Degradation of Computer-aided Design/Computer-aided Manufacturing Composites by Dietary Solvents: An Optical Three-dimensional Surface Analysis.

CLINICAL RELEVANCE: Computer-aided design/computer-aided manufacturing (CAD/CAM) composite resins are susceptible to degradation by dietary solvents. Dietary counselling is prudent when placing such CAD/CAM restorations. SUMMARY: This study determined the effect of dietary solvents on the surface roughness (Ra) of direct, indirect, and computer-aided design/computer-aided manufacturing (CAD/CAM) dental composites. The materials evaluated were a direct composite (Filtek Z350 XT [FZ]), an indirect composite (Shofu Ceramage [CM]), and four CAD/CAM composites (Lava Ultimate [LU], Shofu Block HC [HC], Cerasmart [CS], and Vita Enamic [VE]). Specimens (12×14×1.5 mm) of each material were prepared, measured for baseline Ra, ranked, divided into six groups (n=12), and conditioned in the following media for 1 week at 37°C: air (control), distilled water, 0.02 N citric acid, 0.02 N lactic acid, heptane, and 50% ethanol-water solution. The composite specimens were then subjected to postconditioning Ra testing using an optical three-dimensional surface analyzer (G4e, Alicona Imaging GmbH, Raaba, Austria). Inter-medium and inter-material comparisons were performed with one-way analysis of variance and post hoc Bonferroni test at a significance level of α=0.05. Mean Ra values ranged from 0.086 ± 0.004 µm to 0.153 ± 0.005 µm for the various material/medium combinations. For all materials, conditioning in air (control) and distilled water generally resulted in significantly lower mean Ra than exposure to other dietary solvents. Conditioning in citric acid presented the roughest surfaces for FZ, CM, and CS. For LU, HC, and VE, exposure to lactic acid, heptane, and ethanol solution resulted in the highest mean Ra. Regardless of conditioning media, FZ had the highest and VE the lowest mean Ra compared with other composites. The CAD/CAM composites remained susceptible to surface degradation by dietary solvents despite their industrial polymerization.

Comparison of noninvasive models of fibrosis in chronic hepatitis B.

BACKGROUND AND GOALS: Liver fibrosis influences treatment and surveillance strategies in chronic hepatitis B (CHB). This multicenter study aimed to examine the accuracy of serum fibrosis models in CHB patients including those with low alanine aminotransferase (ALT) levels and serially in those undergoing treatment. METHOD: We examined noninvasive fibrosis models [Hepascore, Fibrotest, APRI, hepatitis e antigen (HBeAg)-positive and -negative models] in 179 CHB patients who underwent liver biopsy and fibrosis assessment by METAVIR and image morphometry. Serial Hepascore measurements were assessed in 40 subjects for up to 8.7 years. RESULTS: Hepascore was more accurate than Fibrotest [area under the curve (AUC) 0.83 vs. 0.72, P = 0.05] and HBeAg-positive model (AUC 0.83 vs. 72, P = 0.03) for significant fibrosis but was not significantly different to APRI or HBeAg-negative scores. Fibrosis area assessed by morphometry was correlated with Hepascore (r = 0.603, P < 0.001), Fibrotest (r = 0.392, P = 0.03), and HBeAg-positive (r = 0.492, P = 0.001) scores only. Among 73 patients with an ALT <60 IU/L, noninvasive models were useful to predict fibrosis (PPV 80-90%) or exclude significant fibrosis (NPV 79-100%). Hepascore increased significantly among patients monitored without treatment and reduced among patients undergoing therapy (0.05/year ± 0.03 vs. -0.04/year ± 0.02, P = 0.007). CONCLUSIONS: Serum fibrosis models are predictive of fibrosis in CHB and assist in identifying subjects with low-normal ALT levels for treatment.

Quality of life and psychological morbidity in women with polycystic ovary syndrome: body mass index, age and the provision of patient information are significant modifiers.

