Development, implementation and evaluation of a multinational FLS mentorship programme in Latin America.

Realising the benefits of systematic secondary fracture prevention requires supporting local sites to get started and becoming effective. We here describe the development, implementation and impact of a regional fracture liaison service (FLS) mentorship programme in Latin America that led to 64 FLS getting started and coverage of 17,205 patients. INTRODUCTION: Despite treatments and service models to deliver effective secondary fracture prevention, most patients are left untreated after a fragility fracture. To improve the capability to get FLS started and more effective, we describe the development, implementation and evaluation of an international programme to develop national communities of FLS mentors as part of the Capture the Fracture Partnership in Latin America. METHODS: The IOF regional team and the University of Oxford developed the curriculum and associated resources for training mentors in setting up FLS, service improvement and mentorship. Mentors were selected during a preparatory meeting, trained using live online sessions followed by regular mentor-led post-training meetings. The programme was evaluated using a pre-training needs assessment and post-training evaluation based on Moore's outcomes. RESULTS: The mentorship programme was initiated in Mexico, Brazil, Colombia and Argentina. The mentors were multidisciplinary, including orthopaedic surgery, rehabilitation, rheumatology, endocrinology, geriatrics, gynaecology and internal medicine. There was 100% participation in training sessions and reported satisfaction with the training. Since the initiation of the training programme, 22 FLS have been set up in Mexico, 30 in Brazil, 3 in Colombia and 9 in Argentina, in comparison with two in Chile and none in any other LATAM countries that were not involved in the mentorship programme. This equates to approximately 17,025 additional patients identified from 2019 to 2021 after initiation of mentorship. The mentors have engaged with 58 FLS for service development. Post-training activities include two published national best practice guidelines and other country-specific resources for FLS in the local language. CONCLUSION: Despite the COVID pandemic, the mentorship pillar of the Capture the Fracture Partnership has developed a community of FLS mentors with measurable improvement in national FLS provision. The programme is a potentially scalable platform to develop communities of mentors in other countries.

Single-Cell Analysis of the Periodontal Immune Niche in Type 2 Diabetes.

Periodontitis (PD) is a common source of uncontrolled inflammation in obesity-associated type 2 diabetes (T2D). PD apparently fuels the inflammation of T2D and associates with poor glycemic control and increased T2D morbidity. New therapeutics are critically needed to counter the sources of periodontal infection and inflammation that are accelerated in people with T2D. The precise mechanisms underlying the relationship between PD and T2D remain poorly understood. Every major immune cell subset has been implicated in the unresolved inflammation of PD, regardless of host metabolic health. However, analyses of inflammatory cells in PD with human periodontal tissue have generally focused on mRNA quantification and immunohistochemical analyses, both of which provide limited information on immune cell function. We used a combination of flow cytometry for cell surface markers and enzyme-linked immunospot methods to assess the subset distribution and function of immune cells isolated from gingiva of people who had PD and were systemically healthy, had PD and T2D (PD/T2D), or, for flow cytometry, were systemically and orally healthy. T-cell subsets dominated the cellular immune compartment in gingiva from all groups, and B cells were relatively rare. Although immune cell frequencies were similar among groups, a higher proportion of CD11b+ or CD4+ cells secreted IFNγ/IL-10 or IL-8, respectively, in cells from PD/T2D samples as compared with PD-alone samples. Our data indicate that fundamental differences in gingival immune cell function between PD and T2D-potentiated PD may account for the increased risk and severity of PD in subjects with T2D. Such differences may suggest unexpected therapeutic targets for alleviating periodontal inflammation in people with T2D.

Exploring the receptor origin of vibration-induced reflexes.

