The value of supplemental prone imaging in low-dose CT lung cancer screening. A technical note.

This technical note presents our experience with the additional prone examination of patients during low dose CT lung cancer screening. The prone examination adds only a minor amount of radiation and time to the study and can reduce false positive findings that are gravity-dependent.

Transplant-Free Survival and Interventions at 6 Years in the SVR Trial.

BACKGROUND: In the SVR trial (Single Ventricle Reconstruction), 1-year transplant-free survival was better for the Norwood procedure with right ventricle-to-pulmonary artery shunt (RVPAS) compared with a modified Blalock-Taussig shunt in patients with hypoplastic left heart and related syndromes. At 6 years, we compared transplant-free survival and other outcomes between the groups. METHODS: Medical history was collected annually using medical record review, telephone interviews, and the death index. The cohort included 549 patients randomized and treated in the SVR trial. RESULTS: Transplant-free survival for the RVPAS versus modified Blalock-Taussig shunt groups did not differ at 6 years (64% versus 59%, P=0.25) or with all available follow-up of 7.1±1.6 years (log-rank P=0.13). The RVPAS versus modified Blalock-Taussig shunt treatment effect had nonproportional hazards (P=0.009); the hazard ratio (HR) for death or transplant favored the RVPAS before stage II surgery (HR, 0.66; 95% confidence interval, 0.48-0.92). The effect of shunt type on death or transplant was not statistically significant between stage II to Fontan surgery (HR, 1.36; 95% confidence interval, 0.86-2.17; P=0.17) or after the Fontan procedure (HR, 0.76; 95% confidence interval, 0.33-1.74; P=0.52). By 6 years, patients with RVPAS had a higher incidence of catheter interventions (0.38 versus 0.23/patient-year, P<0.001), primarily because of more interventions between the stage II and Fontan procedures (HR, 1.72; 95% confidence interval, 1.00-3.03). Complications did not differ by shunt type; by 6 years, 1 in 5 patients had had a thrombotic event, and 1 in 6 had had seizures. CONCLUSIONS: By 6 years, the hazards of death or transplant and catheter interventions were not different between the RVPAS versus modified Blalock-Taussig shunt groups. Children assigned to the RVPAS group had 5% higher transplant-free survival, but the difference did not reach statistical significance, and they required more catheter interventions. Both treatment groups have accrued important complications. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00115934.

Respiratory Responses to Ozone Exposure. MOSES (The Multicenter Ozone Study in Older Subjects).

RATIONALE: Acute respiratory effects of low-level ozone exposure are not well defined in older adults. OBJECTIVES: MOSES (The Multicenter Ozone Study in Older Subjects), although primarily focused on acute cardiovascular effects, provided an opportunity to assess respiratory responses to low concentrations of ozone in older healthy adults. METHODS: We performed a randomized crossover, controlled exposure study of 87 healthy adults (59.9 ± 4.5 yr old; 60% female) to 0, 70, and 120 ppb ozone for 3 hours with intermittent exercise. Outcome measures included spirometry, sputum markers of airway inflammation, and plasma club cell protein-16 (CC16), a marker of airway epithelial injury. The effects of ozone exposure on these outcomes were evaluated with mixed-effect linear models. A P value less than 0.01 was chosen a priori to define statistical significance. MEASUREMENTS AND MAIN RESULTS: The mean (95% confidence interval) FEV1 and FVC increased from preexposure values by 2.7% (2.0-3.4) and 2.1% (1.3-2.9), respectively, 15 minutes after exposure to filtered air (0 ppb). Exposure to ozone reduced these increases in a concentration-dependent manner. After 120-ppb exposure, FEV1 and FVC decreased by 1.7% (1.1-2.3) and 0.8% (0.3-1.3), respectively. A similar concentration-dependent pattern was still discernible 22 hours after exposure. At 4 hours after exposure, plasma CC16 increased from preexposure levels in an ozone concentration-dependent manner. Sputum neutrophils obtained 22 hours after exposure showed a marginally significant increase in a concentration-dependent manner (P = 0.012), but proinflammatory cytokines (IL-6, IL-8, and tumor necrosis factor-α) were not significantly affected. CONCLUSIONS: Exposure to ozone at near ambient levels induced lung function effects, airway injury, and airway inflammation in older healthy adults. Clinical trial registered with www.clinicaltrials.gov (NCT01487005).

