Capabilities of computerized clinical decision support systems: the implications for the practicing dental professional

This article presents the use of captured data within the range of patient care activities of the dental practitioner with an emphasis on prosthodontic activities. It describes the use of computer technology in dentistry during a typical patient encounter in a dental care facility. The oral health record, the need for speech recognition technology, and existing documentation software are discussed. Ongoing development of the capabilities of Clinical Decision Support (CDS) systems is becoming an important part of the oral health setting; including systems applicable to prosthodontics. These systems all rely on a common standardized structure for the electronic (oral) health record (EHR/EOHR). Current developments in radiological technology and digital imaging are explained as well as fundamentals of decision support systems clarified. Recent developments in the representation of domain knowledge as well as the implementation of a dental nomenclature and metathesaurus are also presented. A quality matrix identifies target values for dental informatics while demonstrating an "importance-weighting" of dental characteristics.     

p27 Labeling index and proliferation in gastrointestinal stromal tumors: correlations with clinicopathologic factors and recurrence

BACKGROUND: Low expression of p27, a cyclin-dependent kinase inhibitor, has recently been reported to be associated with poor prognosis of many tumors. Moreover, an inverse relationship between p27 expression and proliferation was also noted. Although accumulating data indicate a correlation between high proliferation rate and aggressive behavior of gastrointestinal stromal tumors, no conclusive correlation between p27 expression and either tumor recurrence or proliferation has been established yet in this disease. The aim of this study was to immunohistochemically investigate the association of p27 expression (as measured by the p27 labeling index: p27LI) with recurrence and proliferation (as measured by the Ki-67 labeling index: KLI) in gastrointestinal stromal tumors. METHODS: p27LI and KLI were investigated in tumor specimens from 50 patients diagnosed with gastrointestinal stromal tumors. Quantitative evaluations of p27LI and KLI were performed on tissue sections stained immunohistochemically with anti-p27 and anti-Ki-67 monoclonal antibodies. RESULTS: Both p27LI and KLI were associated with the presence of recurrence and high mitotic index. A significant inverse correlation was noted between p27LI and KLI (r = -0.82). The recurrence-free survival time was significantly shorter in patients with high KLI (> or = 10%), low p27LI (<18%), mitosis (> or = 4), and larger tumor size (> or = 5.2 cm). Multivariate analysis indicated that p27LI, KLI, and mitosis were independent predictors of recurrence-free survival. CONCLUSIONS: These findings support the view that p27LI is a reliable marker in predicting recurrence and recurrence-free survival in gastrointestinal stromal tumors. Moreover, the concordance of high KLI together with low p27LI, and vice versa, might allow us to measure the aggressiveness of these tumors.     

Evaluation of central neuropathy in type II diabetes mellitus by multimodal evoked potentials

The electrophysiological results in 51 patients with diabetes mellitus type II were compared with those in 30 age and sex matched healthy control subjects. Peripheral and cortical latencies of median and tibial somatosensory evoked potentials (SEP), bilateral I-III and I-V interpeak latencies (IPL) of brainstem auditory evoked potentials (BAEP), bilateral P100 latency of visual evoked potentials (VEP) and bilateral cortical latency and central motor conduction time of motor evoked potentials (MEP) were evaluated. We observed prolonged latencies suggestive of central neuropathy in DM type II. It has been shown that most of the electrophysiological parameters in patients with DM type II correlate with the duration of the disease, some of them with the age of the patient, and few of them with the onset of the disease. To our knowledge, there is no correlation between the electrophysiological parameters and the level of glycemia or the degree of metabolic control. We conclude that central and peripheral neuropathies in DM are related to the duration of the disease and not to the degree of hyperglycemia and metabolic control.     

Surgical treatment of strabismus fixus associated with high myopia

A 55-year-old woman had convergent strabismus fixus associated with high myopia. Bilateral medial rectus recession and loop myopexy of lateral and medial rectus muscles was performed. The clinical characteristics and the possible surgical treatment modalities were discussed. This surgery seems effective on both the restoration of dislocation of the eyeball and the improvement of ocular motility.     

