False-Positive Tuberculin Skin Test Results Among Low-Risk Healthcare Workers Following Implementation of Fifty-Dose Vials of Purified Protein Derivative.

Following large declines in tuberculosis transmission the United States, large-scale screening programs targeting low-risk healthcare workers are increasingly a source of false-positive results. We report a large cluster of presumed false-positive tuberculin skin test results in healthcare workers following a change to 50-dose vials of Tubersol tuberculin.Infect Control Hosp Epidemiol 2018;39:750-752.

Antibacterial effect of genetically-engineered bacteriophage ϕEf11/ϕFL1C(Δ36)PnisA on dentin infected with antibiotic-resistant Enterococcus faecalis.

OBJECTIVE: Enterococcus faecalis is a gram-positive facultative anaerobic bacterium, which is present in 30-89% of teeth with postendodontic treatment failures. E. faecalis is capable of penetrating dentinal tubules and surviving as a monoculture after conventional endodontic therapy, indicating that it is resistant to commonly used endodontic disinfection protocols. Different E. faecalis strains have shown resistance to several antibiotics, and have been associated with both dental pathology and systemic infections. The aim of this study was to evaluate the efficacy of a genetically engineered bacteriophage to disinfect dentin infected with antibiotic resistant strains of E. faecalis. METHODS: Extracted human dentin root segments were cemented into sealable two-chamber devices, fabricated from syringe needle caps to form in vitro infected-dentin models. The models were inoculated with an overnight suspension of either E. faecalis V583 (vancomycin resistant strain) or E. faecalis JH2-2 (fusidic acid and rifampin resistant, vancomycin sensitive strain). After 7days of incubation at 37°C, a suspension of a genetically engineered phage, ϕEf11/ϕFL1C(Δ36)PnisA, was added to the root canal of each infected dentin segment, and the incubation was continued for an additional 72-h. Dentin was harvested from the walls of each root canal and assayed for the residual titer of E. faecalis cells. RESULTS: The recovered E. faecalis titer was reduced by 18% for the JH2-2 infected models, and by 99% for the V583 infected models. CONCLUSION: Treatment: of E. faecalis-infected dentin with bacteriophage ϕEf11/ϕFL1C(Δ36)PnisA consistently resulted in a decrease in the residual bacterial population of both vancomycin-sensitive and resistant strains.

Importance of third mesial canals in mandibular molars: report of 2 cases.

Most mandibular first molars have 2 mesial canals. Two cases of failed endodontically treated first mandibular molars are presented with 2 obturated mesial canals. The cases were retreated with a third mesial canal identified, and instrumented and obturated with resolution of the patients' signs and symptoms. These cases show that consideration must be made to recognize the possibility of a third mesial canal and perform complete treatment to minimize the possibility of failure.

The antimicrobial efficacy of the erbium, chromium:yttrium-scandium-gallium-garnet laser with radial emitting tips on root canal dentin walls infected with Enterococcus faecalis.

BACKGROUND: The authors used an in vitro model to investigate the ability of an erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser with radial emitting tips to disinfect Enterococcus faecalis-infected dentin. MATERIALS AND METHODS: The in vitro infected-dentin model system consisted of a dentin cylinder, prepared from a human anterior tooth root, cemented into a sealable two-chamber device fabricated from a syringe needle cap. The model's lower chamber contained a buffer solution, and the dentin cylinder was placed between the upper and lower chambers. After sterilization, the authors inoculated the root canal of each dentin cylinder with E. faecalis. They used an Er,Cr:YSGG laser with radial emitting tips to irradiate the root canal of each infected dentin cylinder (varying laser power and exposure time). After laser treatment, the authors machined the root canal dentin walls and collected the resulting dentin fillings in the buffer-reservoir. They quantified the E. faecalis titer of each buffer-reservoir by using selective agar plates. RESULTS: The authors found that bacterial recovery decreased when laser irradiation duration or power increased. A greater degree of disinfection was achieved with a 120-second application of laser than with sodium hypochlorite treatment. Finally, they found that a 99.7 percent reduction in bacterial counts could be obtained using the laser. CONCLUSION: The results of this study suggest that the Er,Cr:YSGG laser with a radial emitting tip has a significant antimicrobial effect on dentinal tubules infected with E. faecalis. CLINICAL IMPLICATIONS: Er,Cr:YSGG laser treatment could be a valuable tool for root canal disinfection during endodontic treatment.

