Calcium to phosphorus ratio, essential elements and vitamin D content of infant foods in the UK: Possible implications for bone health.

Adequate intake of calcium and phosphorus in the appropriate ratio of 1-2:1 (Ca:P), in addition to magnesium and vitamin D, is vital for bone health and development of infants. In this feasibility study, the ratio of Ca:P in conjunction with vitamin D and other essential elements (Cu, Fe, K, Mg, Na, and Zn) in a range of commercial infant food products in the UK was investigated. The elemental analysis was carried out using inductively coupled plasma optical emission spectrometry, and vitamin D levels were determined using an enzyme-linked immunosorbent assay. The quantitative data were further evaluated, based on a standardised menu, to measure the total daily intake of an infant aged 7-12 months against the Reference Nutrient Intake. The results from the study show that the Ca:P ratio of the infant's total dietary intake was within the recommended range at 1.49:1. However, the level of intake for each of the nutrients analyzed, with the exception of sodium, was found to be above the Reference Nutrient Intake, which warrants further investigation in relation to both micronutrient interactions and in situations where the intake of fortified infant formula milk is compromised. Finally, as the study is the first to include consumption of infant snack products, the level of total calorie intake was also calculated in order to assess the total daily estimated energy intake; the results indicate that energy intakes exceed recommendations by 42%, which may have implications for obesity.

Enhancement of accelerated carbonation of alkaline waste residues by ultrasound.

The continuous growth of anthropogenic CO2 emissions into the atmosphere and the disposal of hazardous wastes into landfills present serious economic and environmental issues. Reaction of CO2 with alkaline residues or cementitius materials, known as accelerated carbonation, occurs rapidly under ambient temperature and pressure and is a proven and effective process of sequestering the gas. Moreover, further improvement of the reaction efficiency would increase the amount of CO2 that could be permanently sequestered into solid products. This paper examines the potential of enhancing the accelerated carbonation of air pollution control residues, cement bypass dust and ladle slag by applying ultrasound at various water-to-solid (w/s) ratios. Experimental results showed that application of ultrasound increased the CO2 uptake by up to four times at high w/s ratios, whereas the reactivity at low water content showed little change compared with controls. Upon sonication, the particle size of the waste residues decreased and the amount of calcite precipitates increased. Finally, the sonicated particles exhibited a rounded morphology when observed by scanning electron microscopy.

World Workshop on Oral Medicine VI: an international validation study of clinical competencies for advanced training in oral medicine.

OBJECTIVE: To explore international consensus for the validation of clinical competencies for advanced training in Oral Medicine. STUDY DESIGN: An electronic survey of clinical competencies was designed. The survey was sent to and completed by identified international stakeholders during a 10-week period. To be validated, an individual competency had to achieve 90% or greater consensus to keep it in its current format. RESULTS: Stakeholders from 31 countries responded. High consensus agreement was achieved with 93 of 101 (92%) competencies exceeding the benchmark for agreement. Only 8 warranted further attention and were reviewed by a focus group. No additional competencies were suggested. CONCLUSION: This is the first international validated study of clinical competencies for advanced training in Oral Medicine. These validated clinical competencies could provide a model for countries developing an advanced training curriculum for Oral Medicine and also inform review of existing curricula.

Iron bioavailability from commercially available iron supplements.

PURPOSE: Iron deficiency anaemia (IDA) is a global public health problem. Treatment with the standard of care ferrous iron salts may be poorly tolerated, leading to non-compliance and ineffective correction of IDA. Employing supplements with higher bioavailability might permit lower doses of iron to be used with fewer side effects, thus improving treatment efficacy. Here, we compared the iron bioavailability of ferrous sulphate tablets with alternative commercial iron products, including three liquid-based supplements. METHODS: Iron bioavailability was measured using Caco-2 cells with ferritin formation as a surrogate marker for iron uptake. Statistical analysis was performed using one-way ANOVA followed by either Dunnett's or Tukey's multiple comparisons tests. RESULTS: Spatone Apple(®) (a naturally iron-rich mineral water with added ascorbate) and Iron Vital F(®) (a synthetic liquid iron supplement) had the highest iron bioavailability. There was no statistical difference between iron uptake from ferrous sulphate tablets, Spatone(®) (naturally iron-rich mineral water alone) and Pregnacare Original(®) (a multimineral/multivitamin tablet). CONCLUSION: In our in vitro model, naturally iron-rich mineral waters and synthetic liquid iron formulations have equivalent or better bioavailability compared with ferrous iron sulphate tablets. If these results are confirmed in vivo, this would mean that at-risk groups of IDA could be offered a greater choice of more bioavailable and potentially better tolerated iron preparations.

