Carotid endarterectomy with normal findings from a completion study: Is there need for early duplex scan?

OBJECTIVE: The objective of this study was to determine the value of early (< 6 months) duplex scanning after carotid endarterectomy (CEA) with an intraoperative completion study with normal results. Attention was paid to restenosis rates and reoperation for recurrent stenosis within the first 6 months. METHODS: A retrospective review was performed on 380 CEAs (338 patients) with intraoperative completion studies and duplex surveillance within the first 6 months. Results of completion studies, restenosis rates, and recurrent symptoms were evaluated for each operation. Studies were performed from 0 to 200 days postoperatively (median, 28). RESULTS: Intraoperative completion studies included 333 angiograms, 26 duplex scans, and 21 angiograms with duplex scans. Of the 380 intraoperative completion studies, 28 (7.5%) had abnormal findings, including 14 abnormal internal carotid arteries (ICAs). Twenty-four procedures were revised, and the findings of all repeat completion studies were normal. Of the initial completion studies, in four cases, abnormalities (3 ICAs) were insignificant and did not warrant further intervention. Follow-up ICA duplex scans had normal results after 364 (95.8%) CEAs. There were 14 mild recurrent ICA stenoses and two moderate recurrent ICA stenoses; neither had abnormal findings from the completion study. There were no severe recurrent ICA stenoses. External carotid artery (ECA) recurrent stenosis included 7 mild, 15 moderate, and 9 severe restenoses. CONCLUSIONS: Only 0.5% of CEAs developed moderate restenosis. No procedures had severe recurrent stenosis on duplex scan within the first 6 months, and none required intervention. Duplex surveillance in the first 6 months is relatively unproductive, providing that there were normal results from an intraoperative completion study for each patient. Routine surveillance can be started at 1 year.     

Brain responses to stimuli mimicking dental treatment among non‐phobic individuals: A meta‐analysis

Numerous neuroimaging studies have attempted to identify how the brain responds to stimuli mimicking dental treatment in normal non‐phobic individuals. However, results were sometimes inconsistent due to small sample sizes and methodological variations. This meta‐analysis employs standardized procedures to summarize data from previous studies to identify brain regions that were consistently activated across studies, elicited by stimuli such as pictures, sounds, or audiovisual footage mimicking those encountered during dental treatments. A systematic literature search was carried out using PubMed and Scopus. The meta‐analysis analyzed data from 120 healthy subjects from seven neuroimaging studies. We assessed the risk of bias among the included studies with the Risk of Bias Assessment Tool for Nonrandomized Studies. One study appeared to have a high risk of selection bias, whereas the others were considered to have a low risk of bias. Results revealed three clusters of activation with cluster sizes ranging from 768 mm³ to 1,424 mm³. Stimuli mimicking dental treatment consistently activated the bilateral anterior insula; right dorsal anterior cingulate, putamen, and medial prefrontal cortex; and left claustrum. This study confirmed that audio and/or visual stimuli mimicking dental treatment consistently activated the fear‐related brain regions among healthy subjects, mostly consistent with activations from general anxiety but without the involvement of the amygdala.     

The expression and intracellular distribution of phosphoglycerate kinase isoenzymes in Trypanosoma cruzi.

In this paper, we report the subcellular distribution of phosphoglycerate kinase (PGK) in epimastigotes of Trypanosoma cruzi. Approximately 80% of the PGK activity was found in the cytosol, 20% in the glycosomes. Western blot analysis suggested that two isoenzymes of 56 and 48 kDa, respectively, are responsible for the glycosomal PGK activity, whereas the cytosolic activity should be attributed to a single PGK of 48 kDa. In analogy to the situation previously reported for PGK in Trypanosoma brucei, these isoenzymes were called PGKA, C and B, respectively. However, in T. cruzi, PGKA seems not to be a minor enzyme like its counterpart in T. brucei. Whereas PGKC behaved as a soluble glycosomal matrix protein, PGKA appeared to be present at the inner surface of the organelle's membrane. After alkaline carbonate treatment, the enzyme remained associated with the particulate fraction of the organelles. Upon solubilization of glycosomes with Triton X-114, PGKA was recovered from the detergent phase, indicating its (partial) hydrophobic character and therefore, a possible hydrophobic interaction with the membrane. The PGKA gene was cloned and sequenced, but the predicted amino-acid sequence did not reveal an obvious clue as to the mechanism by which the enzyme is attached to the glycosomal membrane.     

A Review of “Optimal Fallow Period” Guidance Across Canadian Jurisdictions

IntroductionUnderstanding how different countries have responded to mitigate the risk of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) transmission in dental offices is important. This article describes the different approaches taken towards optimal fallow periods in Canadian jurisdictions.MethodsWe searched publicly available information from dentist and dental hygiene regulator websites across the 10 provinces and 3 territories in Canada. We also searched for guidance documents on dental associations’ websites or through personal communication with government officials. We extracted and tabulated information on fallow period recommendations or guidance, when available.ResultsNine jurisdictions (6 provinces and all 3 territories) acknowledge or provide guidance on fallow periods following aerosol-generating procedures. Among those who have provided guidance regarding a fallow period, recommendations follow the Centers for Disease Control and Prevention guidance if the air changes per hour (ACH) in the dental operatory is known.ConclusionThe evidence for deciding on optimal fallow period is limited and still being explored, resulting in substantial variation across Canadian jurisdictions. A focus on developing scientific evidence relevant to dentistry and assimilating existing science is crucial to establishing consistency and uniformity in information to deliver safe oral health care services.     

