Influence of vertical growth pattern on faciolingual inclinations and treatment mechanics

Control of faciolingual tooth inclinations is obtained by using rectangular wire with third-order bends and standard edgewise brackets or by using a straight wire in a preadjusted appliance system. Ideal faciolingual inclinations have been determined previously by measuring facial surface contours relative to coronal long axes. This study evaluates faciolingual inclinations based on occlusal table inclinations relative to occlusal planes. The samples compared include untreated ideal occlusions and malocclusions in three different vertical skeletal growth patterns. Faciolingual inclinations of first molars and central incisors were measured relative to the occlusal plane and to selected cephalometric angular measurements. Statistical comparisons between groups revealed significant differences in the inclinations of the upper incisor relative to the occlusal plane (U1-OP) and the inclination of the occlusal plane relative to sella nasion (OP-SN). No statistically significant intergroup differences were found in the inclination of the lower incisor relative to the occlusal plane (L1-OP) or in the faciolingual inclinations of the maxillary and mandibular first molars. On the basis of the large intergroup differences in the mean angle between the occlusal plane and sella nasion (OP-SN), the use of straight-wire appliance therapy is discussed in terms of the potential for creating differential moments. Because differential moments may facilitate or hinder treatment goals, the practitioner must know the biomechanical sequelae resulting from occlusal plane-sella nasion variations, which differ from normative values when preadjusted brackets are used.     

Clinical, microbiological, and epidemiological findings of an outbreak of Mycobacterium abscessus hand-and-foot disease

In 2003, we identified an outbreak of clinically distinct lesions involving the hands and feet associated with a public wading pool in Edmonton, Alberta, Canada. A total of 85 cases were identified. The management and follow-up of 41 children and 1 adult patients is presented. Skin lesions occurred within a median incubation period of 29 days and approximately 88 days for the adult patient. Lesions resolved within a median of 58 days and approximately 150 days for the adult patient. Patients were treated with clarithromycin, topical antibiotic dressings, and/or incision and drainage of pustules or followed without treatment. All resolved without complication. The pool was closed and cleaned. The M. abscessus hand-and-foot disease is characterized by the onset, mainly in children, of tender, erythematous papules, pustules, and abscesses with a self-limited course. This is the first documented M. abscessus outbreak associated with wading pool exposure.     

Influence of time-to-interventions for emergency department critical care patients on hospital mortality.

INTRODUCTION: Patients seeking ED services require intensive interventions. Minimal literature exists on outcomes of mortality for ED patients admitted directly to ICU beds and outcomes of hospital stay. Wait times of the following interventions-time to first medication, first radiologic examination, first blood work, arrival in the emergency department to order for an ICU bed, and time of admission order to leaving the emergency department-were investigated for associations with hospital mortality. METHODS: This study was a quantitative, retrospective, non-experimental, exploratory, comparative analysis of secondary data. RESULTS: Nearly 54% of patients arrived by ambulance; 46% were walk-ins. Mean minutes to ICU admission order was 206.50; from order to leaving the emergency department, 93.56 minutes; and length of stay in the emergency department, 298 minutes. Mortality rates were higher for weekend admissions than for weekday admissions. An implication of logistic regression was that longer periods from order to leaving the emergency department affected hospital mortality rates. DISCUSSION: Mortality rate was more likely to increase the longer it took to leave the emergency department after an admission order. Further study on timeliness of ED interventions related to hospital outcomes may provide the information to revise practice. Using a system-wide database interfaced with an in-hospital system would facilitate the ability to do outcomes research.     

Partnerships for improving dementia care in primary care: Extending access to primary care‐based memory clinics in Ontario,Canada

In Ontario, Canada, the Primary Care Collaborative Memory Clinic (PCCMC) model of dementia care provides a team‐based assessment and management service that has demonstrated increased capacity for dementia care at the primary care level. PCCMCs are established following completion of a multi‐faceted memory clinic training programme. Evidence of the success of this care model has been demonstrated primarily in practice settings with integrated interprofessional healthcare providers (HCPs). Desire to implement PCCMCs in less‐resourced family practice settings without integrated interprofessional HCPs has resulted in partnerships with community agencies and services to create the multifaceted teams needed for this care model. The purpose of this study was to describe the key lessons learned in the development and implementation of 18 PCCMCs in primary care practice models without integrated interprofessional HCPs. Mixed methods included tracking of clinic referrals, pre‐ (N = 122) and post‐ (N = 71) training surveys to assess practice changes and factors facilitating and challenging clinic implementation. Interviews were conducted with 40 team members to identify key lessons learned. Key enablers were access to training, organisational/ management and care provider support, availability of infrastructure supports and clinic coordination. Data were collected between January 2012 and January 2017. PCCMCs were challenged by a lack of sustainable funding, inadequate infrastructure support, competing priorities, maintaining adequate communication among team members, and coordinating multiple schedules. Suggestions to support longer term sustainability were identified, many addressing identified challenges such as securing sustainable funding, and ensuring partners understand the importance of their role and succession planning. This study demonstrated that by establishing community partnerships and leveraging existing community resources, the PCCMC model is generalisable to multiple family practice settings including those without integrated interprofessional staff. Lessons learned can inform the development of interventions for complex chronic conditions requiring interprofessional support in primary care.     

