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Selected AbstractsAdmission Hyperglycemia and Length of Hospital Stay in Patients With Diabetes and Heart Failure: A Prospective Cohort StudyCONGESTIVE HEART FAILURE, Issue 3 2008Yohannes Gebreegziabher MD The authors assessed the relationship between glycemia and length of hospital stay (LOS) in a prospective cohort study of patients with diabetes mellitus and heart failure (HF). Of 212 patients with acute HF exacerbation, 119 (56%) also had diabetes. The mean age of the cohort was 63±0.87 years, and the mean body mass index was 29.3 kg/m2. Diabetic patients had significantly longer LOS compared with the nondiabetics (5.0±0.29 vs 3.4±0.19; P<.001). In patients with diabetes, the mean glycated hemoglobin A1c was 8.3%, admission blood glucose (BG) was 169±7.7 mg/dL, and average BG was 196±8.1 mg/dL. After adjusting for age, sex, weight, hypertension, renal function, and anemia, LOS was significantly correlated with admission BG (r=0.31; P<.001) and average BG (r=0.34; P=.001). In patients with acute HF exacerbation, diabetes significantly prolonged LOS. Hyperglycemia correlated with LOS. [source] Improvement of insulin sensitivity and ,-cell function by nateglinide and repaglinide in type 2 diabetic patients , a randomized controlled double-blind and double-dummy multicentre clinical trialDIABETES OBESITY & METABOLISM, Issue 4 2007J. Li Aim:, To evaluate the efficacy of nateglinide vs. repaglinide in blood glucose (BG) control and the effect on insulin resistance and ,-Cell function in patients with type 2 diabetes. Methods:, A randomized controlled double-blind and double-dummy multicentre clinical trial was conducted. A total of 230 Chinese patients with type 2 diabetes were enrolled in five clinical centres. The patients were divided randomly into group A [repaglinide 1.0 mg three times daily (t.i.d.), n = 115] or group B (nateglinide 90 mg t.i.d., n = 115). At baseline and end of the 12-week clinical trial, standard mixed meal tolerance tests were performed. Results:, A total of 223 patients (96.9%) completed the trial. There was no significant difference between repaglinide and nateglinide groups in the effects of reducing fasting blood glucose (FBG), 30-, 60- and 120-min BG during 12 weeks (p > 0.05). At week 12, no significant difference was shown between the two groups in BG or haemoglobin A1c (HbA1c) (p > 0.05). However, the effect on HbA1c in repaglinide group was stronger than that in nateglinide group (p < 0.05). After 12-week treatment, area under the curve (AUC) of BG decreased (p < 0.05), and AUC of insulin and C-peptide (CP) increased in both groups (p < 0.05). The effects of nateglinide on AUC of BG, insulin and CP were similar to that of repaglinide (p > 0.05). There was no significant difference between the two groups in AUC of BG, insulin or CP in week 12 (p > 0.05). Furthermore, homeostasis model assessment of insulin resistance (HOMA-IR) and ,-cell function indexes measured by HOMA-,, ,I30/,G30 and (,I30/,G30)/HOMA-IR were improved significantly in both groups during 12 weeks (p < 0.05). The effects of improving HOMA-IR and ,-cell function indexes in nateglinide group were comparable with that of repaglinide group (p > 0.05). Conclusions:, The efficacy of repaglinide and nateglinide in FBG, postprandial glucose excursion and early-phase insulin secretion is similar. But the effect of repaglinide 1.0 mg t.i.d. on HbA1c is stronger than that of nateglinide 90 mg t.i.d.. This trial had shown that nateglinide and repaglinide could comparably improve insulin sensitivity and ,-cell function. [source] Inhaled insulin as adjunctive therapy in subjects with type 2 diabetes failing oral agents: a controlled proof-of-concept studyDIABETES OBESITY & METABOLISM, Issue 5 2006M. Hausmann Aim:, This controlled proof-of-concept study investigated inhaled insulin (INH) as adjunctive therapy to existing oral antidiabetic agents in subjects with type 2 diabetes. Methods:, Twenty-four subjects with type 2 diabetes [19 men and 5 women, 56.1 ± 6.6 years, body mass index 32.7 ± 4.2 kg/m2, glycosylated haemoglobin (HbA1c) 8.4 ± 0.8% (mean ± s.d.)] inadequately controlled by metformin and/or sulfonylureas were randomized to receive additional therapy with either INH administered preprandially using a metered-dose inhaler (MDI), or insulin glargine (GLA) injected subcutaneously at bedtime for 4 weeks. Both inhaled and injected insulin doses were titrated to predefined blood glucose (BG) targets. Results:, INH and GLA improved metabolic control to a similar extent. Mean daily BG decreased by 2.8 mmol/l in the INH group (p < 0.001) and by 2.4 mmol/l in the GLA group (p < 0.001). Accordingly, fasting BG (,2.7 vs. ,3.6 mmol/l for INH vs. GLA), preprandial- and 2-h postprandial BG, HbA1c (,1.23 vs. ,1.05%), body weight (,1.9 vs. ,2.3 kg) and serum fructosamine were similarly and significantly reduced in both groups (p < 0.05). Triglycerides decreased significantly with INH (,1.15 ,mol/l; p < 0.001) but not with GLA [,0.52 ,mol/l; not significant (NS)]. Incidence rates of adverse events did not differ significantly, and there were no indications of respiratory tract irritation. Conclusions:, In subjects with type 2 diabetes inadequately controlled by oral agents, preprandial administration of INH delivered by a MDI provided a comparable metabolic control to bedtime GLA and did not show any safety concerns during a 4-week treatment. These results warrant a more extensive investigation of preprandial treatment with INH in longer term studies. [source] Twice daily biphasic insulin aspart improves postprandial glycaemic control more effectively than twice daily NPH insulin, with low risk of hypoglycaemia, in patients with type 2 diabetesDIABETES OBESITY & METABOLISM, Issue 6 2003J. S. Christiansen Objective:, Biphasic insulin aspart 30 (BIAsp30) is a dual release formulation, containing 30% soluble and 70% protamine-crystallized insulin aspart. This study compared the glycaemic control and safety profiles achieved with either twice daily BIAsp30 or NPH insulin in patients with type 2 diabetes not optimally controlled by oral hypoglycaemic agents (OHAs), NPH insulin or a combination of both. Methods:, In this 16-week multinational, parallel-group, double-blind trial, 403 such patients were randomized to receive either BIAsp30 or NPH insulin immediately before breakfast and evening meals. OHAs were discontinued at randomization. Efficacy was assessed by glycosylated haemoglobin (HbA1c) and self-recorded daily 8-point blood glucose (BG) profiles. Hypoglycaemic and other adverse events were the chosen safety parameters. Results:, HbA1c concentration decreased by >0.6% (p < 0.0001 vs. baseline) in both groups, with metabolic control continuing to improve throughout the trial without reaching a stable level. Patients who switched from once or twice daily NPH monotherapy to twice daily BIAsp30 achieved a significantly greater reduction in HbA1c (0.78%) than those randomized to twice daily NPH