Technical quality of root canal treatment performed by undergraduate students using hand instrumentation: a meta-analysis.

The technical quality of root canal treatment (RCT) may impact on the outcome. The quality of education received during undergraduate school may be linked to the quality of treatment provided in general dental practice. In this context, the aim of this systematic review was to answer the following focused questions: (i) What is the frequency of acceptable technical quality of root fillings, assessed radiographically, performed by undergraduate students? (ii) What are the most common errors assessed radiographically and reported in these treatments? For this purpose, articles that evaluated the quality of root fillings performed by undergraduate students were selected. Data were collected based on predetermined criteria. The key features from the included studies were extracted. GRADE-tool assessed the quality of the evidence. MAStARI evaluated the methodological quality, and a meta-analysis on all studies was conducted. At the end of the screening, 24 articles were identified. Overall frequency of acceptable technical quality of root fillings was 48%. From this total, 52% related to anterior teeth, 49% to premolars and 26% to molars. The main procedural errors reported were ledge formation, furcation perforation, apical transportation and apical perforation. The heterogeneity amongst the studies was high (84-99%). Five studies had a high risk of bias, eight had a moderate risk, and 11 had low risk. The overall quality of evidence identified was very low. The conclusion was that technical quality of root fillings performed by undergraduate students is low, which may reveal that endodontic education has limited achievement at undergraduate level. A plan to improve the quality of root fillings, and by extrapolation the overall quality of root canal treatment, should be discussed by the staff responsible for endodontic education and training.

Validity of different tools to assess sleep bruxism: a meta-analysis.

This systematic review and meta-analysis (MA) aimed to evaluate the diagnostic validity of questionnaires, clinical assessment and portable diagnostic devices compared to the reference standard method polysomnography (PSG) in assessing sleep bruxism (SB). Two reviewers searched electronic databases for diagnostic test accuracy studies that compared questionnaires, clinical assessment or portable diagnostic devices for SB, with the reference standard method PSG, comprising previous studies from all languages and with no restrictions regarding age, gender or time of publication. Of the 351 articles, eight met the inclusion criteria for qualitative, and seven for quantitative analysis. The methodology of selected studies was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). The studies were divided and analysed over three groups: three studies evaluating questionnaires, two regarding the clinical assessment of tooth wear and three covering portable diagnostic devices. The MA indicated that portable diagnostic devices showed the best validity of all evaluated methods, especially as far as a four-channel EMG/ECG recording is concerned. Questionnaires and the clinical assessment can be used as screening methods to identify non-SB individuals, although it is not that good in identifying subjects with SB. The quality of evidence identified through GRADEpro, was from very low-to-moderate, due to statistical heterogeneity between studies.

Epiteliopatía pigmentaria placoide posterior aguda de presentación atípica / Atypical manifestations of acute posterior placoid pigment epitheliopathy

Caso clínicoVarón de 35 años con disminución brusca de la visión de su OI y antecedentes de proceso pseudogripal. A la exploración se observa una lesión blanco-amarillenta foveal acompañada de desprendimiento de la retina neurosensorial y un quiste subfoveal. Se decide instaurar tratamiento con corticoides vía oral consiguiéndose una mejoría significativa de la agudeza visual en 4 semanas.DiscusiónLa epiteliopatía pigmentaria placoide posterior aguda es una enfermedad que afecta a adultos jóvenes y sanos, que se caracteriza por tener buen pronóstico visual sin la necesidad, en la mayoría de los casos, de tratamiento. Existen casos en los que se manifiesta de forma atípica, en los que consideramos que se tendría que contemplar el tratamiento farmacológico con corticoides(AU)

Clinical caseA 35-year-old male with rapid loss of vision of his left eye. He complained of a flulike syndrome one week before the beginning of the symptoms. At the left posterior pole there was a white-yellowish subfoveal lesion associated with a subfoveal cyst and neurosensory retina detachment. We decided to initiate treatment with systemic corticosteroids and the sight improved after 4 weeks.DiscussionAcute posterior placoid pigment epitheliopathy is a disease that typically affects young and healthy adults. It is generally self-limiting and has good visual prognosis. Sometimes the disease includes atypical features such as serous detachment of the neurosensory retina. In these cases we consider that the use of systemic corticosteroids would be necessary(AU)

