A major release of urban untreated wastewaters in the St. Lawrence River (Quebec, Canada) altered growth, reproduction, and redox status in experimentally exposed Daphnia magna.

In 2015, five billion liters of untreated urban wastewater (UWW) were released into the St. Lawrence River (Quebec, Canada) over the course of four days in order to repair the Montreal's sewer interceptor network related to the city's primary wastewater treatment plant. The UWW discharge originated mainly from household, industrial, and hospital sources. The objective of this study was to investigate the toxicological effects of this unprecedented punctual UWW release on aquatic invertebrates to gather information that could help understand the potential impacts to the receiving environment of overflow episodes occurring during heavy rain events. Water samples were collected at four impacted and non-impacted sites during and four weeks after the release. The freshwater crustacean Daphnia magna were experimentally exposed to surface water collected from UWW-impacted sites for 13 days and analyzed for life-history endpoints and suitable biomarkers related to oxidative stress (i.e., catalase, superoxide dismutase, lipid peroxidation, and glutathione-s-transferase) and reproduction (chitinase). Results indicated that D. magna growth and reproduction were significantly increased by exposure to UWWs. These effects were correlated with an increase in chitinase activity, which is primarily controlled by reproductive hormones and involved in growth, suggesting potential impacts on these processes. Results also indicated that some UWW samples might have caused oxidative stress during the release but that it was overcome by antioxidant defenses and did not lead to cellular damage. Overall, current results contribute to a better understanding of the biological impacts of UWW to aquatic invertebrates for a better stormwater management.

Mercury in Ringed Seals (Pusa hispida) from the Canadian Arctic in Relation to Time and Climate Parameters.

Mercury is found in Arctic marine mammals that are important in the diet of northern Indigenous peoples. The objectives of the present long-term study, spanning a 45-yr period, were to 1) investigate the temporal trends of total mercury (THg; muscle and liver) and selenium (Se; liver) in ringed seals (Pusa hispida) from different regions of the Canadian Arctic; and 2) examine possible relationships with age, diet, and climate parameters such as air temperature, precipitation, climatic indices, and ice-coverage. Ringed seals were collected by hunters in northern communities in the Beaufort Sea, Central Arctic, Eastern Baffin Island, Hudson Bay, and Ungava/Nunatsiavut regions (Canada) between 1972 and 2017. Mercury levels did not change through time in seal liver, but THg levels in muscle decreased in seals from Hudson Bay (-0.91%/yr) and Ungava/Nunatsiavut (-1.30%/yr). Carbon stable isotope values in seal muscle decreased significantly through time in 4 regions. Selenium-to-THg ratios were found to be >1 for all years and regions. Variation partitioning analyses across regions indicated that THg trends in seals were mostly explained by age (7.3-21.7%), climate parameters (3.5-12.5%), and diet (up to 9%); climate indices (i.e., Arctic and North Atlantic Oscillations, Pacific/North American pattern) explained the majority of the climate portion. The THg levels had a positive relationship with Arctic Oscillation for multiple regions. Associations of THg with air temperature, total precipitation, and sea-ice coverage, as well as with North Atlantic Oscillation and Pacific/North American pattern were found to vary with tissue type and geographical area. Environ Toxicol Chem 2020;39:2462-2474. © 2020 Her Majesty the Queen in Right of Canada. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC. Reproduced with the permission of the Minister of Fisheries and Oceans Canada.

Pulmonary rehabilitation in chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide and an important worldwide cause of disability and handicap. Centered around exercise training, pulmonary rehabilitation is a global, multidisciplinary, individualized and comprehensive approach acting on the patient as a whole and not only on the pulmonary component of the disease. Pulmonary rehabilitation is now well recognized as an effective and key intervention in the management of several respiratory diseases particularly in COPD. Modern and effective pulmonary rehabilitation programs are global, multidisciplinary, individualized and use comprehensive approach acting on the patient as a whole and not only on the pulmonary component of the disease. In the last two decades interest for pulmonary rehabilitation is on the rise and a growing literature including several guidelines is now available. This review addresses the recent developments in the broad area of pulmonary rehabilitation as well as new methods to consider in the development of future and better programs. Modern literature for rationale, physiopathological basis, structure, exercise training as well challenges for pulmonary rehabilitation programs are addressed. Among the main challenges of pulmonary rehabilitation, efforts have to be devoted to improve accessibility to early rehabilitation strategies, not only to patients with COPD but to those with other chronic respiratory diseases.

