Gastrointestinal tolerance of D-allulose in children: an acute, randomised, double-blind, placebo-controlled, cross-over study.

D-Allulose, a low-calorie sugar, provides an attractive alternative to added sugars in food and beverage products. There is however limited data on its gastrointestinal (GI) tolerance, with only two studies in adults, and no studies in children to date. We therefore performed an acute, randomised, double-blind, placebo-controlled, cross over study designed to determine, for the first time, the GI tolerance of 2 doses of D-allulose (2.5 g per 120 ml and 4.3 g per 120 ml) in young children. The primary tolerance endpoint was the difference in the number of participants experiencing at least one stool that met a Type 6 or Type 7 description on the Bristol Stool Chart, within 24 hours after study product intake. Secondary endpoints included the assessment of stool frequency, stool consistency, and the presence of GI symptoms. Only one participant in the low dose group experienced a stool type 6 or 7, while no participants experienced a stool type 6 or 7 in the high dose group. A statistically significant difference in the change in stool frequency compared to placebo in the high dose group (p = 0.044) was found, with no significant difference between the groups for stool consistency and no participants experienced unusual stool frequency. All the encountered adverse events were non-serious, either mild or moderate, and there were no serious adverse events. All in all, D-allulose was tolerated well in children, making this ingredient a good candidate to reformulate commercially produced goods by replacing added sugars with lower caloric content.

Computed Tomography of the Chest as a Screening Tool for Low Bone Mineral Density.

INTRODUCTION: Computed tomography (CT) Hounsfield units (HU) recently emerged as a promising screening tool for low bone mineral density (BMD). We hypothesized that CT HU measurements of the thoracic spine would significantly and positively correlate with dual X-ray absorptiometry (DXA) BMD scans of the femoral neck. MATERIALS AND METHODS: The study included patients with DXA scans and thoracic CT scans at the Walter Reed National Military Medical Center. One author, blinded to the DXA scans, measured HU from the cancellous bone in T4 vertebrae. Another author statistically compared femoral neck DXA T-scores to the CT HU measurements. RESULTS: The study included 145 patients with CT scans and femoral neck DXAs. The osteoporotic and osteopenic groups had a significant difference in HU measurements compared to the normal group within the study (P < .0001 and .002, respectively). A low BMD screening value of 231 HU provided a sensitivity of 90.1% and negative predictive value of 85.7%. CONCLUSION: Thoracic vertebrae HU measurements correlate with a low BMD of the femoral neck as determined by DXA T-scores. A high sensitivity and negative predictive value was achieved with a screening value of 231 HU. Utilization of chest or thoracic spine CT imaging as a screening method provides a quick and available screening tool for assessing low BMD in patients with these scans.Level of Evidence: III (Diagnostic).

Prospective Evaluation of Push-up Performance and Patient-Reported Outcomes Following Open Dorsal Wrist Ganglion Excision in the Active-Duty Military Population.

Background Dorsal wrist ganglia (DWG) are a common wrist pathology that affects the military population. This study prospectively evaluates push-up performance, functional measures, and patient-reported outcomes 6 months after open DWG excision in active-duty patients. Methods Twenty-seven active-duty patients were enrolled and 18 had complete follow-up. Included patients had DWG diagnosis, unilateral involvement, and no previous surgery. The number of push-ups performed within 2 minutes was measured preoperatively and at 6 months. Range of motion (ROM), grip strength, Pain Catastrophization Scale (PCS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, Mayo Wrist Score, and visual analog scale (VAS) pain score were measured preoperatively and at 2 weeks, 6 weeks, 3 months, and 6 months. Results Push-up performance did not significantly change overall. Wrist flexion, extension, and radial deviation returned to preoperative ranges. Wrist ulnar deviation significantly increased from preoperative range. Grip strength deficit between operative and unaffected extremities significantly improved to 0.7 kg at 6 months from preoperative deficit of 2.7 kg. Mean scores significantly improved for the validated outcome measures-PCS from 6.3 to 0.67, VAS pain scores from 1.37 to 0.18, DASH scores from 12.8 to 4.3, and Mayo Wrist Scores from 80.3 to 89.4. No surgical complications or recurrences were reported. Conclusions Findings suggest that almost half of active patients may improve push-up performance after DWG excision at 6 months. Significant improvements were seen in wrist pain, ROM, grip strength, and all patient-reported outcomes, which is useful when counseling patients undergoing excision.

