Electronic dental record-based surveillance of non-communicable conditions.

OBJECTIVE: The objective of the study is to demonstrate that electronic dental records (EDRs) can be used to mine meaningful public health information. STUDY DESIGN: Retrospective electronic dental chart-based reporting of disease prevalence. METHODS: Using dental EDRs (N = 104,768), the authors assessed the prevalence of common non-communicable medical conditions among unique patients seen at a United States (U.S.) dental college. RESULTS: The prevalence of following conditions in patients visiting a U.S. dental college increased steadily with increasing age: hypertension, angina, stroke, myocardial infarction, congestive heart failure, diabetes, cancer, kidney disease, thyroid disease, and allergies. Prevalence of these conditions was several-fold higher in the 66+ years group than among younger adults. Prevalence of many of the assessed conditions approximated published national estimates. CONCLUSIONS: In addition to the indispensable use of EDRs in dental education and patient management, EDRs can be mined to report on prevalence of non-communicable medical conditions among patients/population receiving dental care. Completeness and accuracy of entered information will significantly improve the usefulness of EDR for disease surveillance and research applications.

Two cases of infection with Bacillus anthracis, Romania, October 2011.

A cluster of two confirmed cases of anthrax were reported in October 2011 from a small village with a population of 3,400 people, in south-eastern Romania.One was a fatal case of cutaneous and anthrax meningoencephalitis, while the other had cutaneous anthrax. Both cases had been exposed to one Bacillus anthracis-infected cow via consumption of its meat or being involved in its slaughter.

Anomalous noise in the pseudogap regime of YBa2Cu3O(7-delta).

An unusual noise component is found near and below about 250 K in the normal state of underdoped YBCO and Ca-YBCO films. This noise regime, unlike the more typical noise above 250 K, has features expected for a symmetry-breaking collective electronic state. These include large individual fluctuators, a magnetic sensitivity, and aging effects. A possible interpretation in terms of fluctuating charge nematic order is presented.

Professional charges not reimbursed to dentists in the U.S.: evidence from Medical Expenditure Panel Survey, 1996.

OBJECTIVES: This cross-sectional study examined professional charges not paid to dentists. METHODS: This analysis used logistic regression in SUDAAN examining the 1996 MEPS data from 12,931 adults. RESULTS: Among people incurring dental care charges, 13.6% had more than $50 of unpaid charge (UC). The percapita UC was $53.30. Total UC was higher for highest income group [45.4% of total] compared to lowest income group [26.0%]. The percapita UC of $76.70 for low income group was significantly greater than for high income group ($47.80, P < 0.01). More Medicaid recipients (52% vs. non-recipients: 12%) incurred at least $50 in UC (P < 0.01). Adjusted odds of incurring UC were greater for those employed (OR = 1.3, 95% CI: 1.0-1.7), and for those with private insurance (OR: 1.5, CI: 1.3-1.9). Number of dental procedure types modified the association between Medicaid recipient and UC (OR = 13.6 for Medicaid recipients undergoing multiple procedure types; OR: 2.3 for Medicaid non-recipients with multiple procedure types; OR: 1.9 for Medicaid recipients receiving single dental procedure. CONCLUSIONS: Having private insurance, being unemployed and being Medicaid insured undergoing multiple procedure were strongest predictors of UC.

Dental Restoration Longevity among Geriatric and Special Needs Patients.

INTRODUCTION: Although the population is aging and retaining more teeth, there is a lack of studies that address the longevity of dental restorations placed among older adults. OBJECTIVES: This study aimed to describe the survival trajectory of dental restorations placed in an outpatient population of geriatric and adult special needs patients over a 15-y span, with particular interest in the longevity of subsequent restorations in teeth that received multiple restorations over time. METHODS: Dental restorations of different types and sizes in patients aged ≥65 y treated between 2000 and 2014 at the University of Iowa College of Dentistry were followed until they incurred an event (i.e., restoration replacement, extraction of the tooth, or endodontic treatment of the tooth). Survival analysis and extended Cox regression models were used to generate hazard ratios for selected predictor variables. RESULTS AND CONCLUSION: A total of 9,184 restorations were followed among 1,551 unique patients. During the follow-up period, 28.7% of these restorations incurred an event, and overall the restorations had a median life span of 6.2 y. In multivariable regression models, after controlling for sex and age, a greater number of restoration surfaces were associated with higher risks of failure, and the initial restoration recorded in the database for each participant tended to have a lower risk of failure than that of restorations that included any of those same surfaces that were placed later. This information could be helpful to older adult patients considering various restorative treatment options during the dental treatment-planning and informed consent process. KNOWLEDGE TRANSFER STATEMENT: Informed decision making with regard to potential treatment options is an important component of health and well-being. The present study could contribute to the improved health of older adult dental patients by providing baseline information that clinicians can use as they discuss different restorative treatment options with these patients and their caregivers during the informed consent process.