A unique case of Hajdu-Cheney syndrome and squamous cell carcinoma of the anus.

OBJECTIVE: Hajdu-Cheney syndrome (HCS), first described in 1948 by Hajdu and independently in 1965 by Cheney, is an extremely rare disorder characterized by severe and excessive bone resorption leading to osteoporosis, with a wide range of other systemic complications from connective tissue and bone dysplasia. Currently there are approximately 50 distinct cases reported in the literature. There have been several reports associating polycystic kidneys with HCS and several other connective tissue disorders, suggesting a possibility of a hyperproliferative component to the syndrome. No articles exist in the current literature describing a case of HCS with concurrent carcinoma. Here, we present a case of a 54-year-old nonimmune compromised woman with multiple stigmata of HCS and recently diagnosed anal squamous cell carcinoma. METHOD: This is a case report of HCS and stage T3N0 squamous cell carcinoma of the anus. RESULTS: This is the first report of a patient with HCS with malignancy. CONCLUSIONS: We present a patient with HCS who developed anal squamous cell carcinoma. The mechanism of HCS, which is still unknown, may either make patients more susceptible to carcinoma or may just be a reflection of the normal incidence of anal squamous cell carcinoma given attributable risk factors.

Trends of persistent organic pollutants in ringed seals (Phoca hispida) from the Canadian Arctic.

Ringed seals (Phoca hispida) have been used as bioindicator species of environmental contamination in Canada since the 1970s. In the present study, seals were harvested during subsistence hunts in four regions of the Canadian Arctic: Beaufort Sea, Arctic Archipelago, Hudson Bay, and coastal Labrador. An extensive suite of persistent organic pollutants (POPs) was determined in seal blubber collected for multiple years between 1972 and 2016. Results from this long-term study indicate geographical differences in the contaminant concentrations in seals and the significant general decrease of most POPs, including polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT) and related compounds, chlordanes (CHL), and hexachlorocyclohexanes (HCH) over time in ringed seals. The highest decrease rates (up to -9.1%/year for α-HCH) were found in seals from the Hudson Bay region where all chemicals investigated have significantly decreased since 1986. Significant increases in concentrations of hexachlorobenzene (HCB) in seals from Labrador and ß-HCH in Sachs Harbour, NT and Arctic Archipelago were observed. Site-specific and contaminant-specific associations between climate pattern (i.e., Arctic Oscillation, North Atlantic Oscillation, and Pacific/North American pattern) and mean ice-coverage (total, first-year ice, and old-ice) were found at sites with the longest time trend data (i.e., Arviat, Sachs Harbour/Ulukhaktok and Resolute Bay). Overall, results suggest that North American and international regulations have led to the long-term reduction of most POPs in Canadian Arctic ringed seals by reducing emissions from primary sources. However, other sources of legacy compounds (e.g., environmental reservoirs) as well changes in food web composition and structure in relation to climate changes could also be influencing the very slow rates of decline, or stable levels, of contaminants found in seals at some sites. Further work is warranted to discern between co-variation of climate changes and contaminant concentrations and cause-and-effect relationships.

Spatial and temporal trends of alternative flame retardants and polybrominated diphenyl ethers in ringed seals (Phoca hispida) across the Canadian Arctic.

Concentrations of alternative flame retardants and polybrominated diphenyl ethers (PBDEs) were analyzed in ringed seal (Phoca hispida) blubber collected across the Canadian Arctic during subsistence hunts between 1998 and 2013. More than 80% of sampled animals were females and juvenile males. The highest mean ΣPBDE concentrations (sum of 13 congeners) were found in seals from Nain (Nunatsiavut) as well as Inukjuaq and Arviat (Hudson Bay) and the lowest mean levels were found in seals from Lancaster Sound. BDE-47 and -99 were the predominant PBDE congeners quantified in ringed seals. The most frequently detected non-PBDE flame retardants were polybrominated biphenyl 101 (BB-101, 57% of samples analyzed for this chemical), hexabromocyclododecane (HBCDD; 38%), hexabromobenzene (HBB, 30%), and 2-ethylhexyl-2,3,4,5-tetrabromobenzoate (EHTeBB, 23%). The relative trophic position of seals, estimated using stable isotopes, did not vary over time and did not influence flame retardant blubber concentrations. The relative carbon source increased over time at Arviat and Resolute Bay and weak relationships were observed with ΣPBDEs in blubber of seals. ΣPBDEs increased significantly from 1998 to 2008 in ringed seals from East Baffin and subsequently decreased in recent years. PBDE levels at other sites fluctuated slightly over time. HBCDD concentrations increased at several sites over the past decade. The presence of flame retardants in ringed seals suggests their persistence and their continuous inputs in the Canadian Arctic environment. Monitoring and research on the effects of these contaminants in seals are warranted given the importance of this species in Arctic marine food webs and for local communities.

