Application of the diode laser for soft-tissue surgery in orthodontics: Case series.

Referral to an oral surgeon for soft-tissue surgery before, during or after orthodontic treatment is not uncommon. This process may delay treatment and could potentially increase the risk of complications. In addition, seeing multiple specialties in different environments may demotivate paediatric or anxious patients from pursuing orthodontic treatment and could also adversely affect patient compliance and satisfaction. The development of laser technology provides a safe and effective alternative, allowing the orthodontic clinician to perform soft-tissue surgery. To date, there are no laser exposure protocols or UK guidelines regarding the use of laser surgery in orthodontics. This case series reports four clinical cases that demonstrate potential advantages of using a diode laser for the management of soft tissue in the field of orthodontics.

Information retention of orthodontic patients and parents: A randomized controlled trial.

INTRODUCTION: A randomized controlled trial was undertaken to compare the efficacy of 3 methods of delivering information on short- and long-term recall of information in orthodontic patients and parents. METHODS: Participants who received an audiovisual presentation on orthodontic treatment were randomly allocated to 1 of 3 written information groups (leaflets, generic mind map, or participant's customized mind map). A questionnaire was used to assess short- and long-term retention of information (maximum score 30). RESULTS: Eighty-eight patients (94.6%) and 77 parents (86.5%) completed the study. The average knowledge scores at baseline for the patient groups were 17.71 95 CI 16.28-19.14), 16.58 (14.67-18.49), and 17.37 (15.92-18.81), respectively. The parents' knowledge scores for the 3 groups were 19.06 (17.51-20.62), 19.39 (17.44-21.35), and 18.76 (17.19-20.33), respectively. The short- and long-term knowledge scores improved over baseline in all 3 groups (P <0.0001). The parents achieved higher scores than the patients (P = 0.002) and their rate of forgetting information was less. The knowledge scores of the mind map groups were higher than that of the leaflet group for all cohorts (P = 0.025). No statistical difference was found between the type of mind map. The correlation between patient and parent knowledge scores was significant (P <0.0001) at all 3 time points. CONCLUSIONS: Provision of an audiovisual presentation supplemented with 1 of 3 written information methods is an effective way of delivering information. There was a significant improvement in the retention of information with the use of mind maps compared with leaflets. The generic mind map is equally as effective, more consistent in information delivered, and less labor intensive than the individual customized mind map and therefore would be our recommendation. Participation of parents is important because they comprehend and retain information better. In this study, 100% of parents shared information with their children, perhaps improving the patients' recall.

Response to Letter to the editor from Dr. Kawada regarding the article Dietary glycaemic load and cognitive performance in elderly subjects.

In his offered opinion piece, (Dietary glycaemic load and cognitive performance in elderly subjects) Dr. Kawada comments upon the statistical analysis and suggests that the conclusions of the study should be interpreted with caution. Having closely examined these comments, we believe that they are over-stated and we draw different conclusions. At first viewing, the statistical arguments put forward by Dr. Kawada look complicated, but one may summarize that he believes the analysis lacked statistical power. This argument is directed towards two sets of regression analyses, a Poisson analysis on which one of the messages of the paper hinges, and a second logistic analysis that was acknowledged as statistically underpowered in our publication. No statistical argument is provided as to why the Poisson regression model is underpowered; the critique contains no new scientific content but relies on a technical re-iteration of the limitations of the study (that were highlighted in the original manuscript) combined with quasi philosophical arguments on data set size and the need for biochemical markers in observational dietary studies.

Dietary glycaemic load associated with cognitive performance in elderly subjects.

PURPOSE: Ageing is associated with loss of cognitive function and an increased risk of dementia which is expected to place growing demands on health and long-term care providers. Among multiple causative factors, evidence suggests that cognitive impairment in older subjects may be influenced by diet. The objective of this study was to examine the association between dietary patterns, dietary glycaemic load (GL) and cognition in older Irish adults. METHODS: Community-dwelling subjects (n 208; 94 males and 114 females; aged 64-93 years) were analysed. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire. Cognitive capacity was tested using the Mini-Mental State Examination (MMSE). The data were clustered to derive patterns of dietary intake. Multivariable-adjusted logistic and Poisson regression models were used to examine the relationship between dietary GL and MMSE score. RESULTS: Elderly subjects consuming 'prudent' dietary patterns (high in fruit, vegetables, fish, low-fat dairy and salad dressings and low in red meat and white bread) had higher MMSE scores (better cognitive function) than those consuming 'Western' dietary pattern (high in red meat and white bread and low in fruit and vegetables; P < 0.05). Logistic and Poisson regression analyses both indicated that the MMSE score was inversely associated with the GL of the diet (P < 0.05) even after adjusting for age, gender, diabetes, hypertension, healthy food diversity, nutritional status, residential property price, cardiovascular medications and energy intake. CONCLUSION: In this community-dwelling elderly Irish cohort, consumption of a high glycaemic diet is associated with poorer cognitive performance as assessed by the MMSE.