Processing of visually presented sentences in Mandarin and English studied with fMRI.

Comprehension of visually presented sentences in fluent bilinguals was studied with functional magnetic resonance imaging (fMRI) using a set of conceptually similar sentences in two orthographically and phonologically distinct languages, Mandarin and English. Responses were monitored during scanning. Sentence comprehension in each language was compared to fixation in nine subjects and Tamil-like pseudo-word strings in five subjects. Spatially congruent activations in the prefrontal, temporal, and superior parietal regions and in the anterior supplementary motor area were observed for both languages and in both experiments at the individual and group levels of analysis. Proficient bilinguals exposed to both languages early in life utilize common neuroanatomical regions during the conceptual and syntactic processing of written language irrespective of their differences in surface features.

Optical homodyne PSK demonstration of 1.5 photons per bit at 156 Mbps with rate-(1/2) turbo coding.

We report the first demonstration of a near quantum-limited optical homodyne PSK receiver combined with powerful forward-error-correction coding, achieving 1.5 photons/bit sensitivity, within 4.5 dB of the Shannon limit. Phase-locking was achieved at 1.55 microm using an analog dither-based optical phase-locked loop with an external phase modulator. Analysis for this configuration with arbitrary loop damping is given showing a performance advantage for the overdamped case.

High-sensitivity multi-channel single-interferometer DPSK receiver.

A high-sensitivity method of demodulating wavelength-division-multiplexed optical DPSK channels using a single interferometer is described and demonstrated. We show that this technique can operate within existing standards and achieve near-quantum-limited receiver performance. The resulting hardware simplification has potential to reduce the cost of deploying and scaling future wide-band optical-communication networks employing WDM-DPSK.

Cigarette smoking increases the risk of root canal treatment.

Few studies have investigated smoking as a risk factor for root canal treatment. We studied the effect of smoking on the incidence of root canal treatment, controlling for recognized risk factors, in 811 dentate male participants in the VA Dental Longitudinal Study. Participants were not VA patients. Follow-up ranged from 2 to 28 years. Root canal treatment was verified on radiographs and evaluated with proportional hazards regression models. Compared with never-smokers, current cigarette smokers were 1.7 times as likely to have root canal treatment (p < 0.001), but cigar and/or pipe use was not significantly associated with root canal treatment. The risk among cigarette smokers increased with more years of exposure and decreased with length of abstinence. These findings suggest that there is a dose-response relationship between cigarette smoking and the risk of root canal treatment.

Lesions of endodontic origin and risk of coronary heart disease.

A paucity of epidemiologic research exists regarding systemic health consequences of endodontic disease. This study evaluated whether incident radiographically evident lesions of endodontic origin were related to development of coronary heart disease (CHD) among 708 male participants in the VA Dental Longitudinal Study. At baseline and every three years for up to 32 years, participants (who were not VA patients) received complete medical and dental examinations, including full-mouth radiographs. Cox regression models estimated the relationship between incident lesions of endodontic origin and time to CHD diagnosis. Among those < or = 40 years old, incident lesions of endodontic origin were significantly associated with time to CHD diagnosis (p < 0.05), after adjustment for covariates of interest, with hazard ratios decreasing as age increased. Among those > 40 years old, no statistically significant association was observed. These findings are consistent with research that suggests relationships between chronic periodontal inflammation and the development of CHD, especially among younger men.

Anatomy of stroke, Part II: volumetric characteristics with implications for the local architecture of the cerebral perfusion system.

BACKGROUND AND PURPOSE: The margin of a stroke is assumed to approximate a trace of the isobar of the perfusion threshold for infarction at the time that infarction occurred. Working from this hypothesis, we have analyzed stroke topography and volume in MR images obtained at a time remote from the stroke event. We have derived parameters from these images that may give information on local perfusion competence and microvascular architecture because they influenced the contour of stroke at the time infarction occurred. METHODS: MR images were obtained months after presumed embolic middle cerebral artery stroke in 21 subjects. Volumetric analyses of image data were undertaken with respect to the tissue shape of stroke and scaling ratios of anatomic partitions involved in stroke. RESULTS: For stroke confined to a single volume, the 3-dimensional form conforms to a parabola in which the height-to-width ratios are variable. The ratio for cortex is greater than that for underlying white matter. Scaling ratios indicate a close correlation between volume of cortex and radiata destroyed and total volume of stroke, but the relative proportions vary as a function of location within the M4 territory. CONCLUSIONS: Scaling ratios for cortex and radiata to stroke volume are consistent with vascular studies that depict a modular microvascular perfusion architecture for the cortex and underlying white matter. The stroke descriptors are inferred to be related to the competence of collateral perfusion at the time that stroke occurred. This inference may be tested by serial volumetric analysis of the perfusion-diffusion examination mismatch immediately and over the longer-term evolution of stroke.

