A Custom-Made Lower Limb Dynamometer for Assessing Ankle Joint Torque in Humans: Calibration and Measurement Procedures.

Custom-made dynamometry was shown to objectively analyze human muscle strength around the ankle joint with accuracy, easy portability and low costs. This paper describes the full method of calibration and measurement setup and the measurement procedure when capturing ankle torque for establishing reliability of a portable custom-built electronic dynamometer. After considering the load cell offset voltage, the pivotal position was determined, and calibration with loads followed. Linear regression was used for calculating the proportionality constant between torque and measured voltage. Digital means were used for data collection and processing. Four healthy consenting participants were enrolled in the study. Three consecutive maximum voluntary isometric contractions of five seconds each were registered for both feet during plantar flexion/dorsiflexion, and ankle torque was then calculated for three ankle inclinations. A calibration procedure resulted, comprising determination of the pivotal axis and pedal constant. Using the obtained data, a measurement procedure was proposed. Obtained contraction time graphs led to easier filtering of the results. When calculating the interclass correlation, the portable apparatus demonstrated to be reliable when measuring ankle torque. When a custom-made dynamometer was used for capturing ankle torque, accuracy of the method was assured by a rigorous calibration and measurement protocol elaboration.

Expression of growth mediators in the gingival crevicular fluid of patients with aggressive periodontitis undergoing periodontal surgery.

OBJECTIVES: To describe changes in growth factor mediators in the gingival crevicular fluid (GCF) of patients with aggressive periodontitis (AgP) undergoing regenerative (GTR) and access flap (AF) surgery. MATERIALS AND METHODS: This was a 12-month, single-blind, split-mouth RCT involving 18 AgP patients with a bilateral intrabony defect which was treated with GTR or AF. GCF was collected prior to surgery and at subsequent follow-up visits from 3 days to 12 months post-operatively, and the levels of angiopoietin-1 (Ang-1), vascular-endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), bone morphogenetic protein-2 (BMP-2), osteoprotegerin (OPG), tissue inhibitor of metalloproteinase 1 (TIMP-1), keratinocyte growth factor (KGF) and platelet-derived growth factor-AB (PDGF-AB) were measured. At baseline, 6 and 12 months post-surgery, periodontal clinical parameters were evaluated. ANOVA was applied to test for differences in the amount of mediators (p < 0.05). RESULTS: Higher amounts of BMP-2 and OPG and a higher area under the curve (AUC) of KGF at the GTR versus AF sites were observed. The maximum change in the amount of KGF correlated significantly with periodontal clinical parameters at the GTR sites at 6 and 12 months. The AUC over 30 days of the amount of Ang-1, VEGF and KGF significantly correlated with periodontal clinical parameters at the AF sites at 6 months. CONCLUSIONS: AF and GTR differentially affected the profile of the growth mediators in GCF, and significant correlations between certain GCF mediators and periodontal clinical outcomes were identified. CLINICAL RELEVANCE: GCF components represent attractive prognostic markers for periodontal tissues undergoing repair or regeneration. However, the available evidence is not robust enough to suggest the use of a specific marker, and future adequately powered studies are warranted to identify the most relevant mediators that could be applied in clinical practice.

Clinical outcomes of a vitrified donor oocyte programme: A single UK centre experience.