OBJECTIVE: Polycystic ovary syndrome (PCOS) has clinical features and implications for long-term health that may lead to decreased quality of life (QoL) and psychological morbidity. We studied QoL in women with PCOS, compared the findings with population norms and assessed whether they correlated with reported quality of patient information received. DESIGN: Cross-sectional study. PATIENTS: Women with PCOS by National Institutes of Health (NIH) criteria, diagnosis confirmed by one endocrinologist. MEASUREMENTS: Four questionnaires were mailed: the Short Form-36 (SF-36), the Quality-of-Life Questionnaire for Women with Polycystic Ovary Syndrome (PCOSQ), the General Health Questionnaire-28 (GHQ-28) and an assessment of information quality and sources, the Patient Information Questionnaire (PIQ). RESULTS: Questionnaires were sent to 443 women with PCOS from one endocrinologist's database; 203 women aged 15-65 years agreed to participate. To compare with Australian population norms, data from those women aged 18-44 years (n = 173) were used. Of these, 64% were obese, 18% overweight and 18% of normal weight. The demographics, socioeconomic status and untreated biochemistry of the responders and the total patient group were not significantly different. SF-36 scores were significantly lower than the age- and sex-matched Australian population (P < 0.01), including the overweight subset (P < 0.01). Health-related QoL by PCOSQ was similar to other published studies. GHQ-28 identified psychological morbidity in 62.4%, compared with 26.4% in a matched Australian population (P < 0.0001). Body mass index (BMI) was negatively correlated with QoL (P < 0.01). There was a positive association between the psychological domain of QoL and the subjective assessment of the quality of health-related information in general (P < 0.001), for hirsutism (P < 0.01) and for menstrual irregularity (P < 0.05). CONCLUSIONS: We have shown impaired QoL and increased prevalence of psychological morbidity in PCOS compared with population norms. The perception of inadequate information about the condition correlated with poorer QoL scores. Improved information delivery may lead to an improvement in QoL and needs to be tested with an intervention study.

Does pravastatin increase chylomicron remnant catabolism in postmenopausal women with type 2 diabetes mellitus?

OBJECTIVE: We investigated the effects of pravastatin on chylomicron remnant catabolism measured with a 13C stable isotope breath test and plasma apolipoprotein (apo) B-48 and remnant-like particle (RLP)-cholesterol in postmenopausal women with type 2 diabetes mellitus. PATIENTS AND MEASUREMENTS: Nineteen postmenopausal women with type 2 diabetes were randomized to receive 40 mg/day pravastatin or no treatment for 6 weeks followed by a 2-week washout period, and crossed over for a further 6 weeks. Fractional catabolic rate (FCR) of a chylomicron remnant-like emulsion was determined from 13CO2 enrichment in the breath and plasma using isotope-ratio mass spectrometry and multicompartmental modelling. Plasma apo B-48 and RLP-cholesterol concentrations were also measured as static markers of chylomicron remnant metabolism. RESULTS: Pravastatin significantly reduced plasma concentrations of cholesterol (5.9 +/- 0.3 vs. 4.8 +/- 0.2 mmol/l; P < 0.001), low density lipoprotein (LDL)-cholesterol (3.5 +/- 0.2 vs. 2.6 +/- 0.2 mmol/l; P < 0.001), triglyceride (2.1 +/- 0.3 vs. 1.7 +/- 0.2 mmol/l; P = 0.017), non-high density lipoprotein (HDL)-cholesterol (4.4 +/- 0.3 vs. 3.3 +/- 0.2 mmol/l; P < 0.001), lathosterol/total cholesterol ratio (2.6 +/- 0.2 vs. 2.0 +/- 0.3, P = 0.035), apo B-100 (1.1 +/- 0.1 vs. 0.8 +/- 0.1 g/l; P = 0.001), apo B-48 (4.8 +/- 0.9 vs. 3.3 +/- 0.6 mg/l; P = 0.016), and RLP-cholesterol (31.4 +/- 8.2 vs. 18.6 +/- 4.6 mg/dl; P = 0.024). Pravastatin was also associated with an increase in sitosterol/total cholesterol ratio (2.8 +/- 0.3 vs. 3.1 +/- 0.3, P = 0.029). Chylomicron remnant-like emulsion catabolism was not, however, significantly altered by pravastatin estimated by either breath or plasma clearance measurements. CONCLUSIONS: In postmenopausal women, pravastatin decreases plasma concentrations of remnant lipoproteins by a mechanism that may relate chiefly to inhibition of remnant production, but this requires further evaluation.

