Permanent stoma rates after anterior resection for rectal cancer: risk prediction scoring using preoperative variables.

BACKGROUND: A permanent stoma after anterior resection for rectal cancer is common. Preoperative counselling could be improved by providing individualized accurate prediction modelling. METHODS: Patients who underwent anterior resection between 2007 and 2015 were identified from the Swedish Colorectal Cancer Registry. National Patient Registry data were added to determine presence of a stoma 2 years after surgery. A training set based on the years 2007-2013 was employed in an ensemble of prediction models. Judged by the area under the receiving operating characteristic curve (AUROC), data from the years 2014-2015 were used to evaluate the predictive ability of all models. The best performing model was subsequently implemented in typical clinical scenarios and in an online calculator to predict the permanent stoma risk. RESULTS: Patients in the training set (n = 3512) and the test set (n = 1136) had similar permanent stoma rates (13.6 and 15.2 per cent). The logistic regression model with a forward/backward procedure was the most parsimonious among several similarly performing models (AUROC 0.67, 95 per cent c.i. 0.63 to 0.72). Key predictors included co-morbidity, local tumour category, presence of metastasis, neoadjuvant therapy, defunctioning stoma use, tumour height, and hospital volume; the interaction between age and metastasis was also predictive. CONCLUSION: Using routinely available preoperative data, the stoma outcome at 2 years after anterior resection for rectal cancer can be predicted fairly accurately.

Usually, the goal of rectal cancer surgery is to remove the tumour and construct a bowel join. Sometimes, it is necessary to construct a stoma, which may become permanent. Swedish registry data were used to develop and test a statistical model to forecast the risk of a stoma 2 years after surgery. In addition, an online calculator was developed. The model performed reasonably well, and can be used to inform the patient and surgeon before surgery of the risk of a permanent stoma.

Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal pain (PREVSAM): a randomised controlled trial protocol.

BACKGROUND: Musculoskeletal pain is globally a leading cause of physical disability. Many musculoskeletal-related pain conditions, such as low back pain, often resolve spontaneously. In some individuals, pain may recur or persist, leading to ong-term physical disability, reduced work capacity, and sickness absence. Early identification of individuals in which this may occur, is essential for preventing or reducing the risk of developing persistent musculoskeletal pain and long-term sickness absence. The aim of the trial described in this protocol is to evaluate effects of an early intervention, the PREVSAM model, on the prevention of sickness absence and development of persistent pain in at-risk patients with musculoskeletal pain. METHODS: Eligible participants are adults who seek health care for musculoskeletal pain and who are at risk of developing persistent pain, physical disability, and sickness absence. Participants may be recruited from primary care rehabilitation centres or primary care healthcare centres in Region Västra Götaland. Participants will be randomised to treatment according to the PREVSAM model (intervention group) or treatment as usual (control group). The PREVSAM model comprises an interdisciplinary, person-centred rehabilitation programme, including coordinated measures within primary health care, and may include collaboration with participants' employers. The primary outcome sickness absence is operationalised as the number and proportion of individuals who remain in full- or part-time work, the number of gross and net days of sickness absence during the intervention and follow-up period, and time to first sickness absence spell. Secondary outcomes are patient-reported short-term sickness absence, work ability, pain, self-efficacy, health-related quality of life, risk for sickness absence, anxiety and depression symptoms and physical disability at 1 and 3 months after inclusion (short-term follow-up), and at 6 and 12 months (long-term follow-up). A cost-effectiveness analysis is planned and drug consumption will be investigated. DISCUSSION: The study is expected to provide new knowledge on the effectiveness of a comprehensive rehabilitation model that incorporates early identification of patients with musculoskeletal pain at risk for development of sickness absence and persistent pain. The study findings may contribute to more effective rehabilitation processes of this large patient population, and potentially reduce sickness absence and costs. TRIAL REGISTRATION: ClinicalTrials.gov Protocol ID: NCT03913325 , Registered April 12, 2019. Version 2, 10 July 2020. Version 2 changes: Clarifications regarding trial aim and inclusion process.

Identification and toxicological evaluation of cyclic sulfonium ion degradation products of sulphur mustard.

