Real time three-dimensional echocardiography in assessment of left ventricular dyssynchrony and cardiac resynchronization therapy

Left ventricular (LV) mechanical dyssynchrony is an important prognostic marker for higher morbidity and mortality in patients with symptomatic heart failure. However, the response rate to resynchronization varies among patients meeting current guidelines for Cardiac resynchronization therapy (CRT). Two-dimensional echocardiography and Doppler-based techniques have shown variable results in the assessment of LV dyssynchrony. There is an obvious need for a noninvasive tool that can reliably measure LV dyssynchrony. Accurate prediction of response to CRT will improve patient selection for such therapy. Real time three-dimensional echocardiography (RT3DE) is a novel noninvasive imaging modality that has been recently used in quantitative evaluation of global and regional LV function. A number of published studies have described the use of RT3DE in the measurement of LV dyssynchrony in patients with normal or reduced LV function. The systolic dyssynchrony index derived from RT3DE has been used to quantify LV dysynchrony and to evaluate and predict the response to CRT. This review will discuss the recently published data regarding the role of RT3DE in CRT.     

Influence of procedural variations during the laboratory phase of complete denture fabrication on patient satisfaction and denture quality

Objectives

To compare subjective and objective outcomes of complete dentures fabricated with standard clinical protocols, but omitted selected steps during the laboratory phase.

Materials and methods

Forty-three edentulous patients (mean age 58.1 years, SD 9.9, range 35–78), were consecutively recruited and randomly assigned to one of four groups according to selected variations of laboratory steps: Group 1 (n = 10), omission of secondary casts obtained from impressions in border moulded custom trays; Group 2 (n = 10), omission of secondary casts and face-bow articulator mounting; Group 3 (n = 10), omission of face-bow mounting; Group 4 (n = 13), no steps omitted (control). Clinical procedures for all groups were identical, and performed by senior dental students under supervision of prosthodontists, all of whom were blinded to the Group. At 1-, 4- and 12-weeks after delivery, patients rated their overall satisfaction, as well as a range of functional factors using visual analogue scales. An independent blinded prosthodontist similarly rated four domains of denture quality at the 1-week follow-up.

Results

No significant differences were noted among the groups in all aspects of patients’ assessments at all the time points (P > 0.1). There were no significant differences in prosthodontists’ ratings of denture quality in any of the domains examined (P > 0.1).

Conclusion

Selected omissions of steps (face-bow mounting and/or secondary casts) during the laboratory phase of complete denture fabrication has only a minor role, if any, in subjective and objective outcomes, contrasting with the common belief that such omissions will adversely affect outcomes.

Clinical significance

General practitioners provide most complete dentures. Many do not follow all the procedures they were taught at dental school. Our finding that omitting frequently advocated steps made no difference to patient satisfaction or to denture quality suggests that cost-effectiveness through simplifications be considered in practice and in education.     

Evaluation des sagittalen Profils nach operativer Therapie der thorakalen adoleszenten idiopathischen Skoliose Lenke Typ 1

Introduction

The principle philosophy of posterior spinal instrumentation and fusion (PSIF) for the treatment of adolescent idiopathic scoliosis (AIS) has changed during recent decades. In the past the treatment of AIS mainly focused on correction of the major curve in the frontal plane while the sagittal profile and balancing were only of inferior interest in treatment planning. Various long-term outcome studies have demonstrated that many AIS patients developed a flatback syndrome (decrease of thoracic kyphosis and lumbar lordosis) associated with pain. It was concluded that treatment of AIS should consider the sagittal profile and balance; however, there are only few studies addressing additional procedures, which include the correction of the sagittal profile.

Material and methods

The purpose of this study was to evaluate the effects of different posterior correction techniques on sagittal profile and balance. A total of 36 consecutive patients with thoracic AIS, who were treated with selective thoracic posterior correction were included in this retrospective study. The patients were further assigned to three different subgroups according to different surgical strategies: A: pedicle screws, B: long-head pedicle screws and C: additional Ponte osteotomy. Standardized radiographs in the standing position of the whole spine in two planes were evaluated before and at least 2 years after correction for all patients and a subgroup analysis was done to identify differences between the three groups.

Results

A significant correction of the major curve was achieved in all three groups (p?<?0.001). There was a significant difference between the groups with groups B and C showing significantly higher levels of major curve correction in comparison to group A (p?<?0.001). Concerning the sagittal profile, there was a significant difference in the development of thoracic kyphosis (TK) and lumbar lordosis (LL). While a significant reduction of TK and LL was found in groups A and B after surgery, a significant increase of TK and LL was noted in group C which was associated with a decrease of pelvic tilt and an increase of sacral slope. The 2-year follow-up showed the lowest ODI-% value only in group C which was positively correlated with reduction in pelvic tilt.

Conclusions

The results of this study underline that the PSIF technique alone using pedicle screws leads to a satisfactory correction in the frontal plane but is associated with adverse effects on the sagittal profile (flat back syndrome), corroborating previous studies. It was further shown that significant improvements of sagittal parameters were achieved by adding techniques for the lengthening of the dorsal thoracic column. This approach can therefore be recommended for the treatment of AIS Lenke type 1.     

