Switching from onabotulinum toxin A to abobotulinum toxin A for treating detrusor overactivity in spinal cord injured patient, does it really work?

AIM: To assess the efficacy of switching to Abobotulinumtoxin A (ATA) intradetrusor injections (IDI) after failure of Onabotulinumtoxin A (OTA) IDI for the treatment of neurogenic detrusor overactivity in patients with spinal cord injury (SCI). MATERIALS AND METHODS: A single-centre retrospective chart review study. All SCI patients who started OTA IDI after 2011 and had an ATA IDI switch were included. The primary outcome was the clinical and urodynamic efficacy of the switch to ATA IIDs at the last follow-up. Secondary outcomes were initial efficacy, duration of ATA treatment, and patient outcome including the occurrence of augmentation enterocystoplasty at last follow-up. RESULTS: Sixty-two patients were included. Eighteen patients (28.9%) were initially responders to ATA IDI. Nine patients (14.5%) remained responders at last follow-up after a median of 17 months (AE 8.8-29). Thirty-two patients (51.6%) had had or were awaiting augmentation enterocystoplasty with a follow-up time of 18.5 months (IQR 8-27). Eleven patients (17.7%) were on ATA IDI with low efficacy. Seven patients (11.3%) were switched back to OTA and 3 patients (4.8%) changed their voiding pattern. CONCLUSION: Switching from OTA to ATA toxin for IDI in the treatment of detrusor overactivity after spinal cord injury have long-term efficacy for a limited number of patients but may delay the need for surgery.

[External sphincterotomy in neurological patients with detrusor sphincter dyssynergia: Short and mid-term results]. / Résultat à court et moyen terme du traitement de la dyssynergie vésico-sphinctérienne par sphinctérotomie endoscopique.

BACKGROUND: To evaluate in the short and mid-term the success of external sphincterotomy (ES) in neurological patients with detrusor sphincter dyssynergia (DSD). METHODS: Retrospective, monocentric study, conducted in 51 patients who had a first ES between January 2003 and June 2018, with at least two years of follow-up. The success of ES was defined by maintenance of reflex voiding mode at the end of follow-up. Secondary outcomes were early postoperative complications, rate of revision, functional impact, urodynamic follow-up and upper urinary tract impact. RESULTS: The median age was 50.6 years and the median follow-up was 4.6 years. The success rate was 80% (n=41). Ten patients had to change their voiding mode. For 5 patients, it was related to secondary detrusor low contractility. A second ES was required for 39% of patients. At the end of follow-up, there was a significant improvement in Autonomic Dysreflexia (AD) (26 vs 7 patients, P<0.001), urinary tract infections (UTI) (31 vs 15 patients, P<0.001) and a significant decrease in post-voiding residuals (200 vs 50mL, P<0.001). CONCLUSION: ES allowed to maintain reflex voiding in 80% of our patients. It significantly improves AD and UTI despite a high rate of re-operation (39%). A long-term follow-up is mandatory in order not to ignore a recurrence of bladder outlet obstruction and/or decrease in detrusor contractility, which may justify a re-operation or an alternative bladder management. LEVEL OF EVIDENCE: III.

Spinal cord injury: A multisystem physiological impairment/dysfunction.

Spinal cord injury (SCI) is a complex disease that affects not only sensory and motor pathways below the neurological level of injury (NLI) but also all the organs and systems situated below this NLI. This multisystem impairment implies comprehensive management in dedicated SCI specialized centers, by interdisciplinary and multidisciplinary teams, able to treat not only the neurological impairment, but also all the systems and organs affected. After a brief history of the Spinal Cord Medicine, the author describes how to determine the level and severity of a SCI based on the International Standards for Neurological Classification of Spinal Cord Injury and the prognosis factors of recovery. This article provides also a review of the numerous SCI-related impairments (except for urinary, sexual problems and pain treated separately in this issue), their principles of management and related complications.

A prospective, multi-center, practice-based cohort study on all-ceramic crowns.