In the aftermath of WWII large amount seized German chemical munitions were dumped in the Baltic Sea by Allied forces. In this work, we have compared the chemical content of the solidified blocks of dumped WWII mustard gas collected from the Baltic Sea with solid precipitate from stored mustard gas, known as heel. We have identified the same cyclic sulfonium ions in both samples. In assessing the environmental and toxicological impact of dumped sulphur mustard munitions on the world's oceans the potential risk posed by cyclic sulphur mustard salts have so far not been incorporated. The toxicity of 1-(2-chloroethyl)-1,4-dithiane and its hydrolysis product 1-(2-hydroxyethyl)- 1,4-dithiane was evaluated using three different cell lines. Their effect on released pro-inflammatory cytokines was also measured. The toxicity tests showed low toxicity and low pro-inflammatory response and we therefore conclude that the environmental threat posed by these compounds is low.

Fermentation of Cauliflower and White Beans with Lactobacillus plantarum - Impact on Levels of Riboflavin, Folate, Vitamin B12, and Amino Acid Composition.

As diets change in response to ethical, environmental, and health concerns surrounding meat consumption, fermentation has potential to improve the taste and nutritional qualities of plant-based foods. In this study, cauliflower, white beans, and a 50:50 cauliflower-white bean mixture were fermented using different strains of Lactobacillus plantarum. In all treatments containing cauliflower, the pH was reduced to <4 after 18 h, while treatments containing only white beans had an average pH of 4.8 after 18 h. Following fermentation, the riboflavin, folate, and vitamin B12 content of the cauliflower-white bean mixture was measured, and compared against that of an unfermented control. The riboflavin and folate content of the mixture increased significantly after fermentation. Relative to control samples, riboflavin increased by 76-113%, to 91.6 ± 0.6 µg/100 g fresh weight, and folate increased by 32-60%, to 58.8 ± 2.0 µg/100 g fresh weight. For one bacterial strain, L. plantarum 299, a significant 66% increase in vitamin B12 was observed, although the final amount (0.048 ± 0.013 µg/100 g fresh weight) was only a small fraction of recommended daily intake. Measurements of amino acid composition in the mixture revealed small increases in alanine, glycine, histidine, isoleucine, leucine, and valine in the fermented sample compared to the unfermented control.

Does early identification of work-related stress, combined with feedback at GP-consultation, prevent sick leave in the following 12 months? a randomized controlled trial in primary health care.

BACKGROUND: Experiencing work-related stress constitutes an obvious risk for becoming sick-listed. In primary health care, no established method to early identify, advise and treat people with work-related stress exists. The aim was to evaluate if the use of the Work Stress Questionnaire (WSQ) brief intervention, including feedback from the general practitioner (GP), had an impact on the level of sickness absence. METHOD/DESIGN: In total 271 (intervention group, n = 132, control group, n = 139) non-sick-listed employed women and men, aged 18 to 64 years, who had mental and physical health complaints and sought care at primary health care centers participated in this two-armed randomized controlled trial. The main outcomes were the number of registered sick leave days and episodes, and time to first sick leave during the 12-months follow-up. The intervention included early identification of work-related stress by the WSQ, GP awareness supported by a brief training session, patients' self-reflection by WSQ completion, GP feedback at consultation, and initiation of preventive measures. RESULTS: The mean days registered for the WSQ intervention group and the control group were 39 and 45 gross days respectively, and 31 and 39 net days respectively (ns). No statistical significant difference for the number of sick leave episodes or time to first day of sick leave episode were found between the groups. CONCLUSIONS: The WSQ brief intervention combined with feedback and suggestions of measures at patient-GP-consultation was not proven effective in preventing sick leave in the following 12 months compared to treatment as usual. More research is needed on methods to early identify, advise and treat people with work-related stress in primary health care, and on how and when GPs and other professionals in primary health care can be trained to understand this risk of sick leave due to work-related stress, on how to prevent it, and on how to advise and treat employees at risk. TRIAL REGISTRATION: ClinicalTrials.gov. Identifier: NCT02480855 . Registered 20 May 2015.

High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population-based multicentre study.