STUDY DESIGN: An experimental design. OBJECTIVES: The aim of this study was to determine the latencies of vibration-induced reflexes in individuals with and without spinal cord injury (SCI), and to compare these latencies to identify differences in reflex circuitries. SETTING: A tertiary rehabilitation center in Istanbul. METHODS: Seventeen individuals with chronic SCI (SCI group) and 23 participants without SCI (Control group) were included in this study. Latency of tonic vibration reflex (TVR) and whole-body vibration-induced muscular reflex (WBV-IMR) of the left soleus muscle was tested for estimating the reflex origins. The local tendon vibration was applied at six different vibration frequencies (50, 85, 140, 185, 235, and 265 Hz), each lasting for 15 s with 3-s rest intervals. The WBV was applied at six different vibration frequencies (35, 37, 39, 41, 43, and 45 Hz), each lasting for 15 s with 3-s rest intervals. RESULTS: Mean (SD) TVR latency was 39.7 (5.3) ms in the SCI group and 35.9 (2.7) ms in the Control group with a mean (95% CI) difference of -3.8 (-6.7 to -0.9) ms. Mean (SD) WBV-IMR latency was 45.8 (7.4) ms in the SCI group and 43.3 (3.0) ms in the Control group with a mean (95% CI) difference of -2.5 (-6.5 to 1.4) ms. There were significant differences between TVR latency and WBV-IMR latency in both the groups (mean (95% CI) difference; -6.2 (-9.3 to -3.0) ms, p = 0.0001 for the SCI group and -7.4 (-9.3 to -5.6) ms, p = 0.011 for Control group). CONCLUSIONS: The results suggest that the receptor of origin of TVR and WBV-IMR may be different.

A European epidemiological survey of Vibrio splendidus clade shows unexplored diversity and massive exchange of virulence factors.

The Vibrio splendidus clade has previously been associated with epidemic outbreaks of various aquatic animals, as in the case of the cupped oyster, Crassostrea gigas. To investigate whether involved strains could present a clonal origin and to identify possible alternative background carriage animals or zooplankton, a large epidemiological survey was conducted on isolates of the splendidus clade. For this purpose, Vibrio strains were isolated from various samples including oysters, mussels, sediments, zooplankton, and sea water on the basis of a North/South gradient of the European sea water zone (Ireland, The Netherlands, France, Italy, and Spain). A total of 435 isolates were successfully associated to the V. splendidus clade using real time polymerase chain reaction with 16S specific primers and probes. A multiple-locus variable-number tandem-repeat analysis (VNTR) was conducted on all isolates based on a multiplex PCR-VNTR with a set of primer pairs designed from the V. tasmaniensis LGP32 genome. Preliminary validation of the primers on a set of collection strains from the V. splendidus clade confirmed that the former V. splendidus-related LGP32 and relative strains were related to V. tasmaniensis rather than to the type strain V. splendidus LMG 4042. The VNTR analysis was then successfully conducted on 335 isolates which led to the characterization of 87 different profiles. Our results showed that (1) the high diversity of VNTR did not enlighten significant correlation between a specific pattern and the origin of collected samples. However, populations isolated from animal samples tend to differ from those of the background environment; (2) oyster mortality events could not be linked to the clonal proliferation of a particular VNTR type. However, few different patterns seemed successively associated with samples collected during peaks of oyster's mortality. (3) Finally, no correlation could be seen between specific VNTR patterns and sequence phylogeny of the virulence factors vsm and ompU that were detected among strains isolated during as well as outside mortality events. These results, combined with incongruence observed between the ompU and vsm phylogenetic trees, suggested both large diffusion of strains and massive lateral gene transfer within the V. splendidus clade.

Assessing abnormal iron content in the deep gray matter of patients with multiple sclerosis versus healthy controls.

BACKGROUND AND PURPOSE: It is well known that patients with MS tend to have abnormal iron deposition in and around the MS plaques, in the basal ganglia and the THA. In this study, we used SWI to quantify iron content in patients with MS and healthy volunteers. MATERIALS AND METHODS: Fifty-two patients with MS were recruited to assess abnormal iron content in their basal ganglia and THA structures. One hundred twenty-two healthy subjects were recruited to establish a baseline of normal iron content in deep GM structures. Each structure was separated into 2 regions: a low-iron-content region and a high-iron-content region. The average phase, the percentage area, and the total phase of the high-iron-content region were evaluated. A weighting was also assigned to each subject depending on the level of iron content and its deviation from the normal range. RESULTS: A clear separation between iron content in healthy subjects versus patients with MS was seen. For healthy subjects 13% and for patients with MS 65% showed an iron-weighting factor >3 SDs from the normal mean (P < .05). The results for those patients younger than 40 years are even more impressive. In these cases, only 1% of healthy subjects and 67% of patients with RRMS showed abnormally high iron content. CONCLUSIONS: Iron-weighting factors in the basal ganglia, THA, and the midbrain appeared to be abnormal in roughly two-thirds of patients with MS as measured by SWI.

