Fluctuating asymmetry of dynamic smiles in normal individuals.

The aim of this study was to quantify the fluctuating dynamic facial asymmetry during smiling in a group of 'normal' adults, using three-dimensional (3D) motion facial capture technology. Fifty-four male and 54 female volunteers were recruited. Each subject was imaged using a passive markerless 3D motion capture system (DI4D). Eighteen landmarks were tracked through the 3D capture sequence. A facial asymmetry score was calculated based on either a clinically derived midline or Procrustes alignment; scores were based on the Euclidean distance between landmark pairs. Facial asymmetry scores were determined at three time points: rest, median, and maximum frame. Based on the clinically derived midline and on Procrustes alignment, the differences between male and female volunteers, as well as those at the three different time points, were not clinically significant. However, throughout a smile, facial and lip asymmetry scores increased over the duration of the smile. Fluctuating facial asymmetry exists within individuals, as well as between individuals. Procrustes superimposition and the clinically derived midline produced similar asymmetry scores and both are valid for symmetrical faces. However, with facial asymmetry, Procrustes superimposition may not be a valid measure, and the use of the clinically derived midline may be more appropriate, although this requires further investigation.

Quantitative dynamic analysis of the nasolabial complex using 3D motion capture: A normative data set.

INTRODUCTION: Smile reanimation should be considered from a dynamic perspective. Any intervention should restore normality. To date no such normative dynamic data has been published. AIM: To quantitatively analyse maximal smiles between a healthy group of Caucasian male and female adults using 3D motion capture (4D stereophotogrammetry). METHOD: Using a 3D facial motion capture system 54 males and 54 female volunteers were imaged whilst performing a maximal smile. Eight nasolabial landmarks were digitised and tracked. Differences in displacement and speed of bilateral landmarks between males and females were analysed in each direction (x, y, z and Euclidian), from rest (T0), to median smile (T1) and maximal smile (T2), using paired t-tests and Wilcoxon-Signed Rank tests. RESULTS: In males and females the displacement and speed of the left and right alar base landmarks were similar in the x and y directions but less in the z direction. For the philtrum, the displacement and speed of the bilateral landmarks were similar in the y and z directions, but less in the x direction. The left alar base and left philtrum moved significantly more in males. Left and right cheilion moved a similar amount in the x and y directions but more in the z direction. Labiale superius moved significantly more in the z direction, and labiale inferius moved significantly more in the y direction in males. In conclusion, this study has presented a novel normative data set of dynamic nasolabial complex movement for males and females during maximum smile. The data, as well as providing magnitudes of displacements of the nasolabial complex, also provides the speeds of movement.

Multidrug and Mupirocin Resistance in Environmental Methicillin-Resistant Staphylococcus aureus (MRSA) Isolates from Homes of People Diagnosed with Community-Onset MRSA Infection.

Patients with community-onset (CO) methicillin-resistant Staphylococcus aureus (MRSA) infections contribute to MRSA contamination of the home environment and may be reexposed to MRSA strains from this reservoir. This study evaluates One Health risk factors, which focus on the relationship between humans, animals, and the environment, for the increased prevalence of multiple antimicrobial-resistant MRSA isolates in the home environment. During a trial of patients with CO-MRSA infection, MRSA was isolated from the household environment at the baseline and 3 months later, following randomization of patients and household members to mupirocin-based decolonization therapy or an education control group. Up to two environmental MRSA isolates collected at each visit were tested. MRSA isolates were identified in 68% (65/95) of homes at the baseline (n = 104 isolates) and 51% (33/65) of homes 3 months later (n = 56 isolates). The rates of multidrug resistance (MDR) were 61% among isolates collected at the baseline and 55% among isolates collected at the visit 3 months later. At the baseline, 100% (14/14) of MRSA isolates from rural homes were MDR. While antimicrobial use by humans or pets was associated with an increased risk for the isolation of MDR MRSA from the environment, clindamycin use was not associated with an increased risk for the isolation of MDR MRSA. Incident low-level mupirocin-resistant MRSA strains were isolated at 3 months from 2 (5%) of 39 homes that were randomized to mupirocin treatment but none of the control homes. Among patients recently treated for a CO-MRSA infection, MRSA and MDR MRSA were common contaminants in the home environment. This study contributes to evidence that occupant use of antimicrobial drugs, except for clindamycin, is associated with MDR MRSA in the home environmental reservoir. (This study has been registered at ClinicalTrials.gov under registration no. NCT00966446.)IMPORTANCE MRSA is a common bacterial agent implicated in skin and soft tissue infections (SSTIs) in both community and health care settings. Patients with CO-MRSA infections contribute to environmental MRSA contamination in these settings and may be reexposed to MRSA strains from these reservoirs. People interact with natural and built environments; therefore, understanding the relationships between humans and animals as well as the characteristics of environmental reservoirs is important to advance strategies to combat antimicrobial resistance. Household interactions may influence the frequency and duration of exposure, which in turn may impact the duration of MRSA colonization or the probability for recurrent colonization and infection. Therefore, MRSA contamination of the home environment may contribute to human and animal recolonization and decolonization treatment failure. The aim of this study was to evaluate One Health risk factors that may be amenable to intervention and may influence the recovery of MDR and mupirocin resistance in CO-MRSA isolates.