Spatial and temporal variations of a saxitoxin analogue (LWTX-1) in Lyngbya wollei (Cyanobacteria) mats in the St. Lawrence River (Québec, Canada).

The concentration of the saxitoxin analogue LWTX-1 was quantified in samples of the benthic filamentous cyanobacterium Lyngbya wollei (Farlow ex Gomont) Speziale and Dyck collected in two fluvial lakes of the St. Lawrence River (Canada) over the 2006-2013 period. The study was aimed at documenting the spatial (between fluvial lakes, between sites within each lake) and temporal (inter-annual, monthly) variations of toxin concentration in relation with hydrological (water level), physical (water temperature, conductivity, transparency), chemical (nutrients in overlying water) and biological (L. wollei biomass and mat condition) characteristics. Toxin concentration was hypothesized to vary seasonally with biomass accumulation and environmental conditions. Toxin concentrations measured in Lake Saint-Louis (51±40µg LWTX-1g-1 DM, N=29 days in 2007, 2009-2011) were double those in Lake Saint-Pierre (25±31µg LWTX-1g-1 DM, N=26 days in 2006-2008, 2012-2013); however, August 2007 measurements taken from both lakes did not differ significantly. Ten of the twelve highest values (>100µg LWTX-1g-1 DM) were obtained from Lake Saint-Louis, between April and October in 2007, 2010 or 2011. Under ice samples showed intermediate concentrations of LWTX-1 (42±9µg LWTX-1g-1 DM, N=2). Concentrations of LWTX-1 were positively correlated with Secchi depth (r=0.59, p<0.001), L. wollei biomass (Spearman r=0.31, p<0.01) and %N in filaments (r=0.48, p<0.001), suggesting toxin production was linked to mat growth and metabolism rather than water quality. Although LWTX-1 has been reported to have a low toxicity, monitoring of L. wollei abundance is required to assess the environmental and human health risks posed by this taxon in the St. Lawrence - Great Lakes system.

Reappearance of electroencephalogram slow waves in extended sleep with delayed bedtime.

A three-part study using prolonged nights of sleep was undertaken to verify Broughton's hypothesis of an approximate 12-h ultradrian rhythm of human slow wave sleep (SWS). Part I consisted of 2 8-h adaptation nights followed by a prolonged 15-h night of sleep with bedtime at midnight. A significant return of SWS occurred 12 h and 32 min after the first appearance of SWS. In part II, after 1 adaptation night, subjects were asked to sleep for 15 h but bedtime was delayed until 0400 h. A two-peak return of SWS was observed with a first significant return at 1228 h and a second significant return at 1745 h (i.e., 13 h and 32 min after the first appearance of SWS). In part III, bedtime was again delayed to 0400 h; but subjects were given 3 nights to adapt before the 15 h extended sleep. A single significant return of SWS was then observed at 1656 h, i.e., 12 h and 24 min after the first appearance with no peaks around 1200 h, thus exhibiting the same pattern as in part I. These results suggest that the return of SWS seen normally between 1200 and 1500 h is relatively well entrenched since it remained present in the extended night following sudden bedtime delay. It appears, moreover, that SWS does follow a bimodal 12-h rhythm, which is seen immediately upon extended delayed sleep and can be fully phase-shifted with habituation.

Sleep positions and position shifts in five age groups: an ontogenetic picture.

