Relapse after rigid fixation of mandibular advancement

In 19 subjects rigid fixation of bilateral sagittal split osteotomies was used for mandibular advancement. Five angles and four linear measurements were determined cephalometrically for two time intervals: before surgery to immediately after surgery (T1-T2), and immediately after surgery to six months to one year after surgery (T2-TL). A multiple regression analysis with a backward stepping procedure was used to determine relationships between relapse, as defined by the position of pogonion at T2-TL (PgT2) and B point during this same time interval (BT2). The only significant predictor of PgT2 was PgT1 (P less than 0.001) (amount of advancement of pogonion during the time interval T1-T2). When BT2 was examined, both the change in position of B point at T1-T2 (P less than 0.001) and the change in anterior facial height at T1-T2 (P less than 0.02) were significant predictors of relapse. There were no other predictors of relapse. Advancements of 6 to 7 mm or greater as measured at B or Pg deserve special attention as they were more predisposed to relapse. Methods for preventing relapse are discussed.     

A method to measure pain associated with hypersensitive dentin

Pain associated with dental hypersensitivity has been difficult to assess. An electronic threshold measure was developed to increase the degree of objectivity in a subject's response to a cold thermal stimulus. The apparatus consisted of a miniature thermistor connected to a medical multichannel recorder with a hand-held event recorder. The thermistor was placed adjacent to the hypersensitive area for an accurate temperature measure of the point at which the subject first reported pain. Room temperature air was gently blown on the hypersensitive area, dropping the surface temperature evenly from intraoral temperature to room temperature. Results indicated that this method of assessment provided consistent and reproducible data. The apparatus can detect changes in sensitivity and offers an objective approach to sensitivity studies.     

Controlled-release levodopa/carbidopa. I. Sinemet CR3 treatment of response fluctuations in Parkinson's disease

Eight Parkinson patients with response fluctuations completed an open-label trial of a controlled-release carbidopa/levodopa preparation (Sinemet CR3). At the end of 6 weeks, percent "on" time and mean interdose interval increased, the number of daily doses and "off" periods was decreased, and the variability of plasma levodopa levels and disability scores was reduced. However, response fluctuations continued to occur, day-to-day consistency was poor, and the bioavailability of levodopa appeared less than that of standard Sinemet. Overall benefit waned over the next 3 to 6 months. Oral controlled-release carbidopa/levodopa is capable of reducing fluctuations in plasma levodopa levels and clinical performance in Parkinson's disease. The response to this particular controlled-release formulation was suboptimal and unsustained.     

In vivo activation of myelin oligodendrocyte glycoprotein-specific T cells in healthy control subjects

Collagen-induced arthritis (CIA) is a murine model of autoimmune-mediated polyarthritis. CIA can be prevented by the administration (intravenously) of CII, inducing regulatory CD4+ T cells which produce Th2 cytokines. However, the relative importance of IL-4 in suppressing arthritis remains unclear. To address this question, a neutralizing monoclonal antibody to IL-4 was given to mice treated with tolerized, CII-specific cells. The antibody significantly reversed the expected suppression of arthritis. Moreover, CII administered intravenously to DBA/1 IL4-/- mice (developed by backcrossing C57B1/6 IL4-/- to wild-type DBA/1 mice) was completely ineffective in suppressing disease. These data support the importance of IL-4 in the regulation of autoimmune arthritis. Compensatory increases in mRNA message for other Th2 cytokines were observed, but they did not restore suppression of arthritis. Antibodies to CII, mostly IgG2a, were increased in IL4-/- mice. These studies represent a unique opportunity to analyze the role of IL-4 and its absence on an autoimmune murine model of arthritis.     

Paediatric ACL repair reinforced with temporary internal bracing

Purpose

Instability following non-operative treatment of anterior cruciate ligament (ACL) rupture in young children frequently results in secondary chondral and/or meniscal injuries. Therefore, many contemporary surgeons advocate ACL reconstruction in these patients, despite the challenges posed by peri-articular physes and the high early failure rate. We report a novel management approach, comprising direct ACL repair reinforced by a temporary internal brace in three children.

Methods

Two patients (aged 5 and 6 years) with complete proximal ACL ruptures and a third (aged seven) with an associated tibial spine avulsion underwent direct surgical repair, supplemented with an internal brace that was removed after 3 months.

Results

Second-look arthroscopy, examination and imaging at 3 months confirmed knee stability and complete ACL healing in all cases. Normal activities were resumed at 4 months, and excellent objective measures of function, without limb growth disturbance, were noted beyond 2 years.