insulin (0.58%; p = 0.03). BIAsp30 decreased mean daily postprandial glycaemic exposure to a greater extent than NPH insulin (mean difference = 0.69 mmol/l; p < 0.0001), reflecting greater decreases in the postbreakfast and postdinner increments (of 1.26 and 1.33 mmol/l, respectively), although postlunch increment was relatively increased (by 0.56 mmol/l). Despite the greater reduction in overall postprandial glycaemic exposure in the BIAsp30 group, the overall safety profile of BIAsp30 was equivalent to that of NPH insulin with <2% of patients experiencing major hypoglycaemia, and approximately 33% reporting minor hypoglycaemic episodes, in both groups. Conclusion:, Twice daily BIAsp30 reduced postprandial glucose exposure to a significantly greater extent than NPH insulin and was at least as effective at reducing HbA1c in patients with type 2 diabetes. Both insulins were well tolerated. In patients poorly controlled on OHAs or NPH alone, glycaemic control can be improved by switching to twice daily BIAsp30, without increasing hypoglycaemic risk. [source] A 75% insulin lispro/25% NPL mixture provides a longer duration of insulin activity compared with insulin lispro alone in patients with Type 1 diabetesDIABETIC MEDICINE, Issue 11 2003P. Roach Abstract Aims To compare a new insulin formulation, high mix (HM) [75% lispro (LP) and 25% neutral protamine lispro (NPL)], to regular human insulin (HR) and LP with respect to glucose response and pharmacokinetics following a test meal in patients with Type 1 diabetes. Methods After fasting overnight, patients received an intravenous insulin infusion to standardize blood glucose (BG) to 7.5 mmol/l (135 mg/dl). In a randomised, three-way crossover study, HR was injected 30 min before, and LP or HM was injected immediately before the test meal on three separate occasions. For each patient, LP and HR were administered at identical doses; the HM dose was one and one third times that of HR and LP to maintain the same dose of short or rapid-acting insulin. The insulin infusion was stopped 15 min after the insulin injection. Free insulin and BG concentrations were measured frequently for 7 h following the test meal. Results HM and LP resulted in better glycaemic control than HR during the observation period. BG concentrations during the first 4,5 h did not differ between HM and LP. However, HM exhibited prolonged insulin activity relative to LP beyond 5 h, extending the duration of action by approximately 1 h, and resulting in lower overall BG concentrations when the 0,6- and 0,7-h intervals were considered. Conclusions Compared with LP, HM provided similar glycaemic control for up to 5 h and superior glycaemic control from 5 to 7 h following a standard test meal [source] The case for venous rather than arterial blood gases in diabetic ketoacidosisEMERGENCY MEDICINE AUSTRALASIA, Issue 1 2006Anne-Maree Kelly Abstract Objectives:, For patients with diabetic ketoacidosis (DKA), arterial blood gas (BG) sampling for measurement of pH and bicarbonate has been considered an essential part of initial evaluation and monitoring of progress. There is growing evidence that venous values can be clinically acceptable alternatives to arterial measurements. This article summarizes the recent evidence regarding the validity of venous BG sampling in DKA. Methods:, Medline search for the years 1995 to present, hand search of reference lists, search of on-line evidence-based medicine sites. Results:, In patients with DKA the weighted average difference between arterial and venous pH was 0.02 pH units (95% limits of agreement ,0.009 to +0.021 pH units) and between arterial and venous bicarbonate was ,1.88 mEq/L. Conclusions:, There is reasonable evidence that venous and arterial pH have sufficient agreement as to be clinically interchangeable in patients with DKA who are haemodynamically stable and without respiratory failure. There is some evidence that venous and arterial bicarbonate also agree closely in DKA but this requires confirmation. [source] Seasonal distribution and species composition of daytime biting mosquitoesENTOMOLOGICAL RESEARCH, Issue 2 2009Waseem AKRAM Abstract Adults and immatures of Aedes mosquito populations were collected at temperatures between 40 and 44°C (summer), while larvae were collected at 0°C (winter). Major mosquito activities were observed from February to mid-December at various collection sites that yielded high populations of Aedes spp. from May to September, and high populations of Culex spp. and Anopheles spp. from March to September. In June to July, mosquito activity was suspended because the relative humidity was high (70%); a result of the monsoon rains. In August, with temperature ranging from 38 to 42°C, the populations of Culex, Anopheles and Aedes began to increase (36.8, 32.1 and 26.3%, respectively). Population estimates (through standard prototype Centers for Disease Control (CDC) and Biogents (BG)-sentinel) and species composition of Aedes in forest habitats indicated a rapid increase in the populations of Ae. albopictus (52.3%), Ae. aegypti (19.1%) and Ae. vittatus (28.5%) following the rainy season in July. Areas positive for Ae. albopictus had identical population levels and distribution ranges of Ae. vittatus, however, there were no Ae. aegypti in Ae. albopictus areas from August to September. The population level, seasonal distribution, habitat and areas of adult activity marked by global positioning system (GPS) coordinates are being used for reference and for species composition data of Anopheles spp. (2), Culex spp. (10) and Aedes spp. (5) in addition to associated temperature, relative humidity and physico-chemical factors of larval habitat. Global meteorological changes have caused an expansion of the active period, leading to the mosquito's possibility of being a vector of disease increasing, resulting in the spread of dengue fever. [source] Thiethylperazine-induced parkinsonism: in vivo demonstration of dopamine D2 receptors blockadeEUROPEAN JOURNAL OF NEUROLOGY, Issue 10 2004C. Briani Thiethylperazine (Torecan®) is a piperazine phenothiazine employed to relieve vertigo. Its use may be associated with extrapyramidal side effects (dystonia, akathisia, tardive dyskinesia) (Sulkava, 1984), but parkinsonism has rarely been described. We describe a woman who, 1 month after the onset of thiethylperazine treatment, developed parkinsonism that disappeared 2 months after withdrawal of the drug. However, cerebral single-photon emission computed tomography (SPECT) with the dopamine (DA) D2 receptors ligand 123I-iodobenzamide (123I-IBZM) revealed a persistent reduced DA D2 receptors activity (by 45%) in the basal ganglia (BG), which may be clinically not effective. [source] Prior pallidotomy reduces and modifies neuronal activity in the subthalamic nucleus of Parkinson's disease patientsEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 2 2008A. Zaidel Abstract Parkinson's disease (PD) patients with prior radio-frequency lesions in the internal segment