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Selected AbstractsInjectable calcium phosphate cement as a filler for bone defects around oral implants: an experimental study in goatsCLINICAL ORAL IMPLANTS RESEARCH, Issue 3 2002Luca Comuzzi Abstract: The aim of this study was to evaluate the clinical applicability and biological behavior of a newly developed injectable calcium phosphate (Ca-P) cement as bone filler for gaps around oral implants. Twenty-four step-like implants, creating gaps of 1 and 2 mm, were inserted into the trabecular bone of the medial femoral condyles of six goats. Four different situations were tested: (1) implant + gaps; (2) implant + gaps, but covered with a polylactic acid membrane; (3) implant + gaps that were filled with Ca-P cement; and (4) implant + gaps that were filled with Ca-P cement and covered with a membrane. All implants were left in place for 12 weeks. Histological and quantitative histomorphometrical measurements demonstrated that implants + gaps had generally poor bone contact at the implant base. Furthermore, fibrous encapsulation was observed in the gap part. In contrast, the presence of a membrane promoted bone ingrowth into the gap and also the bone contact at the implant base. Injection of Ca-P cement resulted in an almost complete filling of the gaps around the implant. The cement surface was completely covered by bone. Active resorption and remodeling of cement particles was observed, suggesting a pattern of slow resorption associated with full replacement with newly formed bone. Additional use of a membrane did not result in adjunctive benefits. Bone-to-implant contact at the implant base was comparable with the implants provided only with a membrane. In conclusion, the Ca-P cement used here showed excellent clinical handling properties combined with a superior bone behavior. On the other hand, the degradation rate of the material was still very slow. This current characteristic can hamper the final clinical applicability of the material as gap filler for periimplant or periodontal defects. Résumé Le but de l'étude présente a été d'évaluer l'application clinique et le comportement biologique d'un nouveau ciment de calcium de phosphate injectable (Ca-P) comme comblement osseux pour les cavités autour des implantes dentaires. Vingt-quatre implants créant des cavités de 1 et 2 mm ont été insérés dans l'os trabéculaire des condyles fémoraux moyens de six chèvres. Quatre situations différentes ont été testées: 1) implant + cavités; 2) implant = cavités recouvertes par une membrane en acide polylactique, 3) implant + cavités comblées par le ciment Ca-P et 4) implant + cavités comblées par le ciment Ca-P et recouvertes par une membrane. Tous les implants ont été laissés in situ pendant douze semaines. Les mesures histologiques et quantitatives histomorphométriques ont démontré que les implants + cavités avaient généralement un contact osseux pauvre au niveau de la base implantaire. De plus, une encapsulation fibreuse était observée dans la partie cavité. Par contre, la présence d'une membrane favorisait la croissance osseuse dans la cavité ainsi que le contact osseux à la base de l'implant. L'injection du cément Ca-P résultait en une réparation quasi complète des cavités autour de l'implant. La surface cémentaire était complètement recouverte d'os. La résorption active et le remodelage des particules de cément étaient observés, ce qui suggérait un système de résorption lente associéà un remplacement complet par de l'os néóformé. L'usage additionnel d'une membrane ne s'accompagnait pas de bénéfice supplémentaire. Le contact os/implant à la base de l'implant était comparable à celui des implants installés seulement avec une membrane. En conclusion, le ciment Ca-P possèdait des propriétés cliniques excellentes combinées à un comportement osseux supérieur. Par contre le taux de dégradation du matériel était toujours très lent. Cette caractéristique pourrait gêner l'application clinique finale de ce matériel en tant que comblement des cavités autour des implants ou dans les lésions parodontales. Zusammenfassung Das Ziel dieser Studie war es, die klinische Anwendbarkeit und das biologische Verhalten eines neu entwickelten injizierbaren Kalziumphosphatzements (Ca-P) als Knochenfüller bei oralen Implantaten auszuwerten. Vierundzwanzig stufenförmige Implantate, welche Defekte von 1 und 2 mm kreieren, wurden in den trabekulären Knochen der medialen femoralen Kondylen von 6 Ziegen eingesetzt. Vier verschiedene Situationen wurden getestet: 1) Implantat + Defekte; 2) Implantat + Defekte, aber bedeckt mit einer Membran aus Polimilchsäure; 3) Implantat + Defekte, welche mit Ca-P-Zement gefüllt wurden; 4) Implantat + Defekte, welche mit Ca-P-Zement gefüllt und mit einer Membran bedeckt wurden. Alle implantate wurden 12 Wochen belassen. Histologische und quantitative histomorphometrische Messungen zeigten, dass Implantate + Defekte generell schlechten Knochenkontakt an der Implantatbasis aufwiesen. Ausserdem wurde eine fibröse Einkapselung im Bereich der Defekte beobachtet. Im Gegensatz dazu bewirkte die Präsenz einer Membran das Einwachsen von Knochen in die Defekte und der Knochenkontakt an der Implantatbasis wurde gefördert. Die Injektion von Ca-P-Zement resultierte in einer fast kompletten Auffüllung der Defekte um die Implantate. Die Zementoberfläche war völlig mit Knochen bedeckt. Es konnte eine aktive Resorption und eine Remodellierung der Zementpartikel beobachtet werden. Dies lässt ein Muster mit langsamer Resorption assoziiert mit komplettem Ersatz durch neugebildeten Knochen vermuten. Die zusätzliche Verwendung einer Membran brachte keine weiteren Vorteile. Der Knochen-/Implantat-Kontakt an der Implantatbasis war vergleichbar mit den Implantaten, die nur mit einer Membran abgedeckt worden waren. Zusammenfassend kann festgehalten werden, dass der verwendete Ca-P-Zement eine exzellente Handhabung kombiniert mit ausserodentlichem Knochenverhalten zeigte. Andererseits war die Zersetzungsrate des Materials immer noch sehr Gering. Diese momentanen Eigenschaften können letztendlich die klinische Anwendbarkeit des Materials als Defektfüller bei periimplantären und parodontalen Defekten behindern. Resumen La intención del presente estudio fue evaluar la aplicabilidad clínica y el comportamiento biológico de un cemento recientemente desarrollado de fosfato de calcio (Ca-P) como relleno óseo para huecos alrededor de los implantes orales. Se insertaron veinticuatro implantes del tipo escalón creando huecos de 1 y 2 mm en el hueso trabecular de los cóndilos femorales mediales de 6 cabras. Se probaron cuatro situaciones diferentes: 1) implantes + huecos; 2) implantes + huecos, pero cubiertos con una membrana de ácido poliláctico; 3) implantes + huecos que se rellenaron con cemento de Ca-P; y 4) + huecos que se rellenaron con cemento de Ca-P y se cubrieron con una membrana. Todos los implantes se dejaron en su lugar durante 12 semanas. las mediciones histológicas e histomorfométricas cuantitativas demonstraron que los implantes + huecos tuvieron generalmente un contacto óseo pobre en la base del implante. Posteriormente, se observó una encapsulación fibrosa en la parte del hueco. En contraste, la presencia de la membrana promocionó el crecimiento óseo hacia el hueco y también el contacto óseo en la base del implante. La inyección de cemento Ca-P resultó en un casi completo relleno de los huecos alrededor del implante. La superficie del cemento se cubrió completamente de hueso. La reabsorción activa y la remodelación de las partículas de cemento fueron observadas, lo cual sugiere un patrón de reabsorción lenta asociada con una completa sustitución con hueso neoformado. El uso adicional de la membrana no resultó en beneficios adicionales. El contacto hueso implante en la base del implante fue comparable con los implantes que solo tenían la membrana. En conclusión, el uso de cemento de Ca-P mostró excelentes propiedades de manejo clínico combinado con un superior comportamiento óseo. Por otro lado, el índice de degradación del material fue muy lento. Estas características actuales pueden estorbar la aplicabilidad clínica final del material como rellenador de huecos alrededor de defectos periodontales o perimplantarios. [source] Benefits of an emollient body wash for patients with chronic winter dry skinDERMATOLOGIC THERAPY, Issue 5 2008Laura Hoffman ABSTRACT:, This randomized 5-week study assessed the clinical benefits of a high-emollient body wash versus a regular bar cleanser in terms of improving chronic winter dry skin condition. After 4 weeks, subjects who washed daily with a high-emollient body wash exhibited a significant reduction in all dermatologist-assessed dry skin attributes and improvements in self-evaluated skin condition when compared with baseline measures. Those subjects who washed with a regular bar cleanser experienced a minimal to marked increase in dermatologist-assessed and self-assessed dry skin attributes when compared with baseline. These findings suggested that bathing with a high-emollient body wash, as opposed to a regular bar cleanser, can reduce xerosis