bluuebunny/crossref_metadata_2025 huggingface dataset:
Breast-Feeding and Postpartum Depression: Is There a Relationship?
Authors: Misri Shaila , Sinclair Dana A , Kuan Annie J
Published: January 2017

Objective:

To study the relationship between breast-feeding cessation and the onset of postpartum depression.

Method:

The association between breast-feeding and depression was retrospectively examined in an obstetrical outpatient sample of 51 postpartum women who were suffering from major depression and who had stopped breast-feeding. Self-report questionnaire data were obtained from the subjects; the severity of the illness and the clinical course of each subject were evaluated.

Results:

The majority (39 out of 51; 83%) of the women reported that their depression began before the cessation of breast-feeding, while only 8 patients (17%) stated that their depression was subsequent to breast-feeding cessation.

Conclusions:

In an outpatient sample of depressed postpartum women, the onset of depression preceded the cessation of breast-feeding. The severity of the illness did not appear to influence breast-feeding persistence significantly.
Building Your Practice with Fillers
Authors: Shippert Ron D.
Published: January 2017

Introduction:

The objectives of this article are to (1) evaluate the popular fillers as practice builders and (2) outline a typical practice builder program for the surgeon.

Methods:

Information was gained from a search of the literature, 25 years of clinical experience, and interviews as well as a survey of 35 physicians to determine present surgeon techniques. Fillers were graded 1–5 to qualify as an income generator (with 5 being the highest).

Results:

Autologous fat scores were higher than that of the other fillers, although any filler could be in a practice-builder program. All bioresorbable fillers will need additional fill to obtain the desired results, but fat has an added benefit of some eventual permanence. When more than 5 mL of filler is needed, fat has also has the most reasonable cost. The commercial fillers will cost $93 to $200 per milliliter. Autologous fat, even with the added cost of anesthesia, disposables, and a minor operating room setup, will be more economical for the patient in amounts greater than 5 mL. When the surgeon can charge less for the filler itself, there is more room for a fair professional fee. There are 3 instrument systems available for fat transfer on the market. These systems accomplish different goals; thus, all have their position in the marketplace. These systems include the TissuTrans, the LipiVage, and the Coleman type modified liposuction instruments. The latter includes all micro-cannula-type instruments. Since it has been established that fat trauma during transfer should be minimized, the system and technique that will give the least amount of trauma to the fat cell should be the first choice.

Conclusions:

There is now a resurgence of interest in autologous fat because of the very high costs of commercial substances. Because of public acceptance and the availability and cost of economical raw goods, autologous fat can be a key filler in a practice-builder program. To have a successful goal-oriented program, one must use lipocyte-friendly instruments and put a great deal of effort into training the staff. The program must be organized, advertised, marketed, and reviewed at specific intervals for improvement. NOTE: When speaking of the best practice-builder filler, it is assumed that the surgeon will follow ethical guidelines in choosing the best filler for the patient, not just the filler that fits his or her program.
Ethnic Rhinoplasty: A Universal Preoperative Classification System for the Nasal Tip
Authors: Hopping Steven B. , White Jeremy B.
Published: January 2017

Ethnic rhinoplasty is a complex procedure, particularly with respect to the nasal tip, that has a revision rate that is significantly higher than the rate for Caucasian surgery. Multiple authors have discussed what they propose as the ideal technique combinations in non-Caucasian rhinoplasty. The demand for rhinoplasty is increasing in these patient populations, but their facial features continue to diversify with the combination of characteristics from other ethnicities. This factor further complicates the preoperative thought process. We present a universal nasal tip classification system that emphasizes skin thickness and cartilage strength, rather than ethnic background, to overcome this challenge. This concept will aid surgeons in preoperative planning and will enhance their ability to communicate technical ideas to other surgeons.
The Treatment of Varicose Veins with Compression Sclerotherapy: Technique, Contraindications, Complications
Authors: Mantse Lefter
Published: January 2017

The history of the development of compression sclerotherapy (CS) is described, together with the presently widely used technique, its complications, and its contraindications. The analysis of 1000 patients seen during a 15-month period is described. Compression sclerotherapy was used alone on 343 patients and 20 patients had high ligation of the great saphenous before injection. There was no mortality and there were no significant complications.
Treatment of Extensive Alopecia Combining Scalp Reduction and Punch Grafting in Private Practice
Authors: Frechet Patrick
Published: January 2017

Use of scalp reduction and punch grafting in the treatment of stages V, VI, or VII extensive alopecia still poses questions which have not yet been completely resolved. Having completed a study I conducted with 100 patients, I can now answer the following questions:

What are the evaluation criteria to be used in determining whether a patient may be treated?

What is the maximum area of baldness that can be treated?

Can one expect redistribution of hair to the entire scalp in these patients?

Is there a particular scalp reduction procedure which is more suitable for the treatment of extensive alopecia?

Is it desirable to follow a particular chronology when administering this treatment?

Are these patients sufficiently motivated to continue treatment fully until its completion?

