Radix paramolaris and radix distomolaris in Danish permanent maxillary molars

The School of Dentistry in Copenhagen possesses a collection of 96 human permanent maxillary molars (M sup) with a root complex, the macromorphology of which includes a facially located supernumerary root known as radix paramolaris (RP) and/or a distally located supernumerary root called radix distomolaris (RD). Systematic analysis of these teeth enabled the authors to establish precise criteria for the identification of RP and RD on M sup; 91.5% out of a total of 70 RP identified occurred on M3 sup, 7.2% on M2 sup, and 1.4% on M1 sup. The corresponding percentages for 29 RD identified were: 96.5% on M3 sup, 3.4% on M2 sup, and 0.0% on M1 sup; 50.0% of the 70 RP were separate in relation to the 2 facial root components and 31.5% non-separate; in 18.6% of the RP observed, it was impossible to establish whether or not they were separate. Corresponding frequencies for the 29 RD in relation to the distofacial and lingual root components were 41.3% separate and 37.9% non-separate; 20.7% of the roots could not be categorized. The following clinically relevant macromorphological variables regarding RP and RD were also observed: degree of separation in relation to the respective neighboring root components, degree of divergence in relation to the same macrostructures, apical bend, apical gracility, and pattern of fusion.     

Bladder and sexual dysfunction after mesorectal excision for rectal cancer

BACKGROUND: Urinary and sexual dysfunction are recognized complications of rectal excision for cancer. The aim of this study was to examine the frequency of such complications after mesorectal excision, shortly after this method was introduced. METHODS: Spontaneous flowmetry, residual volume of urine measurement and urodynamic examination, including cystometry and simultaneous detrusor pressure and urinary flow recording, was carried out before and 3 months after curative rectal excision. Urinary symptoms and sexual function were evaluated by means of questionnaires before and after operation. Each patient served as his or her own control. RESULTS: Forty-nine consecutive patients, 39 of whom had a total mesorectal excision (TME) and ten a partial mesorectal excision, were examined before surgery and 35 again after operation. In two patients, a weak detrusor was detected before operation. Two patients developed signs of bladder denervation after operation. Transitory moderate urinary incontinence appeared in four other women. Six of 24 men reported some reduction in erectile function and one became impotent. Two men reported retrograde ejaculation. All the complications were seen in the TME group. CONCLUSION: Mesorectal excision for rectal cancer resulted in a low frequency of serious bladder and sexual dysfunction.     

Dlk1 in normal and abnormal hematopoiesis.

Dlk1 (Pref-1) is a transmembrane and secreted protein, which is a member of the epidermal growth factor-like family, homologous to Notch/Delta/Serrate. We have found by real-time RT-PCR that Dlk1 mRNA levels were high in CD34(+) cells in 10 of 12 MDS samples compared with CD34(+) cells from 11 normals. Also, Dlk1 mRNA was elevated in mononuclear, low density bone marrow cells from 11/38 MDS patients, 5/11 AML M6 and 2/4 AML M7 samples. Furthermore, 5/6 erythroleukemia and 2/2 megakaryocytic leukemia cell lines highly expressed Dlk1 mRNA. Levels of Dlk1 mRNA markedly increased during megakaryocytic differentiation of both CMK megakaryoblasts as well as normal CD34(+) hematopoietic stem cells. High serum levels of Dlk1 occurred in RA (4/10) and essential thrombocythemia (2/10) patients. Functional studies showed that forced expression of Dlk1 enhanced proliferation of K562 cells growing in 1% fetal bovine serum. Analysis of hematopoiesis of Dlk1 knockout mice suggested that Dlk1 contributed to granulocyte, megakaryocyte and B-cell clonogenic growth and was needed for generation of splenic B-cells. In summary, Dlk1 is overexpressed in selected samples of MDS (especially RA and RAEB) and AML (particularly M6, M7), and it appears to be associated with normal development of megakaryocytes and B cells.     

A cross-sectional survey of factors associated with the uptake of smoking cessation aids among smokers and ex-smokers

Background: A cross-sectional survey was conducted in Germany via the online panel PsyWeb with the aim of assessing factors associated with the uptake of smoking cessation aids among smokers and ex-smokers.

Methods: Of the 10,000 panel members invited to participate in the survey, 624 took part.

Main Outcome Measures: Outcomes were measured via questionnaires to assess the uptake of smoking cessation aids, health literacy, readiness to change smoking behavior, and the Fagerström Test for Nicotine Dependence.

