Clinical detection of caries in the primary dentition with and without bitewing radiography

Background:  Inadequate detection of caries in the primary dentition due to non-use of bitewing radiography is commonly encountered in paediatric practice. The present study investigated the increased benefits of using bitewing radiography in addition to the visual-tactile examination technique for detection of primary dentition caries in a non-fluoridated community, and determined the prevalence of "hidden" occlusal caries in the primary dentition.
Methods:  Primary teeth were scored for caries at the restorative threshold using a visual-tactile technique followed by bitewing radiographic examination in a sample of 611 schoolchildren aged 6.4 ± 0.5 yrs to 12.1 ± 0.8 yrs residing in a non-fluoridated city.
Results:  Overall, at the restorative threshold, the visual-tactile technique could detect 62 per cent of occlusal caries compared to 74 per cent for bitewing radiography (p < 0.001). The prevalence of "hidden" occlusal caries was 12 per cent. In contrast, for primary molar proximal surface caries, the visual-tactile technique could detect only 43 per cent of caries compared with 91 per cent for bitewing radiography (p < 0.001).
Conclusions:  In the primary dentition, use of bitewing radiography increases the detection rate of proximal surface caries substantially. It is recommended that bitewing radiography be included as part of the routine examination of children with proximal surfaces that cannot be visualized.     

Clinicopathologic features of antineutrophil cytoplasm autoantibody (ANCA)-associated acute renal failure in Chinese patients

Summary: The clinical course and renal pathologic features of anti-neutrophil cytoplasm auto-antibody (ANCA)-associated renal disease were studied among Chinese patients from a single centre. Eight ANCA positive patients with acute renal impairment were studied, four of whom required dialysis shortly after presentation. Their mean age at presentation was 61.6 ± 4.2 years. Renal histology, obtained in seven patients, showed paucummune crescentic glomerulonephritis in five patients, interstitial nephritis in two patients, and small vessel vasculitis in one patient. Pulmonary baemorrhage was the other common disease manifestation, present in four of the eight patients, necessitating ventilatory support in three patients. Neurologic, cutaneous, and gastrointestinal involvement were also observed. Seven of the eight patients tested positive for pANCA and anti-myeloperoxidase, while cANCA was detected in one patient of the eight patients, six (75%) responded to therapy, consisting of prednisolone and cyclophosphamide in five patients, and antibacterial therapy alone in one patient, who had interstitial nephritis but no evidence of vasculitis. Two patients died from sepsis and severe debilitation one month after presentation. of the other six patients, five had significant improvement of renal function, while one became dialysis-dependent. the levels of ANCA and C-reactive protein remained normal, and disease reactivation was not observed during follow-up for 32.4 ± 6.1 months. Patient and renal survival rates at one year were 75% and 62.5%, respectively. It was concluded that the clinical and pathologic features of ANCA-associated renal disease in Chinese patients are, in general, similar to those described in Caucasians. Nevertheless, cANCA-positivity is distinctly uncommon. the demonstration of interstitial nephritis in two of the eight patients underlines the importance of renal biopsy for correct histologic diagnosis. Early institution of aggressive immunosuppression and supportive therapies are essential for the achievement of favourable outcome in patients with vasculitis.     

Randomised trial of biofeedback training for encopresis

AIMS: To evaluate biofeedback training in children with encopresis and the effect on psychosocial function. DESIGN: Prospective controlled randomised study. PATIENT INTERVENTIONS: A multimodal treatment of six weeks. Children were randomised into two groups. Each group received dietary and toilet advice, enemas, oral laxatives, and anorectal manometry. One group also received five biofeedback training sessions. MAIN OUTCOME MEASURES: Successful treatment was defined as less than two episodes of encopresis, regular bowel movements, and no laxatives. Psychosocial function after treatment was assessed using the Child Behaviour Checklist. RESULTS: Children given laxatives and biofeedback training had higher success rates than those who received laxatives alone (39% v 19%) at the end of the intervention period. At 12 and 18 months, however, approximately 50% of children in each group were successfully treated. Abnormal behaviour scores were initially observed in 35% of children. Most children had improved behaviour scores six months after treatment. Children with an initial abnormal behaviour score who were successfully treated had a significant improvement in their behavioural profiles. CONCLUSIONS: Biofeedback training had no additional effect on the success rate or behaviour scores. Psychosocial problems are present in a subgroup of children with encopresis. The relation between successful treatment and improvement in behavioural function supports the idea that encopresis has an aetiological role in the occurrence and maintenance of behavioural problems in children with encopresis.     

sonic hedgehog信号通路蛋白在人胚胎前列腺发育不同阶段的表达及意义

目的:探明son ic hedgehog信号通路中几个关键的效应蛋白son ic hedgehog(SHH)、Patched1(PTC1)、Smoothened(SMO)及GLI1在人胚胎前列腺组织中的定位表达及变化。方法:应用免疫组织化学方法研究SHH、PTC1、SMO及GLI1在不同胎龄(10~39周)人胚胎前列腺组织中的表达变化情况。结果:随胎龄增大,SHH、PTC1、SMO及GLI1在前列腺组织中的表达水平呈由弱变强,由强渐弱,又由弱转强的双峰变化趋势。SHH和SMO仅表达在胚胎前列腺上皮细胞中;而PTC1和GLI1主要表达在上皮细胞外,也可表达在腺体周围的间质中。结论:SHH信号通路参与了人胚胎前列腺发育的调控过程,可能对于腺体发育初期的诱导发生,以及后期的增殖、分化都具有重要的调控作用。     

Identification of mimotopes for the H4 minor histocompatibility antigen

The H4 minor histocompatibility antigen (HA) of mice includes a single immunogenic peptide presented by H-2Kb molecules that stimulates skin allograft rejection and is immunodominant in the stimulation of cytolytic T lymphocytes (CTL) specific for multiple minor HA. We have identified H4 mimotopes that are recognized by the H4-specific M9 CTL clone through the use of a random peptide library comprised of bacterial clones expressing an inducible fusion protein tailed with the octamer sequence SXIXFXXL. Eight discrete mimotopes were identified that sensitized RMA-S cells for lysis by M9 CTL down to concentrations of 10(-11) M. Comparable reactivity was observed with a short-term, H4- specific CTL line indicating that the mimotopes were not solely specific for the selecting M9 clone. All mimotopes included Gly at p2 and either Val or Ile at p4, suggesting a requirement for a hydrophobic residue with specific conformation. All mimotopes included either Arg or His at p7, implicating a requirement for a specific positively charged amino acid at that position. The sixth position was more variable with four of eight mimotopes having a Val residue with single mimotopes including alternative amino acids, the majority of which were hydrophobic. Analysis of mimotopes for hydrophobicity and charge by reverse-phase HPLC and capillary electrophoresis respectively indicated that (i) mimotopes with Val at both p4 and p6 were hydrophobically similar (but not identical) to the natural H4 peptide, and (ii) a S --> E substitution at p1 resulted in a peptide (EGIVFVRL) with charge characteristics equivalent to those of the natural H4 peptide.