Survey of the effectiveness of masking noises during dental treatment--a pilot study.

OBJECTIVE: The aim of this study was to test the effectiveness of a newly developed system, using masking noises with specific frequencies and amplitudes, adjusted to typical noises experienced during dental treatment such as the high-speed hand-held drill. METHOD AND MATERIALS: In accordance with an analysis of typical noises experienced during dental treatment, masking noises with specific frequencies (frequency range 0.02 to 20 kHz) and amplitudes were created, with the aim of reducing the patients' awareness of typical treatment noises by overlaying frequencies. Two hundred fifty-four outpatients (113 males, 141 females) with a mean age of 32 years (+/- 10.5 years) were enrolled in this study. Patients were treated 15 minutes with and 15 minutes without the masking noise. Patients and practitioners filled out questionnaires aimed to evaluate the effectiveness of the system, sensitivity to noise (scale 0 to 10; 0 = effective, 10 = noneffective), psychologic aspects, and statements of fear. RESULTS: There was a significant reduction in patients' awareness of noise using this system during dental treatment. Most of the patients regarded the masking noise as a pleasureable supplementation to common treatment and would select this manner of dental treatment employing the device again (81.5%); 48.2% said they were more relaxed. The system does not, in principle, interfere with dental treatment, and in most instances, the device does not impede the communication between practitioners and patients. CONCLUSION: The present study demonstrates that using masking noises during dental treatment reduces the sensitivity to drill noise, reduces fear and stress, and may be useful in dental practice as an adjunct to common dental treatment.     

Functional histology of the human thymus

Summary The thymus develops from a paired epithelial anlage in the neck. This review considers how ectoderm (vesicula cervicalis) and endoderm (third pharyngeal pouch) contribute to the epithelial stroma of the thymus. Stromal elements of mesodermal origin are capillaries, septae and perivascular spaces and single invading cells. These elements separate the thymus into pseudolobuli. The thymus epithelial space and the perivascular spaces are always separated from each other by a closed, flat epithelial cell layer, with a basal lamina which contributes to the blood-thymus barrier. From the 9th gestational week, prethymic precursor cells from hemopoietic centers, begin to invade the thymus anlage. There they finally mature to committed post-thymic T cells. The thymus microenvironment of postnatal thymus is composed of six different types of epithelial cells and several stromal cells of mesodermal origin. The location of these diverse stationary cells is described, and their functional significance is discussed. Obviously these stromal cell types have a special function in providing the proper environment for T-cell maturation. The function of the thymus includes the maturation and/or selection of antigen specific T-cells. The main issue of intra-thymic T-cell differentiation is the development and expression of T-cell-antigen receptors. The great diversity of these receptors is generated by a rearrangement of the T-cell-receptor-genes in order to furnish the host with a mature T-cell repertoire that is capable of recognizing the world of extrinsic antigens. In a synopsis the manyfold interrelationships between the thymus microenvironment and the developing thymocytes are summarised.Abbreviations BALT Bronchus Associated Lymphoid Tissue - CD Cluster of Differentiation - cCD3 cytoplasmic CD3 - mCD3 membranous CD3 - C.R. Crown Rump - GALT Gut Associated Lymphoid Tissue - HLA Human Leucocyte antigen - HLA-DR Gene product of the MHC-class II (this antigen is a surface molecule of numerous stationary and free cells of the immune system) - IDC Interdigitating Cell - IL1 Interleukin 1 (cytokine derived mainly from makrophages, but also from other cell types) - IL2 and IL4 Interleukin 2 and 4 (cytokines derived mainly from T-cell, but also from other cell types) - IL4R Interleukin 4-Receptor - Mab Monoclonal antibody - MHC Major Histocompatibility Complex - p.c. post conception - TCR T-Cell-Receptor - TNC Thymic Nurse Cell - TdT Terminal deoxynucleotidyl Transferase     

Fetal Movement Counting—Maternal Concern and Experiences: A Multicenter,Randomized, Controlled Trial