symptoms and improve skin health and appearance without the additional use of a moisturizer. [source] Effectiveness of screening and monitoring tests for diabetic retinopathy , a systematic reviewDIABETIC MEDICINE, Issue 7 2000A. Hutchinson SUMMARY Aims To determine which screening and monitoring tests for diabetic retinopathy are most effective and under what circumstances. Methods A systematic review of the English language literature, published from 1983 to April 1999. Results Available studies are generally limited in their ability to answer the important questions on the effectiveness of tests for early detection of diabetic retinopathy. No randomized controlled trials were identified although primary studies exist for two screening tests: ophthalmoscopy, either direct or indirect, and retinal photography, using either mydriasis or non-mydriasis. Retinal photography under mydriasis appears to be the most effective test, with the majority reporting levels of sensitivity in excess of 80%. However effectiveness is compromised when photographs are ungradable. Ophthalmoscopy can also reach acceptable standards of sensitivity and specificity. Conclusion Based on an assessment of available cohort studies, the most effective strategy for testing is the use of mydriatic retinal photography with the additional use of ophthalmoscopy for cases where photographs are ungradable. This does not exclude the use of ophthalmoscopy alone for opportunistic case finding but there is evidence of considerable variation in effectiveness of this test. [source] If you try to stop smoking, should we pay for it?ADDICTION, Issue 6 2010The cost, utility of reimbursing smoking cessation support in the Netherlands ABSTRACT Background Smoking cessation can be encouraged by reimbursing the costs of smoking cessation support (SCS). The short-term efficiency of reimbursement has been evaluated previously. However, a thorough estimate of the long-term cost,utility is lacking. Objectives To evaluate long-term effects of reimbursement of SCS. Methods Results from a randomized controlled trial were extrapolated to long-term outcomes in terms of health care costs and (quality adjusted) life years (QALY) gained, using the Chronic Disease Model. Our first scenario was no reimbursement. In a second scenario, the short-term cessation rates from the trial were extrapolated directly. Sensitivity analyses were based on the trial's confidence intervals. In the third scenario the additional use of SCS as found in the trial was combined with cessation rates from international meta-analyses. Results Intervention costs per QALY gained compared to the reference scenario were approximately ,1200 extrapolating the trial effects directly, and ,4200 when combining the trial's use of SCS with the cessation rates from the literature. Taking all health care effects into account, even costs in life years gained, resulted in an estimated incremental cost,utility of ,4500 and ,7400, respectively. In both scenarios costs per QALY remained below ,16 000 in sensitivity analyses using a life-time horizon. Conclusions Extrapolating the higher use of SCS due to reimbursement led to more successful quitters and a gain in life years and QALYs. Accounting for overheads, administration costs and the costs of SCS, these health gains could be obtained at relatively low cost, even when including costs in life years gained. Hence, reimbursement of SCS seems to be cost-effective from a health care perspective. [source] Cyclosporin A can achieve immune tolerance in a patient with severe haemophilia B and refractory inhibitorsHAEMOPHILIA, Issue 1 2007D. C. A. CROSS Summary., Immune tolerance induction (ITI) is described in a patient with severe haemophilia B complicated by the presence of an inhibitor. A number of ITI regimes were attempted without success and the patient suffered from frequent relapses and bleeding episodes. Successful ITI was achieved with the additional use of cyclosporin A. The patient developed nephrotic syndrome although had a negative Bethesda titre at this time. When cyclosporin A therapy was ceased, the inhibitor titre rose and the patient suffered again from bleeding episodes. Cyclosporin A was reintroduced at a lower dose. The patient has now received cyclosporin A for 10 years, during which time he has relapsed three times for short periods (2 weeks). He is also on prophylaxis with factor IX three times a week with preinfusion levels >1% and without bleeding. [source] Inter-laboratory evaluation of three flagellin PCR/RFLP methods for typing Campylobacter jejuni and C. coli: the CAMPYNET experienceJOURNAL OF APPLIED MICROBIOLOGY, Issue 6 2003C.S. Harrington Abstract Aims: To compare typeability, discriminatory ability, and inter-laboratory reproducibility of three flagellin PCR/RFLP (fla typing) methods previously described for Campylobacter. Methods and Results: The sample set (n = 100) was diverse, including both C. jejuni (n = 85) and C. coli (n = 15). Two of the three flaA typing methods amplified flaA alone, whereas one, a multiplex assay, amplified flaB in addition to flaA. DdeI restriction enzyme was employed for all methods, but HinfI was also investigated. 