Dynamics of a novel pathogen in an avian host: Mycoplasmal conjunctivitis in house finches

In early 1994, a novel strain of Mycoplasma gallisepticum (MG)--a poultry pathogen with a world-wide distribution--emerged in wild house finches and within 3 years had reached epidemic proportions across their eastern North American range. The ensuing epizootic resulted in a rapid decline of the host population coupled with considerable seasonal fluctuations in prevalence. To understand the dynamics of this disease system, a multi-disciplinary team composed of biologists, veterinarians, microbiologists and mathematical modelers set forth to determine factors driving and influenced by this host-pathogen system. On a broad geographic scale, volunteer observers ("citizen scientists") collected and reported data used for calculating both host abundance and disease prevalence. The scale at which this monitoring initiative was conducted is unprecedented and it has been an invaluable source of data for researchers at the Cornell Laboratory of Ornithology to track the spread and magnitude of disease both spatially and temporally. At a finer scale, localized and intensive field studies provided data used to quantify the effects of disease on host demographic parameters via capture-mark-recapture modeling, effects of host behavior on disease and vice-versa, and the biological and genetic profiles of birds with known phenotypic characteristics. To balance the field-based component of the study, experiments were conducted with finches held in captivity to describe and quantify the effects of experimental infections on hosts in both individual and social settings. The confluence of these various elements of the investigation provided the foundation for construction of a general compartmentalized epidemiological model of the dynamics of the house finch-MG system. This paper serves several purposes including (i) a basic review of the pathogen, host, and epidemic cycle; (ii) an explanation of our research strategy; (iii) a basic review of results from the diverse multi-disciplinary approaches employed; and (iv) pertinent questions relevant to this and other wildlife disease studies that require further investigation.     

Three-year follow-up after rotational atherectomy for the treatment of diffuse in-stent restenosis: predictors of major adverse cardiac events.

Restenosis remains the major limitation of coronary stent implantation, especially in diffuse forms of in-stent restenosis. In this study, rotablation (RA) with adjunct angioplasty of in-stent restenosis was performed in 84 patients. Clinical follow-up and control angiography were obtained 6-month postprocedure. The rate of recurrent restenosis after rotablation for in-stent restenosis at 6-month angiographic follow-up was 45%, resulting in a rate of major adverse cardiac events of 35%. At 3-year follow-up, the cumulative event-free survival rate was 57% for the entire population. The only predictor of MACE at 3-year clinical follow-up by multivariate logistic regression analysis was in-stent lesion length. RA for the treatment of diffuse in-stent restenosis is thereby characterized by high procedural success rates and recurrent angiographic restenosis in 45% of patients with diffuse lesions. Major adverse cardiac events occur most likely within the first 6 months postprocedure. Three years after rotablation of in-stent restenosis, 43% of patients had experienced at least one major adverse cardiac event. Cathet Cardiovasc Intervent 2001;53:334-340.     

A feasible, aesthetic quality evaluation of implant-supported single crowns: an analysis of validity and reliability

Objectives: To test the reliability and validity of six aesthetic parameters and to compare the professional‐ and patient‐reported aesthetic outcomes. Material and methods: Thirty‐four patients with 66 implant‐supported premolar crowns were included. Two prosthodontists and 11 dental students evaluated six aesthetic parameters, the Copenhagen Index Score (CIS): (i) crown morphology score, (ii) crown colour match score, (iii) symmetry/harmony score, (iv) mucosal discolouration score, (v) papilla index score, mesially and (vi) papilla index score, distally. The intra‐ and inter‐observer agreement and the internal consistency were analysed by Cohen's κ and Cronbach's α, respectively. The validity of CIS parameters was tested against the corresponding Visual Analogue Scales (VAS) scores. The Spearman correlation coefficients were used. Six aesthetic Oral Health Impact Profile (OHIP) questions were correlated to the CIS and the overall VAS scores. Results: The intra‐observer agreement was >70% in 2/3 and >50% in all observations. The inter‐observed agreement was >50% in 4/5 of all observations. The mucosal discolouration score had the overall highest observed agreement followed by the papilla index scores. The crown morphology and the symmetry/harmony scores had the overall lowest agreement. The Cronbach α value was over 0.8 for all observers. All CIS scores demonstrated significant (P<0.0001) correlation to the corresponding VAS scores. Low correlation coefficients (CIS/OHIP: r_s<0.36; VAS/OHIP: r_s >?0,24) were found between patient and professional evaluations. Conclusions: The feasibility, reliability and validity of the CIS make the parameters useful for quality control of implant‐supported restorations. The professional‐ and patient‐reported aesthetic outcomes had no significant correlation. To cite this article:
Hosseini M, Gotfredsen K. A feasible, aesthetic quality evaluation of implant‐supported single crowns: an analysis of validity and reliability.
Clin. Oral Impl. Res. 23 , 2012 453–458.
doi: 10.1111/j.1600‐0501.2011.02162.x     

Robot-assisted Radical Cystectomy: Description of an Evolved Approach to Radical Cystectomy

Background

Although open radical cystectomy (ORC) remains the gold standard of care for muscle-invasive bladder cancer, robot-assisted radical cystectomy (RARC) continues to gain wider acceptance. In this article, we focus on the steps of RARC, describing our approach, which has been developed over the past 10 yr. Totally intracorporeal RARC aims to offer the benefits of a complete minimally invasive approach while replicating the oncologic outcomes of open surgery.

Objective

We report our outcomes of a totally intracorporeal RARC procedure, describing step by step our technique and highlighting the variations on this standard template of nerve-sparing and female organ–preserving approaches in men and women.

Design, setting, and participants

Between December 2003 and October 2012, a total of 113 patients (94 male and 19 female) underwent totally intracorporeal RARC.

