Denosumab and invasive cervical root resorption: a case report.

This case report describes an adverse side effect from long-term denosumab therapy in a patient with metastatic breast cancer. The patient presented with extensive invasive cervical root resorption affecting most of her dentition. There were no other identified risk factors. As the treatment of breast cancer evolves leading to improved survival, and the number of cancer survivors increases, it is expected that dental practitioners will see a growing number of patients who are on long-term denosumab. Comprehensive dental examinations including radiographs are warranted to identify unusual or unexpected findings such as invasive cervical root resorption. © 2022 Australian Dental Association.

Timing of dental extractions in patients undergoing radiotherapy and the incidence of osteoradionecrosis: a systematic review and meta-analysis.

This systematic review aimed to examine whether the incidence of osteonecrosis differed between patients who have dental extractions before or after radiotherapy (RT). The reported incidence of osteoradionecrosis (ORN) of the jaws following RT to the head and neck varies widely in the literature. Currently, for patients with head and neck cancer there are no universally accepted guidelines on the optimal timing of dental surgery relative to RT to minimise incident ORN. A literature review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) criteria. A search of PubMed, EMBASE, Evidence-Based Medicine, and Web of Science databases targeted literature published up to and including 10 April 2020. Two independent reviewers assessed studies for eligibility against inclusion criteria. An assessment of bias was conducted for each of the included studies and relevant data extracted. A meta-analysis was undertaken using the statistical methods described. Twenty-four of 708 studies were included. They were heterogeneous and included a wide variation of RT methods, head and neck malignancies, and comorbidities. While some concluded that the incidence of ORN was dependent on the timing of dental extractions in relation to RT, with regard to the risk of its development, others reported additional factors such as age, comorbidities, extent of surgical resection, and dose and field of radiation, as more important predictors than timing. In many there was consistent lack of detail around the timing of dental procedures in relation to the delivery of RT. From 21 studies including 36,294 patients, of whom 14,389 had extractions before RT, the pooled incidence of ORN was 5.5% (95% CI: 2.1% to 10.1%). Significant heterogeneity was found in Cochran's Q-test (p<0.001) and Higgins I2=98.0%. From 21 studies including 37,805 patients, of whom 6030 had extractions after RT, the pooled incidence of ORN was 5.3% (95% CI: 2.9% to 8.2%). Significant heterogeneity was found in Cochran's Q-test (p<0.001) and Higgins I2=80.0%. There was no statistically significant difference between these two groups (random-effects model Q=0.12, p=0.73). Large, longitudinal studies with a priori-specified methods are needed to identify, recruit, and prospectively follow patients with head and neck cancer for the onset of ORN after dental surgery. This will allow clinical guidelines to be established to assist clinicians to plan treatment when extractions are indicated in patients undergoing RT to the head and neck.

Electrochemical regeneration of spent activated carbon from drinking water treatment plant at different scale reactors.

The electrochemical regeneration of real spent activated carbons (AC) used in drinking water treatment plants was studied at different reactor scales. The electrochemical regeneration was carried out in a 6 g filter-press cell and a 3.5 kg batch reactor, allowing the scaling-up of the process between the two electrolytic reactors. The effect of the electrolyte, the divided/undivided compartment configuration and the current density were studied in the filter-press cell. The effect of compartment configuration and the influence of the regeneration time were studied in the scaled-up reactor. A current density of 0.025 A cm-2 was used and the electrodes were Pt/Ti as anode and Pt/Ti and stainless-steel as cathode. The ACs were characterized by N2 adsorption isotherms to analyse the recovery of porosity and TPD-MS to analyse the AC surface after the electrochemical treatment. In filter-press cell, a recovery of the surface area of 96% was achieved after 8 h of treatment, by introducing the AC in the cathodic compartment using 0.05 M H2SO4 solution as electrolyte. In the 3.5 kg electrochemical reactor, 95% of the pristine AC surface area was recovered. Thus, electrochemical methods can provide a green alternative to the regeneration of spent AC.

