bluuebunny/crossref_metadata_2025 huggingface dataset:
The Formation of Hydroxyapatite-Ionomer Cements at 38°C
Authors: TenHuisen K.S. , Brown P.W.
Published: July 2017

This study describes the formation of a calcium polyacrylate-hydroxyapatite cement. Our hypothesis was that calcium phosphates would rapidly hydrolyze in the presence of polyacrylic acid (PAA) to form a cement. PAA, tetracalcium phosphate (TetCP), and dicalcium phosphate (DCP) were reacted together and formed calcium polyacrylate (CPA) and hydroxyapatite (HAp) within 10 h at 38°C, resulting in hardened masses. Reaction times increased with decreasing (HA preactants)/PAA ratios. In the first of three reaction stages, the pH increased while CPA and dicalcium phosphate dihydrate (DCPD) formed. Two steady-state pH conditions occurred during the second stage as TetCP reacted with DCPD and DCP. The first steady-state pH was the result of DCPD and TetCP reacting at near-equilibrium conditions. The second steady-state pH resulted as the reaction became limited by DCP dissolution. The third, diffusionally controlled, stage occurredas DCP and previously formed HA preacted to produce calcium-deficient HAp (Ca/P=1.5). The emphasis of this investigation was to establish the mechanistic path involved and the rate-limiting steps of the reaction.
Procedures for Establishing Efficacy of Antimicrobial Agents for Chemotherapeutic Caries Prevention
Authors: ten Cate J.M. , Marsh P.D.
Published: July 2017

s. Chemotherapeutics are presently considered for use in caries-preventive programs. The laboratory and in vivo testing of these agents, to some extent, parallels the methodology developed for the evaluation of fluoride products. However, fluoride is primarily effective by interfering with the deand remineralization balance between enamel and the oral fluids. Antimicrobial and chemotherapeutic agents interfere with the bacterial colonization, growth, and metabolism of dentalplaque. The initial selection of promising agents isdone, therefore, by determination of the minimum inhibitory concentration (MIC) against a wide range of relevant bacterial species, together with tests of the effects of sub-MIC levels on the expression of virulence factors. In the hierarchy of tests proposed in this paper, studies of bacterial adhesion and enamel caries models form the next phase in the evaluation of agents. Also, mixed-culture studies are recommended to determine how a treatment perturbs a stable microflora. A final stage before clinical testing might involve intra-oral studies on limited numbers of volunteers. These should be tests of intra-oral substantivity and activity of the agents in formulated products, and in situ models of enamel caries lesion formation and remineralization. The latter type of study seems particularly appropriate to ensure that new agents do not decrease the efficacy of the other active components (e.g., fluoride) in caries-preventive products.
Within-subject Coronal Caries Distribution Patterns: An Evaluation of Randomness with Respect to the Midline
Authors: Hujoel P.P. , Lamont R.J. , DeRouen T.A. , Davis S. , Leroux B.G.
Published: July 2017

The distribution of caries among homologous surfaces can exhibit three possible patterns: random, aggregated, or regular. In a random caries pattern, caries lesions are randomly distributed among homologous surfaces. An aggregated caries pattern is distinguished by the aggregation of lesions on one side of the mouth or the other to a greater extent than would be expected by chance alone. For a regular caries pattern, the left-right distribution of lesions is more homogenous than would be expected by chance alone. A test statistic based on the left-right distribution of caries lesions among discordant homologous pairs was developed to investigate which of these three caries patterns is present in a representative sample of the adult United States population. The data originated from the National Survey of Oral Health in the US (Employed Adults), 1985-1986. Of the 15,132 subjects studied, 12,776 subjects had 2 or more decayed or filled teeth. (At least 2 carious or filled teeth are required for detection of patterns.) Approximately 50% of these subjects (n = 6,439) had two or more discordant homologous tooth pairs. With these tooth pairs, the hypothesis of a random caries pattern was rejected in favor of an aggregated caries pattern (p < 0.0001). Similar findings were obtained with discordant homologous surface pairs. This aggregation of caries on one side of the mouth or the other may be due to genetic, infectious, and/or environmental factors.
Formation of Afibrillar Acellular Cementum-like Layers Induced by Alkaline Phosphatase Activity from Periodontal Ligament Explants Maintained in vitro
Authors: Groeneveld M.C. , Everts V. , Beertsen W.
Published: July 2017

Fibroblasts of the periodontal ligament, by their alkaline phosphatase (ALP) activity, are considered to play a role in the formation of acellular cementum. As a means of exploring this hypothesis, periodontal ligament explants from rat incisors were cultured in direct contact with bovine dentin slices in the presence of 10 mmol/L β-glycerophosphate. Periosteal and pericardial tissue explants were maintained under similar conditions. After two weeks, the slices were harvested and processed for electron microscopic examination. Controls included periodontal ligament explants to which the ALP-inhibitor levamisole was added. The results suggest that only ALP-positive cultures from periodontal ligament and periosteum form mineralized layers along the dentin. After demineralization, layers consisted of fine filamentous or granular material of moderate electron-density and resembled afibrillar acellular cementum. Our findings support the hypothesis that periodontal ligament fibroblasts, by means of their ALP activity, play a pivotal role in the formation of acellular cementum.
Cystatins S and C in Human Whole Saliva and in Glandular Salivas in Periodontal Health and Disease
Authors: Henskens Y.M.C. , Veerman E.C.I. , Mantel M.S. , van der Velden U. , Nieuw Amerongen A.V.
Published: July 2017