Repeated Noise Exposure Does Not Reach Hazardous Levels During Total Joint Arthroplasty.

INTRODUCTION: Noise exposure is an occupational health concern for certain professions, especially military servicemembers and those using power tools on a regular basis. The purpose of this study was to quantify noise exposure during total hip arthroplasty (THA) and total knee arthroplasty (TKA) cases compared to the recommended standard for occupational noise exposure. MATERIALS AND METHODS: A sound level meter was used to record cumulative and peak noise exposure levels in 10 primary THA and 10 primary TKA surgeries, as well as 10 arthroscopy cases as controls. Measurements at the distance of the surgeon were taken in all cases. In TKA cases, measurements were taken at 3 feet and 8 feet from the surgeon, to simulate the position of the anesthetist and circulating nurse, respectively. RESULTS: Time-weighted average was significantly higher in THA (64.7 ± 5.2 dB) and TKA (64.5 ± 6.8 dB) as compared to arthroscopic cases (51.1 ± 7.5 dB, P < 0.001) and higher at the distance of the surgeon (64.5 ± 6.8 dB) compared to the anesthetist (52.9 ± 3.8 dB) and the circulating nurse (54.8 ± 11.2 dB, P = 0.006). However, time-weighted average was below the recommended exposure level of 85 dB for all arthroplasty cases. Peak levels did not differ significantly between surgery type or staff role, and no values above the ceiling limit of 140 dB were recorded. Surgeon's daily noise dose percentage per case was 1.78% for THA and 2.04% for TKA. CONCLUSION: Noise exposure in THA and TKA was higher than arthroscopic cases but did not exceed occupational standards. A daily dose percentage of approximately 2% per case indicates that repeated noise exposure likely does not reach hazardous levels in modern arthroplasty practice.

Gingival fibromatosis with congenital hypertrichosis.

Idiopathic gingival fibromatosis is a slowly progressive proliferative fibrous lesion of the gingival tissue, leading to functional, esthetic, and psychological difficulties. This entity is mainly associated with hypertrichosis and epilepsy either as an isolated disorder or as part of a syndrome. We present a case report of a female with severe generalized gingival fibromatosis and hypertrichosis which was treated by conventional gingivectomies under local anesthesia. Postoperative healing was uneventful with a marked improvement in patient's appearance and oral hygiene.

Cervical Spine Computed Tomography Hounsfield Units Accurately Predict Low Bone Mineral Density of the Femoral Neck.

STUDY DESIGN: A retrospective cohort. OBJECTIVE: The objective of this study to determine the correlation between Hounsfield unit (HU) measurements from the C4 vertebral body and dual-energy x-ray absorptiometry (DXA) T-score. SUMMARY OF BACKGROUND DATA: Recent attention has turned to the utilization of HU measurements from computed tomography (CT) as a potential screening method for low bone mineral density (BMD). We hypothesized that cervical spine CT HU measurements will correlate with BMD measurements conducted with DXA scans of the femoral neck. MATERIAL AND METHODS: Patients with cervical CT and femoral neck DXA scans at 1 institution were included in the study. HUs were manually measured from the cancellous bone in the C4 vertebrae by 1 author blinded to DXA scans. HU measurements were compared with femoral neck DXA T-scores for the entire population. RESULTS: A total of 149 patients with 149 cervical CT and femoral neck DXA scans were included in the study. The low BMD group (osteoporotic and osteopenic combined) showed a significant difference in HU compared with the normal groups within the study (P<0.0001). A low BMD screening value of 447 HU captured over 95% of patients with low BMD within our study and provided a sensitivity of 92% and negative predictive value of 82.1%. The male and female intrasex analysis demonstrated a significant difference between the low BMD and normal BMD groups with P=0.001 and P=0.0001, respectively. CONCLUSIONS: HU measurements taken from the C4 vertebral body on CT scan correlate with low BMD of the femoral neck as determined by DXA scan T-scores. Screening values of 447 HU captured 95% of patients with low BMD, with a high degree of sensitivity, and negative predictive value of 80%. Utilization of cervical spine HU as a screening method provides a simple, quick, and easily assessable screening tool for assessing low BMD. LEVEL OF EVIDENCE: Level III-diagnostic.