Temporomandibular Disorder: a practical guide for dental practitioners in diagnosis and management.

Temporomandibular disorder is a broad term encompassing pain and/or dysfunction of the masticatory musculature and the temporomandibular joints. Pain arising from a temporomandibular disorder is a common reason for seeking dental care. It is essential that dental practitioners are able to accurately diagnose and manage this condition. Identifying people at highest risk of developing a temporomandibular disorder and knowing which procedures are more likely to initiate or exacerbate a temporomandibular disorder, are important to reduce the likelihood of its acute and chronic presentation. The aim of this paper is to provide the dental practitioner with a clinical guideline for reference including practical tools to examine, diagnose and manage patients with temporomandibular disorder. In addition the risk profile of patients and procedures is explored to help minimize the occurrence of temporomandibular disorders and mitigate its symptoms. The scope of the dental practitioner in the management of acute and chronic temporomandibular disorders is presented, with guidance about when referral to a specialist is indicated.

The growing problems of dental caries and obesity: an Australian perspective.

Preventable diet-related diseases such as dental caries and obesity are a growing global problem, causing a significant burden on public health systems. Although there has been good evidence for the links between sugar consumption and dental caries for many decades, we are now seeing stronger links implicating sugar in obesity. There is a growing worldwide movement to tackle these problems by targeting the consumption of sugar-sweetened beverages through a range of public policy measures.

Recent developments in the application of nanomaterials to understanding molecular level processes in cobalt catalysed Fischer-Tropsch synthesis.

This perspective offers an overview of using nanomaterials for understanding cobalt catalysed Fischer-Tropsch chemistry. Nanomaterials now afford unprecedented control of size, shape and structure at the nanometre scale. This makes them invaluable tools for studying heterogeneous catalysis. The Fischer-Tropsch reaction, especially using cobalt based catalysts, is a linchpin in many processes for utilising other feedstocks (via gasification) that have been envisaged as short/medium term replacements for crude oil. The underlying chemistry has therefore garnered considerable renewed interest. The current state of the art in mechanistic understanding is summarised and the application of nanomaterials to developing this further is explored. Several specific questions, to which nanomaterials have already contributed answers, are addressed: how do nanomaterials contribute to our understanding of cobalt particle size effects, reducibility, and the effect of support porosity and how do precious metal promoters operate in cobalt catalysed Fischer-Tropsch chemistry? Future possible uses for nanomaterials in studying this field are also identified.

Long-term alteration of follicular steroid concentrations in relation to subclinical endometritis in postpartum dairy cows.

The focus of this study was to investigate the effect of subclinical endometritis (scEndo) on ovarian follicular steroid concentrations in early postpartum pasture-fed dairy cows. Mixed-age lactating dairy cows (n = 169) were examined to ascertain uterine health status on d 21 postpartum (±3 d). From this herd, a cohort of scEndo and uninfected cows (n = 47) were selected using uterine cytology to determine scEndo. To ensure cows with scEndo were selected for the study, a conservative threshold [>18% polymorphonuclear (PMN) cells among uterine nucleated cells] was chosen as a selection threshold. Ovarian follicular dynamics were assessed by ultrasonography on d 21, 42, and 63 postpartum. On the latter 2 d, all follicles >4 mm in diameter were ablated, and 4 d later, the largest (F1) and second largest (F2) follicles were measured and their follicular fluid aspirated. Hematological variables and plasma metabolites were measured also on these days to further characterize scEndo cows. On d 21, the prevalence of scEndo was approximately 9% in this herd; by d 42 infections had self-resolved in the majority (81%) of those cows classified as having scEndo on d 21. The scEndo cows had a delayed return to cyclicity; however, no effect was evident on ovarian follicle size or growth rate. Weeks after scEndo had self-resolved and cyclicity was restored, decreased (P = 0.07) testosterone and increased (P = 0.07) cortisol concentrations were evident in F1 follicles of scEndo compared with uninfected cows. Progesterone concentrations of F1 increased (P < 0.05) in 11- to 16-mm diameter follicles of scEndo cows, whereas estradiol, androstendione, and dehydroepiandrosterone concentrations were decreased (P < 0.05) in F1 8- to 10-mm diameter follicles of scEndo cows. These 3 steroids also differed (P < 0.05) between F1 follicle size categories of scEndo but not uninfected cows. On d 21, mean plasma albumin concentration was decreased (P = 0.02) in scEndo cows. In summary, early postpartum scEndo had surprisingly long-term influences on the steroid concentrations of ovarian follicles long after infections had self-resolved. This is likely to affect oocyte quality and may partially explain the reduced conception rates and longer interval between calving and conception that are often associated with scEndo, although more detailed investigations are required to substantiate this theory.