Massive Transfusion in Cardiac Surgery: The Impact of Blood Component Ratios on Clinical Outcomes and Survival.

BACKGROUND: Cardiac surgery is the most common setting for massive transfusion in medically advanced countries. Studies of massive transfusion after injury suggest that the ratios of administered plasma and platelets (PLT) to red blood cells (RBCs) affect mortality. Data from the Red Cell Storage Duration Study (RECESS), a large randomized trial of the effect of RBC storage duration in patients undergoing complex cardiac surgery, were analyzed retrospectively to investigate the association between blood component ratios used in massively transfused patients and subsequent clinical outcomes. METHODS: Massive transfusion was defined as those who had ≥6 RBC units or ≥8 total blood components. For plasma, high ratio was defined as ≥1 plasma unit:1 RBC unit. For PLT transfusion, high ratio was defined as ≥0.2 PLT doses:1 RBC unit; PLT dose was defined as 1 apheresis PLT or 5 whole blood PLT equivalents. The clinical outcomes analyzed were mortality and the change in the Multiple Organ Dysfunction Score (ΔMODS) comparing the preoperative score with the highest composite score through the earliest of death, discharge, or day 7. Outcomes were compared between patients transfused with high and low ratios. Linear and Cox regression were used to explore relationships between predictors and continuous outcomes and time to event outcomes. RESULTS: A total of 324 subjects met the definition of massive transfusion. In those receiving high plasma:RBC ratio, the mean (SE) 7- and 28-day ΔMODS was 1.24 (0.45) and 1.26 (0.56) points lower, (P = .007 and P = .024), respectively, than in patients receiving lower ratios. In patients receiving high PLT:RBC ratio, the mean (SE) 7- and 28-day ΔMODS were 1.55 (0.53) and 1.49 (0.65) points lower (P = .004 and P = .022), respectively. Subjects who received low-ratio plasma:RBC transfusion had excess 7-day mortality compared with those who received high ratio (7.2% vs 1.7%, respectively, P = .0318), which remained significant at 28 days (P = .035). The ratio of PLT:RBCs was not associated with differences in mortality. CONCLUSIONS: This analysis found that in complex cardiac surgery patients who received massive transfusion, there was an association between the composition of blood products used and clinical outcomes. Specifically, there was less organ dysfunction in those who received high-ratio transfusions (plasma:RBCs and PLT:RBCs), and lower mortality in those who received high-ratio plasma:RBC transfusions.

Utilizing a Collaborative Learning Model to Promote Early Extubation Following Infant Heart Surgery.

OBJECTIVE: To determine whether a collaborative learning strategy-derived clinical practice guideline can reduce the duration of endotracheal intubation following infant heart surgery. DESIGN: Prospective and retrospective data collected from the Pediatric Heart Network in the 12 months pre- and post-clinical practice guideline implementation at the four sites participating in the collaborative (active sites) compared with data from five Pediatric Heart Network centers not participating in collaborative learning (control sites). SETTING: Ten children's hospitals. PATIENTS: Data were collected for infants following two-index operations: 1) repair of isolated coarctation of the aorta (birth to 365 d) and 2) repair of tetralogy of Fallot (29-365 d). There were 240 subjects eligible for the clinical practice guideline at active sites and 259 subjects at control sites. INTERVENTIONS: Development and application of early extubation clinical practice guideline. MEASUREMENTS AND MAIN RESULTS: After clinical practice guideline implementation, the rate of early extubation at active sites increased significantly from 11.7% to 66.9% (p < 0.001) with no increase in reintubation rate. The median duration of postoperative intubation among active sites decreased from 21.2 to 4.5 hours (p < 0.001). No statistically significant change in early extubation rates was found in the control sites 11.7% to 13.7% (p = 0.63). At active sites, clinical practice guideline implementation had no statistically significant impact on median ICU length of stay (71.9 hr pre- vs 69.2 hr postimplementation; p = 0.29) for the entire cohort. There was a trend toward shorter ICU length of stay in the tetralogy of Fallot subgroup (71.6 hr pre- vs 54.2 hr postimplementation, p = 0.068). CONCLUSIONS: A collaborative learning strategy designed clinical practice guideline significantly increased the rate of early extubation with no change in the rate of reintubation. The early extubation clinical practice guideline did not significantly change postoperative ICU length of stay.