Momentousness of denture labeling using Aadhaar number in Indian population.

Personal identification is of prime importance for forensic and medicolegal purposes especially in case of natural calamities, accidents, state of unconsciousness, or loss of memory. The denture labeling is an important method which has been acknowledged by the field of dentistry. Various denture labeling techniques have been advocated but none of them is universal. Aadhaar is the instantly verifiable national identification number assigned to residents of India, which is currently being used vastly by the Government of India. The article describes a simple, economical, and permanent method for inclusion of Unique Identification Number and bar code in dentures.

Low Revision Rates at 10 years for Metal on Metal Hip Implants in a Military Population.

INTRODUCTION: Prior to being largely abandoned due to unacceptably high failure rates and the adverse physiologic reactions to metal ions, metal-on-metal (MoM) total hip arthroplasty (THA) and hip resurfacing (HR) were in widespread use throughout the USA, and the potential benefit of decreased volumetric wear rates made it of particular interest to those who serve a young active population, such as military surgeons. The aim of our study was to determine the revision rate of metal on metal hip implants performed at our military institution and obtain current patient reported outcomes from this cohort. MATERIALS AND METHODS: We conducted a retrospective review of patients who underwent MoM total hip arthroplasty (THA) or hip resurfacing (HR) at our institution from 2006 to 2012. Revision status and component type were determined, and patients were contacted to obtain current HOOS JR scores. RESULTS: We identified 103 THAs in 88 patients and 38 HRs in 33 patients, with mean follow up of 10.2 years. Average age at time of surgery was 48 years, and 85% of the patients were male. The mean HOOS JR score in the THA and HR groups were 84.9 ± 17.6 and 75.8 ± 24.9, respectively (p = 0.38), and were not significantly lower in those who were revised. Two THA revisions occurred for metallosis and one for aseptic loosening of the femoral component. One HR revision occurred for breach of the anterior femoral neck, and one occurred for heterotopicossification. CONCLUSIONS: Revision rates of MoM THA and HR in this young, predominantly male population were 2.9% and 5.3%, respectively, and patients maintained generally good hip-specific outcomes.

Host defense peptides: An insight into the antimicrobial world.

A serious challenge to antimicrobial therapies has emerged due to rapid increase in drug-resistant infections creating an urge for the development of alternative therapeutics. Antimicrobial peptides (AMPs) have gained importance because of their broad-spectrum antimicrobial activities and mediator-like functions linking innate and adaptive immune responses. The multidimensional properties of these peptides hold promising potentials as prophylactic and antimicrobial agents. This review discusses various AMPs and their role in combating microorganisms and infections along with its clinical implication.

Combat-related acetabular fractures: Outcomes of open versus closed injuries.

