Superoxide Dismutase and Clopidogrel: A Potential Role in Peripheral Arterial Disease Treatment.

Oxidative stress plays a crucial role in the pathogenesis of peripheral artery disease (PAD). This study aimed to investigate the effect of clopidogrel on oxidative stress in PAD patients. Seventy subjects were divided into three groups: PAD patients before treatment (B-PAD), PAD patients after treatment with clopidogrel (A-PAD), and healthy controls. Serum levels of superoxide dismutase (SOD), copper (Cu), zinc (Zn), manganese (Mn), and oxidized protein were measured. SOD activities were also determined. The results showed that SOD activities, and SOD specific activities were significantly decreased in PAD patients compared to healthy individuals. After treatment with clopidogrel, SOD activities, and SOD specific activities were continuously decrease in PAD patients. The SOD and oxidized protein concentrations were significantly increased in PAD patients compared to healthy individuals. After treatment with clopidogrel, the oxidized protein concentration was significantly decreased, while SOD concentration was significantly increased in PAD patients. These findings suggest that the treatment by clopidogrel stimulated the production of the enzyme but the ratio of active enzyme remained low. The decrease in oxidized protein can be explained by the treatment having antioxidant efficacy that may have compensated for the deficiency in enzyme activity and led to a decrease in oxidized protein. Additionally, the results of this study provide promising evidence that oxidative stress biomarkers including SOD concentration, T-SOD activity, Mn-SOD activity, and oxidized protein levels have potential utility in the diagnosis and management of PAD.

Swelling of the Muscles of the Shoulder Girdle in a CT Scan is a Leading Finding for the Diagnosis of Polymyositis.

Polymyositis (PM) is an uncommon inflammatory disease of unknown cause, but the disease shares many characteristics with autoimmune disorders. In the past, the diagnosis criteria for PM depended primarily on clinical features, blood enzyme levels, an electromyogram, and muscle biopsies. However, there are still imperfections in the diagnostic criteria of PM. The development of muscle imaging led to revisiting not only the PM diagnosis strategy but also the patients' follow-up. Teaching point: PM should be considered and included in the differential diagnosis of a patient with inflammatory signs and muscular pain, and the radiologist should be aware of its imaging features.

Subacute Combined Degeneration in a Young Female Patient After Sleeve Gastrectomy.

The neurological symptoms of vitamin B12 deficiency are variable but primarily consist of combined spinal sclerosis, peripheral neuropathy, and dementia. Movement disorders and cerebellar ataxia are reported less frequently. We present a case of a young female patient with vitamin B12 deficiency after sleeve gastrectomy, resulting in subacute combined degeneration of the spinal cord (SACD).

Multicenter RCT on intensive caries prevention for children undergoing dental general anaesthesia: Intensive caries prevention for children undergoing dental general anesthesia.

OBJECTIVES: Early childhood caries is a persistent problem often leading to dental treatment under general anesthesia (GA). Thus, this study investigated the effect of two additional individual caries prevention appointments before and after GA. MATERIALS AND METHODS: In this multi-center, 2-arm randomized, controlled clinical trial, 408 children (age 2-5 years, mean 4.2 ± 1.04) intended for GA were recruited and randomly assigned to the intervention and control groups with or without two additional intensive oral hygiene appointments before and after the GA. At baseline and at 6-/12-months follow-ups, approximal plaque index (API), gingival sulcus bleeding index (SBI), caries experience (dmft/s) and initial caries were recorded. RESULTS: Participants in test group and control group (ITT; n = 161 vs. n = 147) as well as drop-outs in test and control groups (n = 40 vs. n = 58) showed no statistical significant difference in baseline characteristics. Test and control groups showed equivalent baseline oral health parameters (API: 78 and 77%, SBI: 22.6 and 23.5%, dmft: 8.5 and 8.2, respectively), which continuously improved during the study. The test group exhibited statistically significant greater improvement (API: 42%, SBI: 7%) than the control (API: 54%, OR: 0.48; P = 0.003; SBI: 12%, OR=0.44; P = 0.005). Due to the robust rehabilitation with predominantly stainless steel crowns and extractions, caries incidence was minimal and, therefore, without statistical significance (mean increase dt, test: 0.5, control: 0.6; P = 0.68), which was also true for new initial carious lesions (mean increase test: 0.8 vs. CONTROL: 0.9; P = 0.55). CONCLUSIONS: Additional preventive sessions for children undergoing treatment under GA improved their oral hygiene parameters signifiqantly. CLINICAL SIGNIFICANCE: Intensive caries prevention appointments for children receiving dental treatment under GA improved their oral hygiene and might reduce their caries risk.