Computed tomography commissioning programmes: how to obtain a reliable MTF with an automatic approach?

The purpose of this study was to assess the spatial resolution of a computed tomography (CT) scanner with an automatic approach developed for routine quality controls when varying CT parameters. The methods available to assess the modulation transfer functions (MTF) with the automatic approach were Droege's and the bead point source (BPS) methods. These MTFs were compared with presampled ones obtained using Boone's method. The results show that Droege's method is not accurate in the low-frequency range, whereas the BPS method is highly sensitive to image noise. While both methods are well adapted to routine stability controls, it was shown that they are not able to provide absolute measurements. On the other hand, Boone's method, which is robust with respect to aliasing, more resilient to noise and provides absolute measurements, satisfies the commissioning requirements perfectly. Thus, Boone's method combined with a modified Catphan 600 phantom could be a good solution to assess CT spatial resolution in the different CT planes.

Embryo loss in cattle between Days 7 and 16 of pregnancy.

Embryo loss between embryonic Days 7 and 16 (Day 0=day of IVF) in nonlactating cattle, Bos taurus, was analyzed using transfer of 2449 (in groups of 3 to 30) in vitro-produced (IVP) blastocysts. In 152 transfers, pregnancy losses attributable solely to recipient failings amounted to between 6% (beef heifers) and 16% (parous dairy cows), of which 3% were caused by uterine infections. Neither season, year, nor the age of the embryos on retrieval affected pregnancy rates. The latter observation indicated that the reason that a recipient failed to retain embryos was already present at the time of transfer. Notably, the proportion of embryos recovered decreased (P=0.03) as more embryos were transferred, particularly at later stages (Day 14, P<0.01). The average length of embryos decreased by approximately 5% for every additional embryo transferred (P<0.0001). These effects may be linked to embryonic migration. Embryo mortality inherent to the embryo during the second week of pregnancy was 24%. Additionally, 9% of Day 14 embryos were of inferior quality, as they did not contain an epiblast. Combining embryo and recipient causes but excluding infection effects, embryonic loss of IVP embryos during the second week of pregnancy amounted to 26% (heifers) or 34% (parous dairy cows). The length of embryos doubled every day between Days 9 and 16, with a 4.4-fold range in sizes representing two thirds of the variation in length. Embryos retrieved from heifers were twice the size of those incubated in parous cows (P<0.0001), indicating faster embryonic development/trophoblast proliferation in heifers. Whereas season did not affect embryo recoveries, length was lower (50%) in winter (winter-autumn, P<0.05; winter-spring, P<0.001). Lastly, transuterine migration in cattle, when transferring multiple embryos, commenced at Day 14 (4%) and had occurred in all recipients by Day 16 (38% of embryos found contralaterally).

Comparison of PENELOPE Monte Carlo dose calculations with Fricke dosimeter and ionization chamber measurements in heterogeneous phantoms (18 MeV electron and 12 MV photon beams).