Abstract: Background: Fetal movement counting may improve timely identification of decreased fetal activity and thereby contribute to prevent adverse pregnancy outcomes, but it may also contribute to maternal concern. This study aimed to test whether fetal movement counting increased maternal concern. Methods: In a multicenter, controlled trial 1,013 women with a singleton pregnancy were randomly assigned either to perform daily fetal movement counting from pregnancy week 28 or to follow standard Norwegian antenatal care where fetal movement counting is not encouraged. The primary outcome was maternal concern, measured by the Cambridge Worry Scale. Analysis was by intention-to-treat. Results: The means and SDs on Cambridge Worry Scale scores were 0.77 (0.55) and 0.90 (0.62) for the intervention and the control groups, respectively, a mean difference between the groups of 0.14 (95% CI: 0.06–0.21, p < 0.001). Decreased fetal activity was of concern to 433 women once or more during pregnancy, 45 and 42 percent in the intervention and control groups, respectively (relative risk = 1.1, 95% CI: 0.9–1.2). Seventy-nine percent of the women responded favorably to the use of counting charts. Conclusions: Women who performed fetal movement counting in the third trimester reported less concern than those in the control group. The frequency of maternal report of concern about decreased fetal activity was similar between the groups. Most women considered the use of a counting chart to be positive. (BIRTH 39:1 March 2012)     

Association between smoking and outcomes in older adults with atrial fibrillation

Tobacco smoking is a risk factor for atrial fibrillation (AF), but little is known about the impact of smoking in patients with AF. Of the 4060 patients with recurrent AF in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, 496 (12%) reported having smoked during the past two years. Propensity scores for smoking were estimated for each of the 4060 patients using a multivariable logistic regression model and were used to assemble a matched cohort of 487 pairs of smokers and nonsmokers, who were balanced on 46 baseline characteristics. Cox and logistic regression models were used to estimate the associations of smoking with all-cause mortality and all-cause hospitalization, respectively, during over 5 years of follow-up. Matched participants had a mean age of 70 ± 9 years (± S.D.), 39% were women, and 11% were non-white. All-cause mortality occurred in 21% and 16% of matched smokers and nonsmokers, respectively (when smokers were compared with nonsmokers, hazard ratio=HR=1.35; 95% confidence interval=95%CI=1.01-1.81; p=0.046). Unadjusted, multivariable-adjusted and propensity-adjusted HR (95% CI) for all-cause mortality associated with smoking in the pre-match cohort were: 1.40 (1.13-1.72; p=0.002), 1.45 (1.16-1.81; p=0.001), and 1.39 (1.12-1.74; p=0.003), respectively. Smoking had no association with all-cause hospitalization (when smokers were compared with nonsmokers, odds ratio=OR=1.21; 95%CI=0.94-1.57, p=0.146). Among patients with AF, a recent history of smoking was associated with an increased risk of all-cause mortality, but had no association with all-cause hospitalization.     

Clinical use of an epinephrine-reduced (1/400,000) articaine solution in short-time dental routine treatments--a multicenter study

The addition of epinephrine in dental local anaesthesia results in a longer and deeper anaesthesia under almost ischemic conditions. For short-time dental treatments, epinephrine-reduced anaesthetics may offer shorter and more individual anaesthesia with reduced potential side effects. The aim of this study was a clinical evaluation of anaesthetic potency and adverse effects of an epinephrine-reduced articaine formulation in dental patients undergoing short-time routine treatment. In a prospective clinical, not interventional, study between January 2008 and February 2009, 908 patients undergoing short-time dental treatment in five medical centers were anaesthetized with 4% articaine 1:400,000 epinephrine (Ubistesin, 3M/ESPE, Seefeld, Germany). Efficacy and safety in clinical use were evaluated. A follow-up after 1 day was conducted by telephone survey. A mean amount of 1.3-ml anaesthetic solution was needed to achieve a complete or sufficient anaesthesia in 97% (n = 876) of cases. A second injection had to be done in 3.7% (n = 34) before and in 11.9% (n = 108) during treatment. Here, the second injection had to be applied after a mean of 48.6 min. The mean duration of soft tissue anaesthesia after infiltration was 146.6 min, after nerve block 187.7 min. The painful treatment took a mean of 50.2 min and the total treatment time summed up to 68.8 min. In 1.7% cases (n = 15), unwanted side effects were observed. The results indicate that a lower concentration of epinephrine in combination with the 4% articaine solution leads to a high success rate of efficacy. The clinical use of a 4% articaine 1:400,000 epinephrine solution can be stated as safe and effective in short dental routine treatments. Reconsiderations concerning limitations of indication or additional contraindications are not necessary.     