AIM: Fashioning a defunctioning stoma is common when performing an anterior resection for rectal cancer in order to avoid and mitigate the consequences of an anastomotic leakage. We investigated the permanent stoma prevalence, factors influencing stoma outcome and complication rates following stoma reversal surgery. METHOD: Patients who had undergone an anterior resection for rectal cancer between 2007 and 2013 in the northern healthcare region were identified using the Swedish Colorectal Cancer Registry and were followed until the end of 2014 regarding stoma outcome. Data were retrieved by a review of medical records. Multiple logistic regression was used to evaluate predefined risk factors for stoma permanence. Risk factors for non-reversal of a defunctioning stoma were also analysed, using Cox proportional-hazards regression. RESULTS: A total of 316 patients who underwent anterior resection were included, of whom 274 (87%) were defunctioned primarily. At the end of the follow-up period 24% had a permanent stoma, and 9% of patients who underwent reversal of a stoma experienced major complications requiring a return to theatre, need for intensive care or mortality. Anastomotic leakage and tumour Stage IV were significant risk factors for stoma permanence. In this series, partial mesorectal excision correlated with a stoma-free outcome. Non-reversal was considerably more prevalent among patients with leakage and Stage IV; Stage III patients at first had a decreased reversal rate, which increased after the initial year of surgery. CONCLUSION: Stoma permanence is common after anterior resection, while anastomotic leakage and advanced tumour stage decrease the chances of a stoma-free outcome. Stoma reversal surgery entails a significant risk of major complications.

Confidence in public institutions: A focus group study on views on the Swedish Social Insurance Agency.

BACKGROUND: From a public health perspective among the working population, it is very important that confidence in the welfare system is high, ensuring the citizens economic security and protecting them from economic stress when falling ill. OBJECTIVE: The aim of this study was to explore how people with experience of health insurance perceive their confidence in the Swedish Social Insurance Agency (SSIA). METHODS: Eight focus groups (n = 41) were conducted and each group met on one occasion. RESULTS: The participants described a systemic change in the work of the SSIA where the rule-of-law was disregarded, with arbitrary assessment, and no transparency. The reception by the SSIA shaped the image of the SSIA. The participants described vulnerability in relation to the SSIA. They felt mistrusted, which left a feeling of impotence that worsened their health. Experiencing vulnerability left a strong impression and affected the participants' confidence negatively. CONCLUSIONS: The following has to be acknowledged to prevent clients from experiencing impaired health, promote return-to-work possibilities, and to push public confidence in the institution in a more positive direction: Politicians and public administrators need to clarify the regulations. The decision-making process needs to be transparent and just. The entire procedure, including continuity as well as a personal, nice reception, has to be ensured.

Strong support for relocation to other work tasks: A cross-sectional study of attitudes to sickness insurance regulations in Sweden.

BACKGROUND: Profound changes are taking place in the Swedish welfare state. The general population's attitudes are important insofar changes will be perceived as fair and effective to become implemented. OBJECTIVE: The aim was to study attitudes to the strictness of the sick-leave rules, relocation to other work tasks after 3 months of sick leave and applications for new jobs after 6 months of sick leave. METHODS: Eligible for this questionnaire study were 1,140 individuals aged 19 to 64 years. Their attitudes were analyzed in relation to age, gender, political ideology and health status. Health status was measured as sick-leave experiences, self-reported health and level of symptoms. RESULTS: Showed that 42% considered the sick-leave rules to be too strict, 60% found relocation to other work tasks to be good while 35% found that applications for new work were good. In logistic regression analyses, high sick-leave experience was associated with increased odds of finding the sick-leave rules too strict and disagreement with relocation to other work tasks or application for new jobs. CONCLUSIONS: In conclusion, strong support was found for relocation to other work tasks with the present employer. Earlier research on returning to work has found workplace interventions to be efficient. From a policy perspective it seems relevant to promote such interventions given the strong public opinion in their favor.

Harmful alcohol habits were no more common in a sample of newly sick-listed Swedish women and men compared with a random population sample.

AIMS: To estimate harmful alcohol habits in a sample of incident sick-listed individuals compared with a random sample from the general population taking social background, health and work-related factors into account. METHODS: Data for this cross-sectional questionnaire study were collected in 2008 in the Västra Götaland region, Sweden. The study population (19-64 year olds) consisted of 2888 consecutive incident sick-leave sample (ISS) and 3567 individuals from a random population sample (RPS). The mailed questionnaire included Alcohol Use Disorder Identification Test and validated instruments on health and work-related factors. Socio-demographic data came from register data. Analyses were made with χ(2) tests and logistic regression analyses. RESULTS: No differences in prevalence of harmful alcohol habits were found between men in the ISS (22%) and the RPS (21%). Compared with women in the ISS, a higher proportion of women in the RPS were likely to report harmful alcohol habits [14 versus 9% (P < 0.001)]. This difference was confirmed in the logistic regression analyses where women in the RPS had higher odds of having harmful alcohol habits compared with women in the ISS [odds ratio (OR) = 1.54 (95% confidence interval (CI): 1.23-1.89)]. Even after controlling for significant confounders (age, low income, high self-reported health and high level of perceived symptoms), we found that the differences in harmful alcohol habits remained [OR = 1.44 (95% CI: 1.16-1.81)]. CONCLUSIONS: Harmful alcohol habits were no commoner in men and women who belonged to the sample of incident sick-leave cases. Future studies are needed to analyse the predictive value of harmful alcohol habits on sickness absence length and the time until return to work after sickness absence.