Cystatins are inhibitors of cysteine proteinases and could play a protective and regulatory role under inflammatory conditions. Since total cystatin activity of whole saliva was increased in periodontal patients (Henskens et al., 1993), we wanted to investigate the types or origins of cystatins involved in this increase. Distinct types of cystatins were identified by isoelectric focusing and immunoblotting with specific antibodies against one of the salivary acidic isoforms, cystatin S, and the widely distributed basic cystatin C. Clarified human whole saliva (CHWS) of healthy subjects contained cystatin S, whereas cystatin C was barely detectable. In contrast, in CHWS of gingivitis and periodontitis patients, both cystatin C and S levels were higher. The origin of cystatin activity was investigated by collecting submandibular (SM), sublingual (SL), and parotid (PAR) saliva from seven subjects with mild gingivitis. Total cystatin activity was about five times higher in SM saliva than in PAR saliva. In SM and SL saliva, both cystatins S and C were demonstrated. In contrast, in PAR samples, solely cystatin C was detectable. The introduction of experimental gingivitis in one periodontally healthy subject resulted in the appearance of a cystatin C band in PAR saliva and in an increase of cystatins S and C in SM saliva. We conclude that the previously observed increase of cystatin activity in whole saliva in inflammatory periodontal disease is, at least in part, due to an increased glandular output of both the isof orm cystatin S (pI 4.7) and the basic cystatin C (pI 9.0).
The Effect of Environmental pH and Fluoride from the Substratum on the Development of Biofilms of Selected Oral Bacteria
Authors: Li Y.H. , Bowden G.H.
Published: July 2017

The present study was initiated to answer the question, "Does fluoride from the substratum influence the accumulation of bacterial cells in an associated biofilm?" 'Fluoride-bound hydroxyapatite' (FHA) and 'fluoride-free hydroxyapatite' (HA) rods were prepared as test and control surfaces, respectively. Biofilms of S. mutans BM71, A. naeslundii genospecies 2 WVU627, and L. casei BM225 accumulated on the surfaces of rods in a semi-defined, mucin-based medium in a chemostat. Culture conditions were varied from pH 4.5 to 7.0 under carbon (glucose) limitation and excess, at a dilution rate of D = 0.1 h-1. Low environmental pH reduced both the numbers of cells on HA surfaces during the early phases (from 0 to 2 h) of accumulation and the final numbers of cells in mature biofilms (20 h). The initial adherence of cells was unaffected by surface fluoride under any of the conditions tested. Similarly, biofilm cells under carbon limitation and those under carbon excess at pH 7.0 were not affected by surface fluoride. However, at low environmental pH values, pH 5.5 for S. mutans and pH 6.0 for A. naeslundii under glucose excess, the accumulation of biofilm cells on the FHA surfaces was significantly reduced (p < 0.05-0.001). Biofilm cell number doubling times of S. mutans and A. naeslundii were increased on FHA relative to HA. Biofilms of L. casei were not significantly affected, even at pH 4.5 in glucose excess. The results confirmed that fluoride from the substratum affected fluoride-sensitive biofilm cells but only under conditions of glucose excess and low pH.
Quantity of Remaining Double Bonds of Propanal-containing Resins
Authors: Peutzfeldt A.
Published: July 2017

Improved mechanical properties of resin composites have been reported to be a consequence of the addition of aldehyde to the resins. The objective of the present study was to examine whether this improvement could be attributed to an increased degree of conversion of double bonds. For this purpose, propanal was added to monomer mixtures, which were then made light-curing. The monomer mixtures were varied with respect to monomer composition and content of propanal. The quantity of remaining double bonds was determined by means of transmission infrared spectra of the resins recorded before and after wet or dry storage for one week. The addition of propanal resulted in a decrease in the quantity of remaining double bonds by as much as 89% as compared with the mixtures without propanal. Negative correlations of statistical significance were found between the content of propanal and quantity of remaining double bonds in BISGMA:TEGDMA-based as well as in UEDMA:HEMA-based resins for both modes of storage. Significant negative correlations were found between the quantity of remaining double bonds and the previously determined mechanical properties.
Clinical Status of Ten Dentin Adhesive Systems
Authors: Van Meerbeek B. , Peumans M. , Verschueren M. , Gladys S. , Braem M. , Lambrechts P. , Vanherle G.
Published: July 2017

