Detection of proximal secondary caries at cervical class II-amalgam restoration margins in vitro

ObjectivesTo compare the performance of LFpen (DIAGNOdent pen) with two different wedge-shaped tips to conventional bitewing radiography (BW) for detecting proximal secondary caries at the cervical margin of amalgam restorations in vitro.MethodsSeventy-five molars with class II amalgam restorations were selected. Depending on the marginal filling extension, data was subdivided into a crown group (C), when the filling ended in enamel, and into a root group (R), when the filling ended beyond the cementum-enamel junction. Bayesian analysis including calculation of the area under the receiver operating curve (AUC) was performed. Furthermore, Spearman correlations between caries and cofactors, such as presence of plaque or stain, occlusal ditching, marginal gap size, filling overhangs, and shortfalls, were calculated. Additionally, for group R the correlation coefficient between LFpen measurements and lesion depth was calculated. Histology served as gold standard.ResultsIn group C both at the D1 and D3 levels, LFpen with two different tips showed a better performance than bitewing radiography (AUC at D1: 0.83/0.79 (LFpen) and 0.63 (BW); at D3: 0.66/0.66 (LFpen) and 0.53 (BW)). In group R, the respective AUC values were 0.53/0.56 (LF) and 0.59 (BW). A significant medium correlation was observed for occlusal ditching and proximal caries. Stain accumulation at the restoration margins especially in combination with filling overhangs interfered with LFpen readings, resulting in false positive measurements.ConclusionsCompared to BW, LFpen enhances the detection of secondary caries lesions at the cervical margin of amalgam restorations that do not extend below the cementum-enamel junction.     

Surgical ventricular reconstruction and subendocardial resection for the treatment of refractory ventricular tachycardia

We describe a case of 64-year-old female patient with ventricular tachycardia intractable to medical treatment and acute heart failure following myocardial infarction. Emergency surgical ventricular reconstruction and subendocardial resection was undertaken. We discuss the option of surgical intervention in this difficult and unusual clinical scenario.     

The 60 Minutes Myocardial Infarction Project: Treatment and clinical outcome of patients with acute myocardial infarction in Germany

AIMS: To describe patient characteristics, pre-hospital delay, treatment,complications and outcome in patients with acute myocardialinfarction admitted to hospitals in Germany. METHODS AND RESULTS: The study was of prospective observational multicentre design.Those involved were consecutive patients with acute Q-wave myocardialinfarction admitted within 96 h of onset of symptoms to 136German hospitals between July 1992 and September 1994 (n=14980,median age 66 (quartiles 57, 74) years, 68% male, 48% anteriorwall infarction). Median pre-hospital delay was 170 (90, 475)min, with 17% arriving within the first hour and 61% within4 h of onset of symptoms. The following patient groups had ashort pre-hospital delay: males, those aged less than 65 years,those admitted at night or the weekend, those with a previousmyocardial infarction, those in need of cardiopulmonary resuscitation,and those with a diagnostic first ECG. The first ECG was diagnosticin 67·6% of cases. Reperfusion therapy was used in 53%,with thrombolytic therapy in 51·6%. Median time fromadmission to initiation of treatment was 30 (20, 55) min. Respectiverates of treatment with aspirin, nitrates, and beta-blockerswere 81%, 83% and 16%. Major complications were cerebral bleeding(0·4%), bleeding requiring transfusions (0·9%),left ventricular rupture (0·6%) and anaphylactic shock(0·1%). Median hospital stay was 20 (13, 26) days. In-hospitaldeath rate was 17·2%. Increased hospital mortality wasobserved with female gender, an unknown or long pre-hospitaldelay, a diagnostic first ECG, anterior wall infarction, traumaor major operation within the last 14 days, renal insufficiencyand malignoma. CONCLUSIONS: ‘Real-life’ hospital mortality is much higher thanpreviously reported in clinical trials. To reduce hospital mortality,the efficacy of thrombolysis should be increased by shorteningthe pre-hospital delay, and the use of concomitant therapy,especially beta-blockers, should be increased.     

Electrical coupling among Bergmann glial cells and its modulation by glutamate receptor activation

We studied the characteristics of electrical coupling between Bergmann glial cells in mouse cerebellar slices using Lucifer Yellow injection, patch-clamping cell pairs, and ultrastructural inspection. While early postnatal cells (days 5–7) were not coupled, coupling was abundant at postnatal days 20–24. Coupled cells were arranged perpendicular to the parallel fibers in a parasagittal section, forming a string, rather than a cluster of cells. Electron microscopy revealed that gap junctions were abundant in the distal parts of the processes. Gap junctions between cell bodies and processes were very rare, and no gap junctions were found between cell bodies of adjacent Bergmann glial cells. The junctional conductance was voltage and time independent and could be markedly reduced by halothane. Alkalization of cells (by applying NH₄⁺ increased the junctional conductance to 150%, while acidification of the cell interior (by removing NH₄⁺) led to a decrease to 70%. Activation of AMPA receptors induced a blockade of the junctional conductance to 30% of the control. This link is most likely mediated by the influx of Ca²⁺ via the receptor since this effect was not observed in Ca²⁺-free medium, suggesting that Ca²⁺ entry via the kainate receptor pore led to the closure of gap junctions. These studies indicate that electrical coupling between Bergmann glial cells is not only developmentally regulated but also controlled by physiological stimuli. © 1996 Wiley-Liss, Inc.     

Personalized Medicine Is the Postgenomic Condition

When President Obama laid out his vision for the U.S. Precision Medicine Initiative in a 2016 Boston Globe op‐ed, he cautioned, “[I]t only works if we collect enough information first.” “Collecting information” is an apt way to describe the subject of both books reviewed here. Jenny Reardon's The Postgenomic Condition: Ethics, Justice, and Knowledge after the Genome traces the history of the Human Genome Project and efforts around the globe to obtain blood samples to extract not only genetic data but also meaning from them. Barbara Prainsack's Personalized Medicine: Empowered Patients in the 21st Century? concerns the capture of digital, quantifiable, and computable information about nearly all aspects of people's lives in the pursuit of personalized medicine. Reardon and Prainsack critique scientists’ and corporations’ appeals to liberal democracy, justice, and empowerment to collect more and more information about people. They reveal the limitations and frequent superficiality of those appeals and remind us that person‐centric ethics rather than data‐centric research is needed to realize a more democratic, just, and empowered society.