Pelvicaliceal biomodeling as an aid to achieving optimal access in percutaneous nephrolithotripsy.

PURPOSE: To investigate prospectively the benefits of three-dimensional stereolithographic biomodeling produced from CT data as an aid to achieving optimal access for percutaneous nephrolithotripsy (PCNL). PATIENTS AND METHODS: Eight patients with complex urinary calculi were selected. Multislice CT scans of the kidney in native and excretory phases were acquired with the patient in the prone position to simulate the position during surgery. Contiguous reconstructed slices were produced from the data volume. The data of interest were processed to transform them into a format acceptable for production of a biomodel. Exact plastic replicas of the pelvicaliceal system and the calculi were created and used for morphologic assessment, preoperative planning, patient education, and surgical navigation. RESULTS: The survey results were based on subjective opinions rather than objective data. The biomodels enhanced the ability to visualize a patient's unique anatomy before surgery. This aided the planning and rehearsal of endourologic procedures. CONCLUSION: Although this study is only a preliminary investigation, we postulate that biomodeling has the advantage of allowing imaging data to be displayed in a physical form. In difficult cases, this technique may improve treatment, operative planning, and communication with colleagues and patients. The limitations of the technology include the manufacturing time and cost, but more accurate puncture-site selection may reduce costs by saving operating time.

Complications associated with percutaneous nephrolithotripsy: supra- versus subcostal access. A retrospective study.

PURPOSE: Percutaneous nephrolithotripsy is an essential procedure for treating complex urinary calculi. To achieve optimal access to a large and complicated stone, an upper calyx puncture is often preferable. However, when performing a puncture above the 12th rib there is risk of an increased number of complications. In this retrospective study, we assessed the kind and frequency of complications after sub- and supracostal punctures of the collecting system of the kidney. MATERIAL AND METHODS: Between 1996 and 2001, 85 patients were treated with percutaneous nephrolithotripsy. In 63 patients a subcostal track, below the 12th rib was established. Puncture was performed under ultrasonic or fluoroscopic guidance in 61 patients and CT-guided in 2 patients. In 17 patients a supracostal puncture, above the 12th rib, was performed under CT guidance and in 5 patients with US or fluoroscopic guidance. RESULT: The main difference regarding preoperative complications was the number of patients complaining of respiratory correlated pain, 7 (32%) in the supracostal puncture group compared with 3 (5%) in the subcostal puncture group. No significant difference regarding peroperative complications was found. Postoperatively, there were 2 major bleedings, one in each group, which had to be treated with arterial embolization. In the supracostal puncture group there were 2 patients with pleural effusion and 2 patients with pneumothorax. CONCLUSION: The complication rate was slightly higher after supracostal puncture as compared with a subcostal approach, especially regarding respiratory correlated pain. When performing a supracostal puncture there is an increased risk that the track passes through the pleural space, which might explain the difference in the panorama of complications.

DNA repair enhancement of aqueous extracts of Uncaria tomentosa in a human volunteer study.

The Uncaria tomentosa water extracts (C-Med-100) have been shown to enhance DNA repair, mitogenic response and leukocyte recovery after chemotherapy-induced DNA damage in vivo. In this study, the effect of C-Med-100 supplement was evaluated in a human volunteer study. Twelve apparently healthy adults working in the same environment were randomly assigned into 3 groups with age and gender matched. One group was daily supplemented with a 250 mg tablet containing an aqueous extract of Uncaria tomentosa of C-Med-100, and another group with a 350 mg tablet, for 8 consecutive weeks. DNA repair after induction of DNA damage by a standard dose of hydrogen peroxide was measured 3 times before supplement and 3 times after the supplement for the last 3 weeks of the 8 week-supplement period. There were no drug-related toxic responses to C-Med-100 supplement when judged in terms of clinical symptoms, serum clinical chemistry, whole blood analysis and leukocyte differential counts. There was a statistically significant decrease of DNA damage and a concomitant increase of DNA repair in the supplement groups (250 and 350 mg/day) when compared with non-supplemented controls (p < 0.05). There was also an increased tendency of PHA induced lymphocyte proliferation in the treatment groups. Taken together, this trial has confirmed the earlier results obtained in the rat model when estimating DNA repair enhancement by C-Med-100.