SLC34A3 intronic deletion in a new kindred with hereditary hypophosphatemic rickets with hypercalciuria

Objective: Hereditary hypophosphatemic rickets with hypercalciuria (HHRH) is an autosomal recessive form of hypophosphatemia with hyperphosphaturia, hypercalciuria, and hypercalcemia. In two reports on six affected kindreds with HHRH, the disease was mapped to chromosome 9q34, which contains the SLC34A3 gene that encodes the renal type 2c sodium-phosphate cotransporter. Our objective was to define the clinical course of these cases in a family with HHRH and to screen for SLC34A3 gene in order to determine whether these mutations are responsible for HHRH.Methods: After clinical and biochemical evaluations, the entire SLC34A3 gene was screened using PCR amplification followed by direct sequencing technique. In this paper, we describe a new kindred with HHRH and a case of progressive and complicated HHRH presenting at age 27 years.Results: We found 101-bp deletion in intron 9 of the SLC34A3 gene. The index patient was homozygous for this mutation which has been previously reported in a Caucasian population. This is the first report for presence of SLC34A3 intron 9 deletion in an Iranian population.Conclusions: These data showed that HHRH can be easily missed or underdiagnosed. Genetic evaluation of patients with familial hypercalciuria, hypophosphatemia and nephrolithiasis is needed for further information on the prevalence and management of this rare disorder. Conflict of interest:None declared.     

Tubercular arthritis of the elbow joint following olecranon fracture fixation and the role of TGF-beta in its pathogenesis

Tuberculosis （TB） occurring after a closed bone fracture in the patient with no history of TB and no evidence of TB infection at the time of initial fracture is a rare entity. We report one such case of a 48-year-old female, who presented in the emergency department with an olecranon fracture which was open reduced and inter- nally fixed with tension band wiring. Patient presented in the outpatient department with serosanguineous discharge at 3 weeks after surgery. The discharge was sent for culture and sensitivity tests, and the patient was managed by anti- biotics and daily dressings. There was wound dehiscence and the underlying implant was exposed, which was removed at 12 weeks after surgery. Repeat debridements and dressings continued for 6 months, but the discharge from the wound site continued. X-rays of the elbow performed at 6 months raised the suspicion of TB, which was confirmed by Ziel-Neelsen staining and histopathological examination of the debrided tissue. Following the confirmation, patient was put on antitubercular drugs. The patient responded to anti- tubercular drug therapy （ATT）, the purulent discharge from the wound ceased, and eventually the wound healed after 2 months of starting ATT.     

Locking Compression Plate in Musculoskeletal Oncology 'a Friend in Need'

Background

We are presenting our experience in the use of locking compression plate (LCP) after juxta-articular oncological resections in addition to its use in pathologic fracture.

Methods

A retrospective audit of skeletal reconstruction using LCP in 25 cases of long bone tumors was performed from 2008 to 2010. Reconstruction following limb salvage surgery was done in 17 patients and internal fixation of pathological fracture was done in 8 patients. All patients were available for > 12 months of follow-up, and thus assessed for union at the resected ends.

Results

There were 8 males and 17 females in the study. The average age at the time of surgery was 30 years (range, 9 to 66 years). The minimum follow-up was 12 months (range, 12 to 32 months). All patients except three went on to heal successfully. Complications occurred in those three patients: wound infection in one, nonunion in another, and periprosthetic fracture in the other patient. In the remaining patients, union was achieved at an average of 6.5 months after reconstruction in curative resection and 4.75 months after fixation of pathological fractures.

Conclusions

Joint sparing limb salvage surgery was made successfully possible after sekeletal reconstruction with LCP. Its use was also quite effective in pathological fractures with poor bone quality. Use of locking plates for musculoskeletal oncological reconstruction resulted in a good and predictable rate of union.     

Trend in dental research output in Iran over a period of 20 years (1990–2009)

Introduction: The number of scientific papers is a conventional metric for the measurement of a country’s research performance in a particular area. Objective: To evaluate the trend in Iranian publications of dental research results in peer-reviewed international scientific journals over the period 1999–2009, using national and international databases, and to compare the results with other countries. Methods: The search process was performed by two independent persons in PubMed and Iranian Medline (IranMedex). Data extraction included the year of publication, total number of dental papers in each year, total number of Iranian dental papers in each year and number of papers with a high level of evidence; these were compared with those in other Asian countries. Results: The total number of dental articles indexed in PubMed during the studied period was 207,689, with 671 being written by researchers who stated their affiliation as Iran. Although the proportion of Iranian dental articles to all published dental articles was 0.01% in 1990, this increased to 1.4% in 2009. Of all clinical trials indexed in PubMed from 1990 to 2009, only 0.62% had an author from Iran. The collaboration rate of authors ranged between 1 and 10. Turkey and Iran had a larger number of dental research publications compared with other Asian countries assessed in this study. Conclusion: During the last two decades, there has been a considerable increase in the number of dental papers by Iranian researchers indexed in the PubMed database.Key words: Dental, research, Iran     

An open-label phase 1 clinical trial of the allogeneic side population adipose-derived mesenchymal stem cells in SMA type 1 patients

Neurological Sciences - Spinal muscular atrophy (SMA), an autosomal recessive neurodegenerative disorder of alpha motor neurons of spinal cord associated with progressive muscle weakness and...