Label swapper device for spectral amplitude coded optical packet networks monolithically integrated on InP.

In this paper the design, fabrication and experimental characterization of an spectral amplitude coded (SAC) optical label swapper monolithically integrated on Indium Phosphide (InP) is presented. The device has a footprint of 4.8x1.5 mm2 and is able to perform label swapping operations required in SAC at a speed of 155 Mbps. The device was manufactured in InP using a multiple purpose generic integration scheme. Compared to previous SAC label swapper demonstrations, using discrete component assembly, this label swapper chip operates two order of magnitudes faster.

Iron stores and cerebral veins in MS studied by susceptibility weighted imaging.

AIM: In this paper, we seek to determine whether the iron deposition as seen by susceptibility weighted imaging (SWI) in the basal ganglia and thalamus of patients with multiple sclerosis is greater than the iron content measured in normal subjects (individuals unaffected by multiple sclerosis). As increased iron content may result from increased venous pressure, such information would add credence to the concept of Zamboni et al (1) that MS is caused by chronic cerebrospinal venous insufficiency. METHODS: Fourteen MS patients were recruited for this study with a mean age of 38 years ranging from 19 to 66 year-old. A velocity compensated 3D gradient echo sequence was used to generate SW images with a high sensitivity to iron content. We evaluated iron in the following structures: substantia nigra, red nucleus, globus pallidus, putamen, caudate nucleus, thalamus and pulvinar thalamus. Each structure was broken into two parts, a high iron content region and a low iron content region. The measured values were compared to previously established baseline iron content in these structures as a function of age. RESULTS: Twelve of fourteen patients had an increase in iron above normal levels and with a particular pattern of iron deposition in the medial venous drainage system that was associated with the confluence of the veins draining that structure. CONCLUSION: Iron may serve as a biomarker of venous vascular damage in multiple sclerosis. The backward iron accumulation pattern seen in the basal ganglia and thalamus of most MS patients is consistent with the hypothesis of venous hypertension.

Characterizing the mesencephalon using susceptibility-weighted imaging.

BACKGROUND AND PURPOSE: The mesencephalon is involved in a number of human neurodegenerative disorders and has been typically imaged with T1-, T2- and T2*-weighted methods. Our aim was to collect high-contrast susceptibility-weighted imaging (SWI) data to differentiate among and within the basic mesencephalic structures: namely, the red nucleus, substantia nigra, and crus cerebri. MATERIALS AND METHODS: High-resolution SWI, 3D T1-weighted, and T2-weighted data were collected to study contrast in the mesencephalon at 1.5T and 4T. Contrast between structures was calculated for SWI high-pass (HP)-filtered-phase, T1 gradient-echo, and spin-echo T2-weighted data. RESULTS: SWI HP-filtered-phase data revealed similar contrast for the red nucleus and substantia nigra when compared with T2-weighted imaging. However, SWI was able to show structures within the red nucleus, substantia nigra, and medial geniculate body that were invisible on T2-weighted imaging. T1-weighted imaging, on the other hand, did not reveal measurable contrast for any of the structures of interest. SWI HP-filtered-phase data at 4T agreed well with india ink-stained cadaver brain studies, which appear to correlate with capillary density. CONCLUSIONS: With SWI, it is possible to create better anatomic images of the mesencephalon, with improved contrast compared with conventional T1- or T2-weighted sequences.

Design and development of a low-cost eye tracking system for the rehabilitation of the completely locked-in patient.

This article describes the design and development process of an eye tracking-based computer system that benefits from the intact ocular motor control of the completely locked-in patient to provide him or her with an alternative means of communication. A completely locked-in patient is an individual who has lost all types of motor control and communication ability with people in his or her environment. This developed system uses a head-mounted web camera to capture real-time images of the patient's eye. These images are then passed to a program, developed using Matlab, which processes them and computes the coordinates of the pupil position. The program then sends commands to an interactive JAVA-based interface, which provides the patient with a matrix of pictograms representing the most essential daily communication activities. When a pictogram is activated (clicked), the system plays back an audible statement, recorded in any language, reflecting the desired activity. Ten healthy adult volunteers, free from any musculoskeletal or neurological disorders, participated in the validation of the system. Validation results revealed a system accuracy of 96.11+/-5.58 % and repeatability of 94.44+/-2.51 %. The rehabilitative system developed in this project offers the locked-in patient, of any social class, the ability of simple yet effective communication. The advantages of this system over existing systems are low cost, low processing power, ease of operation, little training requirements, minimal disturbance to the patient, and ease of customization to any mother tongue.