Laboratory testing of dentin adhesive systems still requires corroboration by long-term clinical trials for their ultimate clinical effectiveness to be validated. The objective of this clinical investigation was to evaluate, retrospectively, the clinical effectiveness of earlier-investigated dentin adhesive systems (Scotchbond, Gluma, Clearf il New Bond, Scotchbond 2, Tenure, and Tripton), and to compare their clinical results with those obtained with four modern total-etch adhesive systems (Bayer exp. 1 and 2, Clearfil Liner Bond System, and Scotchbond Multi-Purpose). In total, 1177 Class V cervical lesions in the teeth of 346 patients were restored following two cavity designs: In Group A, enamel was neither beveled nor intentionally etched, as per ADA guidelines; in Group B, adjacent enamel was beveled and conditioned. Clinical retention rates definitely indicated the improved clinical efficacy of the newest dentin adhesives over the earlier systems. With regard to adhesion strategy, adhesive systems that removed the smear layer and concurrently demineralized the dentin surface layer performed clinically better than systems that modified the disorderly layer of smear debris without complete removal. Hybridization by resin interdiffusion into the exposed dentinal collagen layer, combined with attachment of resin tags into the opened dentin tubules, appeared to be essential for reliable dentin bonding but might be insufficient by itself. The additional formation of an elastic bonding area as a polymerization shrinkage absorber and the use of a microfine restorative composite apparently guaranteed an efficient clinical result. The perfect one-year retention recorded for Clearfil Liner Bond System and Scotchbond Multi-Purpose must be confirmed at later recalls.
The Effect of Nerve Injury on the Incidence and Distribution of Branched Pulpal Axons in the Ferret
Authors: Foster E. , Robinson P.P.
Published: July 2017

In a previous electrophysiological study in ferrets, we demonstrated that some axons in the inferior alveolar nerve branch to supply the pulps of two teeth. We have now investigated the incidence and distribution of branched pulpal axons at various intervals after nerve injury and subsequent regeneration, to study the extent to which the innervation of the teeth returns to normal. In adult male ferrets under anesthesia, the left inferior alveolar nerve was either sectioned (31 animals) or crushed (10 animals). Following recovery periods of six weeks, three months, or one year after nerve section and three months after nerve crush, electrophysiological recordings were made by insertion of pairs of Ag/AgCl electrodes into cavities cut into left mandibular teeth. Electrical stimuli were applied to each tooth in turn, and averaged responses were recorded individually from the other teeth. Latency and amplitude of the action potentials were used to characterize responses from branched pulpal axons. For some branched units, the point of branching was established by determination of the site of the inferior alveolar nerve section which abolished the response. When compared with controls, the results indicated that, following short recovery periods after nerve section, there was an increase in the number of branched pulpal axons supplying non-adjacent teeth, and this branching had occurred at the initial site of nerve injury. Following long recovery periods, there were fewer branched axons than at earlier stages of recovery, but this apparent remodeling had not selectively eliminated axons which branched at the injury site to supply widely separated targets. Nerve crush injury resulted in no increase in the incidence of branched pulpal axons, and branching at the injury site was rare. We conclude that nerve section, but not nerve crush, alters the incidence and distribution of branched pulpal axons.
System for the pH-dependent Release of a Dye in Model Dental Restorations
Authors: Shen C. , Sarrett D. , Batich C.D. , Anusavice K.J.
Published: July 2017

We are developing a system for detecting recurrent caries under dental restorations. The controlled release of dyes under conditions of likely demineralization will alert the dentist to potential secondary caries. Production of acidic species is a characteristic of caries activity; hence, the system uses pH-sensitive polymers to release markers when the pH at the cavity wall of the restored tooth is below 6.5. The objectives of this investigation were to test the hypotheses that (1) the proposed system can be designed to release detectable marker continuously for at least six months in a simulated carious environment, and (2) the transient pH changes in the oral cavity caused by simulated dietary intake will not induce premature marker release from the pH-sensitive polymer placed beneath restorations. Two types of dye-loaded microspheres based on styrene, vinylpyridine, and divinylbenzene were prepared and placed on the floor of model cavity preparations made from an acrylic rod. Each model cavity was restored with a hybrid dental composite, placed in a vial with 5 mL of sodium-lactate/lactic-acid base buffer solution, and stored at 37°C. Solutions of three different pH values were used: 2.86, 4.73, and 6.39. The dye release into storage media was monitored periodically with a UV/VIS spectrophotometer. Results showed that the duration could extend beyond six months for pH > 4.73, and that transient oral pH changes are not likely to result in premature dye release. The data indicate that it would take approximately 21 days for the acidic agent external to the restoration to initiate dye release from restored sites.
Heat-treatment-induced Reduction in the Apparent Solubility of Human Dental Enamel
Authors: Hsu J. , Fox J.L. , Higuchi W.I. , Otsuka M. , Yu D. , Powell G.L.
Published: July 2017