OBJECTIVES: The aim of this prospective, multi-center, practice-based cohort study was to analyze factors associated with the success of all-ceramic crowns. METHODS: All-ceramic crowns placed in a practice-based research network ([Ceramic Success Analysis, AG Keramik) were analyzed. Data from 1254 patients with (mostly in-office CAD/CAM) all-ceramic crowns placed by 101 dentists being followed up for more than 5 years were evaluated. At the last follow-up visit crowns were considered as successful (not failed) if they were sufficient, whereas crowns were considered as survived (not lost) if they were still in function. Multi-level Cox proportional hazards models were used to evaluate the association between a range of predictors and time of success or survival. RESULTS: Within a mean follow-up period (SD) of 7.2(2)years [maximum:15years] 776 crowns were considered successful (annual failure rate[AFR]:8.4%) and 1041 crowns survived (AFR:4.9%). The presence of a post in endodontically treated teeth resulted in a risk for failure 2.7 times lower than that of restorations without a post (95%CI:1.4-5.0;p = 0.002). Regarding the restorative material and adhesive technique, hybrid composite ceramics and single-step adhesives showed a 3.4 and 2.2 times higher failure rate than feldspathic porcelain and multi-step adhesives, respectively (p < 0.001). Use of an oxygen-blocking gel as well as an EVA instrument resulted in a 1.5-1.8 times higher failure rate than their non-use (p ≤ 0.001). SIGNIFICANCE: After up to 15years AFR were rather high for all-ceramic crowns. Operative factors, but no patient- or tooth-level factors were significantly associated with failure. The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00020271).

Calculation of breast volumes from mammogram: Comparison of four separate equations relative to mastectomy specimen volumes.

BACKGROUND AND OBJECTIVES: Accurately assessing breast volume (BV) relative to the volume of breast tissue to be removed could help objectively determine the optimal surgical candidates for breast conserving surgery. The objective of this study was to determine the optimal mammography-based method of BV estimation. METHODS: Mammography data was obtained for patients who underwent mastectomy for breast cancer from 2005 to 2015. This data was used to calculate BV using four previously published equations. Results were compared to mastectomy specimen volumes calculated from specimen weights and breast density. Five practitioners then independently assessed reproducibility and ease of use. RESULTS: Complete mammographic measurements were available for 65 breasts from 45 patients. Median age was 58 years (range 19-82). Mammographic breast density scores were available for 62 breasts. Of the 65 mastectomies performed, 16 (36%) were simple mastectomies. The equation BV = 1/3πRcc Rmlo Hmlo most closely approximated actual breast specimen volumes (R = 0.89, P < 0.0001). Internal correlation of calculated BV was excellent among all practitioners (lowest Pearson R = 0.963). CONCLUSIONS: Breast volumes can be reliably estimated utilizing measurements from a preoperative mammogram. This low-cost method of volumetric analysis can be employed to guide surgical decision making in treatment of patients with invasive breast cancer.

Outdoor, indoor, and personal black carbon exposure from cookstoves burning solid fuels.

Black carbon (BC) emissions from solid fuel combustion are associated with increased morbidity and mortality and are important drivers of climate change. We studied BC measurements, approximated by particulate matter (PM2.5 ) absorbance, in rural Yunnan province, China, whose residents use a variety of solid fuels for cooking and heating including bituminous and anthracite coal, and wood. Measurements were taken over two consecutive 24-h periods from 163 households in 30 villages. PM2.5 absorbance (PMabs ) was measured using an EEL 043 Smoke Stain Reflectometer. PMabs measurements were higher in wood burning households (16.3 × 10(-5) /m) than bituminous and anthracite coal households (12 and 5.1 × 10(-5) /m, respectively). Among bituminous coal users, measurements varied by a factor of two depending on the coal source. Portable stoves (which are lit outdoors and brought indoors for use) were associated with reduced PMabs levels, but no other impact of stove design was observed. Outdoor measurements were positively correlated with and approximately half the level of indoor measurements (r = 0.49, P < 0.01). Measurements of BC (as approximated by PMabs ) in this population are modulated by fuel type and source. This provides valuable insight into potential morbidity, mortality, and climate change contributions of domestic usage of solid fuels.

