypes previously described as European and Asian types. Monteiro pigs and wild pigs had European haplotypes and domestic pigs had both European and Asian haplotypes.

Frailty, pain and psychological variables among older adults living in Hong Kong nursing homes: can we do better to address multimorbidities?

WHAT IS KNOWN ON THE SUBJECT?: Frailty and multimorbidity are common in later life. A higher level of frailty is associated with a higher risk of adverse physical and psychological health situations. Older adults with pain have been reported to be lonelier and more depressed, as well as less happy and less satisfied with their life as compared to those without pain. In view of the high prevalence of pain among older adults and the reversibility of frailty, it is important to explore the relationship between pain, frailty and psychological parameters in order to devise patient-centred interventions. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Frailty index is positively correlated with the presence of pain, and associated with gender, functional mobility and loneliness. Among these significant variables, loneliness was the factor that contributed the most to the frailty index. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is essential to put the focus of healthcare on both the physical and psychological aspects of well-being. All nurses are advised to improve the management of pain in older people in order to lower the levels of pain, frailty and psychological distress among this population. Nursing care should address the loneliness level especially the problem of social loneliness among older adults particularly those living in nursing homes. ABSTRACT: Introduction In view of the high prevalence of pain among older adults and the reversibility of frailty, it is important to explore the relationship between pain, frailty and psychological parameters in order to devise patient-centred interventions. Aim To examine the levels of frailty, pain and psychological parameters among older adults living in Hong Kong nursing homes, and the cross-sectional relationships among these items. Methods A cross-sectional study was conducted among 178 residents from six nursing homes. Frailty, pain, mobility, happiness, loneliness and life satisfaction of participants were assessed using validated questionnaires. Results A multiple linear regression (R(2)  = 0.338, P < 0.05) showed that the frailty index was associated with loneliness, functional mobility and gender. Among these significant variables, loneliness was the factor that contributed the most to the frailty index. Discussion It is essential to put the focus of healthcare on both the physical and psychological aspects of well-being. Findings suggest that apart from improving mobility and reducing pain, loneliness could be a target of psychosocial interventions to reduce frailty and improve quality of life. Implications for practice It is advised that nursing care should address loneliness, especially the problem of social loneliness among older adults particularly those living in nursing homes.

PAX3 and ETS1 synergistically activate MET expression in melanoma cells.

Melanoma is a highly aggressive disease that is difficult to treat owing to rapid tumor growth, apoptotic resistance and high metastatic potential. The MET proto-oncogene (MET) tyrosine kinase receptor promotes many of these cellular processes, but while MET is often overexpressed in melanoma, the mechanism driving this overexpression is unknown. As the MET gene is rarely mutated or amplified in melanoma, MET overexpression may be driven to increased activation through promoter elements. In this report, we find that transcription factors PAX3 and ETS1 directly interact to synergistically activate MET expression. Inhibition of PAX3 and ETS1 expression in melanoma cells leads to a significant reduction of MET receptor levels. The 300-bp 5' proximal MET promoter contains a PAX3 response element and two ETS1 consensus motifs. Although ETS1 can moderately activate both of these sites without cofactors, robust MET promoter activation of the first site is PAX dependent and requires the presence of PAX3, whereas the second site is PAX independent. The induction of MET by ETS1 via this second site is enhanced by hepatocyte growth factor-dependent ETS1 activation, thereby MET indirectly promotes its own expression. We further find that expression of a dominant-negative ETS1 reduces the ability of melanoma cells to grow both in culture and in vivo. Thus, we discover a pathway where ETS1 advances melanoma through the expression of MET via PAX-dependent and -independent mechanisms.

Effects of repeated cocaine administration on sensory inhibition in rats: preliminary data.

We have recently reported that acute administration of cocaine to rats alters their sensory inhibitory capacity as tested in a paired click paradigm (S1/S2). Whether such acutely induced changes are persistent, is not known. In order to shed some light on the degree of spontaneous reversibility of cocaine-induced decreased sensory inhibition, rats were tested immediately after cocaine administration and 9 days after cessation of cocaine exposure. Six rats received cocaine HCl 20 mg/kg intraperitoneally and six rats received normal saline for 5 consecutive days. The amplitudes of the S1 responses were significantly decreased in the cocaine animals during the injection days only, but not 9 days later. Two measures of sensory inhibition were employed, S2/S1 x 100 amplitude ratio and S1-S2 amplitude difference. The ratio measure indicated a significant decrease in inhibitory capacity in the cocaine group during the injection days, and remained significantly decreased 9 days after cessation of cocaine administration. The data suggest that repeated cocaine administration can induce persistent deficit in the ability of the rat's brain to inhibit incoming irrelevant sensory stimuli.

Evaluation of the use of automatic external defibrillation in out-of-hospital cardiac arrest in Hong Kong.