Holcomb and Young (1980) have shown a significant increase in human dental enamel (HE) structural order resulting from heat treatment in the temperature range of from 275 to 400'C. Also, previous work in our laboratory had shown dramatic decreases in the initial dissolution rates (IDRs) of both carbonated apatite (CAP) heated at similar temperatures (from 300 to 500°C) and HE exposed to CO2 laser irradiation for which calculated surface temperatures were in this same range. We hypothesize that thermal treatment shifts the apparent solubility distribution profile of HE toward lower apparent solubilities, paralleling the observed increase in crystal structural order and the decrease in IDRs. Powdered HE was heated in a furnace at temperatures ranging from 150 to 500'C for 24 hours. The apparent solubility distributions of both heated and unheated HE powders were measured by equilibration for 24 hours in a series of partially saturated solutions simulating various amounts of HE dissolved in a pH 4.5 dissolution medium. The apparent solubility distribution for the unheated HE showed a peak at KHAP [the ion activity product based on the Ca10(PO4)6(OH)2 stoichiometry] of 10-121.0. Heat treatment shifted the apparent solubility distribution to lower solubilities: The peak KHAP values were ∼10-124.8 at 200°C; ∼10-127.8 at 300°C; and ∼10-129.1 from 400 to 500°C. This ∼8 orders of magnitude decrease in KHAP for HE heated at from 400 to 500°C correlates with the previously observed reduction in the IDR driving force for laser-treated HE experiencing a similar surface temperature. Furthermore, this decrease in the apparent solubility coincides with the dramatic increase in HE structural order occurring in this temperature range, as observed by Holcomb and Young.
Comminution of Food with Mandibular Implant-retained Overdentures
Authors: Geertman M.E. , Slagter A.P. , van Waas M.A.J. , Kalk W.
Published: July 2017

When complete-denture wearers are treated with from four to six implants and mandibular implant-borne prostheses, masticatory performance improves. No significant improvement has been observed with two implants and implant-mucosa-borne overdentures, suggesting that the masticatory performance of edentulous subjects depends on the degree of support for their mandibular prostheses by implants or alveolar mucosa. To verify this hypothesis, we studied, in a randomized clinical trial, the comminution of an artificial test food during mastication. The trial involved the provision of a new maxillary denture and either a new conventional mandibular denture, a mandibular overdenture retained by two permucosal cylindric implants through a single bar-clip attachment, or a mandibular overdenture retained by a transmandibular implant through five clips on a triple-bar construction with cantilever extensions. In comparison with the subjects wearing mandibular implant-retained overdentures, the subjects with conventional complete dentures needed between 1.5 and 3.6 times more chewing strokes to achieve an equivalent reduction in particle size. No differences in masticatory performance and efficiency were found between the subjects who had received two permucosal cylindric implants and those who had received a transmandibular implant. The results suggest that the increased retention and stability of the mandibular denture, rather than the degree of support by implants or alveolar mucosa, determine the wearer's ability to comminute food during mastication.
Coronal Caries in the Primary and Permanent Dentition of Children and Adolescents 1–17 Years of Age: United States, 1988–1991
Authors: Kaste L.M. , Selwitz R.H. , Oldakowski R.J. , Brunelle J.A. , Winn D.M. , Brown L.J.
Published: July 2017

The Third National Health and Nutrition Examination Survey-Phase 1, conducted from 1988 to 1991 in the United States, included an assessment of dental caries in US children and adolescents and provided the opportunity for differences in dental caries status to be viewed by age, sex, race, and race-ethnicity. The measurement of dental caries in children and adolescents from 2 to 17 years of age included the number of decayed, missing, and filled permanent tooth surfaces and teeth, and the number of decayed and filled primary tooth surfaces and teeth. Additionally, a brief visual inspection for the presence or absence of early childhood caries in the maxillary incisors was conducted for children 12 to 23 months of age. The survey yielded weighted estimates for 1988–1991 for over 58 million US children and adolescents 1 to 17 years of age. For infants aged 12 to 23 months, 0.8% were scored positive for early childhood caries. Over 60% (62.1%) of the children aged 2 to 9 years were caries-free in their primary dentition. Over half (54.7%) of the children 5 to 17 years were caries-free in their permanent dentition. The occurrence of caries in the permanent dentition is clustered: A quarter of the children and adolescents ages 5 to 17 with at least one permanent tooth accounted for about 80% of the caries experienced in permanent teeth. Differences in caries experience were found among race and race-ethnicity subpopulations, and caries patterns for the primary and permanent dentition were dissimilar. Further analyses are needed to explore other potential determinants of caries in children.
Tooth Retention and Tooth Loss in the Permanent Dentition of Adults: United States, 1988–1991
Authors: Marcus S.E. , Drury T.F. , Brown L.J. , Zion G.R.
Published: July 2017

While the overall prevalence of tooth loss and edentulism has been declining in the United States over the past several decades, important variations remain among subgroups of the population. Data from Phase 1 of the Third National Health and Nutrition Examination Survey (NHANES III) provide the most current estimates of the prevalence and distribution of tooth retention and tooth loss in the United States. Weighted analyses were conducted for all adults 18+ years of age (n = 8,366) and for selected age, gender, and race-ethnicity groups. In 1988–91, 89.5% of the population was dentate, and 30.5% had retained all 28 teeth. The mean number of teeth retained was 21.1 for all adults and 23.5 for dentate persons. The most commonly retained teeth in the mouth were the six anterior teeth in the lower arch. Conversely, 10.5% of the population was edentulous. Partial edentulism was much more common in the upper arch than in the lower arch. The most commonly missing teeth were the first and second molars. Age was strongly related to every measure of tooth retention and tooth loss. Gender was not related to any of these measures, after adjustment for age. Race-ethnicity was consistently related to these measures, after adjustment for age and gender. In general, Mexican-Americans had the lowest and black non-Hispanics the highest rates of tooth loss. Future research needs to examine a wide range of potential correlates of tooth retention and tooth loss before we can understand the complex interplay among the personal, dental, and environmental factors influencing tooth retention and tooth loss in the United States.
Denture Use and the Technical Quality of Dental Prostheses Among Persons 18–74 Years of Age: United States, 1988–1991
Authors: Redford M. , Drury T.F. , Kingman A. , Brown L.J.
Published: July 2017