Anatomical patterns of colonization of pets with staphylococcal species in homes of people with methicillin-resistant Staphylococcus aureus (MRSA) skin or soft tissue infection (SSTI).

Methicillin-resistant strains of Staphylococcus aureus (MRSA), Staphylococcus pseudintermedius (MRSP), and other pathogenic staphylococci can cause infections in companion animals and humans. Identification of colonized animals is fundamental to research and practice needs, but harmonized methods have not yet been established. To establish the optimal anatomic site for the recovery of methicillin-resistant coagulase positive staphylococci (CPS), survey data and swabs were collected from 196 pets (dogs, cats, reptiles, birds, fish and pocket pets) that lived in households with an MRSA-infected person. Using broth-enrichment culture and PCR for speciation, S. aureus was identified in 27 of 179 (15%) pets sampled at baseline and 19 of 125 (15%) pets sampled at a three-month follow-up home visit. S. pseudintermedius was isolated from 33 of 179 (18%) pets sampled at baseline and 21 of 125 (17%) of pets sampled at follow-up. The baseline MRSA and MRSP prevalence was 8% and 1% respectively from 145 mammalian pets. The follow-up MRSA and MRSP prevalence was 7% and <1% respectively from 95 mammalian pets. The mouth was the most sensitive single site sampled for isolation of S. aureus and S. pseudintermedius in mammals. In a subset of pets, from which all available isolates were identified, dual carriage of S. aureus and S. pseudintermedius was 22% at baseline and 11% at follow-up. These results identify the mouth as the most sensitive site to screen for pathogenic staphylococci and suggest that it should be included in sampling protocols.

The development and validation of a psychological questionnaire for patients undergoing orthognathic treatment.

OBJECTIVES: To develop a questionnaire to assess the psychosocial aspects which orthognathic patients considered important regarding their dento-facial deformity. SETTING AND SAMPLE POPULATION: A multicentre, prospective, questionnaire development and validation study based in the UK. MATERIAL AND METHODS: Questionnaire development involved item (question) selection through literature review, consultation and feedback from a questionnaire development group and semi-structured interviews. A 'final' questionnaire was tested on a cross-sectional sample of 110 pre-operative and 74 post-operative orthognathic patients and a longitudinal sample of 23 orthognathic patients. Validity was tested using Rasch analysis. RESULTS: Reliability for the Hospital Anxiety and Depression Scale (HADS) section was unsatisfactory (ICC = 0.232-0.829, Cronbach alpha = 0.625-0.670), but for the well- being (ICC = 0.857, Cronbach alpha = 0.827-0.895) and expectations (ICC = 0.861, Cronbach alpha = 0.804-0.882) sections were satisfactory. The well-being section was the only section found to be valid for the pre-and post-operative samples. Responsiveness was satisfactory for the well-being scale (p = 0.001). CONCLUSIONS: A new condition-specific orthognathic questionnaire has been developed which has been shown to be reliable, valid and responsive for the well-being scale. The HADS, as tested by Rasch analysis, was found not to be valid for this orthognathic population.