Inflammatory cytokines are associated with the development of symptom burden in patients with NSCLC undergoing concurrent chemoradiation therapy

Elevations in cancer treatment-induced circulating inflammatory cytokines may be partially responsible for the development of significant symptom burden (e.g., pain, fatigue, distress, disturbed sleep) during concurrent chemoradiation therapy (CXRT). Sixty-two patients undergoing CXRT for locally advanced non-small cell lung cancer (NSCLC) reported symptoms weekly for 15 weeks via the M. D. Anderson Symptom Inventory (MDASI). Serum inflammatory cytokines were assessed weekly during therapy via enzyme-linked immunosorbent assay. Dynamic changes in cytokines and associated symptom profiles were estimated using mixed-effect models. MDASI symptom severity increased gradually as CXRT dose accumulated and peaked at week 8. Serum concentrations of interleukin (IL)-6, IL-10, and serum soluble receptor 1 for tumor necrosis factor (sTNF-R1) increased significantly by week 8 (all p < .05). During CXRT, controlled for age, sex, race, body mass index, cancer recurrence, previous treatment status, total radiotherapy dose, and CXRT delivery technique, an increase in sTNF-R1 was significantly related to an increase in the mean score for all 15 MDASI symptoms (estimate, 1.74; SE, 0.69; p < .05) and to a larger radiation dose to normal lung volume (estimate, 1.77; SE, 0.71; p < .01); an increase in serum IL-6 was significantly related to increased mean severity for the five most severe symptoms (pain, fatigue, disturbed sleep, lack of appetite, sore throat) (estimate, 0.32; SE, 0.16; p < .05). These results suggest a role for over-expressed pro-inflammatory cytokines in significant worsening of symptoms in NSCLC patients undergoing CXRT, and warrant further study to identify biological targets for ameliorating treatment-related symptom burden.     

Additive renoprotective effects of B2-kinin receptor blocker and PPAR-γ agonist in uninephrectomized db/db mice

We recently showed that the bradykinin B2 receptor (B2R) blocker icatibant (Icat) and the peroxisome proliferator-activated receptor-γ agonist rosiglitazone (Ros) exerted anti-inflammatory effects in renal tubular cells exposed to a diabetic milieu. This study aims to explore whether these effects can be translated to an experimental model of type 2 diabetic nephropathy (DN). db/db mice and their nondiabetic db/m littermates underwent sham operation or uninephrectomy (Unx) at 10 weeks and received vehicle (Veh), metformin (Met), Icat, Ros, or Icat plus Ros for 8 weeks before killing. Among the db/db group with Unx, mice that received Icat or Ros had significantly lower serum creatinine and albuminuria, which was further reduced when Icat and Ros were given in combination. These beneficial effects were not observed in the Met group that achieved similar glycemic control as Ros-treated animals. Likewise, the severity of reactive glomerular and proximal tubular hypertrophy, glomerulosclerosis, interstitial injury, cortical F4/80 and α-smooth muscle actin immunostaining, and CCL-2, ICAM-1 and TGF-β overexpression were all attenuated by Icat and Ros, and these effects were enhanced when both agents were combined. Immunohistochemical staining confirmed the proximal tubular expression of CCL-2 (inflammation) and TGF-β (fibrosis). Treatment with Icat was associated with decreased B2R, but increased, B1R expression, which was exaggerated in Unx animals. At the signaling level, Icat and Ros reduced extracellular signal-regulated kinase 1/2 and STAT1 activation, respectively. Our results suggest a deleterious role of the kallikrein-kinin system in murine-accelerated DN, which can be ameliorated by the B2R blocker Icat and enhanced by the addition of Ros. This calls for further evaluation of this novel therapeutic approach in more animal models of diabetic nephropathy.