Oral medicine: defining an emerging specialty in the United States.

Oral medicine is a specialized area of study within the scope of dental medicine. This discipline is often viewed as the crossroads between medicine and dentistry and has become integral in both pre-and postdoctoral dental education. Oral medicine is recognized as a dental specialty throughout most of the world and currently represents an emerging specialty in the United States. Historically, oral medicine has been loosely defined in the United States without a clear consensus definition. Recent published studies regarding international oral medicine postdoctoral programs and clinical practice have helped to provide more specific information regarding oral medicine from many perspectives. This article will review the literature relevant to defining oral medicine in the United States and present a new definition of this important discipline based on recent studies.

Elemental content of commercial 'ready to-feed' poultry and fish based infant foods in the UK.

The study reported herein was conducted in order to establish the concentration of 20 essential and non-essential elements in a representative range of commercial infant foods in the UK targeted for infants aged between 6-12 months. The primary objective of this study was to examine the nutritive values and safety of such complementary infant foods on the UK market in relation to dietary and safety guidelines. Quantitative analyses were conducted on eight different products representing four popular brands (poultry and fish based) of ready to-feed infant foods currently on sale in the UK. Six essential elements, namely: calcium, iron, magnesium, potassium, sodium and zinc were determined by ICP-OES. The concentrations of six essential trace elements (selenium, molybdenum, cobalt, copper, chromium, manganese) and eight non-essential, potentially toxic, elements (arsenic, barium, nickel, cadmium, antimony, lead, mercury, aluminium) were determined by ICP-MS due to the higher sensitivity required. The total daily intakes of essential and trace elements from the consumption of such products were then estimated, based on the results of this study, and were referenced to the Recommended Nutrient Intake (RNI) values and safety guidelines for 6-9 months old children. Based on these comparisons the concentration of essential, except for potassium, and trace elements were found to be inadequate in meeting the RNI. In terms of the risk of exposure to toxicity, the concentration of toxic elements in ready to feed products analysed in this study, were not considered to be of concern. These results suggest that commercial complementary infant foods on the UK market may not contain minimum levels of minerals required for labelling declaration of micronutrient content (Commission Directive 2006/125/EC). This provides opportunities and scope for product optimisation to improve their nutritive value.

Essential and trace elements content of commercial infant foods in the UK.

There is a paucity of data in respect of the nutritional quality of complementary foods for infants and young children aged between 6 and 12months. The primary objective of this study was to examine nutritive values of such complementary infant food on the UK market in order to ascertain their suitability relative to dietary guidelines for the 6-9months age group. Quantitative analyses were conducted on eight different products representing four popular brands (meat and vegetable based) currently on sale in the UK. Eight major mineral and trace elements, namely: calcium, copper, magnesium, iron, zinc, potassium, sodium and selenium were measured by ICP-OES and ICP-MS. The results of these studies were referenced to the Recommended Nutrient Intake (RNI) values for 6-9months old children, and a menu of entire daily intake of minerals and trace elements was composed taking into consideration the nutrient and energy intake from milk consumption. Based on these comparisons, all the food samples studied in this work contained less essential minerals than expected from the RNI values except for potassium in meat and vegetable based recipes. These results suggest that commercial complementary infant foods on the UK market may not contain the minimum levels of minerals required for the labelling declaration of micronutrient content (Commission Directive 2006/125/EC). This provides opportunities and scope for product optimisation to improve their nutritive value.

Dermographism and delayed pressure urticaria.

There are few papers in the literature that describe pressure urticaria in the maxillofacial region. We present 2 cases and discuss the significance and principles of management. One case describes the diagnosis of pressure urticaria and the second describes the dental management of a patient with severe pressure urticaria.

Salivary dysfunction associated with systemic diseases: systematic review and clinical management recommendations.

OBJECTIVES: The objective of this study was to identify systemic diseases associated with hyposalivation and xerostomia and develop evidence-based management recommendations for hyposalivation/xerostomia. STUDY DESIGN: Literature searches covered the English language medical literature from 1966 to 2005. An evidence-based review process was applied to management studies published from 2002 to 2005. RESULTS: Several systemic diseases were identified. From studies published 2002 to 2005, 15 were identified as high-quality studies and were used to support management recommendations: pilocarpine and cevimeline are recommended for treating hyposalivation and xerostomia in primary and secondary Sjögren's syndrome (SS). IFN-alpha lozenges may enhance saliva flow in primary SS patients. Anti-TNF-alpha agents, such as infliximab or etanercept, are not recommended to treat hyposalivation in SS. Dehydroepiandrosterone is not recommended to relieve hyposalivation or xerostomia in primary SS. There was not enough evidence to support any recommendations for the use of local stimulants, lubricants, and protectants for hyposalivation/xerostomia. However, professional judgment and patient preferences may support the use of a specific product for an individual patient. CONCLUSIONS: These evidence-based management recommendations should guide the clinician's management decisions for patients with salivary dysfunction related to systemic disease. Future treatment strategies may include new formulations of existing drugs, e.g., local application of pilocarpine. Recent discoveries on gene expression and a better understanding of the etiopathogenesis of SS may open new treatment options in the future.

Oral lichen planus and oral lichenoid lesions: diagnostic and therapeutic considerations.

Several therapeutic agents have been investigated for the treatment of oral lichen planus (OLP). Among these are corticosteroids, retinoids, cyclosporine, and phototherapy, in addition to other treatment modalities. A systematic review of clinical trials showed that particularly topical corticosteroids are often effective in the management of symptomatic OLP lichen planus. Systemic corticosteroids should be only considered for severe widespread OLP and for lichen planus involving other mucocutaneous sites. Because of the ongoing controversy in the literature about the possible premalignant character of OLP, periodic follow-up is recommended. There is a spectrum of oral lichen planus-like ("lichenoid") lesions that may confuse the differential diagnosis. These include lichenoid contact lesions, lichenoid drug reactions and lichenoid lesions of graft-versus-host disease. In regard to the approach to oral lichenoid contact lesions the value of patch testing remains controversial. Confirmation of the diagnosis of an oral lichenoid drug reaction may be difficult, since empiric withdrawal of the suspected drug and/or its substitution by an alternative agent may be complicated. Oral lichenoid lesions of graft-versus-host disease (OLL-GVHD) are recognized to have an association with malignancy. Local therapy for these lesions rests in topical agents, predominantly corticosteroids.

Management of oral epithelial dysplasia: a review.

One of the goals of the fourth meeting of The World Workshop on Oral Medicine (WWOM IV) included a review of the pathophysiology and future directions for the clinical management of patients with oral epithelial dysplasia, excluding the lips and oropharynx. In the pathophysiology review of dysplasia since WWOM III (1998-2006), a wide range of molecular changes associated with progression of dysplasia to squamous cell carcinoma were found. These include loss of heterozygosity, dysregulation of apoptosis, aberrant DNA expression, and altered expression of numerous tissue markers. Based on the literature search, no single molecular pathway has been identified as the primary factor in progression of dysplasia to squamous cell carcinoma. A systematic review of medical (i.e., nonsurgical) management strategies for the treatment of dysplastic lesions has shown promising results in short-term resolution of dysplasia in the small number of studies that met eligibility criteria for review. However, because of the limited periods of follow-up reported in these studies, it remains unclear as whether resolution of dysplasia would actually be a long-term benefit of these interventions. This question is particularly germane when it is considered in the context of prevention of future development of squamous cell carcinoma. Because of the lack of randomized controlled trials that have shown effectiveness in the prevention of malignant transformation, no recommendations can be provided for specific surgical interventions of dysplastic oral lesions either.

Real-time disease surveillance tools for the swine industry in Minnesota.

The ultimate challenge for integrating geographic information systems (GIS) into swine veterinary activities in the United States is to develop systems that deliver effective decision support to practising veterinarians seeking to control hyper-endemic viral diseases such as porcine reproductive and respiratory syndrome (PRRS). Through collaboration with specialist swine veterinarians and state agencies we have developed two tools designed to enable real-time surveillance for swine diseases, based on capture of veterinary clinical data via the internet. The first is an ArcIMS-based Web-mapping application that enables authorised veterinarians to explore high resolution maps of swine premises throughout the state of Minnesota. This is coupled with a database that enables veterinarians to edit or update farm attribute data, including disease status via the internet. The system is generic so that novel or emerging disease syndromes can be incorporated. The second application is an extension to the Rapid Syndrome Validation Project-Animals which was developed for beef cattle to detect changes in disease incidence through recording of patterns of symptoms. The rationale behind these initiatives is that recent technological advances in relevant disciplines provide opportunities for innovation in surveillance that can enhance the capacity of the industry to combat its most pressing disease challenges in a more efficient manner. The acceptance of these novel tools by industry will assist veterinarians and producers in managing common disease problems, and hopefully serve to diminish the historic reluctance of producers to share information about disease status.

Aging, exercise, and limb vascular heterogeneity in humans.

