Using a novel scoring system for paronychia related to oncologic treatments (SPOT) for assessing paronychia severity and its correlation with pain index and quality of life.

BACKGROUND: Oncologic treatments may lead to the development of paronychia, which may cause severe pain and disability. However, a detailed objective scoring system is lacking. OBJECTIVE: To develop an objective scoring system to quantify the severity of paronychia and also examine the correlation of this score with a pain index and patients' quality of life. METHODS: A novel scoring system for paronychia related to oncologic treatments (SPOT), consisting of four parameters, namely redness, oedema, discharge and granulation tissue, was designed to assess the severity of paronychia. The visual analogue scale (VAS) and Dermatology Quality of Life Index (DLQI) were recorded, and their association with the SPOT scores was analysed. RESULTS: Ninety patients were enrolled from three medical centres in Taiwan. Severity of paronychia was determined by the scores of SPOT. Patients in the severe group had higher DLQI scores (severe vs. mild: P = 0.0018; severe vs. moderate: P = 0.0015). Both the DLQI and pain index scores were significantly higher in patients with higher dominant hand SPOT scores. CONCLUSIONS: The SPOT scores demonstrated the association of the paronychia severity with DLQI and pain. It may thus be useful in clinical practice and future studies.

Drug reaction with eosinophilia and systemic symptoms syndrome associated myocarditis: a survival experience after extracorporeal membrane oxygenation support.

WHAT IS KNOWN AND OBJECTIVE: Myocarditis that develops because of the drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening disease. We report a case of DRESS-associated myocarditis with cardiac failure that required extracorporeal membrane oxygenation (ECMO) for cardiovascular support. CASE SUMMARY: A 14-year-old boy experienced DRESS-associated myocarditis after anticonvulsive therapy with carbamazepine, clonazepam and phenytoin. The clinical signs included hypotension, cardiac arrhythmia and poor left ventricular (LV) performance. Laboratory investigations showed elevated levels of cardiac enzymes. Systemic corticosteroid pulse therapy for 3 days was administered for treating the DRESS syndrome. The patient required inotropic drugs including dopamine, dobutamine and milrinone because of refractory hypotension and poor LV function. He was placed on ECMO support, and intra-aortic balloon pumping was initiated because of poor response to inotropic drugs and stasis of blood flow in the ventricle on hospital day 17. Plasma exchanges for four separate times over 8 days were also performed during ECMO support on day 22. His condition stabilized 13 days after ECMO support was initiated. The patient was discharged on hospital day 50, and the seizure was controlled by the oral form clonazepam, phenobarbital, topiramate and levetiracetam. Three months later, an echocardiogram showed mild dilated cardiomyopathy. WHAT IS NEW AND CONCLUSION: Drug reaction with eosinophilia and systemic symptoms-associated fulminant myocarditis is a life-threatening disease. Traditionally, systemic corticosteroid administration, plasmapheresis, intravenous immunoglobulin infusion and ventricular assist device implantation have been used for the treatment of this disease. To our knowledge, this is the first case of DRESS-associated fulminant myocarditis treated successfully with ECMO support. However, echocardiogram should be followed regularly because dilated cardiomyopathy may be the late sequela.

Measurement and analysis of ambient air particulates and ionic species for composition and concentration studies at the western coast of central Taiwan.

Air-polluting aerosol samples consisting of total suspended particulates, coarse particulates (>2.5 approximately 10 microm in diameter), fine particulates (<2.5 microm in diameter), and ionic species were collected from March 2004 to January 2005 at the western coast of central Taiwan. Statistical methods such as nonparametric test and T statistical analysis were also employed to distinguish the variation difference for pollutants among four seasons in this study. Seasonal variation of ionic species SO4(2-) in the total suspended particulates and fine particulates shows that higher composition was observed among four seasons. The results of T statistical analysis revealed that the concentrations of ionic species NO3- showed no significant changes in coarse and fine particulates among the four seasons. In addition, the results also revealed that the concentrations of ionic species Na+ showed no significant changes in coarse and fine particulates in the seasons of spring and autumn at the western coast of central Taiwan.

A comparison of the effect of carbomer-, cellulose- and mineral oil-based artificial tear formulations.

PURPOSE: To compare the efficacy, safety, and local tolerance between carbomer-based artificial tears, cellulose-, and mineral oil-based artificial tears. METHODS: A randomized, open-label, parallel-group comparative 28-day study was designed for 67 patients who were randomized into three treatment groups. Measurements included the scoring of total subjective symptoms and objective signs, Schirmer-Jones test values, and tear break-up time (BUT) at baseline, and after 2 and 4 weeks of treatment. Safety of study treatment was also assessed. Outcomes measured at baseline and 2 and 4 weeks follow-up included the scoring of total subjective symptoms and objective signs, Schirmer-Jones test values, and tear BUT, subjective assessments, and safety. RESULTS: There were no differences regarding total scores, Schirmer-Jones test, or tear BUT at baseline among these three groups at 2 and 4 weeks. Patients in all three treatment groups experienced a significant improvement from baseline in total scores and Schirmer-Jones test values after treatment. Subjective assessment was better with carbomer-based treatment. CONCLUSIONS: Each artificial tear formulation successfully relieved symptoms and signs of keratoconjunctivitis sicca. The tolerance of carbomer-based artificial tears was comparable to that of cellulose- and mineral oil-based artificial tears.