Different measurements of depth-dose curves and dose profiles were performed in heterogeneous phantoms and compared to dose distributions calculated by a Monte Carlo code. These heterogeneous phantoms consisted of lung and/or bone heterogeneities. Irradiations and simulations were carried out for an 18 MeV electron beam and a 12 MV photon beam. Depth-dose curves were measured with Fricke dosimeters and with plane and cylindrical ionization chambers. Dose profiles were measured with a small cylindrical ionization chamber at different depths. The LINAC was modelled using the PENELOPE code and phase space files were used as input data for the calculations of the dose distributions in every simulation. The detectors (Fricke dosimeters and ionization chambers) were not modelled in the geometry. There is generally a good agreement between the measurements and PENELOPE. Some discrepancies exist, near interfaces, between the ionization chamber and PENELOPE due to the attenuation of the lower energy electrons by the wall of the ionization chamber.

[Parasigmoid abscess revealed by anaerobic osteomyelitis]. / Abcès périsigmoïdien révélé par une ostéomyélite à germes anaérobies.

We report the case of a 66 year-old-patient, who profited by a laminectomy T4 to T7 for spinal cord compression due to an osteomyelitis. Bacteriological samples showed positives gram cocci and Bacteroides fragilis by the culture. The systematic research of a primitive source permitted to find a parasigmoidis abscess, which was treated by a sigmoidectomy with a colorectal anastomosis.

[Acute toxic accident following lumbar plexus block with bupivacaine]. / Accident aigu toxique après bloc du plexus lombaire à la bupivacaïne.

We report the case of a patient who experienced ventricular dysrhythmias and seizure five minutes after the injection of 30 mL of 0.5% bupivacaine with 1:200,000 epinephrine, during a lumbar plexus block performed via the posterior approach described by Winnie. The patient who underwent his total hip arthroplasty was still anaesthetised and under controlled ventilation at the time of bupivacaine administration. Aspiration test performed before injection was negative. Normal cardiac activity and stable haemodynamic condition were restored after one hour of resuscitation including 15 electric shocks and administration of epinephrine (40 mg) and clonidine (300 micrograms). The patient was discharged without neurologic sequelae after four days in the ICU.

Development during single IVP of bovine oocytes from dissected follicles: interactive effects of estrous cycle stage, follicle size and atresia.

Previous work suggests that a number of factors such as follicle size, day of estrous cycle, and level of atresia influence the developmental potential of bovine oocytes in vitro. To understand better the interactions of these factors, 1299 follicles > or =3 mm in diameter were dissected from ovaries of synchronized dairy cows on four days (d2, d7, d10, or d15) during the estrous cycle. The oocyte from each follicle was collected and matured, fertilized, and cultured singly to d8 (d0 of culture = IVF). Control follicles (302) were similarly dissected and processed from an ovary pair randomly collected from the abattoir on each slaughter day. Results showed that development to blastocyst was greater in oocytes collected during phases of follicular growth (d2 and d10) than those collected during phases of follicular dominance (d7 and d15; 44.8% vs. 36.0%, respectively: P < 0.001) over all follicle size categories (3-5 mm, 6-8 mm, 9-12 mm and > or =13 mm). Oocyte competence tended to increase with increasing follicle size (P < 0.1). Follicular cells from follicles containing an oocyte that developed to morula or greater by d8 (484 samples) were analyzed by flow cytometry to measure the level of apoptosis. Results showed an increase in mean percent apoptotic cells in subordinate follicles (18.65 +/- 0.86 over all size categories), particularly those of medium size (25.55 +/- 2.2 for 6-8 mm size follicles; P < 0.001), during the dominance phase compared to growth phase (9.25 +/- 0.95 over all sizes; P < 0.05). These results show a significant affect of the stage of estrous cycle on both oocyte competence and levels of follicular atresia.

Development of bovine embryos in single in vitro production (sIVP) systems.

