The Effect of MIpaste Plus and Reminpro on Incipient Caries Using DIAGNOdent and SEM: An Invitro Study

Background

The remineralization of early caries lesion has an effective role on decreasing caries. For initial remineralization of caries lesion, using Compounds of Casein phosphopeptides (CPP) in different studies has been proposed. REMINPRO including Fluoride, Xylitol and Calcium phosphate has just been offered in the market. This study aims to investigate the efficacy of Reminpro and MI paste plus in terms of remineralization of early enamel lesions.

Accurate cortical tissue classification on MRI by modeling cortical folding patterns

Accurate tissue classification is a crucial prerequisite to MRI morphometry. Automated methods based on intensity histograms constructed from the entire volume are challenged by regional intensity variations due to local radiofrequency artifacts as well as disparities in tissue composition, laminar architecture and folding patterns. Current work proposes a novel anatomy‐driven method in which parcels conforming cortical folding were regionally extracted from the brain. Each parcel is subsequently classified using nonparametric mean shift clustering. Evaluation was carried out on manually labeled images from two datasets acquired at 3.0 Tesla (n = 15) and 1.5 Tesla (n = 20). In both datasets, we observed high tissue classification accuracy of the proposed method (Dice index >97.6% at 3.0 Tesla, and >89.2% at 1.5 Tesla). Moreover, our method consistently outperformed state‐of‐the‐art classification routines available in SPM8 and FSL‐FAST, as well as a recently proposed local classifier that partitions the brain into cubes. Contour‐based analyses localized more accurate white matter–gray matter (GM) interface classification of the proposed framework compared to the other algorithms, particularly in central and occipital cortices that generally display bright GM due to their highly degree of myelination. Excellent accuracy was maintained, even in the absence of correction for intensity inhomogeneity. The presented anatomy‐driven local classification algorithm may significantly improve cortical boundary definition, with possible benefits for morphometric inference and biomarker discovery. Hum Brain Mapp 36:3563–3574, 2015. © 2015 Wiley Periodicals, Inc.     

High-resolution 3-T MR neurography of femoral neuropathy

OBJECTIVE: The femoral nerve is subject to a variety of diseases that may affect the nerve anywhere from the nerve roots to the distal branches. High-resolution 3-T MR neurography (MRN) is being increasingly used for peripheral nerve evaluation because it complements information gained from electrodiagnostic testing. CONCLUSION: There are scattered case reports describing femoral nerve diseases using MRI. This article comprehensively reviews different pathologic abnormalities involving the femoral nerve and illustrates their MRN features with case examples.     

Expression of erbB-3 protein in colorectal adenocarcinoma: correlation with poor survival

Background/aims: The family of erbB receptors includes four transmembrane glycoproteins with tyrosine kinase activity. These receptors are widely expressed in normal tissues, but they also have been implicated in the development of several human adenocarcinomas. c-erbB-3/HER-3 has been detected to a greater or lesser extent in many tissues from the digestive, urinary, reproductive and respiratory tracts. The overexpression of c-erbB-3/HER-3 protein has also been shown in 53%–88% of colorectal adenocarcinomas. In this study we investigated the expression of the c-erbB-3/HER-3 gene product in colorectal tumour samples, and compared the results obtained with several clinicopathological parameters, including the survival of patients. Methods: Paraffin-embedded tissue sections were analysed immunohistochemically, using monoclonal antibody RTJ1 to human erbB-3 protein. Antibody RTJ1 specificity was confirmed by immunoprecipitation followed by Western blotting analysis. Amplification of the erbB-3 oncogene was tested by dot-blot hybridization. Results: Adenocarcinomas of the colon were positive for erbB-3 protein in 78% of samples examined. Dot-blot analysis showed no amplification of the erbB-3 gene in colon adenocarcinomas. Statistical analysis showed that patients with tumours that could not be stained for erbB-3 protein survived significantly longer (P < 0.05) than patients with tumours staining positive for the erbB-3 protein. A Cox proportional-hazards model with stepwise variable selection identified age, sex and erbB-3 expression as important prognostic factors. Conclusion: These findings demonstrate that erbB-3 protein expression could serve as a prognostic factor in colorectal malignancies. Received: 7 August 1999 / Accepted: 8 November 1999     

Triple arthrodesis

A triple arthrodesis is a fusion of the talocalcaneal, calcaneal cuboid, and talonavicular joints. The purpose is to create a well-aligned, plantigrade, and stable foot for patients with deformity or progressive neurologic and arthritic conditions. This article is a comprehensive overview of the procedure. However effective, triple arthrodesis is a challenging procedure for even the most skilled surgeon.     

Effect of Delay in Hospital Presentation on Clinical and Imaging Findings in Acute Pulmonary Thromboembolism

Background

There is limited information on the extent and clinical importance of the delay in hospital presentation of acute pulmonary thromboembolism (PTE).

Objective

The aim of this study was to investigate the delay in hospital presentation of PTE and its association with clinical and imaging findings in PTE.

Methods

This prospective study was conducted on patients admitted to our hospital with a diagnosis of acute PTE between September 2007 and September 2011. Relationships between delay in hospital presentation and clinical findings, risk factors, imaging findings, and in-hospital mortality were analyzed.

Results

Of the 195 patients enrolled, 84 (43.1%) patients presented 3 days after the onset of symptoms. Patients with chest pain, history of immobility for more than 3 days, recent surgery, and estrogen use had significantly less delayed presentation. Right ventricular dysfunction was significantly more frequent in patients with delayed presentation (odds ratio [OR] = 2.38; 95% confidence interval [CI] 1.27−4.44; p = 0.006); however, no relationship was found between delay in presentation and pulmonary computed tomographic angiography or color Doppler sonography findings. Patients with delayed presentation were at higher risk of in-hospital mortality (OR = 4.32; 95% CI 1.12−16.49; p = 0.021).

Conclusions

Our study showed that a significant portion of patients with acute PTE had delayed presentation. Also, patients with delayed presentation had worse echocardiographic findings and higher in-hospital mortality.     

Public Health Implications of Recommendations to Individualize Glycemic Targets in Adults With Diabetes

OBJECTIVE

To estimate how many U.S. adults with diabetes would be eligible for individualized A1C targets based on 1) the 2012 American Diabetes Association (ADA) guideline and 2) a published approach for individualized target ranges.

RESEARCH DESIGN AND METHODS

We studied adults with diabetes ≥20 years of age from the National Health and Nutrition Examination Survey 2007–2008 (n = 757). We assigned A1C targets based on duration, age, diabetes-related complications, and comorbid conditions according to 1) the ADA guideline and 2) a strategy by Ismail-Beigi focused on setting target ranges. We estimated the number and proportion of adults with each A1C target and compared individualized targets to measured levels.

RESULTS

Using ADA guideline recommendations, 31% (95% CI 27–34%) of the U.S. adult diabetes population would have recommended A1C targets of <7.0%, and 69% (95% CI 66–73%) would have A1C targets less stringent than <7.0%. Using the Ismail-Beigi strategy, 56% (51–61%) would have an A1C target of ≤7.0%, and 44% (39–49%) would have A1C targets less stringent than <7.0%. If a universal A1C <7.0% target were applied, 47% (41–54%) of adults with diabetes would have inadequate glycemic control; this proportion declined to 30% (26–36%) with the ADA guideline and 31% (27–36%) with the Ismail-Beigi strategy.

CONCLUSIONS

Using individualized glycemic targets, about half of U.S. adults with diabetes would have recommended A1C targets of ≥7.0% but one-third would still be considered inadequately controlled. Diabetes research and performance measurement goals will need to be revised in order to encourage the individualization of glycemic targets.For nearly a decade, diabetes care guidelines from the American Diabetes Association (ADA) have recommended that the goal of glycemic control should be to lower the A1C to <7.0% for adults living with diabetes (1). This recommendation currently motivates diabetes public health programs and diabetes care translational research. All of these efforts have the overall intention of shifting the national distribution of A1C levels downward in order to improve diabetes outcomes and may lead to overtreatment of A1C levels in certain diabetes populations.Although the standard A1C target of <7.0% is probably the best-known feature of the ADA guidelines, the ADA guidelines also recommend that A1C targets should be based on individual clinical circumstances. Similar recommendations for individualized targets have been supported by the Veterans Health Administration-Department of Defense (VA-DoD), American Geriatric Society, American College of Physicians (ACP), and American Association of Clinical Endocrinologists (AACE) (2–5). Recommendations to individualize targets are based on major type 2 diabetes trials that found different levels of benefit, and even harm, from lower A1C levels depending on diabetes population characteristics (e.g., duration of diabetes, age, and comorbidity) (6–10). According to the ADA, lower A1C targets are recommended for patients with a short duration of diabetes, long life expectancy, and no significant cardiovascular disease (1). Conversely, higher A1C targets are recommended for patients with longstanding diabetes, advanced age, limited life expectancy, a history of macrovascular or advanced microvascular complications, extensive comorbidities, or a high risk for severe hypoglycemia (1–5). Although guidelines have identified these special populations, recommendations on how to set individualized A1C targets have been open to interpretation.Recently, a formal strategy for individualizing targets was published by Ismail-Beigi et al. (11). Similar to diabetes care guidelines, this strategy was based on expert interpretation of outcomes from prominent diabetes trials, including the U.K. Prospective Diabetes Study (UKPDS), Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Control Evaluation (ADVANCE), and Veterans Affairs Diabetes Trial (VADT) (6–10). The Ismail-Beigi strategy used the same clinical characteristics proposed in previous guidelines from the VA-DoD, American Geriatric Society, and ACP (e.g., age, duration of diabetes, history of macrovascular and microvascular complications, comorbidity, and psychosocioeconomic context). Based on their strategy, only adults 20–44 years of age with no history of diabetes-related complications would be recommended an A1C target of ≤6.5%, and several populations are recommended individualized A1C targets above the conventional ADA threshold of <7.0%, including adults 45–65 years of age with established macrovascular or advanced microvascular complications, adults >65 years of age with longstanding diabetes or established macrovascular or advanced microvascular complications, and all adults with advanced age. Additionally, because the Ismail-Beigi strategy suggested ranges of glycemic targets (i.e., ∼7, 7.0–8.0, or ∼8.0%), there exists the potential that some patients who could safely tolerate lower glycemic targets may be undertreated in order to stay within range.These recent calls for greater individualization of A1C targets raise fundamental public health questions. The degree to which the individualization of diabetes care is regarded as important depends on how many U.S. adults with diabetes may be candidates for A1C targets more or less stringent than the conventional target of <7.0%. Previous assessments of diabetes care quality have used population-level A1C thresholds to judge the quality of care (12–14); however, the diabetes care quality may differ from previous reports using these newer standards of individualization (15). In order to understand the potential impact of the individualization of glycemic targets on diabetes care quality, we characterized the U.S. adult diabetes population by clinical variables that have been proposed as reasons to individualize A1C targets. We then operationalized the ADA and Ismail-Beigi strategies for individualization to estimate 1) the distribution of the U.S. adult diabetes population across each individualized A1C target and 2) the size of the population who have measured A1C levels that are at or below their recommended individualized A1C target.