Characterizing cardiac contractile motion for noninvasive radioablation of ventricular tachycardia.

Background: Respiratory motion management strategies are used to minimize the effects of breathing on the precision of stereotactic ablative radiotherapy for ventricular tachycardia, but the extent of cardiac contractile motion of the human heart has not been systematically explored. Objective: We aim to assess the magnitude of cardiac contractile motion between different directions and locations in the heart. Methods: Patients with intracardiac leads or valves who underwent 4-dimensional cardiac computed tomography (CT) prior to a catheter ablation procedure for atrial or ventricular arrhythmias at 2 medical centers were studied retrospectively. The displacement of transvenous right atrial appendage, right ventricular (RV) implantable cardioverter-defibrillator, coronary sinus lead tips, and prosthetic cardiac devices across the cardiac cycle were measured in orthogonal 3-dimensional views on a maximal-intensity projection CT reconstruction. Results: A total of 31 preablation cardiac 4-dimensional cardiac CT scans were analyzed. The LV lead tip had significantly greater motion compared with the RV lead in the anterior-posterior direction (6.0 ± 2.2 mm vs 3.8 ± 1.7 mm; P = .01) and superior-inferior direction (4.4 ± 2.9 mm vs 3.5 ± 2.0 mm; P = .049). The prosthetic aortic valves had the least movement of all fiducials, specifically compared with the RV lead tip in the left-right direction (3.2 ± 1.2 mm vs 6.1 ± 3.8 mm, P = .04) and the LV lead tip in the anterior-posterior direction (3.8 ± 1.7 mm vs 6.0 ± 2.2 mm, P = .03). Conclusion: The degree of cardiac contractile motion varies significantly (1 mm to 15.2 mm) across different locations in the heart. The effect of contractile motion on the precision of radiotherapy should be assessed on a patient-specific basis.

Sleep Apnea Combined with Pulmonary Hypertension in a Veteran Patient Population.

We have investigated the concurrence of sleep apnea and pulmonary hypertension in a Veteran population. We retrospectively reviewed 142 patients who underwent chest CT scans and had a dilated main pulmonary artery, defined as a width exceeding 29 mm on axial images. Approximately 40% of patients with pulmonary hypertension had associated sleep apnea. No significant difference in pulmonary artery diameters could be found between the group without sleep apnea and the group with sleep apnea (34.5 ± 4.2 mm vs. 34.7 ± 4.4 mm, p = 0.373).

Associations between coronary calcification on chest radiographs and mortality in hemodialysis patients.

BACKGROUND: KDIGO (Kidney Disease: Improving Global Outcomes) guidelines recommend lateral abdominal radiographs to assess vascular calcification in incident dialysis patients. However, nearly all dialysis patients in the United States receive chest radiographs at dialysis therapy inception, which may provide readily available information on coronary artery (CAC) and aortic arch calcification (AAC). We determined the prevalence of CAC and AAC visible on plain chest radiographs and their associations with mortality in our dialysis population. STUDY DESIGN: Retrospective analysis. SETTING & PARTICIPANTS: 93 participants who received maintenance hemodialysis at the San Diego Veterans Affairs Medical Center in 2009-2010. PREDICTOR: Presence of CAC and AAC as evaluated by a radiologist. OUTCOME: All-cause mortality. RESULTS: Average age was 64 years, 22% were African American, and 97% were men. CAC and AAC prevalences were 25% and 58%, respectively. During 20 months' follow-up, 28% died. CAC was associated with mortality in models including cardiovascular (HR, 2.41; 95% CI, 1.04-5.59) and dialysis-related (HR, 2.86; 95% CI, 1.24-6.60) risk factors. AAC was associated with HRs of 5.25 (95% CI, 1.46-17.72) in cardiovascular risk factor-adjusted models and 7.31 (95% CI, 2.03-26.34) in dialysis models. When CAC and AAC were both included in models, both CAC (HR, 3.40; 95% CI, 1.24-9.36) and AAC (HR, 6.23; 95% CI, 1.64-23.66) remained significantly associated with mortality. LIMITATIONS: The study sample is relatively small and mostly male. CONCLUSIONS: CAC and AAC are highly prevalent on chest radiographs in dialysis patients and strongly associated with mortality independent of one another. Because these images are nearly ubiquitous, inexpensive, and often obtained for other indications, they should be considered for risk assessment in hemodialysis patients. Future studies are required to determine whether CAC or AAC on chest radiography is additive or duplicative of the risk of aorto-iliac calcification on lateral abdominal radiographs currently suggested by KDIGO.