Anatomy of stroke, Part I: an MRI-based topographic and volumetric System of analysis.

BACKGROUND AND PURPOSE: The clinical diagnosis and treatment of stroke, as well as investigations into the underlying pathophysiology of the disease, hinge on inferences from the anatomy of the stroke lesion. We describe an MRI-based system of topographic and volumetric analysis that considers distribution of infarct with respect to neuroanatomic structures, superficial and deep perfusion compartments, and gray and white matter tissue types. METHODS: MRI-based 3-dimensional topographic and volumetric analysis of presumed MCA embolic stroke was performed months after the acute event in 21 subjects ranging in age from 34 to 75 years. RESULTS: The topography of infarction was greatly variable, with virtually all regions of the MCA territory involved in at least 1 stroke in the series. In 14, there was involvement of the M1 as well as the M2 through M4 territories; in 6, there was involvement of only the M2 through M4 territories; and in 2, there was involvement of only the M1 territory. The volumes varied from 3.1 to 256 cm3, corresponding approximately to a range of 1% to 90% of the total MCA territory. CONCLUSIONS: The system of topographic and volumetric analysis is generally applicable to all strokes in the forebrain where the infarct is visualized in MRI, independent of vascular territory, clinical correlates, and interval between stroke and MRI. The results emphasize the variety of topographic patterns and lesion volumes of strokes. Intended long-range applications include correlation of outcome of stroke with predictions from acute-phase diffusion- and perfusion-weighted imaging and investigations of the potential benefit of therapeutic agents.

Postparathyroidectomy transient thyrotoxicosis.

Three patients are described who had spontaneously resolving transient thyrotoxicosis after resection of a parathyroid adenoma without thyroidectomy or an apparent thyroid abnormality before or during surgery. All had documented thyrotoxicosis that developed within 2 weeks after surgery, which was clinically symptomatic in two of three patients. The thyrotoxicosis was associated with subnormal radioactive iodine thyroid uptake when performed in the two symptomatic patients and was consistent with a postsurgical inflammatory etiology secondary to thyroid gland trauma during parathyroidectomy. In all patients, the clinical and biochemical evidence of thyrotoxicosis resolved within 2 months. Antithyroglobulin and antimicrosomal antibodies were not detected in the two patients who had a complete recovery 3 months after surgery. However, in the patient who had autoimmune thyroiditis, hyperthyroidism due to Graves' disease subsequently developed 19 months after parathyroidectomy and was associated with increasing titers of antithyroglobulin and antimicrosomal thyroidal autoantibodies. From these observations, we conclude that 1) spontaneously resolving transient thyrotoxicosis of varying severity may occur in some patients after parathyroidectomy, which could be secondary to intraoperative thyroid gland manipulation, and 2) while the occurrence of subsequent Graves' hyperthyroidism in a patient with underlying autoimmune thyroiditis may have been a coincidence, this observation also raises the possibility that thyroidal autoantigen released during parathyroidectomy may trigger the reactivation of autoimmune thyroid disease in a predisposed subject.

Analysis of lesions by MRI in stroke patients with acoustic-phonetic processing deficits.

We tested 10 aphasic stroke patients for the ability to discriminate and identify English phonemes. All patients underwent MRI and had their scans analyzed morphometrically. Patients with impairments in acoustic-phonetic processing tended to have lesions involving the left posterior supramarginal gyrus and the bordering parietal operculum, an observation further supported by regression and correlation analyses. These results are interpreted as evidence that the region including the left posterior supramarginal gyrus and parietal operculum plays a significant role in acoustic-phonetic processing.

Subacute necrotizing encephalopathy: oxidative phosphorylation defects and the ATPase 6 point mutation.

Subacute necrotizing encephalopathy (SNE) or Leigh's disease is associated with various defects in oxidative phosphorylation (OXPHOS). However, the relationships between these OXPHOS defects and nuclear DNA or mitochondrial DNA (mtDNA) mutations is still unclear. We evaluated three SNE pedigrees (two singleton cases and a pedigree) biochemically for OXPHOS abnormalities and genetically for four mtDNA point mutations. There was a complex I defect in all three pedigrees that was associated with a complex III defect in two individuals. An mtDNA mutation in the ATPase, subunit 6 gene (np 8993) was present in one SNE pedigree. This mutation was maternally inherited, heteroplasmic, produced marked clinical and biochemical heterogeneity between pedigree members, and varied along the maternal lineage at levels ranging from 0% to > 95% of the total mtDNAs. These mtDNA mutations were not present in the other two pedigrees. These observations emphasize the importance of screening for OXPHOS defects and mtDNA mutations in SNE cases.

Discrimination of normal and aphasic subjects on a test of syntactic comprehension.