of the globus pallidus (GPi, pallidotomy), whose symptoms have deteriorated, may be candidates for further invasive treatment such as subthalamic deep brain stimulation (STN DBS). Six patients with prior pallidotomy (five unilaterally; one bilaterally) underwent bilateral STN DBS. The microelectrode recordings (MERs, used intraoperatively for STN verification), ipsilateral and contralateral to pallidotomy, and MERs from 11 matched PD patients who underwent bilateral STN DBS without prior pallidotomy were compared. For each trajectory, average, variance and mean successive difference (MSD, a measure of irregularity) of the root mean square (RMS) of the STN MER were calculated. The RMS in trajectories ipsilateral to pallidotomy showed significant reduction of the mean average and MSD of STN activity when compared with trajectories from patients without prior pallidotomy. The RMS parameters contralateral to pallidotomy tend to lie between those ipsilateral to pallidotomy and those without prior pallidotomy. The average STN power spectral density of oscillatory activity was notably lower ipsilateral to pallidotomy than contralateral, or without prior pallidotomy. The finding that pallidotomy reduces STN activity and changes firing characteristics, in conjunction with the effectiveness of STN DBS despite prior pallidotomy, calls for reappraisal and modification of the current model of the basal ganglia (BG) cortical network. It highlights the critical role of direct projections from the BG to brain-stem structures and suggests a possible GPi,STN reciprocal positive-feedback mechanism. [source] Biochemical and electrophysiological changes of substantia nigra pars reticulata driven by subthalamic stimulation in patients with Parkinson's diseaseEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 11 2006Salvatore Galati Abstract To understand the events underlying the clinical efficacy of deep brain stimulation (DBS) of the subthalamic nucleus (STN), electrophysiological recordings and microdialysis evaluations were carried out in the substantia nigra pars reticulata (SNr), one of the two basal ganglia (BG) nuclei targeted by STN output, in patients with Parkinson's disease (PD). Clinically effective STN-DBS caused a significant increase of the SNr firing rate. The poststimulus histogram (PSTH) showed an excitation peak at 1.92,3.85 ms after the STN stimulus. The spontaneous discharge of SNr neurons was driven at the frequency of the stimulation (130 Hz), as shown in the autocorrelograms (AutoCrl). The fast Fourier transform (FFT) analysis showed a peak at 130 Hz, and a less pronounced second one at 260 Hz. Accordingly, in the distribution of the interspike intervals (ISIs), the mode was earlier, and skewness more asymmetric. Biochemically, the increased excitatory driving from the STN was reflected by a clear-cut increase in cyclic guanosine 3',5'-monophosphate (cGMP) levels in the SNr. These results indicate that the beneficial effect of DBS in PD patients is paralleled with a stimulus-synchronized activation of the STN target, SNr. Our findings suggest that, during STN-DBS, a critical change towards a high-frequency oscillatory discharge occurs. [source] Inter-rater and test,retest reliability of three contingent valuation question formats in south-east NigeriaHEALTH ECONOMICS, Issue 5 2005Obinna Onwujekwe Abstract This paper examines the inter-rater and test,retest reliability of willingness to pay (WTP) for insecticide-treated mosquito nets and net re-treatment using the bidding game (BG), binary with follow-up (BWFU) and a novel structured haggling technique (SH). Inter-rater reliability was evaluated by having two sets of interviewers administer questionnaires to 109 (BG), 110 (BWFU) and 103 (SH) randomly selected household heads. Test,retest reliability was investigated by repeating interviews on 146 (BG), 161 (BWFU) and 139 (SH) household heads one month after an initial survey. Data analysis used testing of means, Spearman's correlation and Pearson's correlation coefficient for test of reliability, while non-parametric analysis was used to determine factors causing a variation in WTP. The study was conducted in Southeast Nigeria. Inter-rater reliability coefficients were estimated for the individual's WTP for own nets, WTP for others and WTP for re-treatment. Using WTP for own nets as the best reliability estimate, the coefficients were high at values of 0.77 (C.I. 0.72,0.86), 0.75 (C.I. 0.64,0.81) and 0.74 (C.I. 0.63,0.82) in the BG, BWFU and SH, respectively. In test,retest reliability coefficients, the coefficients for WTP for own nets were low-to-moderate at values of 0.51 (C.I. 0.40,0.62), 0.41 (C.I. 0.28,0.53) and 0.56 (C.I. 0.41,0.65) for the BG, BWFU and SH groups, respectively. Factors such as gender, change in income, unplanned expenditures, stated WTP in first survey, time-to-think, external information, and subjecting respondents to more than one interview explained the lower test,retest reliability coefficients. We conclude that the CVM was reliable in the study area and the question formats had similar levels of reliability. The lower coefficients in the test,retest reliability were due to the influence of factors affecting demand that had changed in the intervening period. Standard formats for determining reliability within CVM should be developed for easy comparison of results from different studies. Copyright © 2004 John Wiley & Sons, Ltd. [source] Expedited forwarding end-to-end delay and jitter in DiffServINTERNATIONAL JOURNAL OF COMMUNICATION SYSTEMS, Issue 8 2008Hamada Alshaer Abstract The scheduling disciplines and active buffer management represent the main components employed in the differentiated services (DiffServ) data plane, which provide qualitative per-hop behaviors corresponding to the QoS required by supported traffic classes. In the first part of this paper, we compute the per-hop delay bound that should be guaranteed by the different multiservice scheduling disciplines, so that the end-to-end (e2e) delay required by expedited forwarding (EF) traffic can be guaranteed. Consequently, we derive the e2e delay bound of EF traffic served by priority queuing,weighted fair queuing (PQ,WFQ) at every hop along its routing path. Although real-time flows are principally offered EF service class, some simulations on DiffServ-enabled network show that these flows suffer from delay jitter and they are negatively impacted by lower priority traffic. In the second part of this paper, we clarify the passive impact of delay jitter on EF traffic, where EF flows are represented by renewal periodic ON,OFF flows, and the background (BG) flows are characterized by the Poisson process. We analyze through different scenarios the jitter effects of these BG flows on EF flow patterns when they are served by a single class scheduling discipline, such as first-input first-output, and a multiclass or multiservice scheduling discipline, such as static priority service discipline. As a result, we have found out that