Finally, what questions still remain to be answered?
Syringe Liposuction with Immediate Lipotransplantation
Authors: Hin Lim Cheng
Published: January 2017

We are currently going through an exciting period of reviving an old and neglected method of extracting fat and transplanting it to various parts of the body for the purpose of aesthetic improvement. Many of us working in this field are actively monitoring and gathering scientific data so as to enable us to achieve the safest, simplest, and optimum technique. Although my experience in liposuction spans over a period of only 2 years, I have had many opportunities to evaluate various methods of extracting fat and harvesting it for autologous transplant. This article relates my recent experience with a technique first demonstrated to me by the French pioneer in this field, Dr. Pierre Fournier. It utilizes only the syringe and a 14-gauge needle or a cannula with a special fitting and does away with the bulky high-powered suction aspirator and harvesting devices. The suctioned fat is immediately transplanted, thus minimizing contamination. Infection is rare. Patients remain ambulant and can return to work in 24 to 48 hr.
Autologous Fat Transplantation: An Evaluation of Microcalcification and Fat Cell Survivability following (AFT) Cosmetic Breast Augmentation
Authors: Bircoll Mel
Published: January 2017

Since my introduction of the concept and techniques of autologous fat transplantation, considerable controversy has arisen over the amount of fat cell survivability and the possible formation of microcalcifications interfering with the diagnosis of breast carcinoma. An analysis of 5 years of experience using AFT in breast augmentation is presented. Maximum survival rates of fat cells exceed 80% and the incidence and control of microcalcification is discussed.
Subpalpebral SMAS Suspension as an Adjunct to Midface Osteoplasty during Orthognathic and Craniofacial Surgery
Authors: Jones John K. , Alexander Robert W. , Tiner Billy Don
Published: January 2017

A method of suspending the subpalpebral SMAS at the time of skeletal reconstruction to improve midface augmentation and enhance soft tissue bulk over skeletal fixation devices is presented. Concepts borrowed from refinements in rhytidectomy that improve soft tissue redraping in patients undergoing extensive midface subperiosteal dissection are described.
Use of Lasers in Cosmetic Surgery
Authors: Aspacio Reuel A. , Wheeland Ronald G.
Published: January 2017

Even though laser technology has been available for over 30 years, it has been only within the past 10–15 years that its applications have been exploited extensively for cosmetic surgical procedures. The expansion of laser technologies and applications is in part due to an improved knowledge of laser-tissue interaction, which has resulted in the development of many new and improved laser systems. With the large number of laser systems currently available, every cosmetic surgeon should have a working knowledge of the basic concepts of lasers, laser-tissue interactions, and the capabilities and limitations of each system, in order to maximize the potential benefits of laser systems in patient care.
Tattoo Removal: Selecting the Right Alternative
Authors: Ruiz-Esparza Javier , Fitzpatrick Richard E. , Goldman Mitchel P.
Published: January 2017

Because an ideal method for removing tattoos still eludes us, a plethora of alternatives described in the literature is available. Selecting the right treatment modality requires familiarity with both the advantages and the disadvantages of each technique being considered. This paper attempts to summarize the attributes and pitfalls of commonly used methods of tattoo removal to assist the surgeon in choosing the most suitable method.
Laser Surgery in Microgravity
Authors: Caleel Richard T. , Kuo Paul C. , Colvard Michael D.
Published: January 2017

Human activity in microgravity environments place flight crews at risk to injury that may require surgical triage and care. Current protocols developed to handle surgical care in microgravity are derived from earth-based wound care techniques. Fluid and debris containment, spacecraft environmental contamination, and expediency of wound care in microgravity remain as significant obstacles. For space based surgery, lasers may allow procedures for rapid stabilization of emergency or traumatic injuries, surgical fluid control, hemostasis, and reduce contamination of the aircraft environment. The purpose of this paper is to outline the basic concept of laser surgery in an aviation and microgravity environment using carbon dioxide, neodymium–yttrium—aluminum–garnet (Nd:YAG), KTP, and excimer laser incisions within high altitude, military, aviation, and microgravity environments.

“The plans for extending the human presence beyond the limits of Earth into space are: in the 1990s, to establish a permanent presence on the Space Station; in the first decade of the 21st century, to establish an outpost on the lunar surface, and to follow that in the second decade with an expedition to the surface of Mars.”

“The demands and potential hazards of space flight require that crew members maintain health and peak proficiency at all times.”

“Medical support for space station operations will require new philosophies and new technologies.”