The incidence and management of priapism in Western Australia: a 16 year audit.

The objective of the study was to conduct a retrospective audit of patients who presented with priapism in Western Australia during the years 1985-2000. We searched the records of the teaching hospitals in metropolitan Perth and those of the Keogh Institute for Medical Research for the diagnostic code for priapism. A total of 82 episodes of priapism in 63 patients occurred over this 16 year period. In all, 62 episodes occurred after intracavernosal injections (ICI) and 20 were due to other causes. Treatment of priapism included simple aspiration of blood, intracavernosal injection of alpha-adrenergic agents and surgical shunt procedures. Priapism occurring outside the setting of ICI was more likely to require surgery; seven of 20 episodes. After ICI therapy, eight of 62 episodes required shunts. The use of prostaglandin E1 as the drug of choice in ICI therapy in 1989 led to a fall in the incidence of ICI-induced priapism. Priapism is a major side effect of ICI therapy and an uncommon, although important, side effect of other conditions. The incidence of priapism has fallen with the introduction of prostaglandin E1 monotherapy as the favoured drug for ICI therapy of erectile failure.

Vascular function of forearm microcirculation in postmenopausal women with type 2 diabetes: potential benefit of hormone replacement therapy?

OBJECTIVE: To study the potential effects of hormone replacement therapy (HRT) on vascular function of the peripheral circulation in postmenopausal women with type 2 diabetes. METHODS: Seventeen premenopausal women aged 47.4 +/- 4.4 years (PreM), 23 nondiabetic postmenopausal women aged 59.4 +/- 7.0 years (PM), 15 postmenopausal women with type 2 diabetes aged 60.3 +/- 7.2 years (PMD) and 12 postmenopausal women with type 2 diabetes using HRT aged 61.2 +/- 4.0 years (PMDHRT) were studied. Vascular function of the peripheral circulation was investigated by measuring hyperemic responses of the forearm microcirculation following an ischemic stimulus using venous occlusion, strain-gauge plethysmography. Fasting lipids, glucose and glycated hemoglobin (HbA1c) were also measured. RESULTS: Forearm vascular function was significantly impaired in the PMD group: maximal blood flow (ml/100 ml/min) was 15.23 +/- 8.19 vs. 28.21 +/- 12.30 (PreM), 23.62 +/- 6.62 (PM) and 23.37 +/- 5.78 (PMDHRT) (p = 0.004); flow debt (ml/100 ml) was 3.99 +/- 2.83 vs. 7.40 +/- 4.92 (PreM), 5.66 +/- 3.67 (PM) and 8.57 +/- 4.84 (PMDHRT) (p = 0.0018); vascular resistance (mmHg/ml/100 ml/min) was 11.90 +/- 9.02 vs. 5.04 +/- 2.41 (PreM), 5.55 +/- 2.69 (PM) and 5.96 +/- 1.88 (PMDHRT) (p = 0.003). Fasting lipids, HbA1c and body mass index were not significantly different between the two diabetic groups. CONCLUSIONS: Postmenopausal women with diabetes have abnormal vascular function of resistance arteries that may improve with HRT. HRT may therefore reduce cardiovascular risk in postmenopausal women with type 2 diabetes, and a clinical end-point trial is warranted to test this hypothesis.

Intestinal parasites of raccoons (Procyon lotor) from southwest British Columbia.

This is the first extensive survey of metazoan parasites (particularly of the roundworm Baylisascaris procyonis) from the intestines of raccoons in British Columbia. The sample collected in 1997-1998 consisted of 82 raccoons that had been sick or had been killed accidentally by automobiles. Fifteen parasite taxa were found: 3 nematodes, 9 digenetic trematodes, 2 acanthocephalans and 1 cestode. Ten of these parasites constitute new host records for raccoons, including 4 digenetic trematodes that have been reported in marine birds and mammals on the Pacific Coast of North America. Baylisascaris procyonis infected 61% of the raccoons with a mean intensity of 27. The high rate of infection indicates a large potential for environmental contamination and, thus, human and animal exposure to infectious eggs. Prevention of larva migrans is discussed, particularly for people in contact with raccoons in wildlife rehabilitation centers.