98,100% typeability was obtained for flaA-based methods, but only 93% for the multiplex assay, due to inconsistent amplification of a non-specific product. In addition, there appeared to be selective amplification of flaA over flaB. More DdeI types were generated using a longer flaA PCR amplicon, whilst additional use of HinfI increased the number of types by ca 25%. Inter-laboratory reproducibility for both flaA-based methods was defined at 100%. Conclusions:Fla typing requires standardization with respect to PCR primers and restriction enzymes. This study identified an assay, employing the full flaA gene and DdeI digestion, as an appropriate method on which to standardize. 100% inter-laboratory reproducibility was demonstrated using that method. Significance and Impact of the Study: This work should facilitate progress towards inter-laboratory standardization of fla typing. [source] Sheathless Implantation of Permanent Coronary Sinus-LV Pacing LeadsPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2006PETER HOFFMEISTER Background: Implantation of CS-LV pacing leads is usually accomplished through specialized sheaths with additional use of contrast venography and other steps. Direct implantation at a target pacing site could provide a simplified procedure with appropriate leads. Methods: A progressive CS-LV lead implant protocol was used, with initial attempts made to place the lead directly using only fluoroscopy and lead stylet or wire manipulation. Coronary sinus (CS) sheaths were only used later if direct lead placement failed. Results: There were 105 attempted implants with 96% (101/105) success. Leads were implanted sheathlessly in 69% (70/101) cases. Pacing parameters and final lead position did not differ significantly between implants that did or did not require sheaths for implants. Three peri-procedural complications occurred in implants where sheaths were used. In 33% (33/101) of implants, the leads were placed without the use of sheaths or contrast venography in 20 minutes or less. Conclusions: Direct placement of the CS-LV pacing lead without sheaths can be accomplished successfully in a majority of implants and in ,20 minutes in a third, without inferior pacing parameters. This may provide for shorter or less technically difficult or expensive procedures with low risk. [source] Modelling approaches to compare sorption and degradation of metsulfuron-methyl in laboratory micro-lysimeter and batch experimentsPEST MANAGEMENT SCIENCE (FORMERLY: PESTICIDE SCIENCE), Issue 12 2003Maik Heistermann Abstract Results of laboratory batch studies often differ from those of outdoor lysimeter or field plot experiments,with respect to degradation as well as sorption. Laboratory micro-lysimeters are a useful device for closing the gap between laboratory and field by both including relevant transport processes in undisturbed soil columns and allowing controlled boundary conditions. In this study, sorption and degradation of the herbicide metsulfuron-methyl in a loamy silt soil were investigated by applying inverse modelling techniques to data sets from different experimental approaches under laboratory conditions at a temperature of 10 °C: first, batch-degradation studies and, second, column experiments with undisturbed soil cores (28 cm length × 21 cm diameter). The column experiments included leachate and soil profile analysis at two different run times. A sequential extraction method was applied in both study parts in order to determine different binding states of the test item within the soil. Data were modelled using ModelMaker and Hydrus-1D/2D. Metsulfuron-methyl half-life in the batch-experiments (t1/2 = 66 days) was shown to be about four times higher than in the micro-lysimeter studies (t1/2 about 17 days). Kinetic sorption was found to be a significant process both in batch and column experiments. Applying the one-rate-two-site kinetic sorption model to the sequential extraction data, it