“The major considerations in developing such a system … for use in a spacecraft are to provide a sterile environment as well as to prevent contamination of the cabin with blood and other debris while performing the surgery.”
The Minigraft Revolution: Can We Keep up Ethically?
Authors: Rassman William R.
Published: January 2017

Hair transplantation is fast becoming a boom industry. It is being fueled by a high demand for service, a short supply of providers, and a high value of product. As millions of bald or balding men and women are becoming more aware of self-improvement options, hair restoration is rapidly gaining more attention. One of the most significant problem confronting physicians entering the field of hair transplantation is the general unavailability of formal or informal training. The high value placed on the service reflects 1) the new technology of Minigrafting in Megasessions; 2) the general unavailability of trained physician in the art and science of modern hair transplantation techniques; and 3) the increasing demand for service. Physicians are rallying to the demand for service disproportionately to their ability to achieve a quality product. Great care must be taken not to allow one's enthusiasm to exceed one's skills and abilities.
Multiple Applications of GoreTex Soft Tissue Patch in Facial Plastic Surgery
Authors: Conrad Kris
Published: January 2017

This communication reveals multiple uses, versatility, predictability, and excellent tissue compatibility of GoreTex® membrane in facial plastic surgery. An outline of the technique relying on subcutaneous undermining as opposed to the threading method is provided. Five-year experience (in more than 127 patients) with the GoreTex soft tissue patch demonstrates good tolerance to implants up to 8 mm in thickness and 10 cm2 in area as a tissue filler in the face and neck region. No functional impairment has been documented with the use of large implants to correct nasal labial grooves or in lip augmentation.
Liposculpture in the Superficial Plane: Closed Syringe System for Improvements in Fat Removal and Free Fat Transfer
Authors: Alexander Robert W.
Published: January 2017

This article reviews and compares early beliefs regarding liposuction with improvements provided with utilization of the Tulip Closed Syringe System for liposculpting in the deep and superficial fat planes. Discussion of the mechanism of action of liposculpting with the tumescent is presented. Clinical series described comparing machine suction versus closed syringe system as the vacuum source. The closed syringe system has also afforded the opportunity to harvest fat cells at low pressure, and improved fat cell survival and predictability. Clinical efficacy, safety advantages, and importance of the closed syringe system relative to superficial plane liposculpting are presented. The article suggests an explanation of the intrinsic changes involved in the contour alterations created by liposculpture in the superficial plane.
Current Controversies in Hair Replacement Surgery
Authors: Swinehart James M.
Published: January 2017

Like zucchini seeds in Hawaii, implanted hair follicles will grow almost anywhere: the skill lies in the aesthetic placement and design of the “master plan” for each patient. In this article the author examines seven current controversies in hair replacement surgery. Different techniques, each successful for a significant group of hair replacement surgeons, are evaluated via discussion, table, references, and photographs. Successful hair replacement surgeons often achieve excellent results from a wide variety of techniques. Rather than providing dogmatic answers, the author hopes to stimulate the reader to explore new challenges in fields of clinical study for hair and scalp surgery.
Radiosurgical Donor Harvesting of Hair Transplant Grafts
Authors: Shory Carl B.
Published: January 2017

Various methods of donor graft harvesting have been developed over the past 40 years employing punches and scalpels. A new technique uses a radiowave surgical instrument to cut a strip, which is further sectioned to yield various-sized hair transplant grafts.
The Micrograft Implanter
Authors: Pignataro Anthony S.
Published: January 2017

With the advent of mini- and micrografting in hair transplantation, one has been able to create a more natural, refined hair line. When one considers the time and tedium, as well as the man hours needed to accomplish these results, it's only natural for one to look to simplify and speed the process. Our objective was to find an instrument that would easily implant micrografts and remain affordable. Our micrograft implanter, when used in an assembly line fashion, has decreased our operative time and improved our results. Additionally, we feel that our process is less traumatic than standard micrograft placement techniques.
Improved Scalp Reduction Results with Prolonged Acute Tissue Expansion (PÂTÉ)
Authors: Unger Martin G. , Solish Nowell J.
Published: January 2017

The purpose of this study was to develop a method to remove greater amounts of bald tissue during scalp reduction than has been previously reported with acute tissue expansion, by prolonging local anesthesia as well as the time period of acute tissue expansion. A new method for prolonging the local anesthetic effect was developed, and a tissue expander was placed under the hair- bearing scalp and attached to a tissue compliance measuring device in three patients. Through cyclic loading of the expander for an extended period of time, and with precise pressure monitoring, a marked improvement in scalp reduction results was achieved. All three patients responded dramatically to the procedure, with a 100% increase in the amount of scalp tissue that was removed in Patient 1, a 90% increase in Patient 2, and a 118% increase in Patient 3. Postoperative markings demonstrated minimal stretch-back. Prolonged acute tissue expansion (PÂTÉ) was demonstrated to be an extremely useful adjunct to scalp reduction.
Abdominoplasty: Pearls and Pitfalls
Authors: Pignataro Anthony S.
Published: January 2017

Advances in anesthesia, including improved sedating and amnestic agents as well as tumescent techniques, allow one to perform traditional abdominoplasty on an outpatient basis with greater safety and efficiency. Techniques for primary elimination of dog ears, periabdominal lipectomy, and repositioning of the umbilicus are discussed. Several cases are presented herein. With strict adherence to protocol and technique as well as good patient motivation and compliance, consistently excellent results are safely achieved.
Prevention of Epinephrine Reaction in Tumescent Liposuction with Atenolol (Tenormin)
Authors: Golden Richard R.
Published: January 2017

Patients who receive more than 3000 cc of tumescent solution occasionally develop potentially dangerous tachycardia, and may develop a paniclike reaction of symptomatic overload about 12 hours postoperatively. This article describes how premedication with the beta-blocker tenormin (atenolol) prevents this complication of tumescent liposuction anesthesia.
Eyebrow Transplantation: A Simplified Technique
Authors: Chastain G. Lynne , Duplantis Kathryn
Published: January 2017

Introduction:

Single hair grafts to the eyebrow, performed with a simple technique, offer today's cosmetic surgery patient a simple and natural-looking solution for alopecia of the eyebrow due to various causes, ranging from plucking and trauma to systemic and metabolic processes.