Four new gymnophallid digeneans from rice rats, willets, and molluscs in Florida.

Gymnophalloides heardi n. sp. differs from Gymnophalloides tokiensis Fujita, 1925 and Gymnophalloides seoi Lee et al., 1993 in the smaller body size, presence of a single, lobed vitellarium, and elongate seminal vesicle. In contrast with other gymnophallid digeneans that utilize avian and bivalve hosts, G. heardi is the first species to be reported from a rodent Oryzomys palustris (Harlan); its second intermediate host is a pulmonate gastropod, Melampus bidentatus (L.). Three gymnophallid species were found in the willet Catotrophorus semipalmatus. Parvatrema bushi n. sp. differs from Parvatrema borinquenae Cable, 1953 in the sucker ratios, arrangement of the bean-shaped vitellarium overlapping the ventral sucker, and the shallow genital atrium. Paragymnophallus kinsellai n. sp. differs from Paragymnophallus odhneri Ching, 1973 in the smaller body size, smaller sucker ratio, sharp spines, and highly lobed vitellarium. The third species found in willets was P. borinquenae; its metacercaria was found in a new gastropod host Cerithidea scalariformis (Say). The metacercariae, cercariae, and sporocysts of Parvatrema polymesoda n. sp. were found in the digestive gland of the bivalve Polymesoda maritima. The new species differs from both P. bushi and P. borinquenae in the small, bilobed vitellarium, presence of numerous sensory papillae around the oral sucker, a crenulated ventral sucker, and relatively prominent lateral papillae.

Comparisons of Gymnophallid digeneans from north Pacific and Baltic clams, Macoma balthica (Bivalvia).

Three gymnophallid species in Macoma balthica from the northeastern Pacific Ocean are similar to 3 species in M. balthica from the Baltic Sea. Using light and scanning electron microscopy, we compared the anatomy of the larvae of 2 species of Lacunovermis and of Gymnophallus, and the adults of 2 species of Lacunovermis recovered from incubation on chick allantoic membrane. The third similar pair of Meiogymnophallus multigemmulus and Parvatrema affinis was restudied with light microscopy. Previously described anatomical differences between the 3 pairs of Pacific and Baltic gymnophallids were nullified in this study. Lacunovermis conspicuus Ching, 1965 is synonymized with Lacunovermis macomae (Lebour, 1908), and Gymnophallus gibberosus Loos-Frank, 1971 is synonymized with Gymnophallus somateriae (Levinsen, 1881). Meiogymnophallus multigemmulus Ching, 1965 is synonymized with Parvatrema affinis (Jameson and Nicoll, 1913), becoming M. affinis n. comb.

Profilicollis botulus (Van Cleave, 1916) from diving ducks and shore crabs of British Columbia.

Adults of Profilicollis botulus were found in 6 species of diving ducks in British Columbia including 3 new hosts: common goldeneye, Bucephala clangula (L.); Barrow's goldeneye, B. islandica (Gmelin); and greater scaup, Aythya marila (L.). The identification of the species was verified by the examination of co-types and specimens from eider ducks, Somateria mollissima (L.), from Scotland and oldsquaw, Clangula hyemalis (L.), from New Brunswick. Cystacanths from the hairy shore crab, Hemigrapsus oregonensis (Dana), were similar in morphology to those from Carcinus maenas (L.) from Scotland.

Fish tapeworm infections (diphyllobothriasis) in Canada, particularly British Columbia.

Although the risk of diphyllobothriasis is generally low in Canada, fish tapeworm infections seem to have become more frequent in recent years. This increase is probably a consequence of the growing popularity of raw or inadequately cooked ethnic fish dishes or of a preference for lightly cooked fish, especially salmon. Only freshwater fish become infected with the larvae, but not everyone may realize that salmon can acquire the parasites before they leave their native lakes and rivers for the sea. If fish known to be sources of the tapeworms are to be eaten raw they should first be well frozen or salted to kill the larvae. Physicians should regard fish tapeworm infection as a notifiable disease. In Canada niclosamide, the drug of choice, is available from the manufacturer on a patient-by-patient basis.