INTRODUCTION: Since the onset of the Global War on Terror close to 50,000 United States service members have been injured in combat, many of these injuries would have previously been fatal. Among these injuries, open acetabular fractures are at an increased number due to the high percentage of penetrating injuries such as high velocity gunshot wounds and blast injuries. These injuries lead to a greater degree of contamination, and more severe associated injuries. There is a significantly smaller proportion of the classic blunt trauma mechanism typically seen in civilian trauma. METHODS: We performed a retrospective review of the Department of Defense Trauma Registry into which all US combat-injured patients are enrolled, as well as reviewed local patient medical records, and radiologic studies from March 2003 to April 2012. Eighty seven (87) acetabular fractures were identified with 32 classified as open fractures. Information regarding mechanism of injury, fracture pattern, transfusion requirements, Injury Severity Score (ISS), and presence of lower extremity amputations was analyzed. RESULTS: The mechanism of injury was an explosive device in 59% (n=19) of patients with an open acetabular fracture; the remaining 40% (n=13) were secondary to ballistic injury. In contrast, in the closed acetabular fracture cohort 38% (21/55) of fractures were due to explosive devices, and all remaining (n=34) were secondary to blunt trauma such as falls, motor vehicle collisions, or aircraft crashes. Patients with open acetabular fractures required a median of 17units of PRBC within the first 24h after injury. The mean ISS was 32 in the open group compared with 22 in the closed group (p=0.003). In the open fracture group nine patients (28%) sustained bilateral lower extremity amputations, and 10 patients (31%) ultimately underwent a hip disarticulation or hemi-pelvectomy as their final amputation level. DISCUSSION: Open acetabular fractures represent a significant challenge in the management of combat-related injuries. High ISS and massive transfusion requirements are common in these injuries. This is one of the largest series reported of open acetabular fractures. Open acetabular fractures require immediate damage control surgery and resuscitation as well as prolonged rehabilitation due to their severity. The dramatic number of open acetabular fractures (37%) in this review highlights the challenge in treatment of combat related acetabular fractures.

Assessment of the width of attached gingiva using different methods in various age groups: A clinical study.

BACKGROUND: The width of attached gingiva varies from tooth to tooth and also among individuals with mixed opinions regarding an "adequate" or "sufficient" dimension of the gingiva. Although the need for a so-called adequate amount of keratinized tissue for maintenance of periodontal health is questionable, the mucogingival junction serves as an important clinical landmark in periodontal evaluation. There are various methods of locating the mucogingival junction namely the functional method and the visual method with and without histochemical staining, which aid in the measurement of the width of attached gingiva. MATERIALS AND METHODS: This study was carried out to assess the full mouth mid-buccal width of attached gingiva in individuals of four different age groups. This study also evaluated the difference in visual and histochemical methods in identification of the mucogingival junction to calculate the width of attached gingiva. RESULTS: It was seen that the width of attached gingiva increases with age, and there was no significant difference in the width of attached gingiva by both the methods. CONCLUSION: Width of attached gingival varies in different areas of the mouth and also increases with age with no significant difference in the method of its assessment.

Choroidal metastasis from carcinoma of breast detected on F18-FDG PET CT scan: A case report and review of literature.

Intraocular choroidal metastasis is a very rare cause of blindness. Choroidal hemangioma and melanoma are other causes that may mimic the condition. Carcinoma of breast is the most common primary malignancy that accounts for choroidal metastasis in females and carcinoma of lung is the most common cause in males. Other primary neoplasms which can uncommonly metastasize to the choroid are testis, gastrointestinal tract, kidney, thyroid, pancreas, and prostate. Metastatic neoplasm to the eye outnumbers the primary tumors such as retinoblastomas and malignant melanoma. Sonography is usually the initial investigation after fundus examination to look for the architecture of the lesion. However, it lacks in specificity. We present a case of carcinoma of breast that had visual disturbances and wholebody F18-fluorodeoxyglucose, positron emission tomography-computerized tomography (FDG PET CT) revealed a choroidal lesion in addition to cerebral, pulmonary, and skeletal metastases. Choroidal metastasis from carcinoma of lung has been reported previously on FDG PET. To the best of our knowledge, this is the first case report of carcinoma of breast demonstrating choroid metastasis on F18-FDG PET CT scan.