the EF per-hop behaviors (PHBs) configuration according to RFCs 2598 and 3246 (IETF RFC 2598, June 1999; RFC 3246, IETF, March 2002) cannot stand alone in guaranteeing the delay jitter required by EF flows. Therefore, playout buffers must be added to DiffServ-enabled networks for handling delay jitter problem that suffers from EF flows. Copyright © 2008 John Wiley & Sons, Ltd. [source] An analytical approach to the performance evaluation of the balanced gamma switch under multicast traffic,INTERNATIONAL JOURNAL OF COMMUNICATION SYSTEMS, Issue 4 2007Cheng Li Abstract This paper presents the performance evaluation of a new cell-based multicast switch for broadband communications. Using distributed control and a modular design, the balanced gamma (BG) switch features high performance for unicast, multicast and combined traffic under both random and bursty conditions. Although it has buffers on input and output ports, the multicast BG switch follows predominantly an output-buffered architecture. The performance is evaluated under uniform and non-uniform traffic conditions in terms of cell loss ratio and cell delay. An analytical model is presented to analyse the performance of the multicast BG switch under multicast random traffic and used to verify simulation results. The delay performance under multicast bursty traffic is compared with those from an ideal pure output-buffered multicast switch to demonstrate how close its performance is to that of the ideal but impractical switch. Performance comparisons with other published switches are also studied through simulation for non-uniform and bursty traffic. It is shown that the multicast BG switch achieves a performance close to that of the ideal switch while keeping hardware complexity reasonable. Copyright © 2006 John Wiley & Sons, Ltd. [source] Demonstration of Birbeck (Langerhans cells) granules in the normal chicken epidermisJOURNAL OF ANATOMY, Issue 4 2001ARMANDO PÉREZ-TORRES Mammalian Langerhans cells (LC) are epidermal dendritic cells which originate in bone marrow and migrate toward the T cell area of lymph nodes, where they act as professional antigen-presenting cells. A variety of cell surface markers, such as the ectoenzyme adenosine triphosphatase (ATPase), Ia and CD1a antigens, have been used extensively to identify LC. Ultrastructural identification of this cell type in the mammalian epidermis is made by the demonstration of a typical and unique cytoplasmic organelle, the Birbeck granule (BG). Although we had earlier demonstrated the coexpression of ATPase and Ia antigens on epidermal dendritic cells of the chicken epidermis, the presence of the BG has not previously been documented. The aim of the present study was to investigate whether chicken epidermal LC-like cells possess an organelle similar to the BG, and thus to complete their identification. Our findings are the first demonstration of characteristic rod-shaped, racket-shaped and disc-shaped intracytoplasmic organelles, morphologically similar to the mammalian BG, in avian LC. [source] Monozygotic twins are discordant for chronic periodontitis: clinical and bacteriological findingsJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2 2010Gaudy L. Torres de Heens Torres de Heens GL, Loos BG, van der Velden U. Monozygotic twins are discordant for chronic periodontitis: clinical and bacteriological findings. J Clin Periodontol 2010; 37: 120,128. doi: 10.1111/j.1600-051X.2009.01511.x. Abstract Objectives: The aim of this study was to assess, in monozygotic (MZ) and dizygotic (DZ) twin pairs in whom the proband of the twin pair was suffering from moderate to severe chronic periodontitis, the contribution of genetics, periodontal pathogens and lifestyle factors towards the clinical phenotype. Material and Methods: For this study, 18 adult twin pairs were selected on the basis of interproximal attachment loss (AL) 5 mm in 2 non-adjacent teeth in one twin member. The study included 10 MZ and eight DZ twin pairs, in whom the periodontal condition, presence of periodontal pathogens, educational level, smoking behaviour and body mass index (BMI) were evaluated. Results: Both MZ and DZ twins were discordant regarding AL and alveolar bone loss. Discordance was greater in DZ compared with MZ twins. In MZ twins, the discordance could not be explained by education, smoking, BMI and periodontal pathogens. In DZ twins, 45.6% of the discordance could be explained by more pack-years of the probands. Conclusion: The results confirm a possible role of genetic factors in periodontitis. However, the magnitude of the genetic effects on disease severity may have been overestimated previously. [source] New Shade Guide for Evaluation of Tooth Whitening,Colorimetric StudyJOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 5 2007RADE D. PARAVINA DDS ABSTRACT Statement of the Problem:, Available shade guides lack colorimetric uniformity, which compromises the validity of visual evaluation of tooth whitening efficacy. Purpose:, The objective of this study was to perform a colorimetric analysis of a new shade guide designed primarily for the visual evaluation of tooth whitening efficacy and to compare this shade guide with two commercial shade guides. Materials and Methods:, Color ranges and color distribution of three shade guides (prototype of the new Vita Bleachedguide 3D-Master [BG, Vita Zahnfabrik, Bad Säckingen, Germany], value scale of Vitapan Classical [VC, Vita], and color-ordered Trubyte Bioform porcelain shade guide [TB, Dentsply International, York, PA, USA]) were analyzed (N=3). A circular area (d=1.7 mm) on the middle of the labial surface of the tab, excluding the cervical portion, was measured with a spectroradiometer (D65, 2). Whiteness and yellowness indices were computed. Data were analyzed by analysis of variance and Fisher's PLSD test at a 0.05 level of significance. Results:, The range of color difference (,E*) from the lightest to the darkest tab was 33.8 (BG), 17.1 (VC), and 23.2 (TB). Mean values of ,E* among pairs of adjacent tabs were 3.0 (BG), 4.2 (VC), and 3.3 (TB). BG exhibited the highest R2 values between color coordinate pairs and between whiteness and yellowness indices with the respective color coordinates. Conclusions:, BG exhibited the widest color range and had the most consistent color distribution as compared with the two commercial products. Extension of the lightness range of BG toward higher L* values (bleach shades) was confirmed. CLINICAL SIGNIFICANCE A dental shade guide that is colorimetrically uniform might increase the reliability of visual comparisons of tooth whitening efficacy, whereas the inclusion of realistic bleaching shades in the shade guide will complement contemporary esthetic dentistry. (J Esthet Restor Dent 19:276,283, 2007) [source] Delay in blood glucose monitoring during an insulin infusion protocol is associated with increased risk of hypoglycemia in intensive care units,JOURNAL OF HOSPITAL MEDICINE, Issue 6 2009Rajesh Garg MD Abstract BACKGROUND: Hypoglycemia during