For persons without all or some of their natural teeth in one or both arches, the use of a complete or partial denture and the quality of the denture used are important aspects of their oral health and functioning. This report of prosthodontic findings from the first three years of the 1988–94 National Health and Nutrition Examination Survey (NHANES III-Phase 1) provides estimates of denture use among the US civilian non-institutionalized population 18–74 years of age, as well as seminal information on the technical quality of dental prostheses nationwide.

NHANES III-Phase 1 prosthodontic findings indicate that about one in five persons 18–74 years of age wears a removable prosthodontic appliance of some type. Overall, removable prosthodontic appliances are worn disproportionately more often by women than by men, and less frequently by whites than by blacks. Comparisons among race-ethnicity categories indicate that Mexican-Americans are less likely to use dentures than either of their non-Hispanic counterparts. Analyses of prosthodontic evaluation data indicate that approximately 60% of denture users have at least one problem with a denture.

These findings from the oral component of NHANES III-Phase 1 provide clear indications that, despite increasing trends in tooth retention, dependence on removable prosthodontic appliances is still a reality of life for millions of Americans.
The Relationship Between Subjective Measures of Nasality and Measures of the Oral and Nasal Sound Pressure Ratio
Authors: Clarke Wayne M.
Published: July 2017

The aim of this study was to determine the relationship between subjective and objective measure of nasality in male and female subjects who were considered to have normal speech. The findings indicated that although there was very little correlation between judged nasality ratings and measures of the oral and nasal sound pressure levels, there were a number of factors, such as the sex of the subject and the degree of nasality, which should be considered in all objective measures of this type.
Basil Mitchell
Authors: Hebblethwaite Brian
Published: July 2017

This brief account of Mitchell's life and work concentrates on his return to Anglicanism and his contribution, as an Oxford philosopher working against the stream, to metaphysics and Christian ethics. The influence on him of Austin Farrer and the key role he played in ‘The Metaphysicals’ and in C. S. Lewis's ‘Socratic Club’ are emphasized. There follows an account of Mitchell's main publications in the fields of natural theology, faith and reason, and moral philosophy. Mention is also made of his work on purely theological matters, his contribution to Church of England working parties on ethical issues, and his involvement in the life and worship of the Church.
Jacques Maritain
Authors: Hughes John
Published: July 2017

This article traces the development and contrasts between the early and later political thought of Jacques Maritain, arguing that, beneath the superficial appearance of a radical move from papalist monarchical conservatism towards democratic liberalism, we can see deeper continuities: a consistent qualified support for democracy and religious freedom on the one hand, and an affirmation of the primacy of the spiritual over and against secular liberalism on the other.
Eschatology and the Fortunes of Early British Pentecostalism
Authors: Walsh Tim
Published: July 2017

Pentecostal Christianity's first significant manifestation on British soil is associated with the Sunderland clergyman, the Revd Alexander A. Boddy (1854–1939). Under his tutelage a recognizable movement came to forge its identity in Edwardian Britain. One of the notable features of this religious grouping was its propensity to 'talk about the end of the world'. This article explores both the bleakness of prominent eschatological views and the unique emphasis which enabled Boddy and his sympathisers, somewhat surprisingly, to marry dire prognostications with hope, optimism and exuberance. The ability to do so empowered the movement to consolidate and embark upon a second and more expansive phase of its evolution in the aftermath of the First World War.
Duodenal Ulcer Treated by Highly Selective Vagotomy
Authors: Arigbabu A O , Omole C O , Akinola D O
Published: July 2017

Over a period of 5 years 102 highly selective vagotomies (HSV) were performed. The cases selected excluded gastric outlet obstruction. The results show a significant cure rate of peptic ulcer, without any deaths. It is suggested that the high rate of recurrences and complications reported from other centres might be due to incomplete denervation, most likely due to variations of the nerve or damage to the nerve of Latarjet, amounting to truncal vagotomy — Complete or incomplete, depending on the nature and level of damage to the nerve. From our experience at this centre, HSV has given very good clinical results in the 5 years of review. The procedure is safe and without mortality.
Invagination for Richter-Type Strangulated Hernias
Authors: Horbach Joost M L M
Published: July 2017

A review is given of hernias in Busoga, Uganda. Special attention is paid to strangulated hernias with a Richter-type strangulation for which, in the case of necrotic bowel, on certain criteria, an invagination procedure was performed. The technique and criteria are described and the results are discussed. In less experienced hands, the invagination procedure is preferable to the more complicated resection and anastomosis.
Separation from Mother at Time of Weaning
Authors: Schmutzhard E , Poewe W , Gerstenbrand F
Published: July 2017

