Parkinson’s disease: considerations for dental hygienists

Abstract: The prevalence of Parkinson’s disease (PD) is expected to double over the next 20 years owing to the increase in life expectancy. This progressive disease has several implications relating to oral health, and many are manageable with proper awareness and knowledge about the disease. This article reviews the epidemiology, pathophysiology, and characteristics of PD, as well as the treatments and oral health considerations to enable dental hygienists to undertake an informed approach to patient management strategies and provide optimal care.     

Reduction in length of stay for patients undergoing oesophageal and gastric resections with implementation of enhanced recovery packages

Introduction

The high mortality and morbidity associated with resection for oesophagogastric malignancy has resulted in a conservative approach to the postoperative management of this patient group. In August 2009 we introduced an enhanced recovery after surgery (ERAS) pathway tailored to patients undergoing resection for oesophagogastric malignancy. We aimed to assess the impact of this change in practice on standard clinical outcomes.

Methods

Two cohorts were studied of patients undergoing resection for oesophagogastric malignancy before (August 2008 – July 2009) and after (August 2009 – July 2010) the implementation of the ERAS pathway. Data were collected on demographics, interventions, length of stay, morbidity and in-hospital mortality.

Results

There were 53 and 55 oesophagogastric resections undertaken respectively for malignant disease in each of the study periods. The median length of stay for both gastric and oesophageal resection decreased from 15 to 11 days (Mann– Whitney U, p<0.001) following implementation of the ERAS pathway. There was no significant increase in morbidity (gastric resection 23.1% vs 5.3% and oesophageal resection 25.9% vs 16.7%) or mortality (gastric resection no deaths and oesophageal resection 1.8% vs 3.6%) associated with the changes. There was a significant decrease in the number of oral contrast studies used following oesophageal resection, with a reduction from 21 (77.8%) in 2008–2009 to 6 (16.7%) in 2009–2010 (chi-squared test, p<0.0001).

Conclusions

The introduction of an enhanced recovery programme following oesophagogastric surgery resulted in a significant decrease in length of median patient stay in hospital without a significant increase in associated morbidity and mortality.     

Stability of di-butyl-dichalcogenide-capped gold nanoparticles: experimental data and theoretical insights

Metals capped with organochalcogenides have attracted considerable interest due to their practical applications, which include catalysis, sensing, and biosensing, due to their optical, magnetic, electrochemical, adhesive, lubrication, and antibacterial properties. There are numerous reports of metals capped with organothiol molecules; however, there are few studies on metals capped with organoselenium or organotellurium. Thus, there is a gap to be filled regarding the properties of organochalcogenide systems which can be improved by replacing sulfur with selenium or tellurium. In the last decade, there has been significant development in the synthesis of selenium and tellurium compounds; however, it is difficult to find commercial applications of these compounds because there are few studies showing the feasibility of their synthesis and their advantages compared to organothiol compounds. Stability against oxidation by molecular oxygen under ambient conditions is one of the properties which can be improved by choosing the correct organochalcogenide; this can confer important advantages for many more suitable applications. This paper reports the successful synthesis and characterization of gold nanoparticles functionalized with organochalcogenide molecules (dibutyl-disulfide, dibutyl-diselenide and dibutyl-ditelluride) and evaluates the oxidation stability of the organochalcogenides. Spherical gold nanoparticles with diameters of 24 nm were capped with organochalcogenides and were investigated using X-ray photoelectron spectroscopy (XPS) to show the improved stability of organoselenium compared with organothiol and organotellurium. The results suggest that the organoselenium is a promising candidate to replace organothiol because of its enhanced stability towards oxidation by molecular oxygen under ambient conditions and its slow oxidation rate. The observed difference in the oxidation processes, as discussed, is also in agreement with theoretical calculations.

This study presents the improved stability against oxidation by molecular oxygen under ambient conditions of organoselenium compared with organothiol, and organotellurium.     

Electron beam irradiation for the formation of thick Ag film on Ag3PO4

This study demonstrates that the electron beam irradiation of materials, typically used in characterization measurements, could be employed for advanced fabrication, modification, and functionalization of composites. We developed irradiation equipment using an electron beam irradiation source to be applied in materials modification. Using this equipment, the formation of a thick Ag film on the Ag₃PO₄ semiconductor is carried out by electron beam irradiation for the first time. This is confirmed by various experimental techniques (X-ray diffraction, field-emission scanning electron microscopy, Raman spectroscopy, and X-ray photoelectron spectroscopy) and ab initio molecular dynamics simulations. Our calculations demonstrate that, at the earlier stages, metallic Ag growth is initiated preferentially at the (110) surface, with the reduction of surface Ag cations forming metallic Ag clusters. As the (100) and (111) surfaces have smaller numbers of exposed Ag cations, the reductions on these surfaces are slower and are accompanied by the formation of O₂ molecules.

