Immediate restoration/loading of immediately placed single implants: is it an effective bimodal approach?

Objective: To compare systematically the survival and radiographic marginal bone level changes of two immediate implant protocols in the aesthetic region; immediate single implant restoration/loading in extraction sockets (the bimodal approach) compared with the same in healed sites.
Material and methods: A literature search of electronic databases, Cochrane Oral Health Group's Trials Register, National Research Register, conference proceedings and abstracts was performed without language restriction up to 1 August 2008. Hand searching included several dental journals and authors were contacted for missing information. Controlled trials that compared immediate restoration/loading of single implants placed in extraction sites with those placed in healed sites were selected. The meta-analysis was prepared according to the guidelines of the Quality of Reporting of Meta-analyses statement. The data were analysed using RevMan version 5.0 software. A fixed effects model was chosen with standardized mean differences for continuous data, and risk ratios for dichotomous data with 95% confidence intervals.
Results: Ten studies with 629 implants were included. Immediate single implant restoration/loading in extraction sockets in the aesthetic zone was associated with significantly higher risk of implant failure (risk ratio of 3.62, 95% confidence interval 1.15–11.45, P =0.03). However, the bimodal approach showed favourable marginal bone changes after 1 year.
Conclusion: The review and meta-analysis supported the potential advantages offered by this bimodal approach, but indicated a higher risk when compared with immediate restoration/loading in healed ridges. Further long-term, well-conducted, randomized-controlled studies are needed to confirm the validity of this treatment option.     

Occupational asthma caused by cellulase and lipase in the detergent industry

Three employees from two different detergent companies were investigated for occupational asthma, using skin prick tests, serum specific IgE, and specific bronchial challenge. Two were challenged with lipase and one with cellulase. All three cases had immunological evidence of sensitisation to the detergent enzymes with which they worked. Bronchial challenge in each provoked a reproducible dual asthmatic response, which reproduced their work related symptoms. These are the first reported cases of occupational asthma attributable to cellulase and lipase in the detergent industry. Four of the most common enzymes used in this industry have now been reported to cause occupational asthma; continued vigilance and caution are needed when working with these or other enzymes.     

Smoking cessation and associated factors during pregnancy

OBJECTIVE: To examine smoking habits before and during pregnancy, as well as factors associated with smoking cessation, in three European settings. METHODS: Women seeking antenatal care in Ashford (UK), Minorca and Barcelona (Spain) were recruited to the Asthma Multicenter Infant Cohort Study (AMICS). Questionnaires inquiring into the smoking habits of each woman and her partner, demographic data, occupation, educational level, number of previous children, breast feeding, alcohol intake, and history of asthma and of other allergic diseases were completed during pregnancy and in the first year after delivery. RESULTS: A total of 1,572 pregnant women were included in the three cohorts. Smoking prior to pregnancy was more common in Barcelona (46.2%) than in Minorca (39.8%) or Ashford (31.6%). Cessation rates during pregnancy also differed: 18% of women in Ashford, 20.4% in Minorca and 31.9% in Barcelona were still smoking during the first trimester. In a multivariate regression model, the factors showing a significant (negative) association with smoking cessation during pregnancy were having older children, having a partner who smoked and starting smoking at a young age. CONCLUSIONS: Baseline smoking habits and changes in smoking habits during pregnancy significantly differed between the three communities studied. Women pregnant with their first child, those who had started smoking at a later age and those whose partners were non-smokers were more likely to stop smoking when pregnant.     

Role of the paraventricular nucleus microenvironment in stress integration

The hypothalamic paraventricular nucleus is the primary controller of hypothalamo-pituitary-adrenocortical glucocorticoid release. In performing this function, the paraventricular nucleus summates a variety of information from both external and internal sources into a net secretory signal to the adrenal cortex. In this review, we will provide an overview of neuronal circuit mechanisms governing activation and inhibition of hypophysiotrophic neurons, highlight recent developments in our understanding of nonsynaptic mechanisms regulating paraventricular cellular activity, including dendritic neuropeptide release, direct steroid feedback, cytokine cascades and gaseous neurotransmission, and illustrate the capacity for hypophysiotrophic, neurohypophysial and preautonomic paraventricular effector pathways to work together in control of glucocorticoid release. The current state of knowledge reveals the paraventricular nucleus to be a dynamic entity, capable of integrating diverse classes of signals into control of adrenocortical activation.     

A nurse practitioner and primary care

As a nurse practitioner employed by a community health care center, I find that I am able to practice primary care the way I imagined I might when I was a student. The characteristics and needs of the particular population I serve have given me ample opportunities. The community health center administrators have not always prioritized expenditures the way my colleagues and I think they should, and we are not immune from the financial and market forces that affect primary care in private practices. However, the essence of primary care is valued by the organization, and it offers me the opportunity to provide this care to a community that needs it.     

Do Alterations in the Sex Ratio Occur at Fertilization? A Case Report Using Fluorescent In Situ Hybridization

Purpose: The mechanisms by which the sex ratio might be altered at fertilization were reviewed, following a case of preimplantation gender analysis revealing a significantly skewed proportion of male-to-female embryos. Methods: The case of a known carrier of X-linked hydrocephalus with a history of three affected male pregnancies is presented. Her husband's family history consisted of a strong increase in the number of males relative to females. She had four cycles of stimulated in vitro fertilization, with sex chromosome analysis using fluorescent in situ hybridization (FISH) on suitable cleavage-stage embryos. The difference in the sex ratio of normal male-to-female embryos was compared using a significance probabilities test for sex ratio. The sex ratio of sperm from a semen sample from the male partner was determined by FISH. Results: Fifty embryos were suitable for analysis. A significantly higher number of normal male (n = 20) than normal female (n = 8) embryos was obtained (P < 0.05). The FISH assessment of the husband's semen analysis revealed no alteration in the normal X:Y ratio. Conclusions: As the sperm analysis revealed a normal X:Y ratio, an alteration in the embryo sex ratio might be explained by the preferential binding of Y-bearing sperm to the oocyte, an oocyte-related discouragement of binding of X-bearing sperm, or a postfertilization event.     

Clinical responses to ingested fungal α-amylase and hemicellulase in persons sensitized to Aspergillus fumigatus?

α-Amylase and hemicellulase, derived from culture of Aspergillus species, are commonly added to flour as improvers during baking. Two cases of women occupationally sensitized to α-amylase who developed allergic symptoms after eating baked bread have been reported. With a randomized, controlled study design, we have investigated whether similar responses occur in those sensitized to Aspergillus species. Seventeen subjects with positive skin prick tests to Aspergillus fumigatus were studied. Symptomatic and physiologic responses after ingestion of bread baked with α-amylase and hemicellulase were compared, in a crossover fashion, with those after ingestion of bread baked without enzymes. No increase in respiratory or other symptoms, lung function, or nonspecific bronchial hyperreactivity was reported after ingestion of the enzyme-containing bread. We conclude that important clinical reactions to α-amylase and hemicellulase in baked bread do not frequently occur in those sensitized to Aspergillus species.