Weaning is an important factor in the aetiology of protein energy malnutrition (PEM). In the present study it was shown that the psychological aspects of weaning — i.e. separation from the mother — play a more important role in the development of PEM than do physical factors. Of children suffering from PEM, 80.4% were physically separated from the mother at time of weaning, whereas only 32% of a comparable healthy control group had undergone the trauma of separation.
Chronic kidney disease in primary care
Authors: Mitra Prabir Kumar , Bradley John R
Published: July 2017

It has been estimated that chronic kidney disease (CKD) affects about one in 200 of the population in the UK. There is an increased awareness of the need to identify patients in primary care with CKD at an earlier stage, so that treatments can be initiated to delay progression and prevent complications and appropriate nephrological referral can be made. In this article we will review how measures to identify patients with CKD can improve its management.
Paediatric specialist registrars’ views of educational supervision and how it can be improved: A questionnaire study
Authors: Lloyd B W , Becker D
Published: July 2017

Summary

Objectives

To determine what paediatric specialist registrars think of the educational supervision they have received and what advice they would give to a consultant who wanted to be a more effective educational supervisor.

Design

A questionnaire study.

Setting

The North Thames Deanery, UK.

Participants

129 year 3, 4 or 5 paediatric specialist registrars in the North Thames Deanery.

Main outcome measures

Reported value of educational supervision on a Likert scale; what elements of educational supervision were reported to be most useful; what elements of educational supervision were reported to be done poorly; what advice would specialist registrars give to a consultant who wanted to be a more effective educational supervisor.

Results

86/129 specialist registrars responded (67%). The mean score on the Likert scale (0-a complete waste of time; 100-excellent) was 57 with 37% of respondents giving a score of less than 50. The most valued aspects of educational supervision were: feedback on performance-cited by 50 respondents (56% of respondents); career advice-cited by 43 (48%); objective setting-cited by 36 (40%); pastoral support-cited by 25 (28%). Aspects of educational supervision that were reported to be often not done well were: commitment to educational supervision- cited by 44 respondents (49% of respondents); ensuring sessions are bleep-free-cited by 43 (48%); listening rather than talking-cited by 23 (26%); being encouraging-cited by 18 (20%). Advice to consultants about how to improve educational supervision included: listen rather than talk; be encouraging; treat the trainee as an individual with individual needs.

Conclusions

We can find no other study of trainees’ views about how educational supervision can be improved. Although some trainees found educational supervision very valuable, many did not. Educational supervision should only be carried out by consultants who are committed to the task. An educational supervisor should listen carefully in order to understand the trainee's individual ambitions and needs, should provide specific feedback on performance and should be encouraging.
Improvement in Academic Achievement through Enhancement of Perceptual and Sensory Integrative Functioning
Authors: Schroeder Ruth H.
Published: July 2017

The interdependence of psychological functions such as motor skills, perception, language, and cognition has been well documented by many (Hebb, Piaget, Kephart, Johnson and Myklebust, Frostig, Ayres, and de Quiros, to name a few). It is also quite well established that disorders of perception are concomitants of early academic problems. It is reported by Crosby and Liston (1976) that at least 10 per cent and perhaps as many as 15 per cent of children entering first grade may have neurologically based problems which will inhibit their academic progress. The process of learning is highly dependent upon adequate perceptual functioning (ability to interpret stimuli from the sense organs) as well as sensory integration (ability to filter, organize and integrate sensory information).
Kindergarten and First Grade Teachers’ Attitudes toward Early Entrants, Intellectually Advanced Students, and Average Students*
Authors: Jackson Nancy Ewald , Famiglietti Joseph , Robinson Halbert B.
Published: July 2017

The consistency of kindergarten and first grade teachers’ attitudes toward academically talented early entrants, relative to other types of students, was assessed in a survey conducted in a suburban school district. Teachers were asked to rank hypothetical candidates for their classrooms and to indicate the kinds of information about nonintellectual qualities that would be most helpful in evaluating each potential candidate. Kindergarten teachers consistently assigned lower ranks to early entrants than to other types of students; the rankings of first grade teachers were less consistent. Teachers who had taught early entrants did not assign higher ranks to these children than did teachers who lacked this experience. Information about a child's social maturity level was chosen as most helpful for evaluation of all types of children at both grade levels. Teachers suggested a variety of techniques for working with intellectually advanced students, but few made positive comments about the practice of early entrance. Procedures that might reduce teachers’ concerns about the social competence of early entrants are discussed.
Laser Endoscopic Treatment of Laryngoceles and Laryngeal Cysts
Authors: Myssiorek David , Persky Mark
Published: July 2017

The laryngocele and saccular cyst are uncommon anomalies of the larynx. Two patients, one with an Intemal laryngocele and one with a saccular cyst, were successfully treated by endoscopic laser marsupialization of their lesions. Since neither patient was found to be a suitable candidate for prolonged general anesthesia, the patients did not require a tracheotomy and were discharged the day after surgery. Both patients are doing well, with remarkable Improvement in their voices persisting in their three year follow‐up. The signs, symptoms, diagnosis, treatment, and Indications for endoscopic laser treatment of Intemal laryngoceles and saccular cysts are discussed. Laser marsupialization of Intemal laryngoceles appears to be an acceptable mode of treatment.
Vestibular Habituation Training: Exercise Treatment for Vertigo Based upon the Habituation Effect
Authors: Norré M. E. , Beckers A.
Published: July 2017

