3D-visualization of the temporomandibular joint with focus on the articular disc based on clinical T1-, T2-, and proton density weighted MR images

Objective An approach of 3D-visualization of the temporomandibular joint (TMJ) with special focus on the articular disc based on magnetic resonance imaging (MRI) was developed for the purpose of diagnosis support. Materials and methods Mandibular condyle and fossa were reconstructed as 3D-surfaces. Articular disc, retrocondylar tissue, and the lateral pterygoid muscle were visualized by means of direct volume rendering. By simultaneous visualization of both, the bony surfaces and the soft tissue, anterior disc displacement could be recognized in 3D-context. Additional superposition of the 3D-visualization with the original 2D-MRI slices allowed for a combination with conventional diagnostics. The method was tested for clinical T1-, T2-, and proton density weighted MRI data from four independent medical institutions. Results For all cases, the skeletal anatomy could be reproduced. Applied validation approaches showed good results. Anterior disc displacement could be clearly depicted as well as the incidence of reduction of the disc. By several experienced observers, the approach was rated as significant. Conclusion Although partially non-standard in the clinical routine the new method provided promising results for efficient diagnosis support. Its validity in the medical practice, namely, its impact for dislocation/deformity of the mandibular disc will be further analyzed. This paper has been written on behalf of a publication request following Cars 2006 conference held in June 2006 in Osaka, Japan. The title of the talk at Cars 2006 conference was “An approach for three-dimensional rendering of the mandibular disc based on high-resolution MR images” authored by Kober C, Hayakawa Y, Kinzinger G, Yamamoto M, Sano T, Sader R, see Int J Comput Assist Radiol Surg 2006 1(Suppl 1): 405–406. I apologize for the delay which was caused by very dense time schedule. In return, the article is a considerable extension of the work presented at Cars 2006.     

The GDF5 mutant BB-1 enhances the bone formation induced by an injectable,poly(l-lactide-co-glycolide) acid (PLGA) fiber-reinforced,brushite-forming cement in a sheep defect model of lumbar osteopenia

Background Context

Targeted delivery of osteoinductive bone morphogenetic proteins (eg, GDF5) in bioresorbable calcium phosphate cement (CPC), potentially suitable for vertebroplasty and kyphoplasty of osteoporotic vertebral fractures, may be required to counteract augmented local bone catabolism and to support complete bone regeneration. The biologically optimized GDF5 mutant BB-1 may represent an attractive drug candidate for this purpose.

Frequency and characteristics of diarrhoeagenic Escherichia coli strains isolated from children with and without diarrhoea in Rio de Janeiro, Brazil

The frequency of diarrhoeagenic Escherichia coli (DEC) strains was investigated in 253 children up to 3 years old, with (patient group, PG, 199 children) and without (control group, CG, 54 children) diarrhoea, living in Rio de Janeiro, Brazil. DEC strains were detected in 70 (27.6%) children, including 54 (27.1%) with diarrhoea and 16 (29.6%) without diarrhoea. Enteroaggregative E. coli (EAEC) was the most frequent DEC category, accounting for 14.6% of the isolates in the PG and for 11.1% in the CG. E. coli strains carrying enteropathogenic E. coli (EPEC) virulence markers showed higher incidence in the CG (12.9%) than in the PG (8.0%). E. coli strains belonging to non-classical EPEC groups that carried eae only or eae and bfpA, designated as attaching-effacing E. coli (AEEC) were the most frequent (79.1%). Simultaneous presence of multiple EPEC virulence factors (EAF/eae/bfpA) were only detected among strains isolated from the PG. Enterotoxigenic E. coli (ETEC) strains were isolated from 5.5% of the children in the CG and from 3.5% of those in the PG. Most of the ETEC isolates were LT-probe positive (70%) and none carried both LT-I and ST-I probe sequences. One enteroinvasive E. coli (EIEC) strain was recovered from a child with diarrhoea. No stx-probe positive E. coli strains were detected. Overall, DEC strains were not found to be significantly associated with diarrhoea (p>0.05). However, the higher incidence of EAEC, the most frequent DEC category, among children with diarrhoea, suggests a potential role of EAEC as an important enteric pathogen in the community investigated.     