Efficacy and safety of firocoxib in the management of canine osteoarthritis under field conditions.

A total of 249 client-owned dogs with osteoarthritis were treated with firocoxib (5 mg/kg/day) or a positive control, etodolac (10-15 mg/kg/day), for 30 days. Veterinary examinations were performed on approximately days 0 (visit 1), 14 (visit 2), and 29 (visit 3). Based on defined noninferiority criteria, firocoxib and etodolac were comparable. Based on the magnitude of the change from baseline, improvement with firocoxib was significantly greater than with etodolac for lameness at a trot (visits 2 and 3) and for lameness at a walk, pain on manipulation, and range of motion (visit 3) (P < .05). In weekly owner evaluations, firocoxib provided significantly greater improvement than etodolac (P < .05) at each scoring.

Chondroconductive potential of tantalum trabecular metal.

Mesenchymal stem cells or chondrocytes have been implanted into joints in biodegradable matrices in order to improve the quality of healing cartilage defects; however, insufficient biomechanical strength of the construct at implantation is a limiting factor for clinical application. Logically, a construct with better biomechanical characteristics would provide better results. Tantalum trabecular metal (TTM) is osteoconductive and mechanically similar to subchondral bone. The objective of this pilot study was to determine if TTM is also chondroconductive. Small sections of TTM were cultured with emu and canine chondrocytes in static and dynamic culture environments. The sections cultured in dynamic bioreactors were diffusely covered with a cartilaginous matrix. Sections cultured in static conditions had no growth. Histologic evaluation from emu and canine dynamic cultures showed tissue that was heavily populated with mesenchymal cells that resembled chondrocytes, and glycosaminoglycan staining that was distributed throughout the matrix. Type II collagen content in the canine dynamic culture was 84% by SDS-PAGE. Tantalum trabecular metal is chondroconductive in vitro in a dynamic environment when cultured with adult canine or emu chondrocytes. This technology could be expanded to determine if cartilaginous-metallic constructs may be used for joint resurfacing of osteoarthritic joints.

Effect of postoperative analgesic protocol on limb function following onychectomy in cats.

OBJECTIVE: To evaluate the analgesic effects of topical administration of bupivacaine, i.m. administration of butorphanol, and transdermal administration of fentanyl in cats undergoing onychectomy. DESIGN: Prospective study. ANIMALS: 27 healthy adult cats. PROCEDURE: Cats were randomly assigned to 1 of 3 treatment groups, and unilateral (left forefoot) onychectomy was performed. Gait analysis was performed before and 1, 2, 3, and 12 days after surgery. All forces were expressed as a percentage of the cat's body weight. RESULTS: On day 2, peak vertical force (PVF) was significantly decreased in cats treated with bupivacaine, compared with cats treated with butorphanol or fentanyl. The ratio of left forelimb PVF to PVF of the other 3 limbs was significantly lower on day 2 in cats treated with bupivacaine than in cats treated with fentanyl. No significant differences in vertical impulse (VI) were found between groups on any day. Values for PVF, VI, and the PVF ratio increased progressively following surgery. However, for all 3 groups, values were still significantly decreased, compared with baseline values, 12 days after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that limb function following onychectomy is significantly better in cats treated with fentanyl transdermally or butorphanol i.m. than in cats treated with bupivacaine topically. Regardless of the analgesic regimen, limb function was still significantly reduced 12 days after surgery, suggesting that long-term analgesic treatment should be considered for cats undergoing onychectomy. Irrigation of the surgical incisions with bupivacaine prior to wound closure cannot be recommended as the sole method for providing postoperative analgesia in cats undergoing onychectomy.

Effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament in dogs.