Indoor concentrations of nitrogen dioxide and sulfur dioxide from burning solid fuels for cooking and heating in Yunnan Province, China.

The Chinese national pollution census has indicated that the domestic burning of solid fuels is an important contributor to nitrogen dioxide (NO2 ) and sulfur dioxide (SO2 ) emissions in China. To characterize indoor NO2 and SO2 air concentrations in relation to solid fuel use and stove ventilation in the rural counties of Xuanwei and Fuyuan, in Yunnan Province, China, which have among the highest lung cancer rates in the nation, a total of 163 participants in 30 selected villages were enrolled. Indoor 24-h NO2 and SO2 samples were collected in each household over two consecutive days. Compared to smoky coal, smokeless coal use was associated with higher NO2 concentrations [geometric mean (GM) = 132 µg/m(3) for smokeless coal and 111 µg/m(3) for smoky coal, P = 0.065] and SO2 [limit of detection = 24 µg/m(3) ; percentage detected (%Detect) = 86% for smokeless coal and 40% for smoky coal, P < 0.001]. Among smoky coal users, significant variation of NO2 and SO2 air concentrations was observed across different stove designs and smoky coal sources in both counties. Model construction indicated that the measurements of both pollutants were influenced by stove design. This exposure assessment study has identified high levels of NO2 and SO2 as a result of burning solid fuels for cooking and heating.

CSA: the online portal for determining the clinical standing of ceramic restorations in practice.

For the individual dentist, the Ceramic Success Analysis (CSA) is atried and tested internet-based platform for monitoring the clinical success of all-ceramic restorations. After compiling an insertion protocol and recording the findings from regular clinical follow-up examinations, an analysis follows which culminates in the re-evaluation of the indication and the treatment approach. The evaluations of the 12-year results confirm a high success rate for all-ceramic restorations. Factors which influence the long-term success are: tooth vitality, an indicated crown, the use of a two-bottle dentin adhesive, and the placement of rubber-dam in the adhesive cementation technique.

Powdering or spraying.

Application--especially in combination with the new camera--is so easy and advantageous that it has advanced to become the standard procedure in our practice. Potential for improvement still exists in the stiffness of the cannula, in a release mechanism located separately from the cannula and in the impudent demand to completely do away with powder and spray. Despite announcements to the contrary by alternative systems, the fulfilment of this desire appears to be a long way off.

Challenges of exposure assessment for health studies in the aftermath of chemical incidents and disasters.

Exposure assessment during and after acute chemical incidents and disasters is essential for health studies that may follow. During chemical incidents, the focus usually lies on risk assessment and afterward attention shifts toward possible (long-term) health effects. This may lead to insufficient available data on exposure to study the association between exposure and health outcome, and collection of additional exposure data is often required. Literature on health studies conducted after several chemical incidents was reviewed to obtain better insight on the needs of health studies. Four different types of scenarios were distinguished based on when exposure data were collected and the exposure data used for health studies. These four scenarios gave insight on exposure data needed for conclusive health studies and when different methods of exposure data collection should be used. Literature indicated that adequate and rapid exposure assessment during chemical incidents is vital for health studies, because data that are not collected during or directly after an incident may be irretrievably lost. Poor exposure assessment is not always the only problem in health studies. Problems in health studies including poor exposure assessment may be prevented when the general design and needs of health studies are taken into account when designing contingency plans. Together with measures that will help facilitate funding, design, and coordination of health studies, disaster management programs should, among others, prepare for methods that lead to a swift identification of released substances, determination of concentrations and dispersion of released substances, designing basic questionnaire outlines, and rapid evaluation of the usefulness and necessity of employing biological sampling.

