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For integer n and real u , define Δ (n , u) ≔ | { d : d ∣ n , e u < d ⩽ e u + 1 } |. Then, the Erdős–Hooley Delta function is defined as Δ (n) ≔ max u ∈ R Δ (n , u). We provide uniform upper and lower bounds for the mean-value of Δ (n) over friable integers, i.e. integers free of large prime factors. [ABSTRACT FROM AUTHOR]

Outcomes of endodontic treatment in patients with special needs are not fully understood, leading to reluctance in performing endodontic treatment. This retrospective cohort study evaluated the periapical healing and tooth survival in patients with special needs who had permanent teeth endodontically treated in a hospital setting between 1998 and 2019. Data characterization was performed using univariate analyses. Logistic and Cox regression analyses (P <.05) were performed to identify the odds ratio (OR) and hazard ratio (HR) of the potential prognostic factors, respectively. These predictors were chosen from previous outcome studies in the general population and patients with special needs. A total of 61 patients (108 teeth) met the inclusion criteria. The most common treatment modality was initial therapy with 81.5% of cases being managed without a need for general anesthesia. Healing rate for initial endodontic treatment was 89.9% and was affected by no restoration at follow-up (OR = 0.15; 95% confidence interval [CI], 0.12–0.71; P =.02). After a mean follow-up of 79.36 ± 59.6 months, the survival rate was 73% and was correlated with gender (HR for males = 0.3; 95% CI, 0.1–0.6; P <.05) and age (HR for patients >45 years = 3.7; 95% CI, 1.7–8.2; P <.05). The most common reason for tooth extraction was unrestorable tooth fracture. Endodontic therapy without a need for general anesthesia is a viable treatment option for patients with special needs. If the overall patient condition permits, then treatment can be administered by community dentists rather than waiting for a patient to be seen in a hospital setting. [ABSTRACT FROM AUTHOR]

Masticatory myofascial pain is a musculoligamentous syndrome that can mimic odontogenic pain. Pain referral to odontogenic structures can be traced to hyperirritated myofascial trigger points (MTrPs). This pragmatic study evaluated the concordance between ultrasonography and palpation in detecting MTrPs in the masseter and temporalis muscles. Fifty-seven patients suspected to have temporomandibular disorder were included. MTrPs were palpated manually by expert clinicians. Ultrasonography was then performed by a blind sonographer. The quantity of MTrPs and the involved muscle sections, the pain occurrence, and the location of the MTrPs within the muscle sections were compared using the mean difference (MD) and concordance statistics (Cohen κ and the interclass correlation coefficient [ICC]) as applicable. Ultrasonography located MTrPs as 2.1 ± 1.3 mm2 hypoechoic nodules at a depth of 7 ± 3.3 mm. Ultrasonography moderately agreed with palpation on the quantity of MTrPs per patient (MD = 1; 95% confidence interval [CI], 0.06–1.9; ICC = 0.56; 95% CI, 0.32–0.72). Palpation detected marginally more involved muscle sections per patient (MD = 0.7; 95% CI, 0.06–1.34.05; ICC = 0.64; 95% CