Altered vertebral and femoral bone structure in juvenile offspring of microswine subject to maternal low protein nutritional challenge.

Epidemiological studies suggest skeletal growth is programmed during intrauterine and early postnatal life. We hypothesize that bone development may be altered by maternal diet and have investigated this using a microswine model of maternal protein restriction (MPR). Mothers were fed a control diet (14% protein) or isocaloric low (1%) protein diet during late pregnancy and for 2 weeks postnatally. Offspring were weaned at 4 weeks of age to ad lib or calorie-restricted food intake groups. Femur and vertebra were analysed by micro computed tomography in offspring 3-5 months of age. Caloric restriction from 4 weeks of age, designed to prevent catch-up growth, showed no significant effects on bone structure in the offspring from either maternal dietary group. A maternal low protein diet altered trabecular number in the proximal femur and vertebra in juvenile offspring. Cortical bone was unaffected. These results further support the need to understand the key role of the nutritional environment in early development on programming of skeletal development and consequences in later life.

Effects of postweaning calorie restriction on accelerated growth and adiponectin in nutritionally programmed microswine offspring.

Poor prenatal development, followed by rapid childhood growth, conveys greater cardiometabolic risk in later life. Microswine offspring exposed to perinatal maternal protein restriction [MPR; "low protein offspring" (LPO)] grow poorly in late-fetal/neonatal stages. After weaning to an ad libitum (AL) diet, LPO-AL exhibit accelerated growth and fat deposition rates with low adiponectin mRNA, despite low-normal body fat and small intra-abdominal adipocytes. We examined effects of caloric restriction (CR) on growth and metabolic status in LPO and normal protein offspring (NPO) randomized to AL or CR diets from weaning. CR transiently reduced growth in both LPO and NPO, delaying recovery in female LPO-CR. Over 7.5-12.5 weeks, linear growth rates in LPO-CR were slower than LPO-AL ( P < 0.001) but exceeded NPO-AL; body weight growth rates fell but were lower in LPO-CR versus NPO-CR. Linear acceleration ceased after 12 weeks. At 16 weeks, percent catch-up in LPO-CR was reduced versus LPO-AL ( P < 0.001). Plasma growth hormone was low in LPO ( P < 0.02). CR normalized fat deposition rate, yet adiponectin mRNA remained low in LPO-CR ( P < 0.001); plasma adiponectin was low in all LPO-AL and in female LPO-CR. Insulin sensitivity improved during CR. We conclude that in LPO: 1) CR delays onset of, but does not abolish, accelerated linear growth, despite low growth hormone; 2) CR yields stunting via delayed onset, plus a finite window for linear growth acceleration; 3) MPR lowers adiponectin mRNA independently of growth, adiposity, or adipocyte size; and 4) MPR reduces circulating adiponectin in LPO-AL and female LPO-CR, potentially enhancing cardiometabolic risk.

Influence of preparation design on the quality of tooth preparation in preclinical dental education.

BACKGROUND/PURPOSE: One of the major educational goals in preclinical dental education is to learn tooth preparation techniques. The purpose of this study was to evaluate the influence of different preparation designs on the development of the manual dexterity of students, in order to perform a state-of-the-art tooth preparation. MATERIAL AND METHODS: Seventy-two 1st semester students were divided into two groups and educated in tooth preparation for a ceramic anterior single crown. One group received cylindrical burs with a rounded edge to prepare a typodont model with a shoulder finishing line, while the other group had cylindrical burs with round noses to prepare a chamfer finishing line. All preparations were digitized and evaluated using special software focusing on the parameters of preparation depth and preparation angle. In addition, violation of the adjacent teeth was estimated. Data was statistically evaluated at a level of significance of 5%. RESULTS: The preparation design used did not show a statistically significant influence on the preparation depth or on the preparation angle. A trend to a higher tooth structure removal as required was detected. Furthermore, no influence of the type of preparation design on the number of violated adjacent teeth was found. CONCLUSION: In preclinical dental education, the type of preparation design was found to have no influence on the measured parameters representing the quality of the preparation.

Measuring value at the provider level in the management of cleft lip and palate patients.

"Value" has become a buzzword in current health-care discussions. This study demonstrates a provider-led strategy to measuring costs, an understudied component of the value equation, for a complex diagnosis for the purposes of improvement. A retrospective, microcosting methodology was used to measure costs for all hospital and physician services and costs to the patient over 18 months of multidisciplinary care for patients with cleft lip and palate. Short-term outcomes were also recorded. Overall costs to all parts of the system ranged from $35,826 to $56,611 for different subtypes, and insight was gained into major cost drivers and variations in care that will drive internal improvement efforts. It is critical that providers learn to work together and become familiar with their own costs in conjunction with outcomes as insurers increase pressure to reduce payments or accept alternative payments so that well-informed decisions can be made.

Objective analysis of preparations in dental training: development of analytical software.

Objective analysis of the quality of a stump preparation by conventional methods is complex and expensive. In this regard digitalization has created new possibilities. The high resolution of modern scanners permits visual representation of the most minute preparation parameters. Virtual rulers permit measurement of distances in many construction programs; however, the use of such measuring instruments is too time-consuming for scientific studies. The computer program presented here permits measurement of the preparation angle, calculation of the width of the preparation margin, and determination of the horizontal path of the preparation shoulder. It runs on the Windows XP operating system independently of a CAD construction program. The program analyzes datasets in the STL file format.

Cost differences between the anterior and posterior approaches to the iliac crest for alveolar bone grafting in patients with cleft lip/palate.

PURPOSE: There has been debate in the literature regarding the advantages of an anterior versus posterior approach to the iliac crest harvest for alveolar bone grafting (ABG) in patients with cleft lip and palate. The purpose of this study was to add a cost perspective to the discussion. MATERIALS AND METHODS: This was a retrospective microcost analysis for the perioperative period for 2 approaches to graft harvest for ABG in patients with cleft lip and palate. Patient charts and hospital and physician financial databases were searched for detailed cost data in the 30 days before and after ABG for 18 patients who underwent anterior or posterior iliac crest harvest at Children's Hospital Boston. In addition, short-term outcomes for these 18 patients were documented (duration of operation, need for physical therapy services, complications, and hospital length of stay) and compared with the larger study group at the same institution. RESULTS: There was a trend toward lower overall median costs for posterior compared with anterior iliac crest harvest ($18,269 vs $21,801, respectively; P = .15). The differences in cost were seen in inpatient hospital services after the operation, including ward and physical therapy costs, which were significantly lower for the posterior versus the anterior approach. This corresponded with a shorter median length of stay (1 day vs 2 days, respectively; P = .03). There was no significant difference in operating room, recovery room, or outpatient costs. More patients undergoing posterior harvest had bilateral ABG, offsetting the decreased inpatient costs with increased physician costs. CONCLUSIONS: The overall cost for ABG in patients with cleft lip and palate was not significantly different between the anterior and posterior approached to iliac crest harvest. Inpatient cost was lower in the posterior group because of a shorter length of stay.