Urinary calculi and jejunoileal bypass operation. A long-term follow-up.

Medical records of 56 patients who had undergone jejunoileal bypass (JIB) surgery because of morbid obesity were reviewed. The follow-up time varied from 3 to 25 years (average 16 years). Twenty-two of the 56 patients (39.3%) were found to have renal calculi. The interval between the operation and the occurrence or knowledge of the first stone formation ranged from some months to 19 years. The mean weight loss at 5 years was 36.5 kg. Renal function investigations showed no evidence that the jejunoileal bypass operation alters the renal function. The urinary excretion of oxalate was high: 1.112 mumol/24 h (normal range: 55-400 mumol/24 h), and citrate excretion was low: 1.48 mmol/24 h (normal range: 2-5 mmol/24 h). There was no difference in these respects between stone formers and non-stone formers.

Husbands' involvement in abortion in Vietnam.

This study analyzes the involvement of men in abortion in Vietnam, where induced abortion is legal and abortion rates are among the highest in the world. Twenty men were interviewed in 1996 about the role they played in their wives' abortions and about their feelings and ethical views concerning the procedure. The results showed that both husbands and wives considered the husband to be the main decisionmaker regarding family size, which included the decision to have an abortion, but that, in fact, some women had undergone an abortion without consulting their husbands in advance. Parents and in-laws were usually not consulted; the couples thought they might object to the decision on moral grounds. Respondents' ethical perspectives on abortion are discussed. When faced with an unwanted pregnancy, the husbands adopted an ethics of care and responsibility toward family and children, although some felt that abortion was immoral. The study highlights the importance of understanding husbands' perspectives on their responsibilities and rights in reproductive decisionmaking and their ethical and other concerns related to abortion.

PIP: This study explored men's attitudes and ethical views about abortion and their decision-making role in their wives' abortion in Viet Nam. Data were obtained from a 1996 survey conducted in the province of Quang Ninh and the towns of Uong Bi and La Hong. The total fertility rate in the study area was 2.3 children/woman. The total induced abortion rate was 2.5/woman, which is the highest in Viet Nam. The sample included 20 women drawn from a random sample of 300 women from 2 public abortion clinics. Findings indicate that the mean age of the 20 husbands was 37 years. Most came from large families with 6 children. No one was illiterate. The mean age at marriage was 26 years. The mean interval to first birth was 2 years. All had at least 1 child. The 20 women averaged 2.4 abortions/woman: 2.7 in La Hong and 1.9 in Uong Bi. Three case histories--an old man's, a middle-aged man's, and a young man's--are reported. The old man, who lived through the war years, had 2 sons and a daughter. His wife, after the last birth, had 1 miscarriage and 3 abortions. She removed the IUD due to side effects. The old man desired no more children. The middle-aged man viewed too many children as self-defeating. The young man thought life was too hard to support a large family. Reasons for abortion were mainly economic ones, protection of women's health, and adherence to the two-child policy. About 50% made the abortion decision together. Ethical views ranged from disapproval and deep moral concern to a neutral modern view. The concern for living children and family welfare took precedence.

Occlusal adjustment and myoelectric activity of the jaw elevator muscles in patients with nocturnal bruxism and craniomandibular disorders.

The effects of occlusal adjustments on the myoelectric activity of the anterior temporal and masseter muscles, with the mandible at rest and during maximal clenching in the intercuspal position (ICP), were studied in 24 nocturnal bruxism patients. Before the occlusal adjustment, the patients were treated with a flat occlusal splint for chronic craniomandibular disorders. The results revealed that within the short term the occlusal adjustment, in terms of increased number of occlusal contacts and teeth in contact in ICP, did not change the postural activity, whereas, on average, the level of activation of the jaw elevators, in terms of normalized electromyogram, increased during maximal clenching in ICP. The increase of activity was more pronounced in the masseter muscle than in the anterior temporal muscle.

Abortion ethics--women's post abortion assessments.