Child physical abuse: knowledge of dental students in Hamburg, Germany.

PURPOSE: This study was aimed at evaluating the levels of knowledge of child abuse among students attending the School of Dental and Oral Medicine at the University of Hamburg- Eppendorf, Germany. METHODS: This cross-sectional study utilized a self-administered and structured questionnaire, consisting of 23 multiple-choice questions; the questionnaire focused on rating the students' knowledge of and ability to diagnose child abuse. Each question was analysed with simple descriptive statistics. RESULTS: The students (181) were aware of their legal and ethical responsibilities towards the children and their parents. More than two-thirds (69.6%) responded positively when asked whether a dentist should be legally responsible to report cases of child abuse brought to their attention. The majority of the students (96.1%) agreed that dentists had an ethical duty to report such cases. However, the students were unable to define or describe the signs, symptoms, and social indicators of child abuse. Approximately 93.4% of the students lacked basic training related to child abuse, while 95.7% of them indicated that there was insufficient training in issues related to child abuse. CONCLUSIONS: There is a general lack of information regarding child abuse among dentistry students. The majority of the students showed interest in the topic of child abuse and neglect, but were unable to clearly identify the signs and symptoms. More lectures and workshops relating to child abuse should be available to all dentists to reinforce their knowledge as well as to strengthen their confidence when confronted with suspected cases of child abuse.

Dental status and prosthetic treatment needs among adult refugees in Germany.

OBJECTIVE: Due to the current global situation of refugees, Europe has experienced increased migration from African, Middle Eastern, and Eastern European countries. The objective of this study was to explore oral health, especially prosthetic status and treatment needs, in adult refugees, and to compare these findings with German cohorts. METHOD AND MATERIALS: This representative, multicenter, cross-sectional survey on oral health and treatment needs among refugees was carried out in 10 registration centers for asylum seekers aged 18 to 75 years across Germany in 2016 to 2017. The clinical examination included past caries experience (DMFT) and both existing and necessary prosthetic measures. These measures were registered according to the National German Health Survey 2016 and compared to the German resident population. RESULTS: A high untreated caries experience (DT 3.9 ± 4.6) was found among refugees (n = 288, age 37 ± 12), in addition to the expected increase of caries experience with getting older (DMFT 7.4 ± 5.7 to 14.9 ± 7.7). In contrast to the German resident population, extractions were the preferred past caries treatment, resulting in a considerable number of missing teeth (MT 7.6 ± 7.3, FT 3.6 ± 4.3, 45- to 64-year-olds). Existing prosthetic treatments such as partial and full removable dental prostheses were very rare among refugees (2% to 4%). Fixed dental prostheses were mostly required in the mandible of young adults (25%, 18- to 44-year-olds), while elderly refugees required more often removable dental prostheses (45 to 64 years, 39.7% maxilla, 38.4% mandible). CONCLUSIONS: Newly arrived refugees in Germany exhibit higher dental treatment needs in general and prosthetic treatment needs in particular due to former extractions, which were performed as a main caries treatment.

Listeria innocua Dps as a nanoplatform for bioluminescence based photodynamic therapy utilizing Gaussia princeps luciferase and zinc protoporphyrin IX.

Listeria innocua DNA binding protein from starved cells (LiDps) belongs to the ferritin family and provides a promising self-assembling spherical 12-mer protein scaffold for the generation of functional nanomaterials. We report the creation of a Gaussia princeps luciferase (Gluc)-LiDps fusion protein, with chemical conjugation of Zinc (II)-protoporphyrin IX (ZnPP) to lysine residues on the fusion protein (giving Gluc-LiDps-ZnPP). The Gluc-LiDps-ZnPP conjugate is shown to generate reactive oxygen species (ROS) via Bioluminescence Resonance Energy Transfer (BRET) between the Gluc (470-490 nm) and ZnPP. In vitro, Gluc-LiDps-ZnPP is efficiently taken up by tumorigenic cells (SKBR3 and MDA-MB-231 breast cancer cells). In the presence of coelenterazine, this construct inhibits the proliferation of SKBR3 due to elevated ROS levels. Following exposure to Gluc-LiDps-ZnPP, migration of surviving SKBR3 cells is significantly suppressed. These results demonstrate the potential of the Gluc-LiDps-ZnPP conjugate as a platform for future development of an anticancer photodynamic therapy agent.