Evolución clínica de la neurotomía óptica radial a largo plazo / Long-term clinical outcome of radial optic neurotomy

ObjetivoEstudiar la evolución clínica a largo plazo de los ojos afectos de oclusión de la vena central de la retina (OVCR) intervenidos con neurotomía óptica radial (NOR), analizando los resultados anatómicos y funcionales de estos ojos y sus complicaciones.MétodosEstudio retrospectivo, observacional y descriptivo de 47 ojos correspondientes a 47 pacientes afectos de OVCR. Todos ellos fueron intervenidos con NOR, desde el año 2002 y por el mismo cirujano. Las variables principales analizadas fueron la agudeza visual (AV), la presión intraocular (PIO), la presencia o no de neovascularización del iris, de opticociliares y de recanalización vascular, y las principales complicaciones derivadas del cuadro ocular.ResultadosSe intervinieron 47 ojos de los cuales 21 (44,7%) fueron derechos (OD) y 26 (55,3%) izquierdos (OI). La edad media fue de 58,97 años. Con un seguimiento medio tras la NOR de 32,15 meses, un 70,2% de los pacientes tuvo una estabilización o mejoría de la AV, un 23,4% una neovascularización iridiana y un 42,6% desarrolló opticociliares en la cabeza del nervio óptico.ConclusionesObservamos que la NOR, en casos seleccionados, ayuda a una rápida resolución de la hemorragia intrarretiniana y de la congestión de la papila y puede mejorar la perfusión retiniana. A largo plazo estabiliza e incluso aumenta la AV, disminuyendo así el número de complicaciones a las que conduce la historia natural de la OVCR(AU)

PurposeTo study the long-term clinical outcome through assessment of anatomical and functional results, as well as complications of eyes affected with central retinal vein occlusion (CRVO) that underwent radial optic neurotomy (RON).MethodsRetrospective, observational and descriptive study of 47 eyes corresponding to 47 patients affected by CRVO. All the eyes underwent RON performed by the same surgeon since 2002. The main assessed variables were visual acuity (VA), intraocular pressure (IOP), presence of iris neovascularization and opticocilliary veins, vascular recanalization and complications derived from this pathological entity.ResultsSurgery was performed in 47 eyes, 21 of them (44.7%) were right sided and 26 left sided (55.3%). Mean age was 58.97 years. Mean post-surgical follow-up was 32.15 months. A total of 70.2% of the patients experienced stabilization or VA improvement, 23.4% iridian neovascularisation and 42.6% developed opticocilliary veins in the head of the optical nerve.ConclusionsIt is noticeable that in selected cases, RON produces a quick resolution of the retinal haemorrhage and papillary congestion and may improve the retinal perfusion. Long-term benefits are stabilization or improvement of the VA and a reduction in complications on the natural history in CRVO(AU)

[Atypical manifestations of acute posterior placoid pigment epitheliopathy]. / Epiteliopatía pigmentaria placoide posterior aguda de presentación atípica.

CLINICAL CASE: A 35-year-old male with rapid loss of vision of his left eye. He complained of a flulike syndrome one week before the beginning of the symptoms. At the left posterior pole there was a white-yellowish subfoveal lesion associated with a subfoveal cyst and neurosensory retina detachment. We decided to initiate treatment with systemic corticosteroids and the sight improved after 4 weeks. DISCUSSION: Acute posterior placoid pigment epitheliopathy is a disease that typically affects young and healthy adults. It is generally self-limiting and has good visual prognosis. Sometimes the disease includes atypical features such as serous detachment of the neurosensory retina. In these cases we consider that the use of systemic corticosteroids would be necessary.

[Long-term clinical outcome of radial optic neurotomy]. / Evolución clínica de la neurotomía óptica radial a largo plazo.