Methods:

We present a technique that requires simple instrumentation and the aid of 1 or 2 well-trained assistants. The procedure has been performed on 2 male and 18 female patients.

Results:

The procedure has resulted in a 96% graft survival rate, without complications, producing cosmetically pleasing outcomes.

Conclusions:

A simplified technique for eyebrow transplantation can easily and successfully effect a pleasing and natural look for today's cosmetic surgery patient.
Cardiac Valvular Disease in Asymptomatic Patients Who Have Had Antiobesity Medication
Authors: Shiffman Melvin A.
Published: January 2017

Introduction:

Antiobesity medications have been known to cause pulmonary hypertension and cardiac valvular disease. There is a risk in patients who have taken these medications of sudden hypotension when general anesthesia is induced. This article is a review of the current literature on the subject of valvular disease in asymptomatic patients who have taken antiobesity medications.

Materials and Methods:

The results of five independent surveys of patients who had been exposed to fenfluramine or dexfenfluramine but who had no obvious history of cardiac disease or cardiac symptoms were reviewed.

Results:

As detected by echocardiogram evaluation, the presence of significant valvular disease ranged from 30.0% to 38.3%. For patients having less than 3 months or 3 to 5 months of exposure to the drugs, 22% showed evidence of valvular disease. For patients exposed to the drugs for 6 or more months, the percentage showing valvular disease increased to 35%. An audible cardiac murmur was present in 17% of patients.

Discussion:

The American College of Cardiology issued recommendations that patients who have a history of fenfluramine or dexfenfluramine use undergo a careful cardiovascular physical examination, which should be followed by an echocardiogram in patients with cardiac murmurs or symptoms. The US Department of Health and Human Services Guidelines state that an echocardiogram should be performed on all patients who have taken these drugs.
Disturbed Jaw Behavior in Whiplash-associated Disorders during Rhythmic Jaw Movements
Authors: Häggman-Henrikson B. , Zafar H. , Eriksson P.-O.
Published: January 2017

As shown previously, “functional jaw movements” are the result of coordinated activation of jaw as well as neck muscles, leading to simultaneous movements in the temporomandibular, atlanto-occipital, and cervical spine joints. In this study, the effect of neck trauma on natural jaw function was evaluated in 12 individuals suffering from whiplash-associated disorders (WAD). Spatiotemporal characteristics of mandibular and concomitant head movements were evaluated for three different modes of rhythmic jaw activities: self-paced continuous maximal jaw-opening/-closing movements, paced continuous maximal jaw-opening/-closing movements at 50 cycles/minute, and unilateral chewing. Compared with healthy subjects, the WAD group showed smaller magnitude and altered coordination pattern (a change in temporal relations) of mandibular and head movements. In conclusion, these results show that neck trauma can derange integrated jaw and neck behavior, and underline the functional coupling between the jaw and head-neck motor systems.
Effectiveness of Silver Diamine Fluoride and Sodium Fluoride Varnish in Arresting Dentin Caries in Chinese Pre-school Children
Authors: Chu C.H. , Lo E.C.M. , Lin H.C.
Published: January 2017

Untreated dental caries in Chinese pre-school children is common. This prospective controlled clinical trial investigated the effectiveness of topical fluoride applications in arresting dentin caries. Three hundred seventy-five children, aged 3-5 years, with carious upper anterior teeth were divided into five groups. Children in the first and second groups received annual applications of silver diamine fluoride solution (44,800 ppm F). Sodium fluoride varnish (22,600 ppm F) was applied every three months to the lesions of children in the third and fourth groups. For children in the first and third groups, soft carious tissues were removed prior to fluoride application. The fifth group was the control. Three hundred eight children were followed for 30 months. The respective mean numbers of arrested carious tooth surfaces in the five groups were 2.5, 2.8, 1.5, 1.5, and 1.3 (p < 0.001). Silver diamine fluoride was found to be effective in arresting dentin caries in primary anterior teeth in pre-school children.
Ontario’s Poverty Reduction Strategy
Authors: Benbow Sarah , Gorlick Carolyne , Forchuk Cheryl , Ward-Griffin Catherine , Berman Helene
Published: January 2017