Automatic evaluation of prosodic features of tracheoesophageal substitute voice

In comparison with laryngeal voice, substitute voice after laryngectomy is characterized by restricted aero-acoustic properties. Until now, an objective means of prosodic differences between substitute and normal voices does not exist. In a pilot study, we applied an automatic prosody analysis module to 18 speech samples of laryngectomees (age: 64.2 ± 8.3 years) and 18 recordings of normal speakers of the same age (65.4 ± 7.6 years). Ninety-five different features per word based upon the speech energy, fundamental frequency F₀ and duration measures on words, pauses and voiced/voiceless sections were measured. These reflect aspects of loudness, pitch and articulation rate. Subjective evaluation of the 18 patients’ voices was performed by a panel of five experts on the criteria “noise”, “speech effort”, “roughness”, “intelligibility”, “match of breath and sense units” and “overall quality”. These ratings were compared to the automatically computed features. Several of them could be identified being twice as high for the laryngectomees compared to the normal speakers, and vice versa. Comparing the evaluation data of the human experts and the automatic rating, correlation coefficients of up to 0.84 were measured. The automatic analysis serves as a good means to objectify and quantify the global speech outcome of laryngectomees. Even better results are expected when both the computation of the features and the comparison method to the human ratings will have been revised and adapted to the special properties of the substitute voices.     

In-situ photopolymerization of oriented liquid-crystalline acrylates, 4. Influence of a lateral methyl substituent on monomer and oriented polymer network properties of a mesogenic diacrylate

Mesomorphism and the molecular orientation of 1,4-phenylene bis{4-(6-(acryloyloxy)hexyloxy)benzoate} ( 1 ) and its derivative with a methyl-substituent in the central phenylene group ( 2 ) are studied. The methyl group affects the transition temperatures and the thermodynamic parameters, but not the order parameter of the monomers. The photoinitiated polymerization of the diacrylate monomers in their uniaxially oriented state leads to highly oriented and densely crosslinked polymer networks. The order parameter of these networks depends on the polymerization temperature, but becomes nearly temperature-independent after polymerization. The presence of the methyl group leads to a significant lower degree of order in the polymeric state. In addition, data are presented on the monomeric viscosity of 2 and on the tensile moduli, glass transitions and refractive indices of the oriented polymer networks. In order to extend the mesomorphous temperature range, mixtures of 1 and 2 are also investigated.     

Single-Port Laparoscopic Surgery Technique in Children Using Glove-Port and Conventional Rigid Instruments

Single-port laparoscopic surgery (SPLS) is a surgical technique with many advantages over conventional laparoscopy. Its range of indications has expanded alongside the development of its unique tools and equipment. We are able to safely perform SPLS with the low-cost glove-port method without need of any specially developed SPLS port or the TriPort Access System. For this study, the files of patients who underwent laparoscopic surgeries performed between the dates of January 2013 and December 2014 at our clinic were reviewed. Umbilical access single-port abdominal surgeries which were performed using glove-port technique were included in the study. Two hundred nineteen patients who underwent SPLS surgery were included in the study. Of these patients, 158 (72.1%) were male and 61 (27.8%) were females. 58.4% of the cases were appendectomies (n = 128), 20% were orchidopexies (n = 44), 8.6% were orchiectomies (n = 19), 5.4% were ovarian cyst excisions (n = 12), 3.6% were varicocelectomies (n = 8), 2.2% were peritoneal dialysis catheter placements (n = 5), and 1.3% were nephroureterectomies (n = 3). In 67 cases (30.4%), Kirschner wire was used to eliminate the need for a second port. The study concludes that glove-port SPLS, which can readily be performed using conventional tools and Kirschner wire rather than expensive specially developed instruments, is a preferable technique because it is reliable, more cost-effective, and results in a scarless recovery.     