Unlike quadrupeds, human limbs are exposed to differing homeostatic challenges and uses, which results in significant functional heterogeneity between the arms and legs. In these ACSM symposium proceedings, we report findings from three studies with the overall aim of investigating between-limb vascular differences through evaluation of arm (brachial artery) and leg (common, superficial, and deep femoral arteries) limb blood flow (ultrasound Doppler) during isolated-limb-specific exercise and after postcuff occlusion hyperemia. In a study of young, trained cyclists, a substantial conduit vessel vasodilation (deep femoral artery, approximately 9%) was observed during exercise, but responsiveness normalized to shear stimuli was still less than a conduit vessel in the arm. A subsequent aging study did not demonstrate any significant difference in resting leg or arm blood flow between young and old subjects when flow was normalized for muscle mass. However, we observed an approximately 10-15% reduction in exercising leg blood flow and vascular conductance in these older subjects, whereas exercising arm blood flow was similar between age groups. A separate aging study evaluated age-related changes in flow-mediated vasodilation (FMD), with the older group enrolled in a 6-wk knee-extensor exercise training program. Before training, a significant FMD was observed in the arm of young (3 +/- 1%) but not old (1 +/- 1%) subjects, and a significant leg FMD was observed in both groups. However, pretraining arm vasodilation was similar between young and old when normalized for shear rate. Exercise training significantly improved arm FMD (5 +/- 1%), whereas leg FMD was unchanged. Collectively, these studies demonstrate a significant between-limb vascular heterogeneity in humans that is influenced by age and by exercise training.

Contour and volume assessment of repairing mandibular osteoperiosteal continuity defects in sheep using recombinant human osteogenic protein 1.

BACKGROUND: This study describes the contour and volume of reconstructed mandibles using recombinant human osteogenic protein 1. MATERIAL AND METHODS: The investigation was conducted on six adult sheep, where a unilateral 35 mm parasymphyseal osteoperiosteal continuity defect of the mandible was created. Recombinant human osteogenic protein 1 and type-I collagen (as carrier) were applied to the defects. Radiographic and ultrasonographic examinations were carried out at day 1 of the surgery and 2, 4, 8, and 12 weeks following the surgery. The animals were then sacrificed 3 months after the operation. Postmortem CT-scan was performed for volumetric, cross-sectional area, height and width measurements. RESULTS: Ultrasound was more efficient than radiographs in demonstrating early callus formation at 2 weeks, while radiographic evidence of bone formation was consistently detectable only after 4 weeks. Using the combination of recombinant human osteogenic protein type 1 and type-I collagen resulted in twice the volume, cross-sectional surface area, and height when compared with those of the corresponding region of the contra-lateral non-operated side of the mandible. CONCLUSION: Within 3 months, recombinant human osteogenic protein type 1 on type-I collagen carrier failed to restore the original contour and volume of mandibular osteoperiosteal continuity defects.

Elemental analysis of soil samples for forensic purposes by inductively coupled plasma spectrometry--precision considerations.

Major and trace elemental composition provides a powerful basis for forensic comparison of soils, sediments and rocks. However, it is important that the potential 'errors' associated with the procedures are fully understood and quantified, and that standard protocols are applied for sample preparation and analysis. This paper describes such a standard procedure and reports results both for instrumental measurement precision (repeatability) and overall 'method' precision (reproducibility). Results obtained both for certified reference materials and example soils show that the instrumental measurement precision (defined by the coefficient of variation, CV) for most elements is better than 2-3%. When different solutions were prepared from the same sample powder, and from different sub-sample powders prepared from the same parent sample, the CV increased to c. 5-6% for many elements. The largest variation was found in results for certified reference materials generated from 23 instrument runs over an 18 month period (mean CV=c. 11%). Some elements were more variable than others. W was found to be the most variable and the elements V, Cr, Co, Cu, Ni and Pb also showed higher than average variability. SiO2, CaO, Al2O3 and Fe2O3, Rb, Sr, La, Ce, Nd and Sm generally showed lower than average variability, and therefore provided the most reliable basis for inter-sample comparison. It is recommended that, whenever possible, samples relating to the same investigation should be analysed in the same sample run, or at least sequential runs.

A minimally invasive novel design for a vascular-pedicled bone segment for experimental studies of reconstruction of mandibular defects.

We describe a new minimally invasive vascularised bone segment (VBS) for experimental reconstruction of the mandible. The study was validated and the feasibility was tested on fresh sheep cadavers. The integrity of the arterial blood supply was confirmed using inferior dental artery static arteriography. A pilot investigation was conducted on two adult sheep. Two full thickness bone cuts 35 mm apart were created in the parasymphyseal region. The inferior dental neurovascular bundle was preserved at the posterior bone cut but not anteriorly. A VBS was created, pedicled only on the inferior dental artery. The continuity of the mandible was maintained using fixation plates and the animals were followed up for 12 weeks. There was complete bony union and restoration of approximately 80% of the bony strength. The model is minimally invasive, reduces the operating time, and does not require special equipment and skills in microvascular anastomosis.