This article overviews the second phase of a two-phase study which examined experiences of health and social exclusion among mothers experiencing homelessness in Ontario, Canada. A critical discourse analysis was employed to analyze the policy document, Realizing Our Potential: Ontario’s Poverty Reduction Strategy, 2014–2019. In nursing, analysis of policy is an emerging form of scholarship, one that draws attention to the macro levels influencing health and health promotion, such as the social determinants of health, and the policies that impact them. The clear neo-liberal underpinnings, within the strategy, with a focus on productivity and labor market participation leave little room for an understanding of poverty reduction from a human rights perspective. Further, gender-neutrality rendered the poverty experienced by women, and mothers, invisible. Notably, there were a lack of deadlines, target dates, and thorough action and evaluation plans. Such absence troubles whether poverty reduction is truly a priority for the government, and society as a whole.
Starting a Nutrition Support Team; Short‐Term Pain for Long‐Term Gain
Authors: Tougas Jane Grant
Published: January 2017

In this rapidly changing environment, nutrition support professionals would do well to hone their political skills and use them to persuade their administrators that nutrition support is indeed a cost‐effective therapy that benefits patients—and that it is best delivered in an interdisciplinary approach.
The Role of the Team in the New Health Care Environment
Authors: Clemmer Terry P.
Published: January 2017

Many hospitals have strong political leaders who question the need for a nutrition support service. In addition, the pressures of economic and health care reform are forcing administrators to cut unnecessary and unproven— albeit beneficial—services. The challenge for nutrition support services is clear‐cut: To survive, nutrition support teams must understand the changes in health care and must learn how to adapt to them.
Designing Restorative Justice Policy: An Analytical Perspective
Authors: Lemley Ellen C.
Published: January 2017

The emerging notion of restorative justice loosely rests on several related, though distinct, theoretical, religious, and historical traditions. Efforts to implement restorative justice policies in the criminal processes in the United States have recently experienced a dramatic upsurge. However, successful implementation and theory testing both require careful theoretical specification, something that restorative justice currently seems to lack. This article attempts to identify heretofore unaddressed theoretical problems and offers future directions for researchers and practitioners to both ameliorate those problems and permit adequate testing and implementation. The article also describes current applications of restorative justice programs for offenders that may help clarify conceptual ambiguity.
An Analysis of Factors Related to Prosecutor Sentencing Preferences
Authors: Rainville Gerard
Published: January 2017

Three types of variables have been identified as related to prosecutor decision making in the screening and settlement stages of criminal case-processing—legal, extralegal, and resource variables. The current analysis examines the degree to which these classes of variables affect prosecutor sentence preferences. Ordinary least squares regression is used to relate factors that prosecutors regard as germane to forming sentence preferences to a measure of sentence restrictiveness. Analyses reveal a diminished reliance on legal and extralegal variables in the determination of preferred sentences. In their stead, the available correctional placement options within a prosecutor's jurisdiction as well as the personal values of prosecutors appear to determine the level of sentence restrictiveness that prosecutors desire.
Secondary World
Authors: Hudson David
Published: January 2017

Or how to make change work for the school!
Training Notes
Authors: Everard Bertie
Published: January 2017

This paper aims to alert readers to significant trends outside education, which are likely to affect management and training within education and within the teaching profession
Focus on Scotland
Authors: MacKenzie Malcolm L.
Published: January 2017

More proposals for changes create controversy in Scottish education
Management Topics
Authors: Robertson Colin
Published: January 2017

The lessons for school managers from an inspection on how best to manage ‘high ability children’
An Overview
Authors: Hudson David
Published: January 2017

Our regular correspondent, David Hudson provides an overview on managing the implementation of the National Curriculum
Cueing Employability in the Gig Economy: Effects of Task-Relevant and Task-Irrelevant Information on Fiverr
Authors: Carr Caleb T. , Hall Robert D. , Mason Adam J. , Varney Eric J.
Published: January 2017

When evaluating an applicant online, individuals are often concurrently exposed to a diverse cross-section of self- and other-generated information with varying relevance to the candidate’s actual job skills. Moreover, these various data may not always be internally consistent. Utilizing profiles on the microtask site Fiverr, a fully-crossed 2 × 2 × 2 experiment (N= 92) tested main and interaction effects of exposure positively- and negatively-valenced (1) self-generated task-relevant, (2) self-generated task-irrlevant photographic, and (3) other-generated task-relevant information, all within the same stimulus. Contrast analyses results support significant interactions among cues on perceptions of an applicants’ employability and person-job fit. The significant two- and three-way interactions are discussed with respect to warranting theory and the halo effect, and practical implications for applicants and employers are presented.
Deterioration of Restorative Materials and the Risk for Secondary Caries
Authors: Goldberg A.J.
Published: January 2017

This article reviews the literature related to marginal deterioration of amalgam restorations and the risk for secondary caries. Background information on this characteristic material failure is provided, including how it is measured clinically, its rate of progress with time, and the responsible microstructural mechanisms. The association between degree of marginal fracture and recurrent or secondary caries is reviewed in clinical and in vitro studies. Earlier clinical investigations and a more recent laboratory study demonstrated a strong correlation between gap size and recurrent caries for a caries-active environment, supporting replacement of defective restorations for preventive reasons. However, more recent clinical data show the complex and equivocal nature of this association. Poor specificity and validity for detection of recurrent caries with an explorer and mirror further complicate interpretation of some trials and decision-making in clinical practice. Improved methods of diagnosing recurrent caries and further studies of the factors influencing its initiation and progression are needed.
Clinical Studies Concerning Re-Restoration of Teeth
Authors: Elderton R.J.
Published: January 2017

