Systematic review on self-ligating vs. conventional brackets: initial pain, number of visits, treatment time.

OBJECTIVE: Meta-analysis of differences between conventional and self-ligating brackets concerning pain during tooth movement, number of patient visits, total treatment duration, and ligation times. MATERIALS AND METHODS: Online search in Medline, Embase, and Central focused on randomized clinical trials and controlled clinical studies published between 1996 and 2012. RESULTS: Four studies on pain met our inclusion criteria, two on the number of appointments, two on overall treatment time but none on ligation times. Pain levels did not differ significantly between patients treated with conventional or self-ligating brackets after 4 h, 24 h, 3 and 7 days. The number of appointments and total treatment times revealed no significant differences between self-ligating and conventional brackets. CONCLUSION: The lack of significant overall effects apparent in this meta-analysis contradicts evidence-based statements on the advantages of self-ligating brackets over conventional ones regarding discomfort during initial orthodontic therapy, number of appointments, and total treatment time. Due to the limited number of studies included, further randomized controlled clinical trials are required to deliver more data and to substantiate evidence-based conclusions on differences between the two bracket types considering orthodontic pain, number of visits, treatment, and ligation times.

Substantia nigra hyperechogenicity correlates with subtle motor dysfunction in tap dancers.

Hyperechogenicity of the substantia nigra (SN) detected by transcranial sonography is a typical finding in more than 90% of patients with Parkinson's disease (PD) but may also be visible in about 9% of healthy adults. In this study, we found a correlation between SN hyperechogenicity and subtle motor dysfunction in otherwise healthy young tap dancers. In accordance with former findings, results of the present study confirm the hypothesis that SN hyperechogenicity is a marker for a possible functional impairment of the nigrostriatal system, that may become evident under challenging conditions.

Reduction of Fe(III) ions complexed to physiological ligands by lipoyl dehydrogenase and other flavoenzymes in vitro: implications for an enzymatic reduction of Fe(III) ions of the labile iron pool.

Enzymatic reduction of physiological Fe(III) complexes of the "labile iron pool" has not been studied so far. By use of spectrophotometric assays based on the oxidation of NAD(P)H and formation of [Fe(II) (1,10-phenanthroline)3]2+ as well as by utilizing electron paramagnetic resonance spectrometry, it was demonstrated that the NAD(P)H-dependent flavoenzyme lipoyl dehydrogenase (diaphorase, EC 1.8.1.4) effectively catalyzes the one-electron reduction of Fe(III) complexes of citrate, ATP, and ADP at the expense of the co-enzymes NAD(P)H. Deactivated or inhibited lipoyl dehydrogenase did not reduce the Fe(III) complexes. Likewise, in the absence of NAD(P)H or in the presence of NAD(P)+, Fe(III) reduction could not be detected. The fact that reduction also occurred in the absence of molecular oxygen as well as in the presence of superoxide dismutase proved that the Fe(III) reduction was directly linked to the enzymatic activity of lipoyl dehydrogenase and not mediated by O2. Kinetic studies revealed different affinities of lipoyl dehydrogenase for the reduction of the low molecular weight Fe(III) complexes in the relative order Fe(III)-citrate > Fe(III)-ATP > Fe(III)-ADP (half-maximal velocities at 346-485 microm). These Fe(III) complexes were enzymatically reduced also by other flavoenzymes, namely glutathione reductase (EC 1.6.4.2), cytochrome c reductase (EC 1.6.99.3), and cytochrome P450 reductase (EC 1.6.2.4) with somewhat lower efficacy. The present data suggest a (patho)physiological role for lipoyl dehydrogenase and other flavoenzymes in intracellular iron metabolism.

Echogenicity of the substantia nigra in relatives of patients with sporadic Parkinson's disease.

Increased echogenicity of the substantia nigra (SN) on ultrasound is a typical sonographic finding in Parkinson's disease (PD). Sonographic signal intensity of the SN is related to tissue iron content with higher iron level being associated with increased echogenicity. Recent findings indicate that hyperechogenicity of the SN represents an important susceptibility factor for nigrostriatal degeneration. In this study we determined the prevalence of a characteristic ultrasound sign of Parkinson's disease in first-degree relatives of PD patients. Fourteen patients with sporadic PD and 58 of their relatives underwent neurological, neuropsychological, and ultrasound examination. In addition, four pairs of relatives (one member of each pair exhibiting increased echogenicity of the SN and the other with regular SN echogenicity) underwent (18)F-Dopa PET examination. On transcranial sonography, 26 of the 58 relatives exhibited SN hyperechogenicity. Twenty-four relatives showed minor signs of motor slowing. Relatives with SN hyperechogenicity more often showed signs of hypokinesia (16 v 8 relatives; U test, P = 0.01) and impaired executive functions (Tower of London task, problems solved with the minimum number of moves; U test, P = 0.012) than relatives without this echo pattern. In addition, (18)F-Dopa uptake (influx constants) at the putamen was reduced in subjects with SN hyperechogenicity compared to their relatives without this ultrasound sign (Wilcoxon, P = 0.03). In conclusion, approximately 45% of relatives of PD patients exhibited an increased echogenicity of the SN. This sign is associated with clinical findings and objective measurements, indicating some degree of impaired nigrostriatal function.

Prognostic and diagnostic value of global cerebral blood flow volume and cerebral transit time in acute stroke.

Conventional duplex sonography is a well-established method for the assessment of the brain-supplying arteries in acute stroke. However, ultrasound (US) remains inconclusive in a significant number of stroke patients. Recently, two new US parameters, the cerebral transit time (cTT) and the global cerebral blood flow volume (CBF), have been introduced. In the present study, we investigated the diagnostic and prognostic value of both parameters in stroke patients. Conventional duplex examinations of the extra- and intracranial brain-supplying arteries and measurement of cTT and CBF were performed in 50 consecutive stroke patients within 24 h after symptom onset and compared with US findings in 22 age-matched healthy controls. Neurological deficits and the degree of disability were graded using several stroke scores, and were re-evaluated for outcome measure after 1 year. CBF and cTT were not assessable in 26% and 20% of the patients, respectively. Compared with the healthy control group, stroke patients showed a significant reduction of CBF and prolongation of cTT. More than 50% of patients with otherwise normal routine duplex examination had abnormal CBF or cTT findings. Furthermore, there was a strong correlation between the reduction of global CBF and the outcome after 1 year. Sonographic assessment of the CBF and cTT are additional parameters that might increase the diagnostic sensitivity of US in stroke patients, and may have prognostic relevance.