Results: There was no association between gender or educational status and use of smoking cessation aids according to chi-square tests of independence. Logistic regression showed that health literacy, degree of tobacco dependence, and readiness to change were significantly associated with the uptake of smoking cessation aids. Smokers with a high degree of nicotine dependence, high readiness to change, and low health literacy were more likely to use aids.

Conclusion: The survey results can be used to develop psychological approaches and interventions to promote smoking cessation, e.g., interventions to increase readiness to change among smokers may increase the uptake of aids. Moreover, the results may help to improve patient care by disseminating information on effective aids and thereby promoting smoking cessation among relevant patient groups.     

Two simulation programs to measure continuous attention in obstructive sleep apnea syndrome

Patients with obstructive sleep apnea syndrome suffer from reduced continuous attention due to neuropsychological deficits. Among other means, driving simulator programs are employed for registration and objectification as well as observation of the course of therapy. While Steer Clear by Findley et al. and the driving simulator Carda (Randerath et al.) represent pure continuous attention tests, the new driving simulator test Carsim, measures attention interactively and continuously. This way, more complex functions are recorded. We therefore investigated Carda and the program Carsim to study the various features of both methods. For this purpose, 105 OSAS patients were tested on both driving simulators concerning the mistake rate in Carda and the time of tracking deviations in Carsim. We defined the normal range by using the mean value +/- 2 standard deviations from our earlier publications in healthy persons without sleep disorders. With Carda the mistake rate exceeded in 10 of 105 patients (9.5%) the normal range and with Carsim the frequency of tracking deviations exceeded in 49 of 105 patients (46.7%) the normal range. The incidence of deviation from normal was significantly higher with Carsim testing. By additionally testing the number of pathological cases is with Carda increased from 46.7% to 51.4%. The tests characterize different components of neuropsychological deficits. Driving simulators with tracking tasks describe neuropsychological deficits in comparison with those measuring only components of reaction in a higher percentage.     

Lung function measurements in awake compared to sleeping newborn infants.

Tidal breathing flow-volume loops were recorded in 19 healthy newborn infants when awake and asleep. This preceded and followed measurements of passive lung mechanics (by single breath occlusion). Our aim was to evaluate possible differences in lung function due to state of arousal or any influence of the occlusion technique. Expiratory volumes and flow rates were larger in awake than in sleeping infants before, but not after occlusion measurements. In sleeping, but not in awake infants, expiratory volumes and flow rates were higher after occlusion than before. Respiratory system compliance was significantly larger in sleeping than awake infants, while differences in respiratory system resistance and airway plateau pressure did not reach a significant level. Our results show that lung function can be measured in awake as well as sleeping infants, but differs significantly according to their arousal state, and whether tidal expiratory flow measurements are performed before or after airway occlusion measurements. Separate reference values for awake and sleeping infants may, therefore, be required. Marked intrasubject variability was found in the occlusion measurements, and criteria for acceptable measurements need to be defined.     

Patterns of healthcare service utilisation following severe traumatic brain injury: An idiographic analysis of injury compensation claims data

Background

The rate and extent of recovery after severe traumatic brain injury (TBI) is heterogeneous making prediction of likely healthcare service utilisation (HSU) difficult. Patterns of HSU derived from nomothetic samples do not represent the diverse range of outcomes possible within this patient group. Group-based trajectory model is a semi-parametric statistical technique that seeks to identify clusters of individuals whose outcome (however measured) follows a similar pattern of change over time.

Aim

To identify and characterise patterns of HSU in the 5-year period following severe TBI.

Methods

Detailed healthcare treatment payments data in 316 adults with severe TBI (Glasgow Coma Scale score 3–8) from the transport accident compensation system in the state of Victoria, Australia was accessed for this analysis. A semi-parametric group-based trajectory analytical technique for longitudinal data was applied to monthly observation counts of HSU data to identify distinct clusters of participants’ trajectories. Comparison between trajectory groups on demographic, injury, disability and compensation relevant outcomes was undertaken.

Results

Four distinct patterns (trajectories) of HSU were identified in the sample. The first trajectory group comprised 27% of participants and displayed a rapid decrease in HSU in the first year post-injury. The second group comprised 24% of participants and showed a sharp peak in HSU during the first 12 months post-injury followed by a decline over time. The third group comprised 32% of participants and showed a slight peak in HSU in the first few months post-injury and then a slow decline over time. The fourth group comprised 17% of participants and displayed a steady rise in HSU up to 30 months post-injury, followed by a gradual decline to a level consistent with that received in the first months post-injury. Significant differences were observed between groups on factors such as age, injury severity, and use of disability services.

Conclusions

There is substantial variation in patterns of HSU following severe TBI. Idiographic analysis can provide rich information for describing and understanding the resources required to help people with TBI.