Re-restoring teeth is an important component of operative dentistry, and the perceived presence of Re-restoring caries is a major reason for undertaking it. In the absence of a diagnosis of secondary caries, a morphological discrepancy at the margin of a restoration commonly provides the necessary justification for replacement. However, several studies have demonstrated enormous variation among dentists, both in their diagnosis of secondary caries and in the clinical decisions they make regarding whether or not to restore or re-restore. Many of these decisions must have been wrong. Decisions to re-restore teeth have been shown to be particularly idiosyncratic, and some patients apparently become involved in a repeat restoration cycle whereby the more restorations they have, the more re-restorations they receive.

The desire by some dentists to replace large numbers of restorations, for reasons other than the presence of disease, shows a fallibility of operative treatment. At the same time it suggests that these dentists have considerable faith in this aspect of dental care. There would appear to be a prima facie case for investigating more deeply the factors involved in the clinical assessment of restorations. It should then be possible to improve the standard of diagnosis and treatment decision-making, especially with respect to the need to re-restore teeth.
The Role of myc Oncogenes in Cell Growth and Differentiation
Authors: Littlewood T.D. , Evan G.I.
Published: January 2017

The myc oncoproteins are expressed in a wide range of normal adult and embryonic tissues. They are also found to be over-expressed in a variety of tumor types. All myc proteins are short-lived nuclear phosphoproteins thought to act as regulatory components of cell proliferation. The rapid induction of c- myc mRNA and protein following the addition of growth factors to quiescent cells, together with the short half-life of these molecules, suggests that they are sensitive and continuous indicators of external stimuli, consistent with a role in signal transduction. Furthermore, in untransformed cells, c-myc protein expression is tightly regulated, at least in part, by a mechanism of autoregulation. Deregulated expression of myc genes is a frequent observation in tumors and may lead to a cell becoming independent of one or more growth factors, with the concomitant potential for uncontrolled proliferation. Although the precise functions of the myc proteins are unknown, they all bear the hallmarks of multimeric DNA-binding proteins probably involved in the regulation of expression of specific genes.
Changing Trends in Dental Caries Experience in Great Britain
Authors: Downer M.C.
Published: January 2017

Periodic national surveys of dental health since 1968, and a coordinated program of local surveys of children since 1985, have provided a comprehensive picture of trends in dental caries experience in Great Britain over the course of two decades. This review of some of the findings examines changes in adult caries experience, together with the related phenomenon of total tooth loss; presents evidence of a cohort effect in the decline in caries among children and young adults; and considers likely future trends and their implications for the dental services. Conclusions drawn were: (1) Although the proportion of the population with no natural teeth is declining rapidly among young adults, levels of edentulousness among older age groups will remain high for some time to come; (2) in England and Wales, a modest decline in caries experience of young adults between 1968 and 1978 accelerated between 1978 and 1988 [The greatest change in annual rate of reduction over two decades was in 16-24-year-olds, and in absolute terms, mean DMFT in this age group decreased from 15.7 to 10.4 during the period.]; (3) a cohort effect is discernible in the changing pattern [Thus, caries has apparently stabilized in young children, whereas in adolescents and young adults the rate of decline has increased.]; and (4) smaller improvements in dental health have occurred in Scotland than in England and Wales.
Reproducibility and Detection Threshold of Peri-Implant Diagnostics
Authors: Van Steenberghe D. , Quirynen M.
Published: January 2017

There is an increasing awareness that, for clinical monitoring of oral implants, there is a need for reliable diagnostics and possibly prognostic parameters. Indeed, reports have too often limited results to an inventory of failures, while no mention was made of progressive marginal bone loss or other symptoms of a future failure.

Several parameters, such as marginal bone level assessment and/or probing attachment level, give a precision of up to 0.5 mm. Both measurements also seem related.

The damping characteristics of the individual implant/bone unit also offer a highly reproducible diagnostic tool. The Periotest® allows for detection of subclinical mobilities, and 95% of repeated measurements fall within a range of one unit on the arbitrary scale. So far, these three parameters offer no prognostic value.
New Approaches to the Diagnosis of Oral Soft-Tissue Disease of Viral Origin
Authors: Rodu B.
Published: January 2017