In an attempt to characterize the development of sleep positions and position shifts in the human, 10 subjects (5 males and 5 females) in each of the following five age groups were studied: 3-5, 8-12, 18-24, 35-45 and 65-80 years old. Subjects slept for four consecutive nights (except the 3-5 year olds who slept two nights) in the laboratory where standard polysomnography was recorded. On nights 3 and 4, sleep positions were recorded with a Super 8 Camera taking one frame every 8 seconds and were scored using four dimensions (head, trunk, legs and arms) each consisting of four categories. The results revealed a significant ontogenetic decrease in the number of position shifts with averages of 4.4, 4.7, 3.6, 2.7 and 2.1 changes per hour, respectively. There was a corresponding progressive increase in the duration of positions and in the number of periods of more than 30 minutes of postural immobility. Whereas in children, prone, supine and lateral positions were assumed to occupy an equal proportion of sleep time, trend analyses revealed a significant progressive ontogenetic disappearance of prone positions and a progressive preference, very marked in the elderly, for right-side positions.

Sleep positions in the young adult and their relationship with the subjective quality of sleep.

The sleep characteristics and the body positions of eight good and eight poor sleepers were monitored in the laboratory for 2 consecutive nights preceded by 2 adaptation nights. Throughout the nights, sleep positions and sleep motility were monitored with a super-8 camera, and a new scoring method was used. Overall, the findings supported earlier observations regarding sleep positions and sleep motility. Interestingly, poor sleepers spent more time awake and had more awakenings than good sleepers. Consistently, poor sleepers spent more time on their backs with their heads straight. These results suggest that sleep positions constitute an important sleep variable and that they may be related to the quality of sleep.

Endothelial cells exposed to erythrocytes under shear stress: an in vitro study.

After injury and vascular replacement, endothelial cell recovery is limited and could lead to thrombosis. Seeding small diameter vascular prosthesis with endothelial cells has been proposed to fulfil cell lining and improve surface hemocompatibility. However, detachment of seeded cells occurs following implantation. Previous in vitro studies have looked at the fluid shear stress as a major cause of cell detachment. To our knowledge, the role of erythrocyte collisions has not been investigated. The present in vitro study aims at investigating whether endothelial cell adhesion depends on (i) the presence of erythrocytes in flow and (ii) the latent culture period (1, 24 and 48 h) between seeding and exposure to flow. Endothelial cells were exposed to culture media containing different erythrocyte concentrations using a steady laminar flow of 1350 ml min(-1) in a parallel plate flow chamber. Endothelial cell morphology in dynamic conditions was quantified and compared to that in static conditions. The projected area of cells were mostly found smaller under dynamic than static conditions, particularly at a wall shear stress of 23 dyn cm(-2). Cells from the 1 h latent culture period were oriented parallel to the flow axis and were more elongated than under static conditions. Conversely, endothelial cell shape was slightly modified when either the latent period or the wall shear stress was increased. Disparate orientation was observed on confluent endothelial cells (24-48 h latent period) exposed to shear stress with or without erythrocytes. Increasing fluid viscous forces due to erythrocytes play a critical role on the behaviour of freshly seeded endothelial cells upon exposure to blood flow.

A longitudinal evaluation of fissure sealants applied in dental practices.

Sealants are highly effective in preventing dental caries in the pits and fissures of teeth when applied by trained operators in clinical trials and public health programs. The effectiveness of fissure sealants when applied in dental practices is still not known. The purpose of this longitudinal study was to evaluate the effectiveness of fissure sealants applied in dental practices in preventing dental caries on occlusal surfaces of first permanent molars. In 1990, on the Island of Montréal, 911 randomly selected children, from 6 to 9 years of age, were examined; out of those, 816 and 733 were re-examined in 1991 and 1992, respectively. Only the 733 children with complete examination records were included in this evaluation. Sealant applications were either personally paid for or were paid for by private dental insurers. All children were covered for diagnosis and restorative care by a publicly financed and universal insurance program. Dental treatment records were provided by Quebec's health insurance board. In the epidemiological examination, the occlusal surfaces of first permanent molars, which are the only surfaces included in this analysis, were classified into: sound, non-cavitated and cavitated status, restored, and sealed. Sealants were evaluated for full or partial coverage of the occlusal surface and presence of dental caries. During the first and second years, 11.6% and 17.5% of the students had new sealants. The number of new sealants placed during the two years was 507. Children with caries-free status and whose parents had high school education or higher were significantly more likely to receive sealants during the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Depression and suicide in patients with cancer.