Endovascular repair in management of thoracic aortic aneurysms

Objective Aneurysms of the thoracic aorta are still potentially life-threatening situations. The conventional operation is still associated with morbidity. Endovascular stent graft repair offers an alternative to conventional operation for management of aortic diseases. Our aim was to report our experience with endovascular stent graft repair of thoracic aortic aneurysms. Patients and Methods Between November 2002 and October 2005, endovascular stent graft repair was performed in 26 patients: post-traumatic aortic aneurysm (n = 4), Type B dissection (n = 3) and descending thoracic aortic aneurysm (n = 19). The deployed stent graft systems were Talent-Medtronic (n = 14) and Excluder-Gore (n=12). Results Successful deployment of the stent grafts in the appropriate position was achieved in all patients. There was neither hospital mortality nor paraplegia. Late and non-procedure related death occurred in only one patient (3.8%). An average of 40% shrinkage of the aneurysmal space was observed. There was no early mortality and endoleaks. The median intensive care unit and hospital stay times were 1 and 7 days (range 4–13 days), respectively. Post-operative computed tomography scans were obtained in all patients and complete thrombosis was observed in the false lumen of dissecan aneurysms (n = 3) and sac of saccular aneurysms in 25 patients. Mean follow up time was 17.1 ± 5.4 months. Conclusions Endovascular stent graft treatment for treatment of thoracic aorta aneurysm, Type B dissection and traumatic disease of the thoracic aorta is technically feasible. Although the short and mid-term results are encouraging the long term results will determine the future of this treatment. This study was presented as an oral presentation in the 17th Annual Meeting of the Mediterranean Association of Cardiology and Cardiac Surgery, in Portorož, Slovenia, September 22–24, 2005.     

Serum prolidase I activity and some bone metabolic markers in patients with breast cancer: in relation to menopausal status

OBJECTIVES: The purpose of this study was to investigate the diagnostic value of some osteoblastic/osteoclastic biochemical markers and serum prolidase I activity in breast cancer (BC). DESIGN AND METHODS: Serum bone gla protein (BGP), prolidase I activity, urinary deoxypyridinoline (Dpy) and calcium excretions were measured, in metastatic and nonmetastatic BC patients, and in 52 healthy women. RESULTS: In patients with metastases, bone turnover markers were found to be significantly higher than those in the control group and in patients without metastases. Serum prolidase activity in patients with and without metastases was also significantly higher than those in the control group, but there was no difference between the two patient groups. CONCLUSIONS: Bone turnover has been suggested to be accelerated in BC patients with the more pronounced osteolytic activation, especially in metastatic state. Serum prolidase in premenopausal period appears to be valuable in discriminating cancer patients from controls. BGP and to a lesser degree of Dpy, may be useful markers for predicting the metastatic bone involvement, as well as for the more cost effective management of BC patients and monitoring the effects of antiresorptive therapy of malignant osteolysis before any metastasis could be detected by other invasive techniques.     

Expression pattern of galectin-1 and galectin-3 in rat testes and epididymis during postnatal development

Galectins are a family of lectins-binding beta-galactosides involved in a variety of extracellular and intracellular processes, thereby contributing to homeostasis, cell adhesion, cellular turnover, and immunity. This study aimed to determine the localization and expression of galectin-1 (Gal-1) and galectin-3 (Gal-3) in the testis and epididymis of rats at postnatal [(prepubertal (day 5), pubertal (day 20), postpubertal (day 50) and mature (day 70)] periods by using immunohistochemistry and Western blotting. Gal-1 and Gal-3 were differentially expressed in different types of cells in the testis and epididymis during postnatal development. While we detected Gal-1 expression in some spermatogenic cells and Leydig cells in the testis, not in the epididymal epithelium, Gal-3 was expressed in Sertoli cells, peritubular myoid cells, Leydig cells, smooth muscles and interstitial CD68-positive macrophages. Epithelial cells of the corpus and cauda epididymis showed an intense Gal-3 expression. Gal-1 expression was higher in the testis than in the epididymis on days 50 and 70. The expression of Gal-3 in the testis increased from the prepubertal to mature period. While the expression difference of Gal-3 was not statistically significant in the testis and epididymis until puberty, Gal-3 expression in the postpubertal and mature periods was higher in the epididymis. The expression of Gal-3 in the corpus and cauda epididymis was higher than that in the caput epididymis. In conclusion, our findings suggest that puberty has potential regulatory effect on the expression of galectins in testis and epididymis of rats. Gal-1 and 3 may play a role in the development of the reproductive system and the preservation of the immune-privileged environment in the testis, due to their pro-apoptotic and anti-apoptotic functions. The presence of intense expression of Gal-3 in the corpus and cauda epididymis may contribute to the maturation and storage of spermatozoa.