Conclusion

ACL repair in young children using this technique negates the requirement and potential morbidity of graft harvest and demonstrates the potential for excellent outcome as an attractive alternative to ACL reconstruction, where an adequate ACL remnant permits direct repair.

Level of evidence

IV.

     

Systematic assessment of color removal following vital bleaching of intrinsically stained teeth

Various treatment variables associated with a standard bleaching technique were systematically recorded in 53 individuals exhibiting intrinsic discoloration of permanent teeth. These variables (predictors) included: (1) etiology (fluoride or tetracycline); (2) age of the patient; (3) the presented color of the stain; (4) the intensity of that color; (5) a long versus short bleaching time technique; and (6) the number of bleaching sessions. These were assessed as to their relationship with the results of treatment (dependent variable). The findings of a multiple regression analysis revealed that the contributions of the individual predictors were significantly different between those stains caused by tetracycline ingestion (N = 27) and those stains due to fluoride ingestion (N = 20). The analysis also revealed that those variables contributing to a significant proportion of the variance in results of treatment when tetracycline was the cause were: (1) the color of the stain and (2) the number of bleaching sessions. When fluoride was apparently the causal agent: (1) the bleaching time technique; (2) age of the patient; (3) color of the stain; and (4) the number of bleaching sessions contributed to a significant proportion of the variance in the results of treatment.     

Isolation of myelin basic protein–specific T cells predominantly from the memory T-cell compartment in multiple sclerosis

Myelin antigen–reactive T cells have been implicated in the pathogenesis of multiple sclerosis (MS). Myelin-reactive T cells can be isolated from control subjects as well as individuals who have MS. Experimental models of MS indicate that recently stimulated, myelin-reactive T cells have greater encephalitogenic potential than resting T cells. Activation induces changes in T-cell surface antigens that may distinguish previously stimulated, memory T cells from naive T cells. Therefore, we examined 108 myelin basic protein (MBP)-reactive T-cell lines from 7 MS and 8 control subjects to determine whether MBP-reactive T cells originated in the memory T-cell subset or in the naive subset. Isotypes of CD45 were used that designate memory or naive T cells. In subjects having MS, 84% of the MBP-reactive T cells resided in the memory T-cell subset. However, in control subjects, only 13% of MBP-specific T cells originated from the memory T-cell subset. This result suggests that a substantial proportion of MBP-reactive T cells from some individuals with MS have been previously activated in vivo. This difference provides additional support for the hypothesis that myelin antigen–specific T cells are involved in the pathogenesis of MS. Ann Neurol 1999;45:33–39     

Comparative Analysis of Multiple GWAS Results Identifies Metabolic Pathways Associated with Resistance to A. flavus Infection and Aflatoxin Accumulation in Maize

Aflatoxins are carcinogenic secondary metabolites produced by several species of Aspergillus, including Aspergillus flavus, an important ear rot pathogen in maize. Most commercial corn hybrids are susceptible to infection by A. flavus, and aflatoxin contaminated grain causes economic damage to farmers. The creation of inbred lines resistant to Aspergillus fungal infection or the accumulation of aflatoxins would be aided by knowing the pertinent alleles and metabolites associated with resistance in corn lines. Multiple Quantitative Trait Loci (QTL) and association mapping studies have uncovered several dozen potential genes, but each with a small effect on resistance. Metabolic pathway analysis, using the Pathway Association Study Tool (PAST), was performed on aflatoxin accumulation resistance using data from four Genome-wide Association Studies (GWAS). The present research compares the outputs of these pathway analyses and seeks common metabolic mechanisms underlying each. Genes, pathways, metabolites, and mechanisms highlighted here can contribute to improving phenotypic selection of resistant lines via measurement of more specific and highly heritable resistance-related traits and genetic gain via marker assisted or genomic selection with multiple SNPs linked to resistance-related pathways.     

A comparative study of normal sensibility of the inferior alveolar nerve and the infraorbital nerve

In order to assess the degree of similarity of the infraorbital nerve and inferior alveolar nerve, thirty subjects with no history of sensory injury were examined by a battery of neurosensory tests including: light touch, brush stroke direction, two-point discrimination, and thermal disk temperature assessment. In a matched sample experimental design, the sensibility of the inferior alveolar nerve (lower lip) was compared to the inferior orbital nerve (upper lip). The product moment correlations revealed a significant relationship (degree of sameness) between the upper and lower lip. The comparison of the upper and lower lip appear to be acceptable for retrospective tests for detection of neurosensory injury of the inferior alveolar nerve. Of these tests, light touch appears to be the most consistent while remaining sensitive to individual variation. The thermal disk assessment was least sensitive in that no individual variation could be demonstrated. In addition, there appear to be greater variations in men than in women.