An Anglophone population consisting of 37 aphasic patients and 23 normal control subjects, and a Francophone population consisting of 49 aphasic patients and 23 control subjects were given a task requiring the comprehension of syntactic structures for the correct assignment of thematic roles to nouns. Discriminant analysis was used to classify subjects into aphasic and normal groups according to their scores on the task. In both populations--Anglophone and Francophone--most of the subjects were classified into their actual groups except for an occasional normal subject classified with the aphasic group and a small number of aphasics classified as normal. A cut-off score below which performance is clearly abnormal and above which performance is clearly normal can be set for this test. Patients who performed normally on this test had lesions affecting any single lobe within the dominant perisylvian cortex and mostly consisted of patients with dysarthria, apraxia of speech, and 'mixed' aphasia types. The results have implications for the incidence of aphasic disturbances of syntactic comprehension and for the nature of language representation in the brain.

The capacity theory of sentence comprehension: critique of Just and Carpenter (1992)

The authors review M.A. Just and P.A. Carpenter's (1992) "capacity" theory of sentence comprehension and argue that the data cited by Just and Carpenter in support of the theory are unconvincing and that the theory is insufficiently developed to explain or predict observed patterns of results. The article outlines an alternative to the capacity theory, according to which the unconscious, obligatory operations involved in assigning the syntactic structure of a sentence do not use the same working memory resource as that required for conscious, controlled verbally mediated processes.

Low levels of pyridoxal 5'-phosphate in patients with cystic fibrosis.

To determine the effect of cystic fibrosis on the regulation of plasma pyridoxal 5'-phosphate (PLP), the biologically active form of vitamin B6, we measured this compound in plasma from 56 patients with cystic fibrosis. The concentration of PLP in plasma was assayed by a radioenzymatic technique. The results of this study showed that PLP concentration was decreased significantly (6.44 +/- 5.20 ng/mL, mean +/- SD; median 4.45 ng/mL) in patients with cystic fibrosis as compared with a group of hospitalized children with neither cystic fibrosis nor hepatic disease serving as a control group (13.2 +/- 5.04 ng/mL, mean +/- SD; median 12.5 ng/mL). Additionally, 25% of the population with cystic fibrosis exhibited exceedingly low plasma PLP level (less than 2.75 ng/mL). In patients with cystic fibrosis, significant inverse linear associations were found between plasma PLP and serum levels of SGOT and SGPT (PLP v SGOT: r = -.60, P less than .03; PLP v SGPT: r = -.50, P less than .03). This study demonstrated that a deficiency of plasma PLP is a common abnormality in cystic fibrosis and that the low PLP level may be a reflection of impaired vitamin B6 metabolism associated with this disorder.

Evidence for hypertyraminemia in Reye's syndrome.

Utilizing a specific and sensitive radioimmunoassay, palsma and urine tyramine were measured in 14 consecutive patients with liver biopsy-proven Reye's syndrome. Plasma tyrosine was measured in 11 of these patients. The results revealed significant (P less than .003) elevation in plasma (3.4 +/- .52 ng/ml) (mean +/- SEM) and urine (1.00 +/- .26 mg/24 hr) tyramine as well as plasma tyrosine (204 +/- 52.5 mumole/liter) at the onset of the disease when compared to the levels of tyramine and tyrosine in a group of hospitalized patients without hepatic disorders. Furthermore, there was a positive correlation between plasma tyramine and days in coma (r = .86; P less than .001), and between plasma tyramine and tyrosine (r = 0.80; P less than .001). These data suggest that there is s substantial disturbance of tyrosine metabolism in Reye's syndrome and that the accumulation of this amino acid and its metabolite, tyramine, may contribute to the encephalopathy of this disease.

Hypercatecholaminemia in Reye's syndrome.

To evaluate the role of catecholamines in Reye's syndrome, a specific and sensitive radioenzymatic assay was used to study plasma and CSF concentration of dopamine, norepinephrine, and epinephrine in 14 patients with liver-biopsy-proven Reye's syndrome. The results (median and range) revealed significant (P less than .04, P less than .0024, and P less than .030, respectively) elevation in plasma dopamine (131, 0 to 1,193 pg/mL), norepinephrine (1,455, 20 to 5,271 pg/mL), and epinephrine (345, 7.6 to 2,504 pg/mL) at the onset of the disease when compared with the level of these neurotransmitters in a group of hospitalized patients without hepatic disorders. There was a positive correlation between plasma catecholamines and stage of coma on admission (r = .54 to .86; P less than .001 to .024). Furthermore, the concentration of dopamine, norepinephrine, and epinephrine in the CSF increased significantly during the development of cerebral edema in all patients with Reye's syndrome as compared with concentrations in a control population. Hypercatecholaminemia may contribute to the encephalopathy of Reye's syndrome.