A retrospective 6-month audit of out-of-hospital cardiac arrests in Hong Kong following the introduction of automatic external defibrillators is presented. During the 6-month period from 1 July 1995 to 31 December 1995, resuscitation was attempted on 754 patients. Of the 744 patients with cardiac arrest whose records were available, 53.6% had a witnessed arrest. Few cardiac arrest patients (8.9%) received bystander cardiopulmonary resuscitation (CPR) and the majority (80%) of arrests occurred at home. Six hundred and forty-three (86.4%) patients were declared dead on arrival at hospital or in the Accident and Emergency department; 89 (12%) died in hospital and only 12 (1.6%) were discharged alive. The average ambulance response interval (call receipt to arrival of ambulance at scene) was 6.42 min. The average arrest-to-first-shock interval was 23.77 min. Factors predicting survival included initial rhythm and arrest-to-first-shock interval. The survival rate of 1.6% is low by world standards. To improve the survival rates of people with out-of-hospital cardiac arrest, the arrest-to-call interval must be reduced and the frequency of bystander CPR assistance increased. Once these changes are in place, a beneficial effect from the use of pre-hospital defibrillation might be seen.

The clinical significance of thymidine kinase 1 measurement in serum of breast cancer patients using anti-TK1 antibody.

The activity of total thymidine kinase in serum (S-TK) has been used as a tumor maker for decades. To date such activity has been determined using [125]I-iodo-deoxyuridine as a substrate. The aim of this study was to develop a new, antibody-based technique for the measurement of cytoplasmic thymidine kinase (TK1) in serum. Both mono- and polyclonal antibodies against S-TK1 were used in dot blot assay. S-TK1 was characterized by SDS and IEF techniques. Sixty-five breast cancer patients were studied, including 17 preoperative and 38 postoperative tumor-free patients and 10 patients with metastases to the lymph nodes (N1-2). They were compared to patients with benign tumors (n=21) and healthy volunteers (n=11). S-TK1 was low (0-1.0 pM) in healthy volunteers, while in preoperative patients the level was increased 6-110-fold. Significant differences were observed between preoperative patients and healthy volunteers (p=0.005), preoperative patients and patients with benign tumors (p<0.001), and preoperative patients and postoperative patients without metastases (p<0.001). No significant difference was observed between preoperative patients and postoperative patients with metastases (p=0.191). The S-TK activity in preoperative patients was also high in serum, but no decrease was observed following surgery. In conclusion, the anti-TK1 antibody could be a good marker for monitoring the response of breast cancer patients to therapy.

The effect of bi-level positive airway pressure on postoperative pulmonary function following gastric surgery for obesity.

The severely obese patient has varying degrees of intrinsic reduction of expiratory flow rates and lung volumes. Thus, the severely obese patient is predisposed to postoperative atelectasis, ineffective clearing of respiratory secretions, and other pulmonary complications. This study evaluated the effect of bi-level positive airway pressure (BiPAP) on pulmonary function in obese patients following open gastric bypass surgery Patients with a body mass index (BMI) of at least 40 kg/m2 who were undergoing elective gastric bypass were eligible to be randomized to receive either BiPAP during the first 24 h postoperatively or conventional postoperative care. Patients with significant cardiovascular and pulmonary diseases were excluded from the study. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1.0), peak expiratory flow rate (PEFR), and percent hemoglobin oxygen saturation (SpO2) were measured preoperatively, and on postoperative days 1, 2, and 3. Twenty-seven patients were entered in the study 14 received BiPAP and 13 received conventional postoperative care. There was no significant difference preoperatively between the study and control groups in regards to age, BMI, FVC, FEV1.0, PEFR or SpO2. Postoperatively expiratory flow was decreased in both groups. However, the FVC and FEV1.0 were significantly higher on each of the three consecutive postoperative days in the patients who received BiPAP therapy. The SpO2 was significantly decreased in the control group over the same time period. Prophylactic BiPAP during the first 12-24 h postoperatively resulted in significantly higher measures of pulmonary function in severely obese patients who had undergone elective gastric bypass surgery. These improved measures of pulmonary function, however, did not translate into fewer hospital days or a lower complication rate in our study population of otherwise healthy obese patients. Further study is necessary to determine if BiPAP therapy in the first 24 postoperative hours would be of benefit in severely obese patients with comorbid illnesses who have undergone elective gastric bypass.

Margin quality and microleakage of Class II composite resin restorations.

Margin quality and isotope microleakage analyses of Class II restorations placed in extracted human molars were compared using various composite resins and placement techniques. At occlusal margins, the traditional (experimental) composite resin restoration placed by the incremental technique showed less microleakage than did the traditional (commercial) [corrected] composite resin restoration placed by the bulk technique. In each group, the occlusal and proximal adaptations had significantly higher "excellent margin" than did the cervical adaptation. Thus, the marginal adaptation at the cervical aspect of conventional Class II composite resin restorations may present a problem with respect to microleakage.