BACKGROUND: Induced abortion is often discussed in terms of ethics. The aim of the present report is to describe the abortion ethics as it was expressed by women undergoing a legal abortion. OBJECTIVE: Moral considerations expressed during semistructured interviews by 128 women two weeks after a first trimester abortion in Stockholm 1987-90 are reported. RESULT: The women had faced a choice between abortion and parenthood. At the time of the abortion many of them were living under conditions that meant they were unable to offer a child the security they regarded as a child's right. The conflict the women spontaneously described as their main moral dilemma was not a conflict between the woman and the fetus, but a conflict between several close relationships, also concerning the prospective father. The ethics that the women applied to the problems of abortion was founded on a long-term responsibility to care for persons in their relationships. CONCLUSION: The women interviewed had three levels of moral reasoning simultaneously present. 1. A theoretical level--most of all concerning other women--a liberal view of rights: abortion should be a freely obtainable option. 2. A theoretical level--above all, concerning themselves--a restrictive deontological view: the extinction of life is morally wrong and should be avoided. 3. A practical level--when the problem was a reality: a consequentialist ethics of care. According to this ethics of care it was important that the abortion could be performed as early as possible during pregnancy.

Repeat abortion and contraceptive use. Report from an Interview Study in Stockholm.

Semistructured interviews were made among a random sample of applicants for abortion in Stockholm, when legal abortion on demand had been available in Sweden for 10 years. One hundred and twenty women were interviewed, 75 of them having their first abortion and 45 having a repeat abortion. The use of contraceptives was similar among first-time aborters and repeat aborters, but 70% in both groups had temporarily been without contraceptives at the time of conception. The interviews show that the family circumstances were more difficult for the women who had already experienced an abortion than for those who had not. The study indicates that the male partner and family circumstances were important for the decision to abort. Thus, family planning programs should reach also men. The main way to prevent repeat abortions seen in this study is to prevent abortions in general, by making contraceptives accepted by and easily obtainable for all groups in society, thus diminishing those times when sexually active men and women temporarily do not use contraceptives.

Non-specific steroidal esterase activity and distribution in human and other mammalian tissues.

An NADPH dependent arylamine carcinogen and fatty acid steroid ester metabolizing esterase activity belonging to the B- or carboxylesterase class of non-specific esterase (EC 3.1.1.1) was measured by two different methods: (i) a spectrophotometric assay using alpha naphthyl acetate (ANA) as substrate and (ii) a radiometric method using the conversion of beclomethasone-17,21-dipropionate to beclomethasone-17-monopropionate as the endpoint. The two methods were strongly correlated when assayed in human mononuclear leukocytes (r = 0.89, P < 0.0001) and human mammary tissue (r = 0.91, P < 0.0001). Hence it was concluded that the two substrates are metabolized at least in part by the same enzyme. This esterase activity was abundant in human monocytes, present in T-lymphocytes and equally divided between CD4 and CD8 T-lymphocyte subsets. The same activity was expressed in human liver, colon, stomach, breast and brain tissues. The distribution of this esterase in human tissues showed high activity in liver, intermediate activity in colon, stomach and breast and low activity in brain tissue. The interorgan distribution observed in human tissues was closely mimicked when the esterase activity was assessed in liver, colon and brain tissues from three mouse strains and three rat strains. The non-specific steroidal esterase activity determined by ANA metabolism in human mammary tissue was shown to be reproducible when assayed as triplicate samples from each of 16 different women (intraclass correlation coefficient 67.3%, P < 0.03). The interindividual variation in mammary tissue was high (18.4-fold) and there was a positive correlation between the esterase activity and age (r = 0.58, P < 0.01), as well as a tendency toward bimodal distribution. To our knowledge, these data represent the first systematic study of interorgan and interspecies comparisons of a non-specific steroidal esterase activity.

Therapeutic effects of the plane occlusal splint on signs and symptoms of craniomandibular disorders in patients with nocturnal bruxism.

The long-term effects were studied of a full arch maxillary plane occlusal splint on chronic signs and symptoms of craniomandibular disorders (CMD) in 31 patients with nocturnal bruxism. The results revealed that the score and intensity of signs and symptoms in this type of patient fluctuate from day to day and even within a single day. In spite of continuation of nocturnal bruxism, the symptoms of CMD were cured or improved with the long-term use of the occlusal splint. However, in general, the symptoms recurred after discontinuation of splint therapy. The therapeutic mechanisms of the splint during sleep are discussed.