The five-vessel arch: independent origin of both vertebral arteries from the aortic arch.

An independent origin of the left vertebral artery from the aortic arch is the second most common aortic arch anomaly and occurs in 7% of otherwise healthy persons. Bilateral and independent origins of vertebral arteries are distinctly unusual. We present and illustrate such a case.

Trap door: an alternative procedure to the triangular distal wedge for the elimination of distal periodontal pockets adjacent to edentulous areas.

The study compared a novel trap door (TD) technique with the triangular distal wedge (TW) procedure for the elimination of distal periodontal pockets adjacent to edentulous areas. Thirteen patients with suprabony pockets ≥ 5 mm at the distal surface of terminal molars bilaterally were included in this prospective, single-blinded, randomized clinical trial using a split-mouth design. The authors demonstrated the efficacy of an alternative TD technique in the elimination of the distal pockets adjacent to the terminal molars.

Bovine Coronavirus Infects the Respiratory Tract of Cattle Challenged Intranasally.

Bovine Coronavirus (BCoV) is a member of a family of viruses associated with both enteric and respiratory diseases in a wide range of hosts. BCoV has been well-established as a causative agent of diarrhea in cattle, however, its role as a respiratory pathogen is controversial. In this study, fifteen calves were challenged intranasally with virulent BCoV in order to observe the clinical manifestation of the BCoV infection for up to 8 days after initial challenge, looking specifically for indication of symptoms, pathology, and presence of viral infection in the respiratory tract, as compared to six unchallenged control calves. Throughout the study, clinical signs of disease were recorded and nasal swabs were collected daily. Additionally, bronchoalveolar lavage (BAL) was performed at 4 days Post-challenge, and blood and tissue samples were collected from calves at 4, 6, or 8 days Post-challenge to be tested for the presence of BCoV and disease pathology. The data collected support that this BCoV challenge resulted in respiratory infections as evidenced by the isolation of BCoV in BAL fluids and positive qPCR, immunohistochemistry (IHC), and histopathologic lesions in the upper and lower respiratory tissues. This study can thus be added to a growing body of data supporting that BCoV is a respiratory pathogen and contributor to respiratory disease in cattle.

Thoracic CT findings in Birt-Hogg-Dube syndrome.

OBJECTIVE: Birt-Hogg-Dubé syndrome manifests in the thorax as lung cysts. The purpose of this article is to describe the CT characteristics of cysts in patients with Birt-Hogg-Dubé syndrome and to note other thoracic findings. MATERIALS AND METHODS: The thoracic CT examinations of 17 patients with Birt-Hogg-Dubé syndrome were reviewed retrospectively for the presence, anatomic distribution (upper lung predominant, lower lung predominant, or diffuse), extent (size, number), and morphology (shape, wall thickness) of cysts. Any additional thoracic findings were also noted. RESULTS: The study population consisted of 13 women (76%) and four men (24%) with a mean age of 50.2 ±15.2 years. Two patients (12%) had normal findings on CT. Fifteen patients had cystic lung disease, all of whom had more than one cyst. Most patients had bilateral (13/15, 87%) and lower lung-predominant cysts (13/15, 87%). The cysts varied in size from 0.2 to 7.8 cm. The largest cysts were located in the lower lobes of 14 of 15 patients (93%). Of the nine patients with large cysts, most had at least one multiseptated cyst (7/9, 78%). Five of 15 patients (33%) had more than 20 cysts. Cyst shape varied among the 15 patients and also within individual patients (10/15, 67%) ranging from round to oval, lentiform, and multiseptated. Cysts showed no central or peripheral predominance. CONCLUSION: Discrete thin-walled cysts in patients with Birt-Hogg-Dubé syndrome are more numerous and larger in the lower lobes and vary in size and shape. Large lung cysts are frequently multiseptated. These features may aid in differentiating Birt-Hogg-Dubé syndrome from other more common cystic lung diseases.