OBJECTIVE: To assess the survival rate of vitrified oocytes used in an egg recipient programme and compare the clinical outcomes of pregnancy and live-birth rates per warmed oocyte with fresh autologous oocytes. The differences in the obstetrical outcomes between the two groups were also studied. DESIGN: A prospective case control study from a single in-vitro fertilisaton (IVF) Centre in UK SETTING: Centre of Reproductive and Genetic Health (CRGH), London POPULATION: Vitrified oocytes from egg donors and autologous fresh oocytes from patients attending for an IVF cycle METHODS: The study group consisted of 1490 vitrified oocytes, which were obtained from 145 egg donors who underwent a stimulation cycle at CRGH Centre. The control group included 145 age-matched women who underwent intra cytoplasmic sperm injection (ICSI) treatment with their own oocytes (n = 1528). The clinical outcomes clinical pregnancy rates (CPR) and live-birth rates (LBR) and obstetrical outcomes (gestational age and weight at delivery) were compared between the two groups. Statistical analysis of the summary data and logistic regression analysis was performed using statistical packages (SPSS Version 23 and Stata 2015). The percentages of all parameters in the cases and control groups were compared by Fisher's exact test. A statistical significance level of 5% was adopted throughout the study. MAIN OUTCOME MEASURES: Survival rate per thawed oocyte, clinical pregnancy rate and live-birth rate per embryo transfer was compared to the autologous oocyte group RESULTS: The survival rate of vitrified oocytes was 73.6% (95% CI: 71.3-75.8%). The clinical pregnancy rate (per embryo transfer) using vitrified oocytes was found to be 51.8% compared to 59.3% in the control group. The live birth rate per embryo transfer in the vitrified oocyte group was 46% (95% CI 37.4-54.7%) compared to 57.1% (95% CI 48.5-68.5%) in the control group. The live-birth rate per thawed oocyte was found to be 4.2%. The gestational ages of the fetus at delivery in both the groups were comparable 39.0 (95% CI 32.7-41.9%) and 39.1 (95% CI 25.6-42.0) (p = 0.38). There was no statistically significant difference in the birth weight between the study and the control group 3100 g (750-4337) and 3232 g (1616-4500) respectively (p = 0.28). CONCLUSIONS: This is the first study reporting on the efficacy of a vitrified donor oocyte programme from within the UK. There were no significant differences in the obstetrical outcomes between vitrified donor oocytes and autologous oocytes. The above data will be encouraging for women who are undertaking egg freezing for medical and or social reasons.

Career satisfaction and work-life balance of specialist orthodontists within the UK/ROI.

Objectives To investigate factors affecting career satisfaction and work-life balance in specialist orthodontists in the UK/ROI.Design and setting Prospective questionnaire-based study.Subjects and methods The questionnaire was sent to specialist orthodontists who were members of the British Orthodontic Society.Results Orthodontists reported high levels of career satisfaction (median score 90/100). Career satisfaction was significantly higher in those who exhibited: i) satisfaction with working hours; ii) satisfaction with the level of control over their working day; iii) ability to manage unexpected home events; and iv) confidence in how readily they managed patient expectations. The work-life balance score was lower than the career satisfaction score but the median score was 75/100. Work-life balance scores were significantly affected by the same four factors, but additionally were higher in those who worked part-time.Conclusions Orthodontists in this study were highly satisfied with their career and the majority responded that they would choose orthodontics again. Work-life balance scores were lower than career satisfaction scores but still relatively high. It is important for the profession to consider ways of maintaining, or improving, career satisfaction and work-life balance; including maintaining flexibility of working hours and ensuring that all clinicians have ready access to appropriate training courses throughout their careers (for example, management of patient expectations).

Time to onset of bisphosphonate-related osteonecrosis of the jaws: a multicentre retrospective cohort study.

OBJECTIVES: Osteonecrosis of the jaw (ONJ) is a potentially severe adverse effect of bisphosphonates (BP). Although the risk of ONJ increases with increasing duration of BP treatment, there are currently no reliable estimates of the ONJ time to onset (TTO). The objective of this study was to estimate the TTO and associated risk factors in BP-treated patients. SUBJECTS AND METHODS: Retrospective analysis of data from 22 secondary care centres in seven countries relevant to 349 patients who developed BP-related ONJ between 2004 and 2012. RESULTS: The median (95%CI) TTO was 6.0 years in patients treated with alendronate (n = 88) and 2.2 years in those treated with zoledronate (n = 218). Multivariable Cox regression showed that dentoalveolar surgery was inversely associated, and the use of antiangiogenics directly associated, with the TTO in patients with cancer treated with zoledronate. CONCLUSIONS: The incidence of ONJ increases with the duration of BP therapy, with notable differences observed with respect to BP type and potency, route of administration and underlying disease. When data are stratified by BP type, a time of 6.0 and 2.2 years of oral alendronate and intravenous zoledronate therapy, respectively, is required for 50% of patients to develop ONJ. After stratification by disease, a time of 5.3 and 2.2 years of BP therapy is required for 50% of patients with osteoporosis and cancer, respectively, to develop ONJ. These findings have significant implications for the design of future clinical studies and the development of risk-reduction strategies aimed at either assessing or modulating the risk of ONJ associated with BP.