OBJECTIVE: To determine the outcome and effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament (RCCL) and injury to the medial meniscus in Labrador Retrievers. STUDY DESIGN: Prospective clinical study. ANIMALS: 131 Labrador Retrievers with unilateral RCCL and injury to the medial meniscus and 17 clinically normal Labrador Retrievers. PROCEDURE: Affected dogs had partial or complete medial meniscectomy and lateral suture stabilization (LSS), intracapsular stabilization (ICS), or tibial plateau leveling osteotomy (TPLO). Limb function was measured before surgery and 2 and 6 months after surgery. Treated dogs were evaluated to determine the probability that they could be differentiated from clinically normal dogs and tested to determine the likelihood that they achieved improvement. RESULTS: No difference was found between LSS or TPLO groups, but dogs treated with ICS had significantly lower ground reaction forces at 2 and 6 months. Compared with clinically normal dogs only, 14.9% of LSS-, 15% of ICS-, and 10.9% of TPLO-treated dogs had normal limb function. Improvement was seen in only 15% of dogs treated via ICS, 34% treated via TPLO, and 40% treated via LSS. CONCLUSIONS AND CLINICAL RELEVANCE: Surgical technique can influence limb function after surgery. Labrador Retrievers treated via LSS, ICS, or TPLO for repair for of RCCL and medial meniscal injury managed with partial or complete meniscectomy infrequently achieve normal function. Results of LSS and TPLO are similar and superior to ICS.

Use of pressure platform gait analysis in cats with and without bilateral onychectomy.

OBJECTIVE: To determine peak vertical force (PVF) and vertical impulse (VI) in cats that had or had not undergone bilateral forelimb onychectomy. ANIMALS: 26 healthy adult cats. PROCEDURE: Onychectomized cats (n = 13) had undergone surgery more than 6 months prior to the study. The PVF and VI were collected from all limbs of each cat with a 2-m pressure platform walkway. Cats were allowed to walk at a comfortable velocity, and acceleration was restricted to +/- 0.5 m/s2. Five valid trials were recorded for each cat with all trials collected in a single 1-hour session. All forces were normalized to and expressed as a percentage of the cat's body weight. RESULTS: Gait data were successfully collected in all cats. No significant difference was found for PVF or VI between cats that had or had not had onychectomy. Limb loads were greater in forelimbs than hind limbs for all trials. Mean PVF and VI in the forelimbs of cats in the nononychectomy group were 56.41% and 18.85%, respectively. Mean PVF and VI in the hind limbs of cats in the nononychectomy group were 50.22% and 14.56%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Gait analysis was successfully performed in cats with a pressure platform walkway. The absence of differences in PVF and VI between the 2 groups of cats suggests that bilateral forelimb onychectomy did not result in altered vertical forces measured more than 6 months after surgery in cats.

Assessing the efficacy of perioperative oral carprofen after cranial cruciate surgery using noninvasive, objective pressure platform gait analysis.

OBJECTIVE: To document, using pressure platform gait analysis, the effect of perioperative oral carprofen on limb function and pain after cranial cruciate ligament surgery in dogs. STUDY DESIGN: Blinded, prospective clinical investigation. ANIMALS: Twenty dogs with naturally occurring unilateral cranial cruciate disease. PROCEDURE: Physiologic indices, subjective pain scoring, and pressure platform gait analyses were performed before and 24, 48, and 72 hours after surgery. Correlations were assessed between methods of evaluation and the data was compared across treatment groups. RESULTS: No strong correlations were noted between physiologic data, subjective scoring systems, or gait analysis data at a walk or stance. Although average measures of limb function were nearly twice as large in dogs treated with carprofen, no significant differences between groups over time were identified. No significant differences were noted in any other measure of pain or limb function. Power analysis of peak vertical force at a walk indicated that significant difference would have been detected had the number of dogs in each group been increased to 35. CONCLUSION: When limb function was assessed with pressure platform gait analysis no statistical difference was noted between groups with respect to PVF and VI at a walk or stance, although average ground reaction forces for dogs in the carprofen group were greater than the traditional pain management group at all time points. CLINICAL RELEVANCE: Oral carprofen appears to provide some benefit for the treatment of postoperative orthopedic pain.