This study demonstrates that the electron beam irradiation of materials, typically used in characterization measurements, could be employed for advanced fabrication, modification, and functionalization of composites.     

Enhanced Bone Regeneration Using Porcine Small Intestinal Submucosa

Small instestinal submucosa (SIS) is an easily produced material that has been used experimentally for tissue engineering. To evaluate the ability of SIS to facilitate bone growth within a long-bone defect, a segment of the radius was surgically removed in adult, female Sprague-Dawley rats. The defect was either left unfilled or implanted with SIS, demineralized cortical bone (DMCB), or ovalbumin. The defect was evaluated radiographically and histologically after 3, 6, 12, and 24 weeks. Tissue remodeling within the defect was evident by week 3 in SIS- and DMCB-treated rats. Filling was characterized initially by infiltration of mononuclear cells and extracellular material in SIS-implanted rats and multifocal remodeling bone particles and cartilage formation in DMCB implanted rats. Cartilage was observed as early as 3 weeks and bone as early as 6 weeks in SIS-implanted rats. Filling of the defect arose from multiple foci in DMCB-implanted rats, but was contiguous with and parallel to the ulnar shaft in SIS-implanted rats, suggesting that defect repair by SIS may be conductive rather than inductive. Rats in which the defect was left unfilled demonstrated slow but progressive filling of the defect, characterized by mononuclear cell infiltrates and fibrous extracellular material. In summary, SIS facilitated rapid filling of a longbone defect. These results suggest that SIS may be useful as a bone repair material.     

Long-term follow-up of ruptured intracranial aneurysms treated by microsurgical wrapping with autologous muscle

The purpose of this study is to describe our series of nine unclippable and uncoilable ruptured aneurysms in eight patients treated by microsurgical wrapping with autologous muscle. Records were retrospectively reviewed for rebleeding rate, morbidity and mortality, changes in size or the aneurysm’s configurations, and inflammatory reaction. We conducted a Medline search in the post-microsurgical era, excluding patients in whom wrapping was part of the aneurysm treatment in combination with clipping or coiling. The surgically related morbidity was 12.5 %. Global mortality rate was 25 % due to vasospasm (one case) and rebleeding (one case). Six patients are still alive. Rebleeding rate was 14.3 % within 6 months; then, it was zero. Glasgow outcome scale (GOS) score at discharge was 1 and 4 in one patient, respectively, and 5 in the remaining six. Mean clinical follow-up was 126 months. GOS at last follow-up was 4 and 5 in 50 % of patients, respectively. Mean mRS score was 0.8 at 2 months, and 2.4 at 12 months. Follow-up MR demonstrated persistence of the aneurysm’s sac, without changes in size and configuration. Patients did not describe or exhibit symptoms attributable to complications inherent to the use of muscle. Microsurgical muscle-wrapping of ruptured intracranial aneurysm is safe, is associated with a low rate of acute and delayed postoperative complications and rebleeding, and could be a valid alternative for unclippable and non-amenable to endovascular procedure ruptured aneurysms.     

Laser irradiation did not increase the proliferation or the differentiation of stem cells from normal and inflamed dental pulp

ObjectiveLow-level laser therapy (LLLT) has been reported to be responsible for promoting photostimulatory and photobiomodulatory effects in vivo and in vitro, stimulating cell growth, increasing cell metabolism, improving cell regeneration and invoking an anti-inflammatory response. This study was performed in order to investigate whether low-level laser therapy could increase the proliferation and differentiation potentials of hDPSC isolated from healthy dental pulps and from inflamed pulps.DesignHuman dental pulp stem cells (hDPSC) were isolated from normal and inflamed dental pulps from different patients. STRO-1-positive cells were isolated and irradiated with a red low-level laser (660 nm) in four different energy fluences (0.05, 0.30, 7 and 42 J/cm²); the authors hypothesized that the first three fluences would promote biostimulatory effects, whereas the highest dose would induce antiproliferative effects. The two lower fluences were produced by irradiating the two higher fluences through a dentine disc, which was used to simulate a clinical condition. The proliferation and the cell odonto-osteogenic differentiation competence were compared.ResultsNo statistically significant differences were observed between the proliferation rates and the relative productions of mineralized nodules compared to the respective controls, either for hDPSC from normal or inflamed dental pulps.ConclusionsThe irradiation with low-level InGaAlP red low-level laser (660 nm) in four different energy fluences (0.05, 0.30, 7 and 42 J/cm²) potentiated neither proliferation nor odonto-osteogenic differentiation of hDPSC isolated from patients with normal and inflamed pulps.