Work stress and coronary heart disease: what are the mechanisms?

AIMS: To determine the biological and behavioural factors linking work stress with coronary heart disease (CHD). METHODS AND RESULTS: A total of 10 308 London-based male and female civil servants aged 35-55 at phase 1 (1985-88) of the Whitehall II study were studied. Exposures included work stress (assessed at phases 1 and 2), and outcomes included behavioural risk factors (phase 3), the metabolic syndrome (phase 3), heart rate variability, morning rise in cortisol (phase 7), and incident CHD (phases 2-7) on the basis of CHD death, non-fatal myocardial infarction, or definite angina. Chronic work stress was associated with CHD and this association was stronger among participants aged under 50 (RR 1.68, 95% CI 1.17-2.42). There were similar associations between work stress and low physical activity, poor diet, the metabolic syndrome, its components, and lower heart rate variability. Cross-sectionally, work stress was associated with a higher morning rise in cortisol. Around 32% of the effect of work stress on CHD was attributable to its effect on health behaviours and the metabolic syndrome. CONCLUSION: Work stress may be an important determinant of CHD among working-age populations, which is mediated through indirect effects on health behaviours and direct effects on neuroendocrine stress pathways.     

Work-place social capital and smoking cessation: the Finnish Public Sector Study

Aims To examine whether high social capital at work is associated with an increased likelihood of smoking cessation in baseline smokers. Design Prospective cohort study. Setting Finland. Participants A total of 4853 employees who reported to be smokers in the baseline survey in 2000–2002 (response rate 68%) and responded to a follow‐up survey on smoking status in 2004–2005 (response rate 77%). Measurements Work‐place social capital was assessed using a validated and psychometrically tested eight‐item measure. Control variables included sex, age, socio‐economic position, marital status, place of work, heavy drinking, physical activity, body mass index and physician‐diagnosed depression. Findings In multi‐level logistic regression models adjusted for all the covariates, the odds for being a non‐smoker at follow‐up were 1.26 [95% confidence interval (CI) = 1.03–1.55] times higher for baseline smokers who reported high individual‐level social capital than for their counterparts with low social capital. In an analysis stratified by socio‐economic position, a significant association between individual‐level social capital and smoking cessation was observed in the high socio‐economic group [odds ratio (OR) (95% CI) = 1.63 (1.01–2.63)], but not in intermediate [(OR = 1.10 (0.83–1.47)] or low socio‐economic groups [(OR = 1.28 (0.86–1.91)]. Work unit‐level social capital was not associated with smoking cessation. Conclusions If the observed associations are causal, these findings suggest that high perceived social capital at work may facilitate smoking cessation among smokers in higher‐status jobs.     

Impact of change in the price of percutaneous coronary intervention devices on medical expenses.

Percutaneous coronary intervention (PCI) devices are much more expensive in Japan than in the United States, but their prices were reduced in April 2002. This study evaluated the impact of that change in the price of PCI devices on medical expenses. In-hospital costs of 22 consecutive patients who underwent elective single-vessel PCI without a debulking procedure before April 2002 were collected and the in-hospital cost of each patient was recalculated by applying the current prices of the PCI devices and those in the USA. For patients treated with PCI before April 2002, the in-hospital cost was 1,456,375+/-358,781 yen, but when the current price is used, the in-hospital cost is estimated to be 1,355,812 +/-313,237 yen (7% reduction). If the prices of the devices were reduced to those in USA, there would be a 53% reduction (689,417 +/-99,139 yen). Although the change in the price of PCI devices in April 2002 has reduced in-hospital costs, the devices are still much more expensive in Japan than in the USA. Further reduction of the price is required to make PCI more cost-effective.     