Marginal adaptation of class II resin composite restorations using incremental and bulk placement techniques: an ESEM study.

This in vitro study compared marginal gap formation in class II resin composite restorations. Forty caries-free extracted molars were prepared in a standardized manner for class II restoration by one of four methods: bulk- or incrementally-placed light-activated resin composite (Amelogen), and bulk- or incrementally-placed chemically activated composite (Rapidfill). The restored teeth, after finishing and polishing, and thermocycling, were examined using environmental scanning electron microscopy. Marginal gap measurements at predetermined facial and lingual margin sites showed no significant differences between the two sites within any of the groups. Both the light- and the chemically-activated restorations showed no significant differences in mean marginal gap sizes whether they were placed by incremental or bulk techniques. Amelogen restorations placed by both methods had significantly larger margin gaps than those of each of the Rapidfill groups (P<0.05). Thus, although method of placement of a given material had no significant effect on the quality of marginal adaptation, both of the chemically activated resin composite restorations produced significantly smaller marginal gaps than both the bulk- and incrementally-placed light-activated composites.

Shear bond strength of techniques for bonding esthetic veneers to metal.

STATEMENT OF PROBLEM: New composites with improved qualities have been introduced to the dental profession as alternatives to porcelain. There is concern about the strength and reliability of new metal-resin bonding systems when these composites are used as esthetic veneers over metal frameworks. PURPOSE: This in vitro study compared the shear bond strength of 2 metal-resin bonding techniques with the bond strength of conventional porcelain fused-to-metal (PFM). Effects of water storage and thermocycling were also evaluated. MATERIAL AND METHODS: Ninety disks, cast in a medium gold, high noble PFM alloy, were divided equally into 6 groups, and received 3 treatments for veneering: conventional feldspathic porcelain on 1 group, and a composite (Artglass) bonded to the metal, using 2 metal-resin bonding techniques. Specimens were tested in shear, half of them after a 24-hour dry storage at room temperature and the rest after 10-day storage in normal saline solution at 37 degrees C and thermocycling. Fractured specimens were evaluated under x10 magnification to determine the nature of failure. Statistical analysis was performed with 2-factor analysis of variance (ANOVA). RESULTS: Mean shear bond strength values before and after wet storage and thermocycling were 29.66 and 22.91 MPa for the PFM group; 21.43 and 17.92 MPa for the Siloc group; and 19.34 and 15.64 for the etched group, respectively. The PFM group exhibited significantly higher bond strength values compared with the other 2 groups (P<.001). All groups showed a significant decrease in bond strength values after wet storage and thermocycling (P<.001). CONCLUSION: Wet storage and thermocycling caused a significant decrease in shear bond strength of all specimens. Shear bond strength of conventional feldspathic PFM was significantly higher than that of the 2 metal-resin bonding techniques tested. The 2 latter techniques did not reveal any statistically significant differences.

Preliminary report: laboratory-induced stain removal as assessed by environmental scanning electron microscopy.

Environmental scanning electron microscopy (ESEM) was employed to observe stain removal during brushing with Arm & Hammer Dental Care and Crest Regular Toothpaste. ESEM allows serial examinations of the same sample, and does not require a destructive preparative process. Three extracted molars were cleaned, placed into a 96-hour broth culture of Streptococcus mutans, and stain was produced with undiluted chlorhexidine rinse, concentrated coffee and tea for a period of 23 days. After staining, the teeth were examined by ESEM, then brushed using a toothbrushing machine. Imaging was repeated after 5, 10, 15 and 30 seconds of brushing. As seen with ESEM, the Arm & Hammer product had different effects than those from the distilled water control, suggesting something other than that expected from abrasive and mechanical forces alone. There were also differences from the Crest dentifrice removal on this single sample, suggesting a possible difference between the two products. Further studies are needed to confirm and explain these effects.