insulin infusion therapy is a major problem. We investigated whether a delay in blood glucose (BG) monitoring during an insulin infusion protocol (IIP) in the intensive care unit (ICU) is associated with hypoglycemia. METHODS: Data were collected for 50 consecutive patients treated with Brigham and Women's Hospital's IIP. Point-of-care BG values were obtained from the bedside paper flow sheets and the exact times of individual measurements were ascertained from an internet-based glucose meter download program. Data were carefully studied for protocol time violations, defined as a delay of >10 minutes after the recommended time for BG measurement. RESULTS: A total of 2309 BG values were evaluated for time violation. A total of 1474 (63.9%) measurements had been obtained at the recommended time or earlier; 835 (36.1%) measurements had been obtained >10 minutes after the recommended time for measurement. There were a significantly higher proportion of BG values <80 mg/dL following the time violation as compared to no time violation (17.8% versus 11.6%; P < 0.001). CONCLUSION: We conclude that the risk of hypoglycemia during insulin infusion therapy is higher after a delay in BG measurement. Journal of Hospital Medicine 2009;4:E5,E7. © 2009 Society of Hospital Medicine. [source] Promising outcomes of an adolescent chronic fatigue syndrome inpatient programmeJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5 2009Brett Gordon Introduction: Chronic fatigue syndrome (CFS) is a condition of prolonged and disabling fatigue, which is accompanied by characteristic constitutional and neuropsychiatric symptoms. In children and adolescents, this condition occurring at a developmentally vulnerable time adds to the disability affecting self-concept, autonomy, body image, socialisation, sexuality and academic problems. This case series looks at the effects of a graded exercise programme on physical outcomes, fatigue and mental state in an adolescent population. Methods: Data sets from 16 adolescents who completed combined exercise training as part of the 4-week inpatient intensive CFS programme at the Austin Hospital, Melbourne were analysed. All patients completed an exercise assessment and three questionnaires before beginning any training. A paediatrician (LL) confirmed the diagnosis according to the Fukuda criteria in all patients. Exercise was carefully supervised and prescribed daily by an exercise physiologist (BG) according to each individual's ability and response with the basic aim of increasing exercise tolerance and improving muscle strength and endurance. Results: There was an 18% improvement in volitional time to fatigue (P= 0.02) and 17% improvement in peak oxygen uptake (VO2peak) (P= 0.01). Upper body strength and function improved with a remarkable 70% increase in the number of push-ups. Fatigue severity was reported to improve by 13% (P= 0.01) and depression index improved significantly by 42% (P= 0.02). Conclusions: The significance of these improvements cannot be underestimated as an improvement in physical capacity through increased time to fatigue and less severe fatigue allows adolescents to resume school, social and family activities. [source] Investigation of the absorption mechanisms of baicalin and baicalein in ratsJOURNAL OF PHARMACEUTICAL SCIENCES, Issue 6 2006Liu Taiming Abstract To characterize and compare the absorption mechanisms of baicalin (BG) and baicalein (B), either of them was perfused in situ in rats with ligation of the bile duct as well as without it. Two RP-HPLC methods were developed to determine the drugs' concentrations in the gastric and intestinal perfusates, respectively. The result showed that BG was moderately absorbed in stomach but poorly in small intestine and colon, while B was well absorbed in stomach and small intestine but relatively less in colon. It also indicated that bile could excrete BG and significantly promote the absorption of B. When BG or B was perfused alone in the small intestine after ligation of the bile duct, there came out to be increasing B or BG in the perfusate, respectively. In addition, when B was intravenously administered to rats after ligation of the bile duct, there came out to be BG in the intestinal perfusate. In conclusion, B was more suitable to be administered orally than BG, which was absorbed as B and then restored to BG in the body. Part of the BG formed from the absorbed or intravenously administered B could be excreted back into the gut. © 2006 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 95:1326,1333, 2006 [source] Modulatory effects of 5Hz rTMS over the primary somatosensory cortex in focal dystonia,An fMRI-TMS study,MOVEMENT DISORDERS, Issue 1 2010Susanne A. Schneider MD Abstract Dystonia is associated with impaired somatosensory ability. The electrophysiological method of repetitive transcranial magnetic stimulation (rTMS) can be used for noninvasive stimulation of the human cortex and can alter cortical excitability and associated behavior. Among others, rTMS can alter/improve somatosensory discrimation abilities, as shown in healthy controls. We applied 5Hz-rTMS over the left primary somatosensory cortex (S1) in 5 patients with right-sided writer's dystonia and 5 controls. We studied rTMS effects on tactile discrimination accuracy and concomitant rTMS-induced changes in hemodynamic activity measured by functional magnetic resonance imaging (fMRI). Before rTMS, patients performed worse on the discrimination task than controls even though fMRI showed greater task-related activation bilaterally in the basal ganglia (BG). In controls, rTMS led to improved discrimination; fMRI revealed this was associated with increased activity of the stimulated S1, bilateral premotor cortex and BG. In dystonia patients, rTMS had no effect on discrimination; fMRI showed similar cortical effects to controls except for no effects in BG. Improved discrimination after rTMS in controls is linked to enhanced activation of S1 and BG. Failure of rTMS to increase BG activation in dystonia may be associated with the lack of effect on sensory discrimination in this group and may reflect impaired processing in BG-S1 connections. Alternatively, the increased BG activation seen in the baseline state without rTMS may reflect a compensatory strategy that saturates a BG contribution to this task. © 2010 Movement Disorder Society [source] (613) Radiculopathy Treatment Assessment Using Pain Tolerance TestPAIN MEDICINE, Issue 2 2000Article first published online: 25 DEC 200 Authors: Y. Eugene Mironer, Carolinas Center for Advanced Management of Pain; Judson J. Somerville, The Pain Management Clinic of Laredo Current measurements of the outcomes of chronic radiculopathy treatment are limited to subjective criteria: level of pain, range of motion, etc. Our previous study showed that nerve conductivity does not correlate well with the intensity of pain after treatment of radiculopathy (1). In the current study we looked at the Pain Tolerance Threshold (PTT) as a possible