Effect of Wnt3a delivery on early healing events during guided bone regeneration.

OBJECTIVE: To evaluate the effect of recombinant Wnt3a delivery on the bone regeneration potential following application of the guided bone regeneration (GBR) principle. MATERIALS AND METHODS: A critical-size calvarial defect was created on each parietal bone of 14 Wistar strain rats. One defect was used as the test side and was treated with a collagen sponge carrying 2.0 µg of recombinant Wnt3a protein, whereas the contralateral side served as sham-operated control. Both defects were covered at both the extracranial and intracranial aspects with ePTFE non-resorbable membranes, according to the GBR principle. Following healing periods of 4 and 7 days, qualitative histological and histomorphometric evaluation of undecalcified sections was performed in subgroups of seven animals. The primary outcome parameter was the mean percentage of defect closure in the test and control defects. RESULTS: At 4 days of healing, a network of coagulum and fibrin was observed and initial signs of granulation tissue formation were evident with no apparent differences between the test and control groups. At 7 days of healing, the test group presented newly formed woven bone, originating from the borders of the defect, as opposed to the control group, whereby woven bone formation was not observed in any of the specimens. CONCLUSIONS: The delivery of mouse recombinant Wnt-3a protein in combination with GBR may promote woven bone formation in critical-size calvarial defects at 7 days of healing.

Prevalence and treatment of necrotizing ulcerative gingivitis (NUG) in the British Armed Forces: a case-control study.

OBJECTIVES: Necrotizing ulcerative gingivitis (NUG) has been seen in military populations throughout history. This study aims to determine the prevalence, treatment modality and risk factors associated with NUG in the British Armed Forces. MATERIALS AND METHODS: A whole population dataset of the British Armed Forces was searched to determine cases of NUG during the period 1 January to 31 December 2012. Individual case records were identified, and a case-control study undertaken with data gathered and analysed against a randomised control group, matched for age, sex and service. RESULTS: A prevalence rate for NUG of 0.11 % was determined against the whole military population. The majority of cases received (alone or in combination) the following: oral hygiene instruction (66.5 %), antibiotics (64.4 %) and a mouthwash (58.1 %). Of the cases, 48.7 % received debridement. Analgesics were only prescribed in 8.4 % of the cases, and smoking cessation advice was only given in 10.7 % of the cases. Analysis of risk factors against the control group showed an increase in odds ratios for diagnosis of NUG of 3.4 (95 % CI 2.0-5.7) for current smokers and 7.3 (95 % CI 1.9-28.0) for individuals with an overall Basic Periodontal Examination (BPE) score of 3. CONCLUSIONS: Whilst NUG is a rare disease, it is evident from this study that it still occurs within the British Armed Forces. A strong association was shown between NUG and current smokers and those cases with an overall BPE score of 3. CLINICAL RELEVANCE: This study provides prevalence data for NUG in the British Armed Forces and description of its treatment and associated risk factors. Oral hygiene and smoking must be addressed in patients with NUG and prescribing protocols should be carefully followed.

End-tidal capnometry during emergency department procedural sedation and analgesia: a randomized, controlled study / 世界急诊医学杂志（英文）

@#BACKGROUND:This prospective, randomized trial was undertaken to evaluate the utility of adding end-tidal capnometry (ETC) to pulse oximetry (PO) in patients undergoing procedural sedation and analgesia (PSA) in the emergency department (ED). METHODS:The patients were randomized to monitoring with or without ETC in addition to the current standard of care. Primary endpoints included respiratory adverse events, with secondary endpoints of level of sedation, hypotension, other PSA-related adverse events and patient satisfaction. RESULTS:Of 986 patients, 501 were randomized to usual care and 485 to additional ETC monitoring. In this series, 48％ of the patients were female, with a mean age of 46 years. Orthopedic manipulations (71％), cardioversion (12％) and abscess incision and drainage (12％) were the most common procedures, and propofol and fentanyl were the sedative/analgesic combination used for most patients. There was no difference in patients experiencing de-saturation (SaO2<90％) between the two groups; however, patients in the ETC group were more likely to require airway repositioning (12.9％ vs. 9.3％,P=0.003). Hypotension (SBP<100 mmHg or <85 mmHg if baseline <100 mmHg) was observed in 16 (3.3％) patients in the ETC group and 7 (1.4％) in the control group (P=0.048). CONCLUSIONS:The addition of ETC does not appear to change any clinically significant outcomes. We found an increased incidence of the use of airway repositioning maneuvers and hypotension in cases where ETC was used. We do not believe that ETC should be recommended as a standard of care for the monitoring of patients undergoing PSA.