The consistency and reliability of periodontal bone level measurements using digital scanning radiographic image analysis--a pilot study.

The purpose of the present study was to evaluate the consistency and reliability of alveolar bone height measurement using digital scanning radiographic image analysis (DSRIA). A randomly selected (standardized paralleling technique) periapical radiographs of 20 molar teeth (10 maxillary molars and 10 mandibular molars) from 178 individuals with periodontitis were reporting or referred to the patient population of the dental clinics of the teaching hospital. Radiographic measurements were performed and read by two examiners, with a separation time of three weeks of different tooth groups and as established by double reading of 20 molar teeth in 10 individuals using the DSRIA. The calculating data of radiographic alveolar bone loss (RABL) measured and analyzed by the DSRIA for each molar group were compared based on the inter- and intra-examiners' data. The means and standard deviations were calculated to compare radiographs of the inter- and intra-examiners' groups. The reliability coefficients were computed to assess the consistency and reliability for each molar group. The results revealed that the intra- and inter-examiners' reliability coefficients ranged from 0.986 to 0.995 (p < 0.001, significantly different from 0). An excellent reproducibility was indicated in maxillary molar, mandibular molar and of both arches, respectively. It was concluded that the standard periapical radiograph using the DSRIA has the potential to be a valuable and reliable method in measuring linear alveolar bone defects caused by periodontitis.

[A cross-sectional radiographic study of proximal alveolar bone loss in molars with adult periodontitis].

The purpose of the present study was to document the mean proximal alveolar bone loss of molars. The samples consisted of 219 subjects receiving of full mouth radiographs by standardized paralleling technique from Jan, 1992 to Jun, 1994. All the radiographs of 219 individuals suffered from adult periodontitis at age between 20 and 65 years old were measured, and were assessed mean proximal alveolar bone loss of molars and associated contributing factors. The main results indicated that (1) the mean proximal alveolar bone loss of the maxillary first and second molars accounted for 38. 4% and 33.5%, respectively, whereas the mandibular first and second molars were 34.8% and 31.6%, respectively; (2) within the same dental arch, mean proximal alveolar bone loss of the first molars was significant greater than that of the second molars, while the bone loss in the maxillary first molars was significant greater than that of the mandibular first molars. There was no difference between mean proximal bone loss of the maxillary and mandibular second molars; (3) mean alveolar bone loss of the first molars was significant greater than second molars in the same side of the dental arch. There was no significant difference in the mean proximal alveolar bone loss between right and left side molars. (4) average bone loss was the greatest (39.4%) at the mesial surfaces of maxillary first molars, whereas the least mean alveolar bone loss appeared at the distal surfaces of mandibular second molars. A significant difference of mean proximal alveolar bone loss was found between mesial and distal surfaces in mandibular first molars.

[The study of molar furcation involvements in adult periodontitis. II. Age, sex, location and prevalence].

The purposes of the study were as follows: (1) to evaluate the molar furcation involvement and number of molar correlated with age and sex; and (2) to study the relationship between the means of alveolar bone loss and associated factors of molar furcation involvements (FIs). 1102 molars (703 males and 399 females) were measured in 219 individuals (136 males and 83 females) for the alveolar bone loss and associated factors of molar furcation involvements. Based on the results, we conclude the following: (1) the higher prevalence of FI was in the mandibular first molar (94.6%), whereas the lowest prevalence of FI was in maxillary second molar; (2) except for the mandibular first molar, the prevalence of molar FI markedly increased with an increased age group (16 & 26, r = 0.335, p < 0.01; 17 & 27, r = 0.345, p < 0.01; 37 & 47, r = 0.239, p < 0.01); (3) the prevalence of molar FI was significantly higher in males than in females (p < 0.05); (4) the mean number of molar FI was significant greater in males (mean = 3.45) than in females (mean = 2.69); (5) factors such as age (r = 0.222, p < 0.01), sex, (r = 0.145, p < 0.05), number of remaining teeth (r = -0.330, p < 0.01) and molar FI (r = 0.471, p < 0.01) are strongly associated with the mean alveolar bone loss of molars.

The social structure of schooling.

The term social structure refers to a relatively enduring pattern of social arrangements or interrelations within a particular society, organization, or group. This chapter reviews how the social structure of the larger society and the organizational structure of schools affect the educational process within American schools. The institutional context of schooling is first discussed. The ideology of mass education, social stratification, status attainment, credentialism, and the emphasis on ability differences are considered. The focus then shifts to the organizational structure of schools, beginning with a discussion of the external social context for school organization. Attention is given to professionalism and bureaucracy, institutional forms of organization, decentralized control, and community influences. Finally, the internal structure of school organization is considered: teachers' working conditions, status differences among students, and curriculum tracking. Throughout, the emphasis is on ways in which social structure influences what is taught in school, how it is taught, and what is learned.

A computer program for stepwise logistic regression using maximum likelihood estimation.

A computer program has been written which performs a stepwise selection of variables for logistic regression using maximum likelihood estimation. The selection procedure is based on likelihood ratio tests for the coefficients. These tests are used in a forward selection and a backward elimination at each step. The use of the program is illustrated by several examples.