Surgical procedure

We performed RARC, extended pelvic lymph node dissection, and a totally intracorporeal urinary diversion (UD) in all patients. In the accompanying video, we focus on the standard template for RARC, also describing nerve-sparing and female organ–preserving approaches.

Outcome measurements and statistical analysis

Complications and oncologic outcomes are reported, including overall survival (OS) and cancer-specific survival (CSS) using Kaplan-Meier analysis.

Results and limitations

RARC with intracorporeal UD was performed in 113 patients. Mean age was 64 yr (range: 37–84). Forty-three patients underwent intracorporeal ileal conduit, and 70 had intracorporeal neobladder. On surgical pathology, 48% of patients had ≤pT1 disease, 27% had pT2 disease, 13% had pT3 disease, and 12% had pT4 disease. The mean number of lymph nodes removed was 21 (range: 0–57). Twenty percent of patients had lymph node–positive disease. Positive surgical margins occurred in six cases (5.3%). Median follow-up was 25 mo (range: 3–107). We recorded a total of 70 early complications (0–30 d) in 54 patients (47.8%), with 37 patients (32.7%) having Clavien grade ≥3. Thirty-six late complications (>30 d) were recorded in 30 patients (26.5%), with 20 patients (17.7%) having Clavien grade ≥3. One patient (0.9%) died within 90 days of operation from pulmonary embolism. Using Kaplan-Meier analysis, CSS was 81% at 3 yr and 67% at 5 yr.

Conclusions

Our structured approach to RARC has enabled us to develop this complex service while maintaining patient outcomes and complication rates comparable with ORC series. Our results demonstrate acceptable oncologic outcomes and encouraging long-term CSS rates.     

The impact of vitamin and/or mineral supplementation on lipid profiles in type 2 diabetes

OBJECTIVE: The purpose of the present study was to assess the impact of Mg + Zn, Vitamins C + E, and combination of these micronutrients on serum lipid and lipoprotein profiles in type 2 diabetic patients. MATERIALS AND METHODS: In a randomized, double-blind, placebo controlled clinical trial, 69 type 2 diabetic patients were randomly divided into four groups, each group receiving one of the following daily supplement for 3 months; group M: 200 mg Mg and 30 mg Zn (n = 16), group V: 200mg Vitamin C and 150 mg Vitamin E (n = 18), group MV: minerals plus vitamins (n = 17), group P: placebo (n = 18). Fasting blood and urine samples were collected at the beginning and at the end of the trial. Serum triglyceride, total cholesterol, high density lipoprotein cholesterol (HDL-c) and low density lipoprotein cholesterol (LDL-c) were measured enzymatically. Apolipoproteins (apo) A1 and B were measured by immunoturbidimetric method. Adjustment for differences in baselines covariates and changes in variables during study were performed by analysis of covariance using general linear models. RESULTS: Results indicate that after 3 months of supplementation mean serum levels of HDL-c and apo A1 increased significantly in the MV group by 24% (50.4 +/-19.3 mg/dl versus 40.6 +/- 10.8 mg/dl) and 8.8% (169.8 +/- 33.8 mg/dl versus 156.1+ /- 23.9 mg/dl), respectively (P < 0.01). There were no significant changes in the levels of these parameters in the other three groups. Serum levels of total cholesterol, LDL-c, triglyceride, and apo B were not altered after supplementation in all four groups. CONCLUSION: It is concluded that since co-supplementation of Mg, Zn, Vitamins C and E significantly increases HDL-c and apo A1, supplementation of these micronutrients could be recommended for the type 2 diabetic patients based on their daily requirements.     

活体异体结膜缘和羊膜移植治疗化学性眼外伤造成的角膜缘干细胞缺失(英文)

目的:评价利用活体异体结膜缘和羊膜移植治疗化学性眼外伤造成的角膜缘干细胞缺失的临床效果。方法:从2005-07/2007-12,本研究包括了9名男性化学性眼外伤患者(10眼)。所有患者接受了亲属活体异体结膜缘和羊膜移植,2例眼接受了睑缝术。用环孢菌素和泼尼松龙进行全身性免疫抑制。结果:在3例眼中观察到完全角膜上皮化(30%),其中1例在术后1.5mo出现免疫排斥,角膜溶解引起穿孔,加大全身性免疫抑制剂量来控制病情。3例眼中植片无法在角膜表面重新形成上皮,被定为原发性失败。其余4眼有部分上皮形成,但上皮细胞无法完全覆盖角膜表面。术前最佳矫正视力从手动到1m处数指,术后最佳矫正视力从光感到20/80。有5眼视力得到改进,不需其他治疗。手术失败的主要原因为干眼症和持续性炎症。结论:对于能控制泪量和眼部炎症的病例,亲属活体异体角膜缘和羊膜移植是治疗化学性眼外伤造成的角膜缘干细胞缺失最佳方法之一。     

Effects of voice therapy as objectively evaluated by digitized laryngeal stroboscopic imaging

Objective measurements derived from digitized laryngeal stroboscopic images were used to demonstrate changes in vocal fold vibration and in the size of benign lesions after 3 months of voice therapy. Forty chronically dysphonic patients were studied. By means of a rigid stroboscope, pretreatment and posttreatment recordings were made of the vocal folds at rest and under stroboscopic light during phonation. From each recording, images of the positions at rest and during vibration at maximal opening and at maximal closure were digitized. The surface areas of any lesions and of the glottal gap were independently measured in the digitized images by 2 experienced laryngologists. Referential distances were determined in order to compensate for discrepancies in magnification in the various recordings. After 3 months of voice therapy, significant improvement in lesion size and degree of maximal closure during vibration could be demonstrated in about 50% of the patients. The degree of maximal opening did not prove to be a significant parameter.