measurement of the results of radiculopathy treatment. Twenty patients with chronic radiculopathy (13 lumbar and 7 cervical) underwent epidural steroid injections at the level of involvement. Before, and approximately one week after the procedure, we measured PTT in both the involved and contralateral extremity at 3 different frequencies (5Hz, 250Hz, and 2000 Hz) using Neurometer. Level of pain was also assessed using a Visual Analog Scale (VAS). Initial PTT results showed great interpersonal variability. Nearly half of the patients did not show significant differences in PTT between affected and unaffected sides. Of interest, the majority experienced intolerable pain at 2000 Hz stimulation at lower than maximal intensity output, which contradicts previous findings (2). Dynamics of the PTT measurements after treatment did not directly correlate with changes in the level of pain. Nevertheless, in 7 out of 8 patients with low PTT (relative to the unaffected side) it increased significantly, with noticeable decrease of VAS score. Similar results were not found in patients with either normal initial PTT score or minimal improvement of pain. 1. Mironer YE, Somerville JJ The current perception threshold evaluation in radiculopathy: efficacy in diagnosis and assessment of treatment results. Pain Digest 1998;8:37,38. 2. Liu SS, Gerancher JC, Bainton BG, et al. The effects of electrical stimulation at different frequencies on perception and pain in human volunteers: epidural versus intravenous administration of fentanyl. Anesth Analg 1996;82:98,102. [source] Late cardiotoxicity after bolus versus infusion anthracycline therapy for childhood cancersPEDIATRIC BLOOD & CANCER, Issue 6 2003Monesha Gupta MBBS Abstract Objective To compare the long-term myocardial function of patients who had been treated with infusion anthracycline therapy (administered continuously over >24 hr, IG) versus bolus therapy (administered over <30 min, BG). Methods We selected 25 patients (BG) and 19 patients (IG) who had three or more years of disease free survival. We evaluated the echocardiograms for left ventricular shortening fraction (SF) obtained at baseline, within one year after the end of therapy (early follow-up), and on long-term follow-up. Results The mean anthracycline dose in the BG was 385 mg/m2 and in the IG was 345 mg/m2 (P,=,0.07). During therapy, one patient in BG and none in IG developed diminished SF. During early follow-up, five of the 22 patients in BG and one of the 17 patients in IG developed diminished SF (P,=,0.2). Of these five patients with diminished SF, three patients in BG and none in IG continued to have abnormally low SF long-term. At mean of 7 years, five of the 25 patients in BG and two of the 19 in IG had diminished SF on (P,=,0.7). Late left ventricular dilatation was seen in 8% in BG and 5% in IG (P,=,1.0). Conclusions At mean of 7 years after end of therapy, diminished cardiac function was seen in 20% of the patient who had received bolus anthracycline compared to 11% of patients who had received it via infusion. This difference did not prove to be statistically significant. Med Pediatr Oncol 2003;40:343,347. © 2003 Wiley-Liss, Inc. [source] Use of CoZmonitor® in youth with type 1 diabetes,PEDIATRIC DIABETES, Issue 2 2008Erin Cobry Background:, The purpose of this study was to evaluate the effectiveness of directly integrating self-monitoring blood glucose (BG) information with insulin pump therapy on overall glycemic control. Methods:, In this randomized trial, 34 youth with type 1 diabetes using insulin pump therapy were trained on the use of the Deltec Cozmo® Insulin Pump. Seventeen were randomized to use the CoZmonitor® Blood Glucose Module, a device that attaches to the back of the pump using FreeStyle® technology to perform BG tests which read directly on the pump screen. The remaining 17 (control group) used a FreeStyle Flash meter, a stand-alone BG meter, for their BG testing. At baseline, 3 and 6 months, the subjects filled out a questionnaire, had a hemoglobin A1c (HbA1c) test, and had pumps and meters downloaded. Results:, After 3 months of study, there were no changes in mean HbA1c (± SD) values for the experimental (8.7 ± 1.1 to 8.6 ± 1.1) or the control groups (9.1 ± 1.4 to 9.2 ± 1.5). There were also no significant differences in HbA1c values after 6 months. The average number of BG tests per day did not change significantly in either group during the study. After 3 and 6 months, the experimental group rated satisfaction with the use of the CoZmonitor at 4.4 and 3.8 (respectively) on a five-point Likert scale, with 5 being the most satisfied. Conclusions:, Although significant changes in HbA1c values or the number of BG tests were not found, use of the BG module had a positive level of satisfaction. [source] Giant solitary fibrous tumour of the pleura: a rare but usually benign intrathoracic neoplasmTHE CLINICAL RESPIRATORY JOURNAL, Issue 2 2009Uffe Bodtger Abstract Background:, Low forced expiratory volume (FEV1) and low performance status usually preclude surgical treatment of lung neoplasms. Earlier case reports have suggested that curative, safe surgery is possible in extrapulmonal intrathoracic neoplasms. Methods:, A case report of an 83-year-old women with progressing dyspnoea secondary to a huge left-side neoplasm. Results:, Work-up reveal an FEV1 of 0.4 L, and a giant solitary fibrous tumor of the pleura. The tumor was surgically removed in toto without complications: weighting approximately 3 kg, and benign histology. The patient was without dyspnoea at discharge and at 1-year follow-up. Conclusion:, Safe and curative surgery is possible in patients with extrapulmonal neoplasm despite poor FEV1. Please cite this paper as: Bodtger U, Pedersen JH, Skov BG and Clementsen P. Giant solitary fibrous tumour of the pleura: a rare but usually benign intrathoracic neoplasm. The Clinical Respiratory Journal 2009; 3: 109,111. [source] Characterisation of a P140K mutant O6 -methylguanine-DNA-methyltransferase (MGMT)-expressing transgenic mouse line with drug-selectable bone marrowTHE JOURNAL OF GENE MEDICINE, Issue 9 2006Belinda A. Kramer Abstract Background Gene transfer of the P140K mutant of O6 -methylguanine-DNA-methyltransferase (MGMT(P140K)) into hematopoietic stem cells (HSC) provides a mechanism for drug resistance and the selective expansion of gene-modified cells in vivo. Possible clinical applications for this strategy include chemoprotection to allow dose escalation of alkylating chemotherapy, or combining MGMT(P140K) expression with a therapeutic gene in the treatment of genetic diseases. Our aim is to use MGMT(P140K)-driven in vivo selection to develop allogeneic micro-transplantation protocols that rely on post-engraftment selection to overcome the requirement for highly toxic pre-transplant conditioning, and to establish and maintain predictable levels of donor/recipient chimerism. Methods Using stably transfected murine embryonic stem (ES) cells, we have generated a C57BL/6 transgenic