Single in vitro production (sIVP) of embryos enables the study of developmental parameters of individual oocytes or embryos. Because several previously published sIVP systems showed varying levels of success, we attempted to design a simple, semidefined sIVP system that resulted in developmental rates similar to those obtained through group production (gIVP). In a 5 x 3 x 4 factorial experiment, 4200 oocytes were randomly assigned to combinations of various maturation (sIVM), fertilization (sIVF), and culture (sIVC) treatments based on media TCM199 (5 treatments), TALP (3 treatments), and SOF/aa/BSA (4 treatments), respectively. All sIVP steps were carried out in 10-12 microl drops under oil. Embryo development to blastocyst on days 7 and 8 of culture was determined and blastocyst cell numbers measured as an indicator of embryo quality. No interaction was found within any combination of sIVM, sIVF and sIVC treatments. Also, there was no difference in percentage of development to various stages for embryos in any of the sIVM or sIVF treatments (over all treatment combinations). However, when treatment combinations included charcoal-treated serum addition on day 5 of culture, a significant increase in development (39.0% total blastocysts/total oocytes vs. 22.7, 23.8 and 23.5% for the other 3 sIVC treatments, respectively; P < 0.001) and decrease in mean cell number (114.2 vs. 149.1, 150.5 and 143.7 cells, respectively; P < 0.001) was observed. These results are comparable to those routinely obtained in this laboratory with gIVP and establish standard conditions for individual embryo production.

Let's talk: a working party for special schools.

The Special Schools Working Party was formed in summer 1996 to improve communication channels and foster understanding between speech and language therapist, school and home. It consists of representatives from all three groups in the six schools involved. The Working Party has produced a document which describes everyone's role and agreed procedures for liaison and training. Its greatest benefit lies in the opportunities for discussion and exchange of ideas. In the future the Working Party is planning to audit customer satisfaction of the service and continue to develop ideas for improving its accessibility.

Comparison of seasonal changes in reproductive parameters of adult male European fallow deer (Dama dama dama) and hybrid Mesopotamian x European fallow deer (D. d. mesopotamica x D. d. dama).

In a study, aimed at comparing seasonal reproductive development of European fallow deer (Dama dama dama) with Mesopotamian (D. d. mesopotamico) x European F1 hybrids, five adult males of each genotype, which had been raised together since birth, were maintained as a bachelor group. Morphometric (body weight, neck circumference and testis diameter), endocrine (plasma testosterone concentrations) and seminal (ejaculate volume, spermatozoa per ejaculate and spermatozoa motility) parameters were recorded at fortnightly or monthly intervals for a 15-month period, and antler status was noted daily during the general periods of casting and velvet stripping. In addition, two bucks of each genotype were blood sampled via indwelling jugular catheters every 30 min for 24-h periods on five occasions (2-3 months intervals) during the year, and plasma was analysed for concentrations of testosterone and LH. Parameter profiles of the two genotypes were compared by global and time series ante-dependence covariance analysis to investigate overall profile similarity and the seasonal nature of any observed differences. Plasma hormone profiles from high-frequency blood sampling were subjected to PULSAR analysis to determine pulse frequency and amplitude. Throughout the study hybrid males were approximately 30% heavier than European males. However, both genotypes exhibited dramatic but parallel patterns of body weight change (global P = 0.054). Neck circumference was correlated with body weight throughout (P < 0.05), with similar regression slopes between the genotypes at any sampling time (P > 0.10). Covariance adjustment to a common initial body weight was performed to eliminate the effects of large body weight differences on muscle hypertrophy and regression. While profiles of corrected neck circumference were significantly different at the global level (P < 0.01), analysis by time revealed differences occurring only during the latter period of muscular regression in spring. However, profiles of other parameters, including testis diameter, plasma testosterone concentrations, spermatozoa per ejaculate and percentage motile spermatozoa, exhibited significant displacement between genotypes (global P < 0.05) evident as 2-4 weeks advancement in the sexual development (late summer/autumn) and quiescence (spring) phases for hybrid males relative to European males. Furthermore, mean dates of antler casting and velvet stripping were significantly earlier by 2-3 weeks for hybrid males than European males (P < 0.05). High frequency blood sampling revealed markedly seasonal patterns of secretion of testosterone and LH, with hybrid males exhibiting an apparent earlier onset of high-amplitude testosterone 'surges' in February (late summer) compared to those occurring in April (autumn) for European males. When viewed collectively, the data indicate strongly that the Mesopotamian influence is evident in the earlier attainment of sexual development and fertility in late summer and autumn, and earlier onset of sexual quiescence in spring. This is in accord with anecdotal information on earlier reproductive patterns in purebred Mesopotamian fallow deer.