was possible to associate the stronger bonded fraction of metsulfuron-methyl with its kinetically sorbed fraction in the model. Although the columns exhibited strong significance of multi-domain flow (soil heterogeneity), the comparison between bromide and metsulfuron-methyl leaching and profile data showed clear evidence for kinetic sorption effects. The use of soil profile data had significant impact on parameter estimates concerning sorption and degradation. The simulated leaching of metsulfuron-methyl as it resulted from parameter estimation was shown to decrease when soil profile data were considered in the parameter estimation procedure. Moreover, it was shown that the significance of kinetic sorption can only be demonstrated by the additional use of soil profile data in parameter estimation. Thus, the exclusive use of efflux data from leaching experiments at any scale can lead to fundamental misunderstandings of the underlying processes. Copyright © 2003 Society of Chemical Industry [source] Correlation with digital dermoscopic images can help dermatopathologists to diagnose equivocal skin tumoursBRITISH JOURNAL OF DERMATOLOGY, Issue 3 2006J. Bauer Summary Background, A variety of pigmented skin tumours can lead to diagnostic difficulties in dermatopathology. Objectives, To investigate whether the interobserver agreement between histopathological diagnoses of equivocal pigmented tumours made by two referral centres can be improved by additional use of dermoscopic images. Material and methods, Retrospective study using 160 tumours excised in the pigmented skin lesions clinic in Graz and 141 from Tübingen. Tumours were diagnosed in the referring centres using clinical data, histopathology and, if required, immunohistochemistry. The tumours were initially diagnosed as 74 melanomas, 218 melanocytic naevi and nine nonmelanocytic tumours. Haematoxylin and eosin sections, patients' age and sex, tumour localization and digital dermoscopic images were then exchanged between the participating centres. Then, diagnoses were made initially based solely on dermatopathology and clinical information. After a washout phase, the same sections were reevaluated with the additional use of dermoscopic images. The main outcome measures were the Cohen's , -coefficients of the initial diagnoses of the centre submitting the cases and the diagnoses of the other centre without and with dermoscopy. Results, The , -coefficient between the initial diagnoses with those made by the second centre without dermoscopy was 0·90 in Graz, 0·73 in Tübingen, and 0·81 overall. With the additional use of dermoscopy the , -value was invariably high with 0·89 in Graz, and improved to 0·87 in Tübingen, and to 0·88 overall. Conclusions, The additional use of digital dermoscopic images further improved the overall very good agreement of histopathological diagnoses between two referral centres. [source] Effect of platelet-rich plasma on the early bone formation around Ca-P-coated and non-coated oral implants in cortical boneCLINICAL ORAL IMPLANTS RESEARCH, Issue 2 2008Dimitris Nikolidakis Abstract Objectives: The purpose of the present study was to investigate the effect of local application of platelet-rich plasma (PRP) on the early healing of cortical bone around Ti implants with two different surface configurations. Material and methods: Six goats were used in this study. PRP fractions were obtained from a venous blood sample of the goats and administered immediately before implant insertion. PRP was applied via gel preparation and installation of the gel into the implant site, or via dipping of the implants in PRP fraction before insertion. A total of 36 implants (18 non-coated and 18 Ca-P-coated) were placed into the tibial cortical bone. The animals were sacrificed at 6 weeks after implantation and implants with surrounding tissue were prepared for histological examination. Histomorphometrical variables like the percentage of implant surface with direct bone,implant contact and the percentage of new and old bone adjacent to the implant were evaluated. Results: More interfacial bone-to-implant contact was observed for all the three groups of Ca-P-coated implants and the Ti/PRP liquid group. All groups revealed similar percentages of old and new bone adjacent to the implant. Conclusions: It was concluded that the additional use of PRP did not have any effect on the early cortical bone response to the Ca-P-coated implants, while PRP in a liquid form showed a tendency to increase bone apposition to roughened titanium implants. [source] | ||||||||||