A two-year clinical evaluation of TPH for restoration of Class II carious lesions in permanent teeth.

To evaluate the clinical suitability of a barium silicate-filled composite (TPH) for restoration of posterior teeth, 50 Class II restorations were restored in 36 patients. Restorations included 22 molars and 32 premolars. Cavity preparations were protected with calcium hydroxide or a resin-modified glass ionomer cement, or both. Enamel was etched for 30 seconds with 37 percent H3PO4. All dentin surfaces were treated with a dentin bonding system that was placed, cured, and restored in 2 microns increments. The restorations were finished using diamond burs, polishing points, and paste. Evaluation periods were at zero (50 restorations), 6 months (35 restorations), 1 year (31 restorations), and 2 years (29 restorations), using the USPHS System and M-L indirect scale. At zero time, 50 restorations were scored "a" in all categories by using two independent evaluators. After 6 months, 35 restorations were graded with one "a" in postoperative sensitivity. After 1 year, 31 restorations were evaluated with one additional "b" for marginal integrity. After 2 years, 2 additional "b" for marginal integrity and 1 "b" for surface staining were noted. No "c" was observed in any categories throughout this study. Wear analysis revealed, on average, 2 microns of wear after 6 months, 7.8 microns of wear after one year, and 10.3 microns of wear after 2 years.

Use of environmental scanning electron microscopy to evaluate dental stain removal.

The purpose of the study was to assess the usefulness of environmental scanning electron microscopy (ESEM) to evaluate stain removal from extracted teeth. The ESEM differs from conventional SEM in that no sample preparation is needed, eliminating artifactual changes. Furthermore, the same sample can be viewed on multiple occasions, allowing "before" and "after" pictures of the same tooth. As a model stain removal device, we tested the Sonicare sonic toothbrush, which has previously been shown to remove dental stain in vivo. Twelve freshly extracted teeth with extrinsic coffee, tea or tobacco stain were obtained for the study. Nine of these had heavy stain (stain covering more than one-third buccal or lingual surface) and were used without further modification. Three teeth were treated in vitro with chlorhexidine and a mixture of coffee and tea to enhance staining. All teeth were examined by ESEM at three times: prior to brushing, after 15-30 seconds of brushing, and after 60-80 seconds of brushing. Light microscopy and 35 mm photography was also done to correlate the ultrastructural changes with those visible at low magnification. Water, mouthwash and 30% slurry of toothpaste were used as fluid vehicles during brushing, but little difference in stain removal was noted among these three fluids. Approximately half the stain was removed within 15-30 seconds, and most visible stain was removed in 60-80 seconds of brushing. Pits and crevices of tooth enamel that were smaller than the bristle diameter, and thus would be inaccessible to abrasive cleaning by direct bristle contact, were generally found to be stain-free. These findings confirm previous reports of the stain removal effectiveness of the Sonicare, and demonstrate the usefulness of ESEM for stain removal studies.

[Handling of antineoplastic products and nurses' knowledge]. / Manipulation des produits anticancéreux et information des infirmières.

Nurses are exposed to a variety of risks while handling cytotoxic drugs. A study was conducted in 6 different hospitals where those drugs are used. We inquired about the nurses information about their possible toxicities and the protection measures used while preparing and giving these drugs. The results showed that 50% of the 43 nurses questioned don't have complete information about these toxicities and nearly 60% of them do not apply any preventive measure for safe handling of the drugs especially the use of disposable gloves, the use of coveralls with long sleeves and the use of protective glasses.

Test of the neurolinguistic programming hypothesis that eye-movements relate to processing imagery.

Bandler and Grinder's hypothesis that eye-movements reflect sensory processing was examined. 28 volunteers first memorized and then recalled visual, auditory, and kinesthetic stimuli. Changes in eye-positions during recall were videotaped and categorized by two raters into positions hypothesized by Bandler and Grinder's model to represent visual, auditory, and kinesthetic recall. Planned contrast analyses suggested that visual stimulus items, when recalled, elicited significantly more upward eye-positions and stares than auditory and kinesthetic items. Auditory and kinesthetic items, however, did not elicit more changes in eye-position hypothesized by the model to represent auditory and kinesthetic recall, respectively.