Panoramic measures for oral bone mass in detecting osteoporosis: a systematic review and meta-analysis.

Different quantitative and qualitative indices calculated on oral panoramic radiographs have been proposed as useful tools to screen for reduced skeletal bone mineral density (BMD). Our aim was to systematically review the literature on linear and qualitative panoramic measures and to assess the accuracy of these indices by performing a meta-analysis of their sensitivity and specificity. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was followed. Fifty studies were included in the qualitative appraisal and 19 were considered for meta-analysis. The methodological quality of the retrieved studies, assessed with the QUADAS-2 tool, was on average low. Three indices were reported by most of the studies: mandibular cortical width, panoramic mandibular index, and the Klemetti index. Mandibular cortical width presented with a better accuracy in excluding osteopenia/osteoporosis (specificity), since patients with a cortical width more than 4 mm had a normal BMD in 90% of the cases. Almost all studies used a cutoff of 0.3 for the panoramic mandibular index, resulting in an estimated sensitivity and specificity in detecting reduced BMD, respectively, of 0.723 (SE 0.160; 95% confidence interval [CI], 0.352-0.926) and 0.733 (SE 0.066; 95% CI, 0.587-0.841). The presence of any kind of mandibular cortical erosion gave an estimated sensitivity and specificity in detecting reduced BMD, respectively, of 0.789 (SE 0.031; 95% CI, 0.721-0.843) and 0.562 (SE 0.047; 95% CI, 0.47-0.651) and a sensitivity and specificity in detecting osteoporosis, respectively, of 0.806 (SE 0.105; 95% CI, 0.528-0.9200) and 0.643 (SE 0.109; 95% CI, 0.417-0.820). The mandibular cortical width, panoramic mandibular index, and Klemetti index are overall useful tools that potentially could be used by dentists to screen for low BMD. Their limitations are mainly related to the experience/agreement between different operators and the different image quality and magnification of the panoramic radiographs.

Video modelling for reducing anxiety related to the use of nasal masks place it for inhalation sedation: a randomised clinical trial.

AIM: A randomised controlled trial to investigate if video modelling can reduce the level of dental anxiety and increase the patient's acceptance of the nasal mask usage for children receiving dental treatment using inhalation sedation (IS). METHODS: A sample of 80 (8-16 years) children due to have dental treatments under IS were randomly allocated to either the modelling video or the control video (oral hygiene instruction). The level of anxiety was recorded before and after watching the video on the Abeer Children Dental Anxiety Scale and each child's ability to cope with the subsequent procedure was assessed on the visual analogue scale. A two-group Chi-square test was used as the basis for the sample size calculation; a significance level of 0.025 was chosen rather than the conventional 0.05 to avoid spurious results arising from multiple testing. RESULTS: Children in the test group had significantly less anxiety after watching the video than those in the control group throughout the subsequent dental procedure; particullary, at the time of the nasal mask administration (P<0.001). CONCLUSIONS: Video modelling appeared to be effective at reducing dental anxiety and has a significant impact on the acceptance of the nasal mask administration for Inhalation Sedation in children.

Video modelling and reducing anxiety related to dental injections - a randomised clinical trial.