Vestibular habituation training is an exercise treatment for postional vertigo based on the assumption that such a type of vertigo can be cured by habituation effect. The latter is produced by repeating the situation eliciting vertigo. In this way the mechanisms of adaptation and compensation ore stimulated, processes of which have been considered “error controlled.” Clinical experience with the vestibular habituation training test battery (consisting of 19 maneuvers) showed that in each particular patient only a limited number of responses were positive in various combinations. Selecting the exercises is then a logical consequence. Followup showed a progressive reduction of the positive cases, as well as the number of positive maneuvers. This is in accordance with the development of compensation as it has been observed in experimental conditions and with the decline of progressive responses observed in habituation experiments.
Primary Placement of Osseointegrated Implants in Microvascular Mandibular Reconstruction
Authors: Urken Mark L. , Buchbinder Daniel , Weinberg Hubert , Vickery Carlin , Sheiner Alan , Biller Hugh F.
Published: July 2017

The goal of mandibular reconstruction is to rehabilitate the patient by restoring occlusal relationships, lower facial contour, oral continence, and a denture‐bearing surface. One of the major advantages of the use of vascularized bone over all other methods of mandibular reconstruction is its ability to achieve dental rehabilitation rapidly. The use of osseointegrated dental implants is a valuable adjunct in oral rehabilitation. It provides the most rigid form of stabilization to withstand the forces of mastication. In situations In which soft tissue reconstruction or the height of the alveolar ridge is not sufficient for a tissue‐borne denture, implants offer the most suitable alternative. Mandibular reconstruction with free tissue transfer techniques is Ideally suited for the placement of implants. These can be inserted at the time of mandibular reconstruction. Four months after surgery, when the integration process has occurred, the implants are unroofed, loaded, and ready for prosthetic placement. We will present several representative patients who underwent mandibular reconstruction with microvascular free bone transfer who have been successfully rehabilitated by osseointegrated implants. The process of osseointegration, different types of dental implants, and issues regarding radiation and Implants are discussed. This is the first report of dental rehabilitation by primary placement of dental implants in patients undergoing microvascular mandibular reconstruction.
Improved Preservation of Facial Nerve Function in the Infratemporal Approach to the Skull Base
Authors: Leonetti John P. , Brackmann Derald E. , Prass Richard L.
Published: July 2017

Although the infratemporal approach described by Fisch provides excellent exposure of the jugular foramen, intrapetrous carotid artery, and lateral skull base, the anterior displacement of the seventh cranial nerve often results In temporary facial paralysis. The use of a modified technique for facial nerve mobilization resulted In significant improvement of both early and final facial function. Since that earlier report, continuous intraoperative electrical facial nerve monitoring has been used during the infratemporal approach in 20 additional cases. Immediate postoperative facial function was normal in 93% of the monitored coses and In 70% of the cases in the unmonitored group. More Importantly, no patients in the monitored group developed grade V or VI weakness after surgery, whereas 48% of the unmonitored patients had grade V or VI weakness during the early postoperative period. This article will describe how intraoperative facial nerve monitoring is used during infratemporal surgery and will compare early facial function in 31 unmonitored patients with early facial function in 20 monitored procedures.
Electrically Stimulated Increases in Cochlear Blood Flow: II. Evidence of Neural Mediation
Authors: Sillman Jonathon S. , Masta Robert I. , LaRouere Michael J. , Nuttall Alfred L. , Miller Josef M.
Published: July 2017

In a companion paper, we reported that electrical stimulation increased cochlear blood flow (CBF). This response was found to be an increasing function of current intensity and was frequency‐selective, with the best response at approximately 500 Hz continuous sinusoidal current. The present investigation seeks to discover the mechanism of this effect. Direct measurement of cochlear temperature during electrical stimulation revealed no evidence of local heating. Autonomic neuronal activation is not likely, as neither atropine, hexamethonium, nor propranolol abolished the evoked CBF response. Strial activity could be suppressed by the use of furosemide, but the evoked CBF response persisted. Inactivation of auditory afferent neurons with kainic acid also did not change the evoked CBF response. Dimethyl sulfoxide, a potent oxygen‐free radical scavenger, did suppress the evoked CBF response to a small but significant degree. This suggests that oxygen‐free radicals may be produced within the cochlea during electrical stimulation. Finally, the evoked CBF response was completely suppressed by procaine and tetrodotoxin, with recovery of evoked CBF response accompanying recovery of cochlear action potentials. These data indicate that stimulation of neural fibers, distinct from autonomic and auditory afferent neurons, may modulate CBF.
A Comparison of Laser Doppler and Intravital Microscopic Measures of Cochlear Blood Flow
Authors: LaRouere M. J. , Sillman J. S. , Nuttall A. L. , Miller J. M.
Published: July 2017