Association between body mass index and dental health in 1,290 children of elementary schools in a German city

The aim of the present study was to investigate the association between caries frequency and body mass index (BMI) in German elementary school children. A total of 1,290 elementary school children (648 boys, 642 girls) were examined. The dental examination included the determination of caries frequency (DF-T/df-t values). The medical evaluation assessed the pupils’ general health and BMI. The study showed that 3.6% of the children were underweight, 74.8% had a normal weight, 11.9% were overweight, and 9.7% were obese. Underweight children showed natural healthy teeth in 44.7%, those with normal weight in 40.7%, whereas children with high weight and obese children showed natural healthy teeth in 30.5% and 31.7%, respectively. A significant association between high weight and caries frequency in the first dentition (p = 0.0067) and in the permanent dentition (p = 0.0002) could be observed. The association remains statistically significant after adjusting for age. The number of natural healthy teeth decreased with age (p = 0.001) and BMI (p = 0.0061) and was different between girls and boys (p = 0.0334). This study demonstrated a significant association between caries frequency and weight in school children. In future preventive programs, the importance of nutrition should not only be emphasized with respect to general diseases but also with regard to carious lesions.     

Preoperative MRI of the Breast (POMB) Influences Primary Treatment in Breast Cancer: A Prospective,Randomized, Multicenter Study

Background

Breast magnetic resonance imaging (MRI) has shown high sensitivity in determining tumor extent, multifocality, and occult contralateral breast cancer. Low specificity, unnecessary mastectomies, and costs are arguments against MRI. The purpose of this study was to determine whether preoperative breast MRI would affect primary surgical management, reduce reexcision/reoperation procedures, and influence the choice of neoadjuvant treatment in patients with newly diagnosed breast cancer.

Methods

This prospective, randomized, multicenter study included 440 breast cancer patients younger than aged 56 years from three, Swedish, large-volume breast units. Patients were randomly allocated on a 1:1 basis to either preoperative staging with breast MRI (n = 220) or no breast MRI (n = 220) (control group). Treatment planning of all patients was discussed at multidisciplinary team conferences.

Results

In patients randomized to the MRI group, who had an observed higher percentage of planned breast-conserving surgery (BCS) compared with the control group, a change from suggested breast conservation to mastectomy occurred in 23 of 153 (15 %) patients. Breast MRI provided additional information in 83 of 220 (38 %) patients, which caused a change in treatment plan in 40 (18 %). The breast reoperation rate was significantly lower in the MRI group: 11 of 220 (5 %) versus 33 of 220 (15 %) in the control group (p < 0.001). The number of mastectomies, axillary reoperations, and the number of patients receiving neoadjuvant chemotherapy after definitive treatment did not differ significantly between the groups.

Conclusions

Preoperative staging with breast MRI in women younger than age 56 years altered the treatment plan in 18 % of the patients. Although a higher MRI-related conversion rate from breast conservation to mastectomy was found, the final numbers of mastectomies did not differ between the two groups. The breast reoperation rate in the MRI group was significantly reduced.     

Deletions of the short arm of chromosome 2 characterize a new cytogenetic subgroup of benign thyroid tumors

Cytogenetic studies of thyroid hyperplasias and adenomas have shown that besides cases with an apparently normal karyotype different groups of cytogenetic abnormalities exist. Herein we describe the cytogenetic analyses of two benign thyroid tumors with deletions of the short arm of chromosome 2. A similar case has been described previously. Besides the previously well-established subgroups, alterations of chromosome 2 may thus characterize a new cytogenetic subgroup of benign thyroid tumors. Genes Chromosom Cancer 16:149–151 (1996). © 1996 Wiley-Liss, Inc.