CONTEXT: This study was part of a successfully completed PhD and was presented at the IADR/AADR General Session (2013) in Seattle, Washington, USA. The report of this clinical trial conforms to the CONSORT statement. OBJECTIVES: A randomised controlled trial to investigate if video modelling can influence a child's anxiety before the administration of local anaesthesia (LA). METHOD: A sample of 180 (6- to 12-year-old) children due to have dental treatments under LA were randomly allocated to the modelling video or the control video (oral hygiene instruction). The level of anxiety was recorded before and after watching the video on the Abeer Children Dental Anxiety Scale (ACDAS) and the child's ability to cope with the subsequent procedure was assessed on the visual analogue scale (VAS). A two group chi-square test was used as the basis for the sample size calculation; a significance level of 0.025 was chosen rather than the conventional 0.05 to avoid spurious results arising from multiple testing. RESULTS: Children in the test group had significantly less anxiety after watching the video than children in the control group throughout the subsequent dental procedure; in particular at the time of the LA administration (p <0.001). CONCLUSION: Video modelling appeared to be effective at reducing dental anxiety and has a significant impact on needle phobia in children.

Evaluation of a chronic disease management system for the treatment and management of diabetes in primary health care practices in Ontario: an observational study.

BACKGROUND: Computerized chronic disease management systems (CDMSs), when aligned with clinical practice guidelines, have the potential to effectively impact diabetes care. OBJECTIVE: The objective was to measure the difference between optimal diabetes care and actual diabetes care before and after the introduction of a computerized CDMS. METHODS: This 1-year, prospective, observational, pre/post study evaluated the use of a CDMS with a diabetes patient registry and tracker in family practices using patient enrolment models. Aggregate practice-level data from all rostered diabetes patients were analyzed. The primary outcome measure was the change in proportion of patients with up-to-date "ABC" monitoring frequency (i.e., hemoglobin A1c, blood pressure, and cholesterol). Changes in the frequency of other practice care and treatment elements (e.g., retinopathy screening) were also determined. Usability and satisfaction with the CDMS were measured. RESULTS: Nine sites, 38 health care providers, and 2,320 diabetes patients were included. The proportion of patients with up-to-date ABC (12%), hemoglobin A1c (45%), and cholesterol (38%) monitoring did not change over the duration of the study. The proportion of patients with up-to-date blood pressure monitoring improved, from 16% to 20%. Data on foot examinations, retinopathy screening, use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, and documentation of self-management goals were not available or not up to date at baseline for 98% of patients. By the end of the study, attitudes of health care providers were more negative on the Training, Usefulness, Daily Practice, and Support from the Service Provider domains of the CDMS, but more positive on the Learning, Using, Practice Planning, CDMS, and Satisfaction domains. LIMITATIONS: Few practitioners used the CDMS, so it was difficult to draw conclusions about its efficacy. Simply giving health care providers a potentially useful technology will not ensure its use. CONCLUSIONS: This real-world evaluation of a web-based CDMS for diabetes failed to impact physician practice due to limited use of the system. PLAIN LANGUAGE SUMMARY: Patients and health care providers need timely access to information to ensure proper diabetes care. This study looked at whether a computer-based system at the doctor's office could improve diabetes management. However, few clinics and health care providers used the system, so no improvement in diabetes care was seen.

Body mass index as a predictive factor of periodontal therapy outcomes.

Body mass index (BMI) and obesity are associated with the prevalence, extent, and severity of periodontitis. This study investigated the predictive role of overweight/obesity on clinical response following non-surgical periodontal therapy in patients with severe periodontitis. Two hundred sixty adults received an intensive course of non-surgical periodontal therapy. Periodontal status at baseline and 2 months was based upon probing pocket depths (PPD), clinical attachment levels (CAL), and whole-mouth gingival bleeding (FMBS) as assessed by two calibrated examiners. Generalized estimating equations (GEE) were used to estimate the impact of BMI and overweight/obesity on periodontal treatment response while controlling for baseline status, age, smoking status (smoker or non-smoker), and full-mouth dental plaque score. BMI (continuous variable) and obesity (vs. normal weight) were associated with worse mean PPD (p < .005), percentage of PPD > 4 mm (p = .01), but not with FMBS (p > .05) or CAL (p > .05) at 2 months, independent of age, smoking status, or dental plaque levels. The magnitude of this association was similar to that of smoking, which was also linked to a worse clinical periodontal outcome (p < .01). BMI and obesity appear to be independent predictors of poor response following non-surgical periodontal therapy.

Long-term effectiveness of intralesional triamcinolone acetonide therapy in orofacial granulomatosis: an observational cohort study.