Comparison of preoperative computed tomography and surgical findings in maxillofacial infections.

PURPOSE: To examine the accuracy of computed tomography (CT) in predicting the presence of surgically confirmed abscess in patients presenting with deep maxillofacial infections (DMIs). MATERIALS AND METHODS: The medical records of 36 patients with clinically suspected DMI were reviewed. All patients underwent preoperative CT scan to determine whether abscess or cellulitis was present. The operative reports of all patients were compared with their preoperative CT scan findings. RESULTS: Of 36 patients, 30 had abscess predicted by preoperative CT scan. The positive predictive value for DMI based on CT findings interpreted by an oral surgeon and confirmed as an abscess at operation was 90%, whereas the negative predictive value was 33%. When findings were interpreted by a radiologist, the positive predictive value was 94.1% whereas the negative predictive value was 26.3%. Thirty patients had abscess predicted by preoperative CT scan when interpreted by an oral surgeon, whereas seventeen had abscess predicted by a radiologist. At operation, 3 of 30 patients had cellulitis whereas 27 had abscess, for a false-positive rate of 60% and false-negative rate of 12.9%. On the basis of preoperative radiography, 1 of 17 patients had cellulitis whereas 16 had abscess, for a false-positive rate of 16.7% and a false-negative rate of 46.7%. The agreement between CT and operative findings in predicting abscess by an oral surgeon was 80.6% and by a radiologist was 58.3%. CONCLUSION: CT yielded high sensitivity for the detection of DMI abscess but poor specificity, likely because of the paucity of cellulitis.

Marginal microleakage of triage sealant under different moisture contamination.

PURPOSE: Glass ionomer sealants (GISs) are promoted in pediatric dentistry for their moisture-friendly properties. This study's purpose was to investigate the marginal leakage of a glass ionomer sealant (Fuji Triage) under different moisture environments. METHODS: Eighty extracted teeth were distributed into 4 groups: (1) control; (2) saliva contamination with 1-second air-thinning; (3) saliva contamination with 10 seconds of air-drying; and (4) saliva contamination with reconditioning. Sealants were placed after contamination. All extracted teeth underwent thermocycling followed by 1% methylene blue dye and distilled water wash. All extracted teeth were then sectioned buccolingually into 3 cross-sections and examined at 60X under a stereomicroscope. Microleakage was assessed using a dye penetration scoring system (score=0-3). Data were analyzed with Kruskal-Wallis and Mann-Whitney tests. RESULTS: The control group showed significantly lower marginal leakage than the other 3 groups (P<.02). There was no statistically significant difference among the 3 contaminated groups (P>.34). CONCLUSIONS: Fuji Triage sealant had the least marginal leakage under a moisture-controlled environment. When saliva was introduced during the application of the material, microleakage significantly increased. When contamination occurred, 1-second air-thinning of the saliva, 10-second air-drying of the saliva, or reconditioning before sealant application did not show a difference in decreasing microleakage.

Fears and concerns of individuals contemplating esthetic restorative dentistry.