Depression is a prevalent psychiatric syndrome in the cancer population. We review the spectrum of conditions in which depressive features are present, from normal responses to crises in cancer to depression secondary to organic causes. The different modalities of treatment, including pharmacologic, psychotherapeutic and social interventions, are described. Specific guidelines for the management of the suicidal cancer patient are given and physician-assisted death is discussed.

Delirium in terminal cancer: a prospective study using daily screening, early diagnosis, and continuous monitoring.

A pilot prospective cohort study was conducted to determine delirium frequency and outcome in cancer patients consecutively hospitalized for terminal care (median stay: 12 days). Screening for delirium symptoms was performed daily, using the Confusion Rating Scale. Patients positive on screening had a diagnostic assessment within 24 hours using the Confusion Assessment Method. Monitoring of symptoms was continued until death. Eighteen (20%) of the 89 study patients were positive on screening at admission. Among the 71 patients free of delirium at admission, the incidence of confirmed delirium was 32. 8% (95% CI, 21.3-44.3%). Patients positive on screening received a higher mean equivalent parenteral daily dose of morphine than other patients (72 mg vs. 41 mg, p = 0.08). Significant symptom improvement occurred in 16 (50%) of the 32 delirious cases. Delirium is a serious and frequent complication in terminal cancer whose outcome may not be as poor as previously considered.

Olfactory adaptation, threshold shift and recovery at low levels of exposure to methyl isobutyl ketone (MIBK).

The anatomic position of olfactory receptors renders them vulnerable to airborne pollutants. Chamber inhalation studies have shown dose-dependent olfactory adaptation and temporary olfactory threshold perception shift for particular inhaled substances. The present study was undertaken to examine olfactory perception threshold (OPT) and adaptation of healthy subjects exposed for 7h to MIBK. Volunteers (n = 4) were exposed in an inhalation chamber to MIBK at concentrations of 20 ppm and 40 ppm. For each of 6 exposure days, OPT for MIBK and PM-Carbinol were determined once before exposure and at 3 successive intervals following exit. Exhaled air samples were taken at regular intervals during and after exposure. Perceived odor intensity and symptoms were ascertained through a questionnaire filled out hourly. On all days, post-exposure OPT-MIBK at chamber exit was significantly higher than pre-exposure, representing a ninefold increase in concentration; recovery was dose-dependent and not complete 95 min. after exit. No threshold shift was observed for OPT-PM-Carbinol. Perceived odor intensity was high when entering the chamber, but diminished with time, stabilizing after approximately 2 hours. Symptoms of nose, eye or throat irritation and headache were present in some subjects. The findings of this study suggest that at these levels of MIBK, there is olfactory adaptation during exposure and a transient OPT shift for the inhaled substance. Persons exposed professionally or environmentally to certain organic solvents may suffer temporary smell loss which hinders odor detection.

An adaptation of hydrophobic interaction chromatography for estimation of protein solubility optima.

This study describes an adaptation of hydrophobic interaction chromatography (HIC) that can be used to estimate protein solubility optima. The method does not support determination of absolute, e.g. quantitative solubility, however it does provide a basis for identifying the salt concentration, pH, or additive concentrations that support the highest relative solubility. The magnitude of a given salt's effects are consistent with its ranking in the Hofmeister series. IgG in solutions of strong 'precipitating' salts exhibits a classical salting-in/salting-out curve, described by a solubility minimum at low ionic strength, increasing to a well-defined maximum, and then losing solubility with further elevation of salt concentration. The direct effect of pH on protein solubility, as well as its indirect effect via modification of the ionic equilibria of dissolved salts, can also be tracked. Cooperative effects of solubility modifiers such as amino acids can likewise be assessed. The technique can be a useful tool in the development of liquid formulations for protein pharmaceuticals.

Prevalence of non-cavitated and cavitated carious lesions in a random sample of 7-9-year-old schoolchildren in Montreal, Quebec.