BACKGROUND: It has been suggested that intralesional triamcinolone injections represent a safe and effective therapeutic strategy in controlling the permanent disfiguring swelling of orofacial granulomatosis (OFG). However, robust supporting evidence is lacking, due to the variable and inconsistent design of available studies. OBJECTIVES: To investigate whether a standardized regimen of intralesional triamcinolone has beneficial long-term effects on orofacial swelling of OFG. We also studied potential associations with a number of prognostic factors. METHODS: We designed a retrospective observational study of a homogeneous cohort of 22 well-phenotyped patients with OFG. The primary outcome was defined as a statistically significant decrease in post-treatment disease severity. Statistically significant association with prognostic factors was the secondary outcome. Statistical analysis included Wilcoxon signed-rank tests and logistic regression. RESULTS: Compared with pretreatment, there were statistically significant decreases in disease severity scores at all time points until 48 months post-treatment (P < 0·01). Logistic regression analysis showed there was no independent prognostic variable of statistical significance (P > 0·05). The majority of patients (14/22, 63·6%) received one course of intralesional triamcinolone and did not experience disease recurrence. The mean disease-free period after the first course of intralesional therapy was 28·9 ± 18 months (95% confidence interval 28·7-29·1). No adverse effects were reported. CONCLUSIONS: This is the first study to have employed robust cohort methodology and sound statistics to demonstrate long-term effectiveness of intralesional triamcinolone in controlling the disfiguring swelling of OFG. Because of limitations inherent in observational studies, further research in the form of randomized case-control trials is needed to confirm the present findings.

Oral health and impact on performance of athletes participating in the London 2012 Olympic Games: a cross-sectional study.

BACKGROUND: Oral health is important both for well-being and successful elite sporting performance. Reports from Olympic Games have found significant treatment needs; however, few studies have examined oral health directly. The aim of this study was to evaluate oral health, the determinants of oral health and the effect of oral health on well-being, training and performance of athletes participating in the London 2012 Games. METHODS: Cross-sectional study at the dental clinic within the Polyclinic in the athletes' village. Following informed consent, a standardised history, clinical examination and brief questionnaire were conducted. RESULTS: 302 athletes from 25 sports were recruited with data available for 278. The majority of athletes were from Africa, the Americas and Europe. Overall, the results demonstrated high levels of poor oral health including dental caries (55% athletes), dental erosion (45% athletes) and periodontal disease (gingivitis 76% athletes, periodontitis 15% athletes). More than 40% of athletes were 'bothered' by their oral health with 28% reporting an impact on quality of life and 18% on training and performance. Nearly half of the participants had not undergone a dental examination or hygiene care in the previous year. CONCLUSIONS: The oral health of athletes attending the dental clinic of the London 2012 Games was poor with a resulting substantial negative impact on well-being, training and performance. As oral health is an important element of overall health and well-being, health promotion and disease prevention interventions are urgently required to optimise athletic performance.

The influence of maxillary central incisor height-to-width ratio on perceived smile aesthetics.

OBJECTIVE: To determine the influence of varying the width-to-height ratio of maxillary central incisors on perceived smile aesthetics. DESIGN: Cross-sectional study. SETTING: Postgraduate dental teaching hospital. METHODS: A posed female smile was digitally modified using Adobe Photoshop(®). Three images were created; central incisors with normal form, tooth wear and delayed apical migration. For each image the length of the teeth was altered to create a set of nine images with normal form (66% to 96% width-to-height ratios), and sets of five images with tooth wear and with delayed apical migration (78% to 96% ratios). The images in each set were ranked in order of most to least attractive by 32 dentists, 32 technicians and 32 patients. RESULTS: An 82% width-to-height ratio was perceived as the most attractive for normal central incisors although there is variability in the responses. There is a definite trend towards the extremes of very long or very short teeth being less attractive. The very long central incisors, and those with tooth wear were perceived as unattractive. The patients rated fewer images from the tooth wear and delayed apical migration sets as unattractive compared to the dentists and technicians. CONCLUSION: The width-to-height ratios perceived as most attractive correspond with the higher end of ideal ratios proposed in the dental literature (75-80% width-to-height ratio). Significant differences exist between the aesthetic perceptions of dentists, technicians and patients and there is lack of agreement within each group, in particular within the patient group. The individual variability in patient response should be taken into account during treatment planning.