mouse line with expression of MGMT(P140K) within the hematopoietic compartment for use as a standard source of donor HSC in such models. Functional characterisation of transgene expression was carried out in chemotherapy-treated transgenic mice and in allogeneic recipients of transgenic HSC. Results Expression of the transgene provided chemoprotection and allowed in vivo selection of MGMT(P140K)-expressing cells in transgenic mice after exposure to O6 -benzylguanine (BG) and N,N,-bis(2-chloroethyl)- N -nitrosourea (BCNU). In an allogeneic transplant experiment in which transgenic HSC were engrafted into 129 strain recipients following low intensity conditioning (Busulfan, anti-CD8, anti-CD40Ligand), MGMT(P140K)-expressing cells could be selected using chemotherapy. Conclusions This MGMT(P140K) transgenic mouse line provides a useful source of drug-selectable donor cells for the development of non-myeloablative allogeneic transplant models in which variation in transplant conditioning elements can be investigated independently of gene transfer efficiency. Copyright © 2006 John Wiley & Sons, Ltd. [source] A bicistronic SIN-lentiviral vector containing G156A MGMT allows selection and metabolic correction of hematopoietic protoporphyric cell linesTHE JOURNAL OF GENE MEDICINE, Issue 9 2003Emmanuel Richard Abstract Background Erythropoietic protoporphyria (EPP) is an inherited disease characterised by a ferrochelatase (FECH) deficiency, the latest enzyme of the heme biosynthetic pathway, leading to the accumulation of toxic protoporphyrin in the liver, bone marrow and spleen. We have previously shown that a successful gene therapy of a murine model of the disease was possible with lentiviral vectors even in the absence of preselection of corrected cells, but lethal irradiation of the recipient was necessary to obtain an efficient bone marrow engraftment. To overcome a preconditioning regimen, a selective growth advantage has to be conferred to the corrected cells. Methods We have developed a novel bicistronic lentiviral vector that contains the human alkylating drug resistance mutant O6 -methylguanine DNA methyltransferase (MGMT G156A) and FECH cDNAs. We tested their capacity to protect hematopoietic cell lines efficiently from alkylating drug toxicity and correct enzymatic deficiency. Results EPP lymphoblastoid (LB) cell lines, K562 and cord-blood-derived CD34+ cells were transduced at a low multiplicity of infection (MOI) with the bicistronic constructs. Resistance to O6 -benzylguanine (BG)/N,N,-bis(2-chloroethyl)- N -nitrosourea (BCNU) was clearly shown in transduced cells, leading to the survival and expansion of provirus-containing cells. Corrected EPP LB cells were selectively amplified, leading to complete restoration of enzymatic activity and the absence of protoporphyrin accumulation. Conclusions This study demonstrates that a lentiviral vector including therapeutic and G156A MGMT genes followed by BG/BCNU exposure can lead to a full metabolic correction of deficient cells. This vector might form the basis of new EPP mouse gene therapy protocols without a preconditioning regimen followed by in vivo selection of corrected hematopoietic stem cells. Copyright © 2003 John Wiley & Sons, Ltd. [source] ORIGINAL ARTICLE: Safety Analysis of the Diaphragm in Combination with Lubricant or Acidifying Microbicide Gels: Effects on Markers of Inflammation and Innate Immunity in Cervicovaginal FluidAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 2 2009Deborah J. Anderson Objective, Diaphragms are being considered for use with vaginal microbicide gels to provide enhanced protection against sexually transmitted pathogens. The purpose of this study was to determine whether use of a diaphragm with microbicide or placebo gel causes cervicovaginal inflammation or perturbations in cervicovaginal immune defense. Method of study, Eighty-one non-pregnant women were randomized into three groups and instructed to use Milex® (CooperSurgical, Inc., Trumbull, CT, USA)diaphragms overnight for 14 days in combination with one of the two acid-buffering microbicide gels [ACIDFORMÔ (Instead Inc., La Jolla, CA, USA) or BufferGelÔ (BG; ReProtect Inc., Baltimore, Maryland)] or placebo gel (K-Y Jelly®; Personal Products Inc., Raritan, NJ, USA). Cervicovaginal lavages (CVLs) were performed prior to study entry and on days 8 and 16. Nine soluble mediators of vaginal inflammation or immune defense were measured in CVLs by Bio-Plex or ELISA. Results, Use of diaphragms with placebo or microbicide gel was not associated with increased levels of inflammation markers. Concentrations of secretory leukocyte protease inhibitor (SLPI) were markedly reduced in the BG group. Conclusion, Daily use of a diaphragm with placebo or acidifying microbicide gel did not cause cervicovaginal inflammation. However, diaphragm/BG use was associated with markedly reduced levels of SLPI, an important mediator of innate immune defense. Further studies are warranted to establish the safety of diaphragm/microbicide gel combinations. [source] The Gross and Micro Anatomy of the Accessory Sex Glands of the Male Agouti (Dasyprocta leporina)ANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 3 2009W. M. Mollineau Summary This study was a follow up to the study on the gross anatomy of the male agouti (Dasyprocta leporina) reproductive system. The seminal vesicles of the agouti are lobulated structures. The mean diameter of the large lumen is 883.6 ± 76.83 ,m. The mucosa (24.1 ± 0.92 ,m), which is lined by pseudo-stratified columnar epithelium is thrown into folds, which often branch. The lamina muscularis mucosa is thin and is made of loose connective tissue containing blood vessels. The mucosa of the leaf-like coagulating glands of the agouti is folded. The mean diameter of the lumen is 488.3 ± 41.96 ,m. The mucosa contains tubuloalveolar glands, which have a mean length of 199.5 ± 28.83 ,m. The thin epithelium, 15.0 ± 1.25-,m wide, consists mostly of pseudo-stratified columnar cells. The epithelium also has surface modifications in the form of apical blebs and cilia. The epithelium of the agouti's lobulated prostate gland is also folded creating a large lumen with a mean diameter of 995.5 ± 55.70 ,m. The mucosa contains tubular and tubuloalveolar glands, each having a mean length of 134.4 ± 13.59 ,m. The epithelium (13.9 ± 1.16 ,m) consists of pseudo-stratified columnar cells. The pea-shaped bulbourethral gland (BG) of the agouti consists of convoluted tubular, mucous secretory units, which are irregularly shaped each with a mean length of 177.9 ± 7.10 ,m and a mean width of 63.5 ± 3.97 ,m. The BG of the agouti are ventro-lateral to the rectum and dorsally positioned to the pubic symphysis, and connected to the urethra by short ducts. [source] A novel monoclonal antibody recognizing ,(1,3) glucans in intact cells of Candida and Cryptococcus,APMIS, Issue 10 2008N. KONDORI The cell walls of all medically important fungi contain a unique polyglucose compound, ,(1,3) glucan. In the present