PURPOSE: To study the long-term clinical outcome through assessment of anatomical and functional results, as well as complications of eyes affected with central retinal vein occlusion (CRVO) that underwent radial optic neurotomy (RON). METHODS: Retrospective, observational and descriptive study of 47 eyes corresponding to 47 patients affected by CRVO. All the eyes underwent RON performed by the same surgeon since 2002. The main assessed variables were visual acuity (VA), intraocular pressure (IOP), presence of iris neovascularization and opticocilliary veins, vascular recanalization and complications derived from this pathological entity. RESULTS: Surgery was performed in 47 eyes, 21 of them (44.7%) were right sided and 26 left sided (55.3%). Mean age was 58.97 years. Mean post-surgical follow-up was 32.15 months. A total of 70.2% of the patients experienced stabilization or VA improvement, 23.4% iridian neovascularisation and 42.6% developed opticocilliary veins in the head of the optical nerve. CONCLUSIONS: It is noticeable that in selected cases, RON produces a quick resolution of the retinal haemorrhage and papillary congestion and may improve the retinal perfusion. Long-term benefits are stabilization or improvement of the VA and a reduction in complications on the natural history in CRVO.

Successful AV fistula creation does not lead to higher catheter use: the experience by the Northwest Renal Network 16 Vascular Access Quality Improvement Program. Four years follow-up.

BACKGROUND: In 2002, the Center for Medicare and Medicaid Services (CMS) required all 18 Renal Networks to participate in a Vascular Access Quality Improvement Program (QIP). The Northwest Renal Network (NWRN 16) chose to increase arteriovenous fistula (AVF) use. NWRN 16 hypothesized that strategies which targeted the improvement of AVF rate and the reduction of catheter use were the same. In December 2001, 44.2% of hemodialysis (HD) patients in the NWRN 16 received HD using an AVF which met the Dialysis Outcome Quality Initiative (K/DOQI) 40% AVF guideline for prevalent patients. However, 43% of HD facilities (2869 patients) had less than 40% of AVF and higher HD catheter rates than the average Network catheter rates (25.0 vs. 20.3%). To address the needs of underperforming facilities, NWRN 16 provided education and tools for their vascular access decision makers to promote AVF creation and catheter reduction. METHODS: In 2002, NWRN 16 sponsored four regional workshops targeted at nephrologists, vascular surgeons, HD nurses, and interventional radiologists. RESULTS: Percentage of AVFs in use in invited facilities increased from 31.3% pre-intervention to 56.2% at 4 yrs: 78% increase (99% confidence interval: 77.8% to 81.5%). Percentage of catheters increased from 25% to 25.8%: 3.2% change over 4 yrs (99% confidence interval: 2.5% to 4%). CONCLUSION: The success of Network 16's AVF interventions demonstrates the effectiveness of Network education promoting multidisciplinary teamwork, and innovative strategies to increase dramatically AVF use without substantial increase in catheter use.

Successful multidisciplinary interventions for arterio-venous fistula creation by the Pacific Northwest Renal Network 16 vascular access quality improvement program.

BACKGROUND: In December 2001, 44.2% of hemodialysis (HD) patients in the Northwest Renal Network (NWRN 16) received dialysis using an arteriovenous fistula (AVF). Substantial differences were noted in percentages of patients with AVF, ranging from 5% to 90% of the facility population, suggesting wide variation in physician practice patterns within the Network. To address the needs of facilities having < 40% AVF, NWRN 16 provided education and tools for their vascular access decision-makers to promote AVF creation. METHODS: In 2002, the Network sponsored 4 regional workshops targeted to nephrologists, vascular surgeons, dialysis nurses, and interventional radiologists. RESULTS: 46 facilities (43% of all Network facilities) had <40% AVF in use in December, 2001, dialyzing 2940 patients (Invited Units). Percent AVF in use in all the Invited Facilities increased from 31.3% pre-intervention to 39.8% at 1 year (p<0.001 vs pre) to 56.2% at four years: 79.8% increase in the prevalent AVF rate over a four-year period (95% confidence interval: 77.8% to 81.7%). CONCLUSION: Low prevalent AVF rates in many NWRN 16 facilities may have resulted from differences in physician practice patterns. The success of Network 16 AVF Intervention demonstrates the effectiveness of Network education promoting multidisciplinary teamwork, innovative strategies to increase AVF rates among dialysis patients.

Comparative morphogenesis of three PRRS virus strains.