Cutaneous germinal center cell-derived lymphomas. A clinical histopathological and immunopathological study of 18 cases.

Eighteen cases of cutaneous germinal center cell-derived lymphomas (CGCCL) were classified into 3 types according to Kiel classification: centrocytic lymphomas (CC), 7; centroblastic-centrocytic lymphomas (CB/CC), 9; and centroblastic lymphomas (CB), 2. The duration of the disease was 3-14 months (median 9.5 months) after the first admission. In all cases, monomorphous cutaneous nodules were found as the initial manifestation of the disease. Twelve cases of CGCCL, especially those of CB and CB/CC, initially presented with normochromic anemia, a finding which is helpful in the diagnosis of the disease. Cytomorphologically, CB tumor cells were easily identified, white CC cells were hard to distinguish from the cells of nonepidermotropic cutaneous T cell lymphoma. In many cases, however, electron microscopic examination and cytochemical stains of skin biopsy tissue imprints are useful in diagnosing CGCCL. Immunoenzyme labelling (ABC method) with monoclonal antibodies indicated that B1, K and lambda positivity are very important markers for CGCCL. Our findings also showed a higher percentage of rK type in CGCCL as compared to the Western countries.

     

Reversal of pulmonary hypertension and subsequent repair of atrial septal defect after treatment with continuous intravenous epoprostenol.

We report the first case in the world literature of a patient with an atrial septal defect, severe pulmonary hypertension, and equalization of pulmonary and systemic pressures, who underwent successful closure of an ASD following prolonged therapy with the intravenous vasodilator epoprostenol. Judicious use of continuous prostacyclin in apparently inoperable patients with congenital heart disease may be associated with significant reversal of pulmonary hypertension, and conversion to an operable state.     

广东顺德地区急性脑梗死患者中医证候与牛津郡社区卒中项目分型的相关性中医微观辨证探讨

目的探讨广东顺德地区急性脑梗死患者经牛津郡社区卒中项目分型后中医证候的分布及其规律性.方法以2001-10/2004-10广东佛山市顺德区第一人民医院收治192例急性脑梗死患者为观察对象,所有患者发病3 d内接受资深中医师辨证和量化评分参照<中风辨证诊断标准>,将脑梗死分为6个中医证型①气虚证.②阴虚阳亢证.③风证.④火热证.⑤痰证.⑥血瘀证.以证型评分≥7分为证型诊断确立,最高分为30分.还将上述6个证型分为虚实证,其中阴虚阳亢证、火热证、痰证、血瘀证属于实证,气虚证属于虚证,而风证属于有虚有实或虚实夹杂之证.患者同时接受牛津郡社区卒中项目分型调查,分为前全循环梗死、部分前循环梗死、后循环梗死和腔隙性梗死4型.比较不同牛津郡社区卒中项目分型脑梗死患者的中医证型构成、中医虚实证型分布和各种中医证型组合例数分布情况. 结果按意向处理分析,192例患者均进入结果分析.①牛津郡社区卒中项目分型分布192例中前全循环梗死15例(7.8%);部分前循环梗死26例(13.5%);后循环梗死17例(8.8%);腔隙性梗死134例(69.8%).②不同牛津郡社区卒中项目分型患者的中医证型构成前全循环梗死组中以火热证和风证分布最多,气虚证分布最少;部分前循环梗死组中风证和痰证最为多,气虚证和阴虚阳亢证偏少;风证和火热证在后循环梗死组中分布较多,后者中阴虚阳亢和气虚证分布较少;腔隙性梗死组中最多为风证和血瘀证,余下各项分布较不明显.③不同牛津郡社区卒中项目分型患者的中医虚实证型分布各个亚型中的实证和虚实夹杂证例数均明显多于虚证(P＜0.05),但各个亚型中实证和虚实夹杂证之间分布无明显区别(P＞0.05).④不同牛津郡社区卒中项目分型患者各种中医证型组合例数分布前全循环梗死组亚型组的中医单一证型者明显少于3种证型组合者,而腔隙性梗死组中中医单一征型者明显多于3种和4种证型组合者(P＜0.05),余下各亚组中不同证型组合间无显著区别(P＞0.05).结论①急性脑梗死患者牛津郡社区卒中项目分型中腔隙性脑梗死最多,次之为部分前循环梗死组和后循环梗死组,而前全循环梗死组最少,且无论是哪一种分型,中医证型分布在前位的均有风证、痰证或火热证.②各亚型之间中医虚、实证分布较均匀,说明仅以虚实很难反映病情及预后程度.③病情重者(前全循环梗死亚型组)的中医单一证型者明显少于3种证型组合者,而病情轻者(腔隙性梗死组)中医单一征型者明显多于3种和4种证型组合者.