Intestinal microbiota, diet and health.

The human intestine is colonised by 10¹³ to 10¹4 micro-organisms, the vast majority of which belong to the phyla Firmicutes and Bacteroidetes. Although highly stable over time, the composition and activities of the microbiota may be influenced by a number of factors including age, diet and antibiotic treatment. Although perturbations in the composition or functions of the microbiota are linked to inflammatory and metabolic disorders (e.g. inflammatory bowel diseases, irritable bowel syndrome and obesity), it is unclear at this point whether these changes are a symptom of the disease or a contributing factor. A better knowledge of the mechanisms through which changes in microbiota composition (dysbiosis) promote disease states is needed to improve our understanding of the causal relationship between the gut microbiota and disease. While evidence of the preventive and therapeutic effects of probiotic strains on diarrhoeal illness and other intestinal conditions is promising, the exact mechanisms of the beneficial effects are not fully understood. Recent studies have raised the question of whether non-viable probiotic strains can confer health benefits on the host by influencing the immune system. As the potential health effect of these non-viable bacteria depends on whether the mechanism of this effect is dependent on viability, future research needs to consider each probiotic strain on a case-by-case basis. The present review provides a comprehensive, updated overview of the human gut microbiota, the factors influencing its composition and the role of probiotics as a therapeutic modality in the treatment and prevention of diseases and/or restoration of human health.

Draft Genome Sequence of Lactobacillus crispatus EM-LC1, an Isolate with Antimicrobial Activity Cultured from an Elderly Subject.

Here we report the 1.86-Mb draft genome sequence of Lactobacillus crispatus EM-LC1, a fecal isolate with antimicrobial activity. This genome sequence is expected to provide insights into the antimicrobial activity of L. crispatus and improve our knowledge of its potential probiotic traits.

Nationwide survey of surgically assisted rapid maxillary expansion.

We aimed to gather data on the current practice of surgically assisted rapid maxillary expansion (SARME) in the UK. Surveys were posted in the mail to all members of the British Association of Oral and Maxillofacial Surgeons (n=379) and 166 (44%) responded. In the previous year 69 responders (42%) had done at least one SARME operation. The technique used by individual surgeons may be more experience-based than evidence-based, which leads to considerable variation.

Gut microbiota composition correlates with diet and health in the elderly.

Alterations in intestinal microbiota composition are associated with several chronic conditions, including obesity and inflammatory diseases. The microbiota of older people displays greater inter-individual variation than that of younger adults. Here we show that the faecal microbiota composition from 178 elderly subjects formed groups, correlating with residence location in the community, day-hospital, rehabilitation or in long-term residential care. However, clustering of subjects by diet separated them by the same residence location and microbiota groupings. The separation of microbiota composition significantly correlated with measures of frailty, co-morbidity, nutritional status, markers of inflammation and with metabolites in faecal water. The individual microbiota of people in long-stay care was significantly less diverse than that of community dwellers. Loss of community-associated microbiota correlated with increased frailty. Collectively, the data support a relationship between diet, microbiota and health status, and indicate a role for diet-driven microbiota alterations in varying rates of health decline upon ageing.

Ergonomic task analysis of ultrasound-guided femoral nerve block: a pilot study.

STUDY OBJECTIVE: To apply ergonomic task analysis to the performance of ultrasound-guided (US-guided) femoral nerve block (FNB) in an acute hospital setting. DESIGN: Pilot prospective observational study. SETTING: Orthopedic operating room of a regional trauma hospital. SUBJECTS: 15 anesthesiologists of various levels of experience in US-guided FNB (estimated minimum experience < 10 procedures; maximum about 50 procedures, and from basic trainees to consultants); and 15 patients (5 men and 10 women), aged 77 ± 15 (mean ± SD yrs) years. MEASUREMENTS/OBSERVATIONS: A data capture "tool", which was modified from one previously developed for ergonomic study of spinal anesthesia, was studied. Patient, operator, and heterogeneous environmental factors related to ergonomic performance of US-guided FNB were identified. The observation period started immediately before commencement of positioning the patient and ended on completion of perineural injection. Data were acquired using direct observations, photography, and application of a questionnaire. MAIN RESULTS: The quality of ergonomic performance was generally suboptimal and varied greatly among operators. Eight (experience < 10 procedures) of 15 operators excessively rotated their head, neck, and/or back to visualize the image on the ultrasound machine. Eight operators (experience < 10 procedures) performed the procedure with excessive thoracolumbar flexion. CONCLUSION: Performance of US-guided FNB presents ergonomic challenges and was suboptimal during most of the procedures observed. Formal training in US-guided peripheral nerve blockade should include reference to ergonomic factors.