The morphogenesis of a Dutch PRRS field strain virus (Lelystad virus) was studied and compared to that of a U.S. field strain VR2332 and its attenuated vaccine strain JJ1882. Porcine lung alveolar macrophages (PLAM) and CL2621 cells were infected with high doses of virus (MOI = 10). At 4, 6, 9, 12, 18, 24, and 48 h post infection (hpi) cells were fixed for electronmicroscopy or for detection of viral antigens by immunoperoxidase staining. From 6 hpi on, viral antigens were detected in the cytoplasm and from 9 hpi on completely assembled virus particles could be detected in infected cells. The three strains were similar in assembly of new virus particles, envelopment at the smooth endoplasmic reticulum, and egress from infected cells. However, distinct differences were seen in replication time of the three strains in various cell types. The Lelystad virus replicated very fast and efficiently in PLAM while VR2332 and JJ1882 replicated preferably in CL2621 cells. JJ1882 replicated faster in CL2621 cells than VR2332 did, probably because of increased adaptation to the cell-line. Although the U.S. and European strains differ at the level of the genome, morphogenesis is not visibly altered. There is however a distinct difference in preferred cell type between the European strain and the two U.S. strains.

Lymphocyte subpopulations and concentrations of soluble CD8 and CD4 antigen after anaerobic training.

In 13 middle-aged, moderately trained men (40-60 yr) we investigated the influence of anaerobic training on immunological parameters measured at rest. The 4 week anaerobic training program (two 30-min sessions weight lifting and one interval training per week; lactate levels 4-6 mM and 8-10 mM, respectively), caused a significant increase of the mean arm muscle force by 7% (handgrip test, p < 0.05). Evaluation of lymphocyte subsets was performed by means of three-colour immunofluorescence analysis (FACS). After 4 weeks of training we found a significant reduction of the CD4+ T-cell counts by 15% (p < 0.05) paralleled by a fall of naive cells (CD3+/CD4+/CD45RA+) by 16%, which, however, was statistically not significant. While percentages of CD3+ lymphocytes decreased significantly by 6% (p < 0.001), absolute numbers of CD3+ T-lymphocytes were not detectably affected and also the relative ratio of CD8+ T-cell subsets, i.e. the ratio of suppressor vs cytotoxic T-cells (CD3+/CD8+/CD11b+, CD3+/CD8+/CD11b- respectively) remained unchanged. Likewise the serum concentrations of the soluble CD8 and CD4 antigen (sCD8/sCD4) as determined by sandwich enzyme immunoassays were found to be unaffected. We conclude that 40-60 years old healthy human subjects performing anaerobic training experience on average a significant decrease of circulating CD4+ T-lymphocytes, while other parameters including the activation parameters sCD8 and sCD4 remained unchanged.

Early excision and grafting vs. nonoperative treatment of burns of indeterminant depth: a randomized prospective study.

Compared to nonoperative treatment with silver sulfadiazine cream, early excision and grafting of 22 patients with indeterminant burns of less than 20% TBSA resulted in an average shorter hospitalization, lower cost, and less time away from work than 25 patients treated nonoperatively. While early excision and grafting resulted in increased use of blood products and operating room facilities, this did not result in increased patient morbidity. Long-term followup demonstrated no difference in need for reconstruction, incidence of blisters, incidence of loss of motion, or contour irregularities. Those patients treated nonoperatively required more late grafts for closure and demonstrated more hypertrophic scarring. Those treated by early excision demonstrated more mesh graft irregularity. We conclude that in otherwise healthy patients with dermal burns of indeterminant depth less than 20% total body surface area, early excision and grafting is the preferred form of treatment.

HLA antigens in a family with both parents and several siblings affected by Graves' disease.

A family with autoimmune thyroid disease is described. Four members had Graves' disease and 3 had diffuse goitres. Both parents (second cousins) carry the HLA haplotype: HLA Aw24, Bw39(w6), Cw-, DR3, MT2. Only females with this haplotype show thyroid symptoms. These findings emphasize the involvement of HLA linked genes in susceptibility to Graves' disease.

[Investigation of demands in data and text processing by an ergonomic job description questionnaire (DT-EIJDQ) (author's transl)]. / Anforderungsermittlung im Bereich der Daten- und Textverarbeitung mit einem arbeitswissenschaftlichen Erhebungsverfahren zur Tätigkeitsanalyse (DTV-AET).

A questionnaire for Ergonomic Job Description is developed for the area of text and data processing. The contents and structure of the method are described and its applicability is demonstrated in a field study. To interprete the data, methods of cluster, profile, and factor analyses are used. The jobs for which the data have been collected are classified according to their specific demands by the use of factor analysis. Further applications of the method are outlined.