Potential for pet animals to harbour methicillin-resistant Staphylococcus aureus when residing with human MRSA patients.

Colonization by methicillin-resistant Staphylococcus aureus (MRSA) may be persistent in people and is horizontally transmissible. The scientific literature suggests that domestic pets may also participate in cross-transmission of MRSA within households. The objectives of this study were to evaluate the prevalence of and risk factors for MRSA carriage by pets residing in households with an MRSA-infected person. From 66 households in which an MRSA-infected patient resided, we screened 47 dogs and 52 cats using a swab protocol. Isolates from pets and humans were genotyped using two techniques and compared for concordance. Human participants completed a 22-question survey of demographic and epidemiologic data relevant to staphylococcal transmission. Eleven of 99 pets (11.5%) representing 9 (13.6%) of households were MRSA-positive, but in only six of these households were the human and animal-source strains genetically concordant. Human infection by strain USA 100 was significantly associated with pet carriage [OR = 11.4 (95% CI 1.7, 76.9); P = 0.013]. Yet, for each day of delay in sampling the pet after the person's MRSA diagnosis, the odds of isolating any type of MRSA from the pet decreased by 13.9% [(95% CI 2.6, 23.8); P = 0.017)]. It may be concluded that pets can harbour pandemic strains of MRSA while residing in a household with an infected person. However, the source of MRSA to the pet cannot always be attributed to the human patient. Moreover, the rapid attrition of the odds of obtaining a positive culture from pets over time suggests that MRSA carriage may be fleeting.

Elective orthognathic treatment decision making: a survey of patient reasons and experiences.

OBJECTIVE: Few studies have explored decisions about orthognathic treatment (OGT) from the patient's perspective. This study describes the factors associated with the patient's decision to have or not have orthognathic treatment, and assesses whether the process can be considered to be informed decision making. DESIGN: A cross-sectional survey employing both interview and questionnaire methods, conducted in four OGT services in Yorkshire. SAMPLE: Participants were patients aged over 16 years, either making an OGT decision over a 6-month period or had made their treatment choice 18-42 months prior to the study start date in 2003. MEASURES: Questionnaires assessed patient demographics, dental history and psychopathology (anxiety, satisfaction with self, body satisfaction, facial appearance); interviews explored patients' reasons for, and experiences of, orthognathic treatment. RESULTS: Of 138 patients approached, 61 participated (mean age 25 years, 66% female). Psychopathology scores were within the normal range. The thematic content analysis of interview transcripts found: reasons given for having OGT were to improve the 'bite', as well as gaining a more normal facial appearance; most patients reported the service information was satisfactory, but about half made negative comments, with some reporting staff communications made them feel worse; knowledge of OGT risks and benefits was poor; patients had strong emotions about their facial appearance and the orthognathic treatment they received, which did not seem to be addressed by current practice. CONCLUSIONS: Some OGT patients do not appear to be making informed decisions about their treatment. They seem to have unmet needs in relation to support for their decision making, and managing the emotional effects of undergoing and adjusting to treatment. The implications for information provision, assessment and support during treatment are discussed.

Humoral measurement of type-1 hypersensitivity reactions to a commercial Malassezia allergen.

Malassezia pachydermatis is considered to be a contributing factor to canine atopic dermatitis (AD). The purpose of this study was to investigate the humoral response to a commercially produced M. pachydermatis extract. Fifteen atopic dogs with Malassezia overgrowth on the skin (MD), 16 atopic dogs without MD, three atopic dogs with overgrowth of Malassezia in the ears only (MO), and 12 normal dogs were intradermally tested with M. pachydermatis extract at 50, 100, 250, 500, 1000, 2000 and 4000 PNU mL(-1). All dogs were evaluated cytologically by cutaneous tape strip and bilateral ear exudate sampling to determine presence of MD or MO. Each had serum evaluated for anti-Malassezia IgE using three Malassezia extracts with an ELISA assay. The irritant threshold concentration at which healthy nonatopic dogs ceased to react was 1000 PNU mL(-1). There was a significant difference in intradermal test reactivity between the atopic groups. At this dilution, 93% (14/15) of the atopic MD group, 31% (5/16) of the atopic group without MD or MO, and 100% (3/3) of the atopic MO only group reacted. There were no significant differences in the serum IgE levels as measured by the Greer ELISA assay, between any groups using any of the three extracts. These results support that Greer's M. pachydermatis extract is useful for intradermal testing of dogs with an allergic phenotype, and that atopics with MD are more likely to have a type-1 Malassezia hypersensitivity than those without. The ELISA assay may require further development in order to be useful for the diagnosis of Malassezia hypersensitivity.