Clinical results of Cerec inlays in a dental practice over a period of 18 years.

In a German dental practice, 299 patients were treated with 1011 ceramic fillings between June 1987 and October 1990. The restorations were produced according to the Cerec method and in each case inserted adhesively at the same appointment. The clinical success was continuously observed and documented. The period in place was between 15 and 18 years. Event criteria were loss of the tooth or of the restoration, fracture with partial loss of tooth and/or restoration, marginal caries, marginal repair and endodontic complication. The probability of success according to the Kaplan-Meier method was reduced after 16.7 years to a value of 84.4%. No further event was observed up to the final time of 18.3 years. If "restoration still in place" is made the basis for the survival analysis, ie, therapeutic measures such as trepanation and marginal correction with composite remain unconsidered, then the Kaplan-Meier value for the observation period is 89%. The size of the filling had no influence on the success prognosis. Premolars achieved a better result than molars. Vital teeth prove to be better than non-vital teeth. The use of dentin adhesives increased the probability of success. A total of 121 events, 86 of these losses of restoration, occurred in the observation interval. The most frequent causes were ceramic and tooth fractures.

The family of CONSTANS-like genes in Physcomitrella patens.

The CONSTANS (CO) gene plays a central role in the regulation of flowering time in Arabidopsis, and is a member of a family of 17 CO-like genes. CO and CO-like genes have been found in all flowering plants, but not in yeast and animals. To address the question of the origin of CO, we analysed this gene family in the moss Physcomitrella patens, a phylogenetically distant organism. Database searches in EST libraries that almost completely covered the Physcomitrella transcriptome, and Southern blotting, identified only three genes that had all of the hallmarks of CO. Further analysis demonstrated that these are most similar to CO-like genes AtCOL3/AtCOL4/AtCOL5, a group of Arabidopsis genes closely related to, but distinct from CO, suggesting that the CO branch of the AtCOL phylogeny does not exist in the Physcomitrella genome. Since 17 COL genes occur in Arabidopsis and only three closely related and two distantly related genes were found in Physcomitrella, the family of CO-like proteins appears to be smaller in Physcomitrella than in Arabidopsis, in agreement with observations made with other gene families. The data also indicate that CO-like genes must have existed in the common ancestor of bryophytes and flowering plants, and that CO originated in the group of CO-like genes represented by AtCOL3/AtCOL4/AtCOL5. Furthermore, expression of the three closely related Physcomitrella homologues is regulated by light, suggesting that the role of CO in flowering time control was probably derived from an ancestral function in light signal transduction.

Occlusal surface design with Cerec 3D.

Apart from the better visualization and simplified entry, the introduction of the new Cerec 3D software has also created new possibilities for designing the occlusal morphology. In this case, not only have the proven Extrapolation, Correlation and Function modes been improved and their use simplified, but an extension of these possibilities by combining different procedures has been introduced.

Submicrometer metallic barcodes.

We synthesized multimetal microrods intrinsically encoded with submicrometer stripes. Complex striping patterns are readily prepared by sequential electrochemical deposition of metal ions into templates with uniformly sized pores. The differential reflectivity of adjacent stripes enables identification of the striping patterns by conventional light microscopy. This readout mechanism does not interfere with the use of fluorescence for detection of analytes bound to particles by affinity capture, as demonstrated by DNA and protein bioassays.

Long-term clinical performance of CEREC restorations and the variables affecting treatment success.

Since the first patient was treated with a CEREC restoration in 1985, several system developments have expanded the indications for which this system can be applied. Concurrently, ongoing research in private practices has contributed to documentation supporting the placement of CEREC restorations based on their performance relative to specific criteria, including tooth vitality, papillary bleeding, quality of margins, quality of ceramic used, treatment required, and failures. This article summarizes the methodology and findings of the ongoing clinical evaluations of 1,010 ceramic restorations, including inlays and onlays, placed in 299 patients during a 39-month period, that were reexamined at 9 to 12 years postplacement.