Many inner ear disorders may be caused by alterations in cochlear blood flow (CBF). However, each measurement technique used to monitor CBF has limitations in examining the relationship between otopathologic states and blood flow. This study Investigates laser Doppler flowmetry (LDF) and its fundamental drawback: The unknown relationship of LDF output to actual CBF. LDF readings are directly compared with concurrent intravital microscopy (IVM) measures of erythrocyte velocity in the lateral wall of the guinea pig cochlea. Positive end expiratory pressure, spontaneous respiration of 5% and 10% carbon dioxide, phenylephrine, and direct electrical stimulation of the cochlea were used to manipulate CBF. High, positive correlations were found between simultaneous LDF and IVM measurements of CBF. In addition, the study demonstrated that current microdissection techniques used to perform IVM do not cause changes in CBF. IVM measurements of CBF are a more sensitive indicator of CBF changes than are LDF measures. Despite the high correlation between measurement techniques within a single manipulation, simultaneous LDF and IVM measurements differed between manipulations. This may reflect regional changes in CBF affected by these manipulations and differences in the sampled vascular beds contributing to these two measures. It is unlikely that a single calibration factor can be defined that would allow the conversion of LDF output to actual units of blood flow across different manipulations used to alter CBF.
Panendoscopy: A Valuable Procedure?
Authors: Hordijk G.J. , Bruggink T. , Ravasz L.A.
Published: July 2017

The significance of panendoscopy, performed as part of the routine diagnostic procedure, must be questioned when the incidence of synchronous primary tumors found by this procedure is only 1% to 2%, as in patients with head and neck cancer in the Dutch population. In order to detect a group of patients with a higher probability of secondary tumors, patients were selected for panendoscopy on the following criteria: Localization and histology of the index tumors, as well as on smoking and drinking habits. In spite of this selection, the yield of panendoscopy was still below 2%. Until other criteria for the selection of a subset of patients with a high incidence of synchronous tumours are found, the indication for panendoscopy as part of a routine diagnostic procedure has to be constantly questioned, and panendoscopy should therefore be performed only when this procedure is part of a prospective study.
Total Facial Nerve Decompression for Recurrent Facial Paralysis: An Update
Authors: Graham Malcolm D. , Kartush Jack M.
Published: July 2017

Recurrent facial paralysis (RFP) is a rare disorder that in some individuals may lead to worsening sequelae. Melkersson‐Rosenthal syndrome is a variant of RFP that is associated with recurrent facial edema. In the past, decompression of the mastoid segment of the facial nerve has not been successful in preventing recurrences. In 1981 we began performing total facial nerve decompression for RFP and in 1986 reported its efficacy in one patient with Melkersson‐Rosenthal syndrome and in another in whom both nerves were decompressed for alternating bilateral paralysis. An additional four cases with 3 to 8 years of followup demonstrate no recurrences in any patient. Total facial nerve decompression for RFP in selected patients appears efficacious in preventing recurrences. Decompression will remain investigational until further followup is obtained. Furthermore, its salutary effect should not be extrapolated to Bell's palsy without further Study.
Spinal Fluid Profile following Surgery in the Subarachnoid Space
Authors: Roland Peter S. , Meyerhoff William L. , Balcombe Kenneth L. , Mickey Bruce E.
Published: July 2017

Neurotologic and skull base procedures that include dissection within the subarachnoid space carry with them the potential for meningitis. Postoperative aseptic leptomeningitis occurs more frequently than purulent bacterial meningitis. Differentiation between these two conditions early in the postoperative period is important to avoid delay in or unnecessary treatment. The definitive diagnosis is made with cerebral spinal fluid culture. Early differentiation between postoperative aseptic leptomeningitis and purulent bacterial meningitis on the basis of results of cerebral spinal fluid profile before cerebral spinal fluid culture would result in earlier appropriate therapy.
Survival of the Vestibular Nerve after Labyrinthectomy in the Cat
Authors: Cass Stephen P. , Davidson Paul , Goshgarian Harry
Published: July 2017

Temporal bone studies in cat, monkey, and man demonstrate that the cell bodies of the primary vestibular neurons located in Scarpa's ganglion persist after labyrlnthectomy. However, it is not known whether the centrally directed axon process of deafferented vestibular neurons survive or degenerate after labyrinthectomy. If the central axon were to persist, then the primary vestibular neuron could influence vestibular compensation or produce symptoms of vestibular dysfunction. In the present study the temporal bones and brain stem of four cats were prepared for light microscopic examination with hematoxylin‐eosin, silver, and trichrome connective tissue stains. Cell counts within Scarpa's ganglion were performed. After labyrinthectomy, many intact axons were demonstrated in the brain stem, a finding that correlated with survival of neurons in Scarpa's ganglion. This study provides anatomic evidence that primary vestibular neurons that survive labyrinthectomy may retain their central axon processes. The persistence of this neural pathway and data from behavioral studies in the cat suggest that vestibular neurons may affect vestibular compensation after labyrinthectomy. Deafferented vestibular neurons may play a role in human vestibular compensation and dysfunction.