Orthodontic preparation for orthognathic surgery: how long does it take and why? A retrospective study.

We investigated the duration of pre-operative orthodontic treatment of patients who had combined orthodontic and orthognathic treatment and examined the variables that influenced this. Records of patients who had undergone such treatment in the past 5 years were collected (n=65) from three consultant orthodontists and one Senior Specialist Registrar/Fixed Term Training Appointment (FTTA). The number of days from placement of the first active orthodontic component to the day that final planning impressions were taken was used to calculate the duration of treatment before the patient was ready for operation. The variables investigated were: sex, age, malocclusion, extractions (excluding third molars), and the clinician. The median duration of pre-operative treatment was 17 months (range 7-47). Only the orthodontist appeared to affect this duration, but this requires further investigation as it may merely reflect variation in other factors such as compliance. We conclude that patients should be informed that the pre-operative phase may last 12-24 months.

Forestadent Young Specialist Prize (1999).

This paper describes the clinical orthodontic treatment of the three cases that were awarded the 1999 Forestadent Young Specialist Prize. There are two Class II division 1 cases treated by different treatment modalities and a Class II division 2 case complicated by a palatally ectopic maxillary canine. These case reports demonstrate the three main treatment modalities available to the orthodontist for treating skeletally-based malocclusions, i.e. growth modification, orthodontic camouflage, and a combined surgical-orthodontic approach.

Dermatologic disorders in dogs with diabetes mellitus: 45 cases (1986-2000).

OBJECTIVE: To characterize skin lesions and causative infections in diabetic dogs and evaluate other potential causes of dermatologic disorders, including concurrent endocrinopathies, allergic skin disease, and long-term corticosteroid administration. DESIGN: Retrospective study. ANIMALS: 45 dogs with diabetes mellitus (DM) that were examined by dermatologists. PROCEDURE: Medical records were reviewed for signalment; allergic conditions prior to development of DM; prior corticosteroid administration; and results of dermatologic examinations, ear and skin cytologic examinations, skin scrapings for parasites, bacteriologic and fungal culturing of ear and skin specimens, histologic examinations, and endocrine testing. RESULTS: Bacterial skin infection was the most common dermatologic disorder (n = 38 [84%]), followed by otitis (26 [58%]) and Malassezia-induced dermatitis (19 [42%]). Twenty-two (49%) dogs had pruritic skin disease consistent with allergic dermatitis, which preceded diagnosis of DM. Prior corticosteroid administration was reported in 21 (47%) dogs. Concurrent hyperadrenocorticism was diagnosed in 13 (29%) dogs, and concurrent hypothyroidism was diagnosed in 5 (11%) dogs. Iatrogenic hyperadrenocorticism was diagnosed in 1 additional dog. Only 10 (22%) dogs did not have a documented concurrent endocrinopathy or allergic disease that could have caused the dermatitis. CONCLUSIONS AND CLINICAL RELEVANCE: Bacterial and yeast-induced dermatitis and otitis develop in dogs with DM. Many diabetic dogs with dermatologic problems have a preexisting allergic condition, history of prior corticosteroid administration, or concurrent endocrinopathy that may be a more likely cause of dermatologic problems than DM alone.

A retrospective study of canine and feline cutaneous vasculitis.