Embryo transfer in fallow deer (Dama dama): superovulation, embryo recovery and laparoscopic transfer of fresh and cryopreserved embryos.

Multiple ovulation-embryo transfer (MOET) protocols for farmed fallow deer (Dama dama) were investigated in a series of 3 experiments. A total of 37 donors, of either European (D.d. dama ; n = 30) or Mesopotamian hybrid (D.d. mesopotamica x D.d. dama ; n =7) genotype, each received an intravaginal silastic device containing 0.3 g progesterone (CIDR-type G device) for 14 d and injections of 0.5 units ovine FSH (8 x 0.06 unit injections from Days 10 to 14 of device insertion) and 100 IU PMSG (either with the first or last FSH injection). All donors received laparoscopic intrauterine inseminations of fresh semen (50 x 10(6) spermatozoa) from a Mesopotamian sire 36 h after withdrawal of CIDR devices. Embryos were recovered by laparotomy on Day 6 (Day 0 = estrus). Mean ovulation rates for the 3 experiments were 8.1, 9.8 and 7.0, with no effect of PMSG timing (P>0.10). However, embryo recovery rates, albeit low throughout the study (29.6%), were significantly improved with later PMSG administration (33.9 vs 20.1%; P<0.05). Hybrid and European donors performed in a similar manner. A range of embryo development stages was recovered throughout the study. In 2 experiments laparoscopic transfer of embryos to 48 recipient does treated previously with intravaginal CIDR devices for 14 d yielded a total pregnancy rate of 37.5%. In the experiment with fresh embryos, the use of clenbuterol to reduce uterine turgidity resulted in a higher proportion of does conceiving (3/4 ; 75%) compared with that of the untreated does (0/6 , 0%; P<0.05). In the second experiment, in which all the does routinely received clenbuterol, 10/19 (53%) and 5 19 (26%) does conceived following the transfer of fresh and cryopreserved embryos, respectively (P<0.05). While the overall efficiency of the MOET program was low (equivalent of 0.9 to 1.0 surrogate pregnancies per donor), improvements in the recovery rate of transferable embryos have considerable potential for genetic improvement of farm stock and captive propagation of endangered Mesopotamian fallow deer through maternal surrogacy programs.

Management ... working day of a health services manager. Manchester FHSA.

Sue Beaumont is GP Fund Holding Development Manager for Manchester FHSA, covering a population of over 505,000 and over 100 practices in an inner-city area. Newly appointed after a seven-year absence from the NHS, she has an interesting perspective on the reforms.

Erythrocyte volume, plasma volume, and acid-base changes in exercise and heat dehydration.

Variations in erythrocyte volume [mean corpuscular volume (MCV)] were evaluated during exercise and heat stress to determine the influence on calculated plasma volume and content changes. The results of this study on 17 men indicate that the human red blood cell can increase, decrease, or remain constant in volume during physical stress depending on the combined interactions of plasma osmolality and blood pH. Shrinking of MCV can occur when the increase in plasma osmolality is larger than 5 mosmol/kg H2O and the blood pH remains within 0.1 pH units of its resting value. Erythrocyte swelling is usually noticed with maximal exercise when the blood pH is less than 7.10, in spite of 20 mosmol/kg H20 increments in plasma osmolality. The regression equations indicate that during 30 min of exercise in a cool environment the plasma shifts calculated by either the hematocrit or the hematocrit + hemoglobin method fall within 1% of each other, but during resting heat exposure the hematocrit technique under-estimates the fluid shift by 2.5-3.0%. Application of these considerations to the calculation of plasma content changes during stress made it clear that the pattern of plasma potassium content is quite different with maximal as compared with submaximal exercise.