Questionnaires that focus on the fear of dental treatment typically include a narrow list of previous treatment-related factors. By omitting items concerned with psychologic, emotional, and interpersonal traits that impact treatment, practitioners often fail to gain additional valuable information on related anxiety issues. This study was undertaken to identify previously unrecognized or poorly discussed sources of fear and anxiety in patients seeking esthetic dental treatment. The Esthetic Clinic at Tufts University School of Dental Medicine recruited 62 participants who were asked to score their level of anxieties and concerns based on 24 different items on a 0 to 5 Likert scale. In addition, age, gender, and type of procedure in consideration were the only other variables recorded. The item that elicited the highest level of anxiety was "not feeling happy with my new smile." Thirty-eight respondents (61.3%) said they feel "markedly anxious"or "severely anxious" or answered "avoid completely." Concerns "that the outcome might look false and unnatural" or "that the dentist might not redo it if I am not satisfied with the outcome" both received 37 out of 62 (59.7%) similar responses. These results suggest obstacles to treatment exist not only in areas typically investigated but also in factors rarely discussed during the patient-practitioner encounter. The practitioner needs to consider a broader range of issues when addressing the patient's concerns.

Prevalence of ICD-9-CM codes for chronic kidney disease in individuals with cardiovascular disease risk factors.

BACKGROUND: Chronic kidney disease (CKD) is a risk factor for cardiovascular disease (CVD). METHODS: We determined the prevalence of diagnosed CKD in 87,128 members older than 40 years of age without CVD who were enrolled in a regional medical care plan with at least 1 claim for medical care. RESULTS: The prevalence of diagnosed CKD was 4%, and 8%, 6%, 5% and 10% in patients with diabetes, hypertension, hyperlipidemia and all 3 risk factors, respectively. In multivariate analysis, the odd ratios for CKD were 1.8 (95% confidence interval [95% CI], 1.7-2.0) for older age, 2.5 (95% CI, 2.3-2.8) for diabetes, 2.2 (95% CI, 2.2-2.4) for hypertension, 1.5 (95% CI, 1.4-1.7) for hyperlipidemia and 4.4 (95% CI, 2.8, 5.1) for all 3 risk factors. CONCLUSION: Prevalence of diagnosed CKD among patients with CVD risk factors is low but increases with age and number of risk factors, suggesting inadequate awareness of CKD. This may have implications for control of CVD risk factors in patients with CKD.

Evaluation of the coronary sinus on chest computed tomography in patients with and without pulmonary artery hypertension.

OBJECTIVE: To identify and measure the coronary sinus (CS) in patients with and without pulmonary artery hypertension (PAH) using chest computed tomography (CT). METHODS: Using a 4-channel GE LightSpeed CT scanner, nongated axial chest CT images were obtained after intravenous injection of contrast material. Catheterization of the right side of the heart was performed in patients with known or suspected PAH. RESULTS: The CS was identified in all 60 patients (mean +/- SD, 60.5 +/- 17.5 years; 45% men) without PAH (control group) (mean +/- SD, diameter 7.05 +/- 1.90 mm). In 24 patients (9 men; average age +/- SD, 54.1 +/- 14.5 years) with known or suspected PAH (study group), pulmonary artery (PA) pressures were increased; the CS was dilated (mean +/- SD, 9.4 +/- 4. 2 mm); and its size correlated with right atrial pressure (r = 0.358, P = 0.061), mean PA pressure (r = 0.568, P = 0.005), systolic PA pressure (r = 0.375, P = 0.071), and diastolic PA (r = 0.561, P = 0.004). CONCLUSION: The CS is routinely visualized and measurable on chest CT. In patients with PAH, CS dilation is associated with increased PA pressures.

Influence of patient head positioning on measured axial tooth inclination in panoramic radiography.