Twenty-one cases of cutaneous vasculitis in small animals (dogs and cats) were reviewed, and cases were divided by clinical signs into five groups. An attempt was made to correlate clinical types of vasculitis with histological inflammatory patterns, response to therapeutic drugs and prognosis. Greater than 50% of the cases were idiopathic, whereas five were induced by rabies vaccine, two were associated with hypersensitivity to beef, one was associated with lymphosarcoma and two were associated with the administration of oral drugs (ivermectin and itraconazole). Only the cases of rabies vaccine-induced vasculitis in dogs had a consistent histological inflammatory pattern (mononuclear/nonleukocytoclastic) and were responsive to combination therapy with prednisone and pentoxifylline, or to prednisone alone. Most cases with neutrophilic or neutrophilic/eosinophilic inflammatory patterns histologically did not respond to pentoxifylline, but responded to sulfone/sulfonamide drugs, prednisone, or a combination of the two.

Dental arch relationships in Yorkshire children with unilateral cleft lip and palate.

OBJECTIVE: To assess the dental arch relationships of children with a complete unilateral cleft lip and palate (UCLP), born consecutively between 1983 and 1987, who had undergone primary cleft repair in the West Yorkshire region of the United Kingdom. The treatment outcome of this UCLP sample was then compared with the results of a previously published intercenter European study. DESIGN: A retrospective study with standardized record collection and blind assessment. SETTING: Regional dental hospital providing secondary and tertiary health care to the local population. PATIENTS: 35 UCLP patients whose primary repair had been performed within West Yorkshire. INTERVENTIONS: Dental casts obtained for each subject within 12 months of their 10th birthday. MAIN OUTCOME MEASURES: The West Yorkshire models were randomly mixed with an anonymous sample of 115 UCLP cases from other cleft centers in the U.K. The dental arch relationships of the 10-year-old models were assessed by applying the Goslon Yardstick. RESULTS: One-third of the West Yorkshire cleft sample were rated as belonging to Goslon group 2 (good result), another third to group 3 (fair result), and the remaining third to groups 4 and 5 (poor/very poor result). Numerically, the results were of a slightly higher standard than that previously published for other U.K. and European cleft centers but were inferior to the treatment outcome of two European centers. No statistically significant differences were found between the outcome results of the West Yorkshire group and the other cleft centers. CONCLUSIONS: These results provide useful baseline data against which progress in achieving improved treatment outcome for West Yorkshire UCLP children can be determined by future research.

Personality types of dental school applicants.

A questionnaire-based prospective study was carried out to measure the personality styles of students being interviewed for a place on the 1997/98 dental undergraduate course in Leeds, England. A total of 334 applicants attended for interview between November 1997 and March 1998, of which 311 anonymously and voluntarily completed a personality questionnaire. The Keirsey Temperament Sorter was used to measure the strength and nature of preferences along four dimensions: extroversion-introversion (E-I), sensing-intuition (S-N), thinking-feeling (T-F) and judging-perceiving (J-P). 4 personality types accounted for 79% of the students, 21% were divided among nine personality types with no type comprising more than 6.7% of the students. The remaining 3 possible personality types were not represented in this student population. Further comparisons revealed significant differences between this student sample and the general population in the judging-perceiving preference and also an intra-group gender difference with regard to the thinking-feeling (T-F) preference. A predominance of the S-J (sensing with judging) temperament type was also confirmed. Personality questionnaires may be a useful adjunct in the selection process of dental school applicants. The identification of a student's working and learning style preference has implications for both the dental undergraduate curriculum and the teaching methods employed by dental school staff.

Malassezia dermatitis and otitis.

The incidence of dermatitis and otitis resulting from overgrowth of M. pachydermatis is great enough that cytological sampling techniques should be considered a routine part of the dermatological examination. Because most cases of MD and Malassezia otitis cannot be grossly distinguished from bacterial pyoderma and otitis, respectively, efficiency in performing cytology testing of skin and ear canal exudate is essential to the successful diagnosis and management of pruritic skin diseases and otitis. Although Malassezia infections are rarely primary, therapy can be instituted to remove the yeast as a confounding factor while a differential diagnosis is pursued in evaluating the underlying disease process.

Cutaneous vasculitis and vasculopathy.