study, murine monoclonal antibodies were produced against linear and ,(1,6) branched ,(1,3) glucans, and their specificities were characterized for reactivity to other , glucans, fungal cell wall fragments, and fungal cells. Their reactivity was also compared with that of rabbit polyclonal antibodies raised against the same immunogens. Two mouse monoclonal antibodies (AG and BG) recognized immunoreactive epitopes in ,(1,3)(1,6) glucan by ELISA. In an inhibition assay of the anti-,(1,3)(1,6) activity of the monoclonals, the homologous antigen effectively inhibited the activity as expected, while ,(1,3) also inhibited the assay but to a much lesser extent. No inhibition was obtained by ,(1,3)(1,4) or ,(1,6), while a cell wall extract of Candida albicans (PPM) effectively inhibited both monoclonals. Cell wall fragments of C. albicans (CaCW) and Cryptococcus neoformans (CnCW) inhibited the anti-,(1,3)(1,6) activity of AG, while BG was much less or not inhibited at all. Immunofluorescence confirmed the unique antibody specificity of AG by its recognition of a ,(1,3)(1,6)-associated epitope on the cell surfaces of C. albicans,C. krusei, C. glabrata, and nonencapsulated C. neoformans. The epitope for the AG antibody is suggested to be present in the branching point of ,(1,3)(1,6), or in the randomly coiled ,(1,3) polyglucan due to the presence of branches. Thus, monoclonal antibodies to ,(1,3)(1,6) glucans may have potential as tools in the laboratory diagnosis of invasive yeast infections. [source] Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defectsAUSTRALIAN DENTAL JOURNAL, Issue 1 2010M Esposito Background:, Periodontitis is a chronic infective disease of the gums caused by bacteria present in dental plaque. This condition induces the breakdown of the tooth supporting apparatus until teeth are lost. Surgery may be indicated to arrest disease progression and regenerate lost tissues. Several surgical techniques have been developed to regenerate periodontal tissues including guided tissue regeneration (GTR), bone grafting (BG) and the use of enamel matrix derivative (EMD). EMD is an extract of enamel matrix and contains amelogenins of various molecular weights. Amelogenins are involved in the formation of enamel and periodontal attachment formation during tooth development. Objectives:, To test whether EMD is effective, and to compare EMD versus GTR, and various BG procedures for the treatment of intrabony defects. Search strategy:, We searched the Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE and EMBASE. Several journals were handsearched. No language restrictions were applied. Authors of randomized controlled trials (RCTs) identified, personal contacts and the manufacturer were contacted to identify unpublished trials. Most recent search: February 2009. Selection criteria:, RCTs on patients affected by periodontitis having intrabony defects of at least 3 mm treated with EMD compared with open flap debridement, GTR and various BG procedures with at least 1 year follow-up. The outcome measures considered were: tooth loss, changes in probing attachment levels (PAL), pocket depths (PPD), gingival recessions (REC), bone levels from the bottom of the defects on intraoral radiographs, aesthetics and adverse events. The following time-points were to be evaluated: 1, 5 and 10 years. Data collection and analysis:, Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two authors. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). It was decided not to investigate heterogeneity, but a sensitivity analysis for the risk of bias of the trials was performed. Main results:, Thirteen trials were included out of 35 potentially eligible trials. No included trial presented data after 5 years of follow-up, therefore all data refer to the 1-year time point. A meta-analysis including nine trials showed that EMD treated sites displayed statistically significant PAL improvements (mean difference 1.1 mm, 95% CI 0.61 to 1.55) and PPD reduction (0.9 mm, 95% CI 0.44 to 1.31) when compared to placebo or control treated sites, though a high degree of heterogeneity was found. Significantly more sites had <2 mm PAL gain in the control group, with RR 0.53 (95% CI 0.34 to 0.82). Approximately nine patients needed to be treated (NNT) to have one patient gaining 2 mm or more PAL over the control group, based on a prevalence in the control group of 25%. No differences in tooth loss or aesthetic appearance as judged by the patients were observed. When evaluating only trials at a low risk of bias in a sensitivity analysis (four trials), the effect size for PAL was 0.62 mm (95% CI 0.28 to 0.96), which was less than 1.1 mm for the overall result. Comparing EMD with GTR (five trials), GTR showed statistically significant more postoperative complications (three trials, RR 0.12, 95% CI 0.02 to 0.85) and more REC (0.4 mm 95% CI 0.15 to 0.66). The only trial comparing EMD with a bioactive ceramic filler found statistically significant more REC (-1.60 mm, 95% CI ,2.74 to ,0.46) at the EMG treated sites. Authors' conclusions:, One year after its application, EMD significantly improved PAL levels (1.1 mm) and PPD reduction (0.9 mm) when compared to a placebo or control, however, the high degree of heterogeneity observed among trials suggests that results have to be interpreted with great caution. In addition, a sensitivity analysis indicated that the overall treatment effect might be overestimated. The actual clinical advantages of using EMD are unknown. With the exception of significantly more postoperative complications in the GTR group, there was no evidence of clinically important differences between GTR and EMD. Bone substitutes may be associated with less REC than EMD. Plain language summary:, Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defects. Emdogain might have some advantages over other methods of regenerating the tissue supporting teeth lost by gum disease, such as less postoperative complications, but has not been shown to save more compromised teeth or that patients noticed any aesthetic improvement 1 year after its application. Bacteria in plaque can cause gum disease (periodontitis) that breaks down tissue supporting teeth. Surgical cleaning tries to stop the disease to save loose teeth. Bone grafting, guided tissue regeneration and enamel matrix derivatives (such as Emdogain) aim to regenerate support tissues. Emdogain contains proteins (derived from developing pig teeth) believed to regenerate tooth attachment. The review found that adjunctive application of Emdogain regenerates about 1 mm more tissue than surgical cleaning alone, although it is unclear to which extent such improvement is noticeable since patients did not find any difference in the aesthetic results. Emdogain showed similar clinical results to guided tissue regeneration, but is simpler to use and determines less complications. Bone substitutes may induce less gum retraction than Emdogain. No serious adverse reactions to Emdogain were reported in trials. [source] |