Molecular biology is changing the face of diagnostic medicine, and infectious diseases of the oral soft tissues are among the targets of these advances in biotechnology. As an illustration of these concepts, a PCR-based detection and typing system for human papillomaviruses (HPVs) will be discussed. A single "consensus" set of oligomeric nucleotide primers can be used to amplify a 571- to 594-base-pair region of the E1 open reading frame of HPV 6, 11, 16, and 18. These HPV types are commonly associated with preneoplastic and cancerous lesions of the genital, respiratory, and digestive tracts. PCR amplification yields single bands of similar size for these viruses by agarose gel electrophoresis. Digestion of the resultant products by the restriction endonuclease AccI yields distinctive and reproducible banding patterns by polyacrylamide gel electrophoresis (with ethidium bromide) due to their internal sequence diversity. The system is sensitive; without radioisotopes, it can detect and type HPV 18 in as little as 100 pg of DNA from HeLa cells. We have used it to confirm HPV in fresh-frozen tumors. Computer sequence analysis can be used to modify the system for the detection of new HPV types as they are characterized. Other applications of molecular-biology-based detection systems for infectious diseases of the head and neck region will be discussed.
Non-Infectious Diseases of the Oral Soft Tissue: a New Approach
Authors: Williams D.M.
Published: January 2017

A significant proportion of the non-infectious diseases of oral mucosa are either auto-immune in nature or have lesions which are the result of immunologically-mediated events. These include pemphigus, benign mucous membrane pemphigoid, linear IgA bullous dermatosis, dermatitis herpetiformis, epidermolysis bullosa acquisita, erythema multiforme, and lichen planus. Although each of these has certain specific characteristics, all may produce bullae, erosions, and ulcers on the oral mucosa, resulting in confusingly similar clinical presentations. With careful clinical, histological, and immunofluorescence examination, it is possible to establish a definitive diagnosis in a high proportion of cases. However, one of the most exciting developments which has emerged from recent research into these diseases is their precise molecular characterization. This raises the prospect of accurate, highly specific diagnostic tests which would provide the basis for sound clinical management, with original approaches replacing the somewhat unsatisfactory symptomatic treatment which is often all that is available.
Bacterial-Protein Interactions in the Oral Cavity
Authors: Douglas C.W.I.
Published: January 2017

Bacteria in the oral cavity must interact with salivary proteins if they are to survive. Such interactions can take several forms, either providing nutrients, a means of adhesion to surfaces, or resulting in aggregation or killing and, therefore, clearance of organisms.

Recent work has provided an insight into the mechanisms of some of these bacterial-protein interactions, revealing complexity and diversity. For example, the interaction between a putative Streptococcus mutans adhesin, PI (B, I/II, etc.), and a parotid glycoprotein results in adhesion when it occurs at a surface or aggregation when in solution, and different domains of PI appear to be involved in the two processes. An alternative strategy is employed by Actinomyces viscosus, which interacts, via its type-1 fimbriae, with a proline-rich salivary protein; however, this interaction occurs only when the PRP is adsorbed to a surface. A. viscosus takes advantage of a conformational change in the PRP when it becomes surface-bound, which exposes a cryptic part of the molecule. A third, and intriguing, type of interaction is seen between various streptococci and salivary amylase. This does not result in either adherence or aggregation but provides organisms with the ability to utilize starch breakdown products for metabolism. An understanding of the mechanisms involved in bacterial-protein interactions could conceivably lead to novel methods for controlling specific pathogens, but the systems operating in the mouth are numerous, complex, and diverse.
Control of Specific Plaque Bacteria
Authors: Russell R.R.B.
Published: January 2017

The Specific Plaque Hypothesis posits that particular bacteria are of unique importance in the etiology of dental caries and periodontal diseases, and a logical conclusion is that these bacteria should be the targets for our 'magic bullets' in devising plaque-control methods. This paper considers the development of preventive measures based on understanding of the significance of particular bacterial species and the properties of those bacteria. Knowledge of the importance of specific organisms as mediators of disease and molecular studies on the properties of potential virulence factors may reveal potential targets for inhibition, blocking by synthetic analogues, or functional inactivation by antibodies.
Mouthrinses
Authors: Adams D. , Addy M.
Published: January 2017

Mouthrinses have been used for centuries for medicinal and cosmetic purposes, but it is only in recent years that the rationale behind the use of the ingredients has been subject to scientific research and clinical trials. Although Listerine held its position formany years in the vanguard of the anti-plaque agents, the advent of mouthrinses containing chlorhexidine was a major breakthrough in the research for a chemical means to prevent disease. Since that time, and especially in the past ten years, the number of formulations that claim to have anti-plaque, anti-calculus, and anti-caries activity has increased, and much emphasis has been placed on such substances as an adjunct to, or indeed to replace, conventional toothbrushing techniques.

This review covers the literature on mouthrinses over the past five years, concentrating more on the anti-plaque, anti-gingivitis, and anti-calculus formulations. In the first section, the methods of conducting clinical trials of mouthrinses are discussed, and a plea is made for a greater degree of standardization of methodology with agreed acceptable levels of clinical benefit. Trials of established mouthrinses are considered, and the advantages and disadvantages of several newer formulations discussed.