Although uncommon to rare in occurrence, cutaneous vasculitides and vasculopathies are becoming better recognized entities in veterinary medicine. The heterogeneity in their clinical presentations can be confusing, and the diagnostic evaluation of suspected cases can be clinically and financially challenging. The most important step is confirming a vasculitic/vasculopathic process histologically and then searching for an underlying cause. As many cases are diagnosed as idiopathic by exclusion, a familiarity with treatment options is important and may be guided in some cases by the histological inflammatory pattern. Because of the frequent temporal association with drug administration, any case of vasculitis requires a thorough drug history and physical examination for systemic complications. Familiarity with breed-associated vasculopathies is also key in properly diagnosing and managing these problems.

Eosinophilic dermatitis with edema in nine dogs, compared with eosinophilic cellulitis in humans.

A unique eosinophilic dermatitis with edema in dogs is characterized by extremely erythematous coalescing macules and plaques with associated edema, and is similar to eosinophilic cellulitis (Wells' syndrome) in humans. Histopathologic features include a profound eosinophilic dermal infiltrate, focal areas of collagen fiber degeneration surrounded by eosinophils (flame figures), dilated vessels, and dermal edema. Etiopathogenesis is unknown, but a hypersensitivity reaction to medications, arthropod bites, or other foreign antigens is suspected.

A prospective evaluation of Bass, Bionator and Twin Block appliances. Part I--The hard tissues.

A prospective clinical study with a random allocation of 47 adolescent patients to three different functional appliance groups was established and compared with an untreated control group over a 9-month period. Treatment was undertaken with either a Bionator, Twin Block, or Bass appliance. Pre- and post-treatment cephalograms were used to quantify the skeletal and dentoalveolar changes produced by the appliances and compared with those observed in the control group as a result of growth. Both the Bionator and Twin Block appliances demonstrated a statistically significant increase in mandibular length (3.9 +/- 2.7 mm; 3.7 +/- 2.1 mm, respectively) compared with the control group (P < 0.05), with an anterior movement of pogonion and point B. Highly statistically significant increases (P < 0.01) were seen in lower face heights for all the appliance groups compared with the control group. The Twin Block group showed the least forward movement of point A due to a change in the inclination of the maxillary plane. The Bionator and Twin Block groups showed statistically significant reductions in the inclination of the upper incisors to the maxillary plane (P < 0.05). The Bass group showed minimal change in the inclination of the lower labial segment to the mandibular plane. The Bionator group demonstrated the greatest proclination of the lower labial segment (4.0 +/- 3.6 degrees). Clinically important changes were measured in all the appliance groups when compared with the control group. Differences were also identified between the functional appliance groups. The Twin Block appliance and, to a lesser extent, the Bionator appeared the most effective in producing sagittal and vertical changes.

Type-1 hypersensitivity reactions to Malassezia pachydermatis extracts in atopic dogs.

OBJECTIVE: To investigate the potential allergenic role of the yeast Malassezia pachydermatis in dogs with clinical diagnosis of atopic dermatitis. ANIMALS: 5 clinically normal nonatopic dogs, 10 atopic dogs with cytologic evidence of Malassezia dermatitis, and 12 atopic dogs without cytologic evidence of Malassezia dermatitis. PROCEDURE: A crude yeast extract was produced by disrupting the cell wall of M pachydermatis. The crude extract and 8 of its fractions, which were generated by fractionation in a high-performance liquid chromatography column, were injected along with 46 commercial allergens for intradermal allergy testing of normal and atopic sample populations. Significant difference between atopic populations was evaluated, using a threshold concentration of crude yeast extract that failed to induce wheal-and-flare responses in normal nonatopic dogs. RESULTS: Atopic dogs with cytologic evidence of Malassezia dermatitis had significantly greater wheal-and-flare reactions to intradermal injection of crude extract of M pachydermatis than did atopic dogs without cytologic evidence of Malassezia dermatitis. CONCLUSIONS: It is concluded that M pachydermatis is capable of promoting type-1 hypersensitivity reactions in dogs with an atopic dermatitis phenotype. CLINICAL RELEVANCE: Currently, Malassezia dermatitis is principally managed by use of antifungal chemotherapy. Because the yeast appears to be a contributing allergen in dogs with atopic dermatitis, hyposensitization with M pachydermatis extracts may offer a future alternative to extended or repeated episodic administration of antifungals for extended control of recurrent infections.