This report describes the prevalence of non-cavitated and cavitated carious lesions in 911 randomly selected children in grades one through three on the Island of Montreal, Quebec, Canada. The criteria for diagnosis were developed for a longitudinal epidemiological study of restorative treatment decisions by dentists practising under a provincial dental insurance program for children. The intra- and inter-examiner reliability correlation coefficients of the two examiners were excellent (Kappa > or = 0.80). The most frequent carious lesion found in the examined children were non-cavitated carious lesions (incipient) within 1.5 of the gingival line on smooth tooth surfaces, and stained or non-cavitated carious lesions on pits and fissures. Out of 911 children in the study, 19.6% had sealants. Children whose parents completed a university education had a significantly lower prevalence of non-cavitated and cavitated carious lesions and fillings, and a significantly higher mean number of sealants than children whose parents had only primary school education. Education status of the parents was a significant risk marker of children with high caries experience and these children had a significantly higher mean number of non-cavitated carious lesions. This study has found that non-cavitated carious lesions are significantly more prevalent than cavitated carious lesions in children.

Assessing the preovulatory LH surge with a three-hour radioimmunoassay.

A rapid, simple and precise luteinizing-hormone (LH) assay would appear to be the most appropriate approach to predicting ovulation in in vitro fertilization and artificial insemination programs based on natural ovulation. Therefore, we modified a standard LH radioimmunoassay into a convenient assay providing reliable results within three hours after blood collection. The antigen-antibody reaction takes place during a two-hour incubation under nonequilibrium conditions at 20 C. The immune complex is precipitated with polyethyleneglycol containing sheep anti-rabbit antibodies. The standard curve of the rapid method shows characteristics (ED-50, slope, sensitivity, range, precision) similar to those of the regular assay, and the results of both assays are comparable over a wide range of values. The interassay variation is less than 15%. The preovulatory LH surge has been evaluated in 32 cycles (20 women) with successive dosages of daily blood samples taken every three to five hours. LH surges vary in shape and duration. In most of the cycles the LH surge is relatively steep, and the maximum LH value is observed within 17 hours after the beginning of the LH rise in 87% of the cycles. Detection of the initial rise in the LH peak on the basis of successive assays of frequent blood samples seems to be reliable in predicting ovulation.

Mechanical properties of the rabbit cornea during wound healing after treatment with epidermal growth factor.

To determine whether epidermal growth factor (EGF) accelerates the healing of corneal tissue, we measured the tensile strength, ductility (total deformation at rupture) and toughness of 60 rabbit corneas with 7-mm perforating wounds after topical treatment with EGF or saline for 8, 13 or 23 days. The three mechanical properties were measured using corneal strips mounted on an Instron tensometer. A traction speed of 5 cm/min was chosen from speed-response curves for the three measures of interest. Since the values for eyes of a single rabbit were correlated, we used the data for one eye, selected at random, from each animal in the data analysis. EGF enhanced tensile strength (p = 0.003) and toughness (p = 0.03) of corneas without reducing ductility. The difference in tensile strength and toughness between EGF- and saline-treated corneas was more striking at 8 and 13 days than at 23 days. Histologic studies at 13 and 23 days supported these observations: at 13 days the healing process was more advanced in EGF-treated corneas, whereas at 23 days no histologic differences were noted. We conclude that EGF accelerates wound healing in rabbit corneas with perforating wounds without reducing ductility of the corneal tissue.

Restorative treatments received by children covered by a universal, publicly financed, dental insurance plan.

OBJECTIVES: This study sought to identify risk markers associated with the provision of new restorations in children and to investigate whether the carious status of a tooth surface is associated with the restorative decisions of dentists. METHODS: A total of 911 schoolchildren in grades one, two, and three were randomly selected from the island of Montreal, Quebec, Canada. Dental examinations were carried out in 1990, 1991, and 1992. Tooth surfaces of first permanent molars were classified as sound, noncavitated, and cavitated. The carious status of a tooth was matched with restorative decisions reported to the insurance board. RESULTS: The presence of a carious cavity was a strong risk marker for placement of new restorations (odds rations > or = 4.11). After one year, less than 2 percent of sound tooth surfaces of first permanent molars were restored and about 21 percent of noncavitated tooth surfaces were restored. When new class I restorations placed in maxillary first permanent molars within 3-6 months after the baseline examination were evaluated, we found that between 73 percent and 86 percent of these new restorations were placed in sound or noncavitated tooth surfaces. A similar trend also was observed in mandibular first permanent molars. Poor agreement between epidemiologic diagnosis and restorative decisions was found. The restorative profile of dentists was a significant risk marker for placement of new restorations. CONCLUSION: The majority of new restorations in first permanent molars were placed in sound and noncavitated tooth surfaces because of the ubiquitous prevalence of these tooth surfaces and the validity problems of current caries diagnosis methods.