Decision-making algorithm for sequential treatment of diaphyseal bone gaps in war-wounded patients in the Middle East.

INTRODUCTION: Tibial bone gaps after war injuries are common and can be managed by different types of surgery, including compression, bone graft, tibialisation of fibula, bone transport, and free flaps. Here, we present an algorithm developed at a humanitarian surgical hospital to manage tibial bone gaps. We also identify some key factors affecting patient outcomes and describe some clinical considerations for choosing treatment strategy. METHOD: We performed retrospective data analysis on war-wounded adult patients with tibial injuries treated at our project according to the described algorithm. Patient outcomes were followed for at least four  years. Outcomes assessed were length of stay, complication rate, re-admission (late complications), and final discharge. RESULTS: Among the 200 included patients, 103 (51.5%) had bone gaps. Univariate analysis showed that the presence of a bone gap, but not its size, was associated with significantly increased risk of early complications, while type of surgery was significantly correlated with re-admission. Presence of a bone gap and type of surgery were each significantly associated with length of stay. Bone gap size showed no correlation with outcomes, an unexpected finding. DISCUSSION: Soft tissue damage with compromised vascularity may explain the lack of association between bone gap size and outcomes. Specialised centres using standardised approaches to complex surgical reconstruction can play an important role in expanding the evidence base needed to improve case management. CONCLUSIONS: Less invasive procedures may lead to better patient outcomes, although unfortunately may not always be possible given the nature of the injury and/or injury site.

Gastric Perforation following Intragastric Balloon Insertion: Combined Endoscopic and Laparoscopic Approach for Management: Case Series and Review of Literature.

BACKGROUND: Obesity is a serious disease, with substantial morbidity and mortality. The endoscopic placement of an intragastric balloon (IGB) in association with a low-calorie diet is an option for the treatment of obesity. IGB complications include dislocation of the balloon causing intestinal obstruction, upper gastro-intestinal bleeding and perforation, especially during balloon insertion or removal. Our work aims at decreasing the morbidity of open laparotomy in the management of such gastric perforations. METHODS: We report three cases of gastric perforation following IGB insertion that needed surgical intervention. Decision was made to treat them with a minimally invasive combined endoscopic and laparoscopic approach to decrease postoperative morbidity. RESULTS: All patients were successfully treated by a minimally invasive approach with less morbidity than the conventional open laparotomy. CONCLUSION: Gastric perforation should be suspected in any patient with IGB who presents with an acute abdomen. This can be managed with a minimal invasive approach.

The short musculoskeletal functional assessment (SMFA) score amongst surgical patients with reconstructive lower limb injuries in war wounded civilians.

BACKGROUND/OBJECTIVES: The MSF programme in Jordan provides specialized reconstructive surgical care to war-wounded civilians in the region. The short musculoskeletal functional assessment score (SMFA) provides a method for quantitatively assessing functional status following orthopaedic trauma. In June 2010 the Amman team established SMFA as the standard for measuring patients' functional status. The objective of this retrospective study is to evaluate whether the SMFA scores can be useful for patients with chronic war injuries. METHODS: All patients with lower limb injuries requiring reconstruction were enrolled in the study. Each patient's SMFA was assessed at admission, at discharge from Amman and during follow-up in home country. In the analysis we compared patients with infected versus non-infected injuries as well as with both high and low admissions dysfunctional index (ADI). RESULTS: Among infected patients, higher ADI correlated with more surgeries and longer hospital stay. Infected patients with ADI >50 required an average of 2.7 surgeries while those with ADI <50, averaged 1.7 operations (p = 0.0809). Non-infected patients with ADI >50 required an average of 1.6 operations compared to 1.5 for those with ADI <50 (p = 0.4168). CONCLUSIONS: The ADI score in our sample appeared to be useful in two areas: (1) hospital course in patients with infection, where a high ADI score correlated with longer hospital stays and more surgeries, and (2) prognosis, which was better for non-infected patients who had high ADI scores. A scoring system that predicts functional outcome following surgical reconstruction of lower limb injuries would be enormously useful.