Double Pituitary Adenomas: Six Surgical Cases

While double pituitary adenomas have been found in approximately 1% of autopsy pituitaries, those in surgically resected material have been only rarely reported. We report herein 6 cases of double pituitary adenomas, which consisted of two histologically and/or immunohistochemically different areas among approximately 450 surgical specimens. Five out of 6 patients were men and the age was ranged between 18 and 61 years old. All these 6 patients presented acromegaly or acrogigantism and hyperprolactinemia was noted in 3 patients. In 2 patients (cases 1 and 2) the two adenomas belonged to different adenoma groups (GH-PRL-TSH group and FSH/LH group), while in the remaining 4 patients (cases 3–6) the two adenomas belonged to the same group (GH-PRL-TSH group). Thus, in all patients at least one of the two adenomas was GH-producing adenoma. Reasons for a high incidence of GH-producing adenomas in surgically resected double pituitary adenomas may include the presence of a variety of histologic subtypes among GH-producing adenomas and the advantage of cytokeratin immunostaining to distinguish these subtypes. In regard to pathogenesis of double pituitary adenomas, adenomas in cases 1 and 2 may be of multicentric occurrence, while those in cases 3–6 may occur through different clonal proliferation within originally one adenoma, resulting in diverse phenotypic expressions. Since there were patients with familial MEN 1 (case 2) and familial pituitary adenoma unrelated MEN 1 (case 3), genetic background should be also considered. Double pituitary adenomas in surgically resected material may not be so infrequent. Further molecular analysis will provide new insights into understanding the pathogenesis of pituitary adenomas and their mechanisms of multidirectional phenotypic diffrentiation.     

Effects of an excess and a deficiency of endogenous parathyroid hormone on volumetric bone mineral density and bone geometry determined by peripheral quantitative computed tomography in female subjects

Peripheral quantitative computed tomography (pQCT) is useful for evaluating volumetric bone mineral density (vBMD) as well as bone mineral density (BMD) of cortical and trabecular bones separately. Although PTH affects cortical and trabecular bones differently, the effects of endogenous PTH on vBMD and bone geometry have not previously been examined with pQCT. We, therefore, investigated the effects of an excess and a deficiency of endogenous PTH on bone by employing dual-energy x-ray absorptiometry and pQCT in 36 female patients with primary hyperparathyroidism (hyper), nine female patients with idiopathic or postoperative hypoparathyroidism (hypo), and 100 normal controls matched to age, gender, and body size (cont). Lumbar BMD by dual-energy x-ray absorptiometry was higher in the order: hypo > cont = hyper, and radius-1/3 BMD was significantly higher in the order: hypo > cont > hyper. The area of radius-1/3 was significantly higher in hyper than in cont. As for pQCT, trabecular vBMD was significantly higher in the order: hypo > cont > hyper at the 4% site (hypo, 157.5 +/- 36.7 mg/cm(3); cont, 123.4 +/- 47.5 mg/cm(3); hyper, 98.4 +/- 41.7 mg/cm(3)). Cortical vBMD was higher in the order: hypo > cont > hyper at the 20% site (hypo, 1141.1 +/- 53.1 mg/cm(3); cont, 1090.2 +/- 72.9 mg/cm(3); hyper, 1038.6 +/- 89.1 mg/cm(3)). Total bone area and endosteal and periosteal circumferences were significantly higher in hyper than in cont and hypo. Cortical area and thickness were higher in the order: hypo > cont > hyper. Bone strength indices were not significantly different among the three groups. In conclusion, vBMD evaluation revealed that an excess of endogenous PTH was catabolic for both cortical and trabecular bones, and that bone mass (especially trabecular bone mass) was preserved under a condition of deficient endogenous PTH. An excess of endogenous PTH stimulated periosteal bone formation, which might partly compensate for a decrease in bone strength induced by low BMD.