Survival analysis of composite Dahl restorations provided to manage localised anterior tooth wear (ten year follow-up).

OBJECTIVE: To evaluate ten-year survival and clinical performance of resin-based composite restorations placed at increased vertical dimension as a 'Dahl' type appliance to manage localised anterior tooth wear.Design A prospective survival analysis of restorations provided at a single centre.Setting UK NHS hospital and postgraduate institute. METHODS: The clinical performance of 283 composite resin restorations on 26 patients with localised anterior tooth wear was reviewed after a ten year follow-up period. The study used modified United States Public Health Service (USPHS) criteria for assessing the restorations. Survival of the restorations was analysed using Kaplan-Meier survival curves, the log-rank test, and the Cox proportional hazards regression analysis. RESULTS: The results indicated that the median survival time for composite resin restorations was 5.8 years and 4.75 years for replacement restorations when all types of failure were considered. The restorations commonly failed as a result of wear, fracture and marginal discoloration. The factors that significantly influenced the survival of these restorations were the incisal relationship, aetiology, material used, and the nature of opposing dentition. The biological complications associated with this treatment regime were rare. Patient satisfaction remained high despite the long term deterioration of the restorations. CONCLUSION: With some degree of maintenance, repeated use of composite resin restorations to treat localised anterior tooth wear at an increased occlusal vertical dimension is a viable treatment option over a ten-year period.

Statistical power in testing a hypothesis.

In comparing or assessing methods of treatment it is vital that the appropriate number of patients is selected in order to ensure that the conclusions drawn are statistically viable. This annotation describes the relevance of a statistical power analysis in the context of hypothesis testing to the determination of the optimal sample size of a study. The power of the test indicates how likely it is that the test will correctly produce a statistically significant result.

Histology, immunocytochemistry and qRT-PCR analysis of Atlantic salmon, Salmo salar L., post-smolts following infection with infectious pancreatic necrosis virus (IPNV).

Infectious pancreatic necrosis (IPN) is a very serious viral disease in terms of its impact on production of Atlantic salmon, Salmo salar L., fry and post-smolts. Post-smolts of Atlantic salmon were injected with infectious pancreatic necrosis virus (IPNV) and cohabited with naive fish to produce natural infection. Cohabitant fish were sampled every 2 days, up to day 36 post-infection (p.i.). From 90 cohabitant fish, 11 (12.2%) were positive by immunohistochemistry (IHC). The first detection of IPNV by IHC occurred on day 16 p.i. which coincided with the onset of mortality in this group. Besides the pancreas, the liver was found to be a key target organ for IPNV. For the first time, the virus was observed in the islets of Langerhans and in the kidney corpuscles of Stannius which suggests that the virus could affect the fish's metabolism. The liver of two fish, which showed the most widespread presence of IPNV by IHC, had a pathology including focal necrosis and widespread presence of apoptotic hepatocytes, many of which did not stain for virus by IHC. Up-regulation of cytokine gene expression was found only in the IHC-positive (IHC+ve) fish and reflected the level of infection as determined by IHC positivity of the liver. In most fish, interferon (IFN), Mx, γIFN and γIP were up-regulated in liver and kidney, while only IFN and Mx were up-regulated in gill. IL1ß and TNFα were not induced in any tissue. The gill showed variable levels of constitutive expression of IL1ß and γIFN. The two fish with liver pathology had the highest level of IFN expression, especially relative to the level of Mx expression, in the liver compared with the other IHC+ve fish which did not have a liver pathology. The results suggest that following widespread infection of hepatocytes, the cells may over-produce IFN, resulting in apoptosis of neighbouring cells with subsequent death from liver failure.

Method agreement analysis: a review of correct methodology.

The correct approach to analyzing method agreement is discussed. Whether we are considering agreement between two measurements on the same samples (repeatability) or two individuals using identical methodology on identical samples (reproducibility) or comparing two methods, appropriate procedures are described, and worked examples are shown. The correct approaches for both categorical and numerical variables are explained. More complex analyses involving a comparison of more than two pairs of data are mentioned and guidance for these analyses given. Simple formulae for calculating the approximate sample size needed for agreement analysis are also given. Examples of good practice from the reproduction literature are cited, and common errors of methodology are indicated.