Reconstruction of nonunion tibial fractures in war-wounded Iraqi civilians, 2006-2008: better late than never.

OBJECTIVE: To describe medical care and surgical outcome after functional reconstructive surgery in late-presenting patients who already had at least one prior operation. DESIGN: Retrospective review of medical care and surgical outcome from August 2006 to December 2008 using patient records for initial data with active follow-up for the latest outcome information. SETTING: Médecins sans Frontières surgical programme in Jordan Red Crescent Hospital, Amman, Jordan. PATIENTS: Sixty-two civilians with nonunion tibial fractures caused by war-related trauma in Iraq; 53 completed follow-up. INTERVENTION: Amputation and/or reconstruction. MAIN OUTCOME MEASUREMENTS: Late surgical complications (after the patient's return to Iraq) were analyzed for infection recurrence, bone union, and functional condition (defined using the Short Musculoskeletal Functional Assessment score). RESULTS: Almost three fourths of patients arrived with infected injuries, 9 of whom had amputation as the initial surgery; the rest, and all uninfected patients, had reconstruction. Excluding loss to follow-up, only 4 of 53 (8%) patients who arrived with an infected injury had infection recurrence. Excluding loss to follow-up and amputation, 2 of 14 (14%) patients in the uninfected and 5 of 30 (17%) in the infected injury group did not achieve successful tibial union. Mean Dysfunctional and Bothersome Indices overall were 27.1 and 29.8, respectively, with similar results for all 3 groups (amputations, uninfected, and infected injuries). CONCLUSIONS: Our study shows that patients with infected and uninfected injuries surgically treated in Amman achieved similar outcomes. Despite late presentation, our patients had a comparable outcome to other studies dealing with early reconstruction. Reconstruction for the infected group required longer treatment time. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Biometric characteristics of eyes with exfoliation syndrome and occludable as well as open angles and eyes with primary open-angle glaucoma.

OBJECTIVE: To describe differences in axial length scan (A-scan) and ultrasound biomicroscopy (UBM) parameters in eyes with exfoliation syndrome (XFS) and occludable angles (XFSOc), XFS and open angles (XFSOp), and eyes with primary open-angle glaucoma (POAG). DESIGN: Cross-sectional descriptive study. PARTICIPANTS: Seventy-two eyes of 72 patients (mostly Caucasians) were identified through glaucoma clinics at the University of Ottawa;19 eyes had XFSOc, 31 eyes XFSOp, and 22 eyes POAG. METHODS: After a detailed ophthalmic history and examination, A-scan biometry and UBM were done to assess anterior segment parameters: central anterior chamber depth (ACD), lens thickness, trabecular meshwork-iris angle, and angle opening distance (AOD). Lens/axial length factor and the relative lens position were calculated. The above measurements were compared across the 3 groups. RESULTS: We found statistically significant differences in measurements among the groups. ACD was shallowest in eyes with XFSOc (1.88 [SD 0.07] mm), followed by XFSOp (2.37 [SD 0.05] mm), and POAG (2.64 [SD 0.08] mm). XFSOc had thicker lenses (5.28 [SD 0.09] mm) compared with the other groups: XFSOp (5.03 [SD 0.06] mm) and POAG (4.84 [SD 0.09] mm). Lens/axial length factor was highest in XFSOc (2.34 [SD 0.05] mm) versus XFSOp (2.12 [SD 0.03] mm) and POAG (2.02 [SD 0.05] mm); relative lens position was lowest in XFSOc (2.27 [SD 0.03] mm) versus XFSOp (2.31 [SD 0.02] mm) and POAG (2.36 [SD 0.03] mm). CONCLUSIONS: Eyes with XFSOc in our study demonstrated lens thickening and shallow central ACD versus eyes with XFSOp and eyes with POAG. This suggests the possibility that cataract formation and (or) zonular weakness may contribute to the development of an occludable angle in eyes with XFS.