OBJECTIVE: Panoramic radiographs are routinely used to assess the mesiodistal axial inclination of teeth (MDAI) in orthodontic treatment. These radiographs are sensitive to minor deviations from standard head position that result in image distortions. The aim of this study is to measure and quantify the changes in MDAI on panoramic radiograph resulting from changes in patient head position. MATERIALS AND METHODS: The testing devise was a human skull with guide wires placed on the facial surface of the teeth and alveolar process along the long axis of each tooth. Panoramic radiographs were captured digitally with the orientation of the skull in Frankfurt horizontal plane parallel to the floor and with 1 degrees , 2 degrees , 5 degrees , 7 degrees , and 10 degrees both superior and inferior rotations. The mesiodistal tooth angulations were determined using MIPAC software (DentalEye and LEAD Technologies, Inc. 2005). RESULTS: The more distal the position of the tooth in the arch the greater the change in MDAI with a change in vertical head position. A maximum change of approximately 10 degrees was observed in MDAI of both the maxillary and mandibular molars with a corresponding superior head tilt of 10 degrees. The Mandibular anteriors displayed significant inconsistencies in MDAI with both superior and inferior head tilt. A superior head tilt produced a greater change in mesiodistal angulation than did an inferior head tilt. CONCLUSIONS: Accurately taken panoramic radiographs can serve as a convenient tool for evaluating the MDAI before, during and after orthodontic treatment. Additional radiographs are recommended for the mandibular anteriors.

Sensitivity of direct tissue fluorescence visualization in screening for oral premalignant lesions in general practice.

Various specialty clinics and research centers have conducted studies of direct tissue fluorescence visualization as a screening technique for oral premalignant lesions and early oral squamous cell carcinoma (OSCC). The effectiveness of the VELscope in a private practice setting is unknown. This pilot study is the first report to assess the VELscope system as a screening adjunct among lower-risk populations seen by a primary care clinician in a general practice setting. This study involved a retrospective comparison of two oral cancer screening examination protocols conducted on a presumably low-risk patient population seen in a private general dentistry practice. For one year, all patients age 12 or older received oral examinations, according to a standard oral cancer screening protocol. The following year, the same population was examined according to the same protocol with the addition of direct tissue fluorescence visualization using the VELscope. Screening with incandescent light examination yielded a prevalence of mucosal abnormalities of 0.83%, none of wich were premalignant. Screening with incandescent light examination combined with direct tissue fluorescence visualization yielded a 1.3% prevalence of mucosal abnormalities; based on surgical biopsy and histopathologic examination, 83% of these were potentially premalignant epithelial dysplasia.

Ozone effects on blood biomarkers of systemic inflammation, oxidative stress, endothelial function, and thrombosis: The Multicenter Ozone Study in oldEr Subjects (MOSES).

The evidence that exposure to ozone air pollution causes acute cardiovascular effects is mixed. We postulated that exposure to ambient levels of ozone would increase blood markers of systemic inflammation, prothrombotic state, oxidative stress, and vascular dysfunction in healthy older subjects, and that absence of the glutathione S-transferase Mu 1 (GSTM1) gene would confer increased susceptibility. This double-blind, randomized, crossover study of 87 healthy volunteers 55-70 years of age was conducted at three sites using a common protocol. Subjects were exposed for 3 h in random order to 0 parts per billion (ppb) (filtered air), 70 ppb, and 120 ppb ozone, alternating 15 min of moderate exercise and rest. Blood was obtained the day before, approximately 4 h after, and approximately 22 h after each exposure. Linear mixed effect and logistic regression models evaluated the impact of exposure to ozone on pre-specified primary and secondary outcomes. The definition of statistical significance was p<0.01. There were no effects of ozone on the three primary markers of systemic inflammation and a prothrombotic state: C-reactive protein, monocyte-platelet conjugates, and microparticle-associated tissue factor activity. However, among the secondary endpoints, endothelin-1, a potent vasoconstrictor, increased from pre- to post-exposure with ozone concentration (120 vs 0 ppb: 0.07 pg/mL, 95% confidence interval [CI] 0.01, 0.14; 70 vs 0 ppb: -0.03 pg/mL, CI -0.09, 0.04; p = 0.008). Nitrotyrosine, a marker of oxidative and nitrosative stress, decreased with increasing ozone concentrations, with marginal significance (120 vs 0 ppb: -41.5, CI -70.1, -12.8; 70 vs 0 ppb: -14.2, CI -42.7, 14.2; p = 0.017). GSTM1 status did not modify the effect of ozone exposure on any of the outcomes. These findings from healthy older adults fail to identify any mechanistic basis for the epidemiologically described cardiovascular effects of exposure to ozone. The findings, however, may not be applicable to adults with cardiovascular disease.