Quality of life in health care workers with latex allergy.

BACKGROUND: Exposure to latex gloves and glove powder makes health care workers (HCWs) particularly susceptible to developing an allergy to latex. AIMS: To assess the impact on the quality of life (QOL) of HCWs who are allergic to latex products before removal from latex exposure and after removal from exposure. METHODS: We studied 39 latex allergic HCWs from the Health & Safety Executive south area. Twenty-nine attended for an assessment with the occupational physician and were asked to fill out a questionnaire. Spirometry, immunoglobulin E levels and latex radioallergosorbent test levels were measured. RESULTS: In total, 29/39 (74%) of patients responded. All of the participants had a type 1 allergy to latex. All individuals reported a significant improvement of symptoms once latex was removed from their working environment. Of those that reported skin complaints, 83% reported that their skin no longer had an impact on their QOL once latex was removed. Over 90% (n = 26) of all participants stated that their eye/nose symptoms had no longer an impact on their QOL and 86% (n = 25) of all participants stated that their respiratory symptoms had no impact on their QOL following the removal of latex from their working environment. Overall, 45% of the respondents had changed jobs: 61% of this group changed to a completely nonclinical post. CONCLUSIONS: On average, 86% of latex allergic HCWs reported that their QOL had improved significantly since their removal from latex. In employees who are latex allergic/sensitized, taking latex avoidance measures results in cessation or diminution of symptoms.

An ergonomic task analysis of spinal anaesthesia.

BACKGROUND AND OBJECTIVE: Ergonomics is the study of physical interaction between humans and their working environment. The objective of this study was to characterize the performance of spinal anaesthesia in an acute hospital setting, applying ergonomic task analysis. METHODS: A data capture sheet was developed using a series of multidisciplinary expert discussions and piloted on: five procedures. The final version of this sheet was applied to 24 further procedures. Data were acquired using direct observations, video recordings and application of a questionnaire. The domains of interest were patient, operator and environmental factors related to ergonomic performance. RESULTS: At least one important deficit in ergonomic performance was identified during each of the 24 procedures. None of the 24 assistants who helped to position the patients had specific training for this purpose. Eleven out of 24 operators exhibited marked (>/=60 degrees ) thoracolumbar flexion for at least a part of the procedure. Seven out of 24 operators positioned the instrument tray to their nondominant side prior to commencing the procedure. All studied patients were exposed during at least a part of the procedure at a relatively low temperature [17.5 +/- 1 degrees C (16-20.7) (mean +/- SD (range)]. CONCLUSION: In the setting described, spinal anaesthesia is usually performed in a manner which is clearly suboptimal in terms of ergonomics. This underrecognized problem needs to be addressed through education and training.

Microarray analysis of retinoid-dependent gene activity during rat embryogenesis: increased collagen fibril production in a model of retinoid insufficiency.

Retinoic acid (RA) is an essential mediator of embryogenesis. Some, but not all, of its targets have been identified. We previously developed a rat model of gestational retinoid deficiency (RAD; Power et al. [1999] Dev. Dyn. 216:469-480) and generated embryos with developmental impairments that closely resemble genetic and dietary models of retinoid insufficiency. Here, we used microarray analysis and expression profiling to identify 88 transcripts whose abundance was altered under conditions of retinoid insufficiency, as compared with normal embryos. Among these, the induction by RAD of genes involved in collagen I synthesis (COL1A1, IA2 and VA2, prolyl-4-hydroxylase-alpha1) and protein galactosylation (galactokinase, ABO galactosyltransferase, UDP-galactose transporter-related protein) was especially noteworthy because extracellular matrix regulates many developmental events. We also identified several genes involved with stress responses (cathepsin H, UBC2E, IGFBP3, smoothelin). Real-time polymerase chain reaction analysis of selected candidates revealed excellent agreement with the array findings. Further validation came from the demonstration that these genes were similarly dysregulated in two genetic models of retinoid insufficiency, the retinol binding protein null-mutant embryo and the Raldh2 null-mutant embryo. In situ hybridization of RAD embryos found increased collagen IA1 and IGFBP3 mRNA within the connective mesenchyme and vasculature, respectively, and a failure to repress the growth factor midkine within the RAD neural tube. Many of the identified genes were not known previously to respond to retinoid status and will provide new insights to retinoid roles and to the consequences of retinoid insufficiency.