Effect of velocity on ground reaction forces in dogs with lameness attributable to tearing of the cranial cruciate ligament.

OBJECTIVE: To ascertain the effectiveness of evaluating ground reaction forces (GRFs) at velocities during walking and trotting in dogs with naturally occurring lameness and determine whether walking would provide sufficient motion to adequately characterize GRFs with respect to trotting. ANIMALS: 29 dogs with a naturally occurring tear of the cranial cruciate ligament. PROCEDURE: Dogs were walked and trotted over a force platform, and GRFs were recorded during the stance phase. Correlation was used to assess the agreement between walking and trotting for GRF The coefficient of variation was calculated to assess the relative variation of outcome variables among the gaits. Group means for walking GRF were compared between dogs that trotted and that failed to trot. RESULTS: GRFs during walking and trotting were highly correlated. The coefficient of variation was smaller for GRFs during walking than during trotting. Dogs that failed to trot had significantly smaller mean values of peak vertical force and vertical impulse during walking, compared with values for dogs that were able to trot. CONCLUSIONS AND CLINICAL RELEVANCE: Either velocity is acceptable for GRF evaluation in dogs. Mean GRF during walking was significantly different between dogs that could and could not trot, principally because dogs with the most severe lameness failed to trot. These dogs would be eliminated from a clinical study, and thus, that study would become biased toward dogs that were less lame. In that situation, differences between interventions may be less pronounced, because they would be evaluated on dogs with less lameness.

The relationship between limb function and radiographic osteoarthrosis in dogs with stifle osteoarthrosis.

OBJECTIVE: To evaluate the relationship between limb function and radiographic evidence of stifle osteoarthrosis (OA) in dogs. STUDY DESIGN: The relationship between force platform data and radiographic OA score was evaluated on 2 separate days using regression analysis. Interday variation was also assessed. ANIMALS: Forty-one dogs with visible lameness and radiographic evidence of stifle OA. METHODS: Force platform data were collected at a velocity of 1.7 to 2.0 m/s for 5 trials on day 1 and day 8. Radiographs taken on day 1 were scored using a previously reported OA scoring system. RESULTS: No significant relationship was found between force platform data and OA score. No significant differences were found between any day 1 and day 8 force platform values. CONCLUSIONS: Although radiographic evidence of stifle OA provides evidence of pathology, it does a poor job of representing limb function. In addition, the absence of significant differences between day 1 and day 8 values in this population of dogs supports use of only a single force platform evaluation before measuring a treatment effect. CLINICAL RELEVANCE: The presence of OA in the stifle joint does not correlate with clinical function; radiographic outcome should be used cautiously as a predictor of clinical outcome.

Observation of depth and incidence of the mesial groove between the mesiobuccal and mesiolingual orifices in mandibular molars.

The purpose of this study was to analyze the mesiolingual-mesiobuccal groove indentations at the pulpal floor in mandibular first and second molars. The depth and incidence of occurrence were assessed. Sixty freshly extracted, mature teeth were kept in a 2.5% sodium hypochlorite for 5 to 7 days. The teeth were accessed without touching the floor of the chamber. The dental debris was washed thoroughly and then the patency and the presence of two mesial canals were established with a #10 file. The teeth were placed in 2.5% sodium hypochlorite for 3 to 5 days and later rinsed and air-dried before placement in centrifuge tubes. A vinyl polysiloxane impression material was injected into the chambers, and the teeth were centrifuged. The impressions were carefully removed and then measured by using a dissecting microscope and a transparent millimeter ruler. The ruler, at zero, placed at the mid-floor area of the impression and viewed from the mesial, measured (to the nearest 0.5 mm) the depth of the mesial groove between the mesiolingual and mesiobuccal canals. Due to imperfect impressions, 50 teeth were included in the study. The recorded average in depth was 1.0 mm. Some of the impressions had depths measuring 3.5 mm. This could be a significant space when considering the limitations of instrumentation techniques. There is the question of whether this area may remain untouched, thereby effecting the prognosis of treatment in both vital and nonvital teeth. Modifications in access preparation and/or an increased emphasis on irrigation and intracanal medication may be needed.