From the review, it appears that chlorhexidine has no equal in its effects on reduction of plaque and gingivitis, but major drawbacks lie in the taste and stain-producing problems. The pre-brushing rinse, Plax, does not have unqualified success in all trials, though the more recent European formulation may have promise. Newer rinses which inhibit bacterial adhesion to tooth surfaces also appear promising, and it is suggested that more work on combinations of active ingredients is necessary.
Connective Tissue Degradation in Health and Periodontal Disease and the Roles of Matrix Metalloproteinases and Their Natural Inhibitors
Authors: Reynolds J.J. , Hembry R.M. , Meikle M.C.
Published: January 2017

Connective tissue remodeling is essential for normal growth and development, and many diseases have long been associated with the breakdown of the collagenous matrix of bone, cartilage, and related tissues. Recent work has established that members of the family of matrix metalloproteinases (MMPs) are key enzymes in matrix degradation. They function at neutral pH and can digest synergistically all the matrix macromolecules. Biochemical and cloning studies indicate that there are three major groups, collagenases, gelatinases, and stromelysins. Naturally occurring inhibitors, TIMPs (Tissue Inhibitors of Metallo Proteinases ), are important controlling factors in the actions of MMPs, and tissue destruction in disease processes often correlates with an imbalance of MMPs over TIMPs. The major inhibitor is TIMP-1 (or TIMP), a 30-kDa glycoprotein that is synthesized by most cells. The expression of MMPs and TIMPs by cells is regulated by many cytokines (particularly interleukin-1, IL-1), growth factors, and hormones, some of which are specific to cell type and others that are ubiquitous (e.g.,transforming growth factor β, TGF-P).

One way in which pathogenic organisms might mediate tissue degradation in periodontal diseases is through the ability of cell wall antigens to stimulate cytokine production by circulating mononuclear cells. These would then induce MMP synthesis by resident gingival cells, thereby initiating degradative events. Direct in vivo evidence for the source of collagenase and other MMPs in periodontal tissues is limited. By using specific polyclonal antibodies and indirect immunofluorescence, we could demonstrate the presence of collagenase, stromelysin-1, gelatinase A, and TIMP in human gingival biopsy specimens. Their distributions are extremely variable, in both the connective tissue and the epithelium, but the results indicate that host cell production of MMPs may contribute to tissue remodeling in periodontal disease.
The Influence of Axial Grooves on Dislodgment Resistance of Prosthetic Metal Crowns in Maxillary Fourth Premolar Teeth of Dogs
Authors: Goldschmidt Stephanie , Collins Caitlyn J. , Hetzel Scott , Ploeg Heidi-Lynn , Soukup Jason W.
Published: January 2017

The reported failure rate for full veneer crowns in dogs is suboptimal, particularly in teeth with naturally poor retentive features such as the maxillary fourth premolar tooth of dogs. Although the data regarding crown retention on the maxillary fourth premolar in dogs are limited, there are data that suggest the crown failure rate could be similar to that of the canine tooth. Thus, methods to improve retentive features of the preparation design should be pursued. The objective of the present study is to quantify the influence of axial grooves on the dislodgment resistance of full veneer metal crowns in dogs. Crown dislodgment testing was performed on cast alloy dies of the maxillary fourth premolar tooth with unfavorable retentive features prepared with and without axial grooves, to quantify the difference in force required to dislodge a cemented full veneer crown. The force required to cause crown dislodgment was recorded for each crown. Statistical analysis revealed a significant increase ( P < .001) in the force required for crown dislodgment in teeth prepared with axial grooves compared to those prepared without axial grooves.
Guided Tissue Regeneration in Four Teeth Using a Liquid Polymer Membrane
Authors: Alterman Jennifer B. , Huff John F.
Published: January 2017

Periodontal disease is one of the most common diseases diagnosed in dogs and cats. Guided tissue regeneration (GTR) is a treatment alternative to extraction of strategically important teeth. The barrier membrane used in the GTR procedure is of key importance. The purpose of this case series was to evaluate a liquid polymer gel as a membrane for GTR. The polymer gel ( N-methyl-2-pyrrolidone and poly [DL-lactide]) combined with 8.5% doxycycline hyclate was used in place of a traditional membrane in 4 teeth. The teeth were re-examined 6 months postoperatively for radiographic evaluation. A decrease in probing depth and new alveolar bone formation was seen 6 months postoperatively. Improvement in periodontal disease stage was seen in 2 of the 4 teeth. Larger controlled trials with histopathologic evaluation are indicated to further assess the use of this polymer as a membrane in GTR. However, the clinical outcomes of all 4 treated teeth were considered successful.
Spinning Straw into Gold: the Tenuous Strategy, Funding, and Financial Performance Linkage
Authors: Crittenden William F.
Published: January 2017

This study investigates relationships between strategic process elements, sources of funding, and the growth and financial strategies pursued by 31 nonprofit social service organizations. Organizations were categorized on the basis of their achievement of a balanced budget and targeted funding goals. Based on these criteria, the most successful firms (a) maintained or developed a strong relatedness in program offerings; (b) were financially oriented, with a diverse funding base, and with fund-raising efforts targeting a specific source category for increase; (c) emphasized marketing; and (d) principally sought growth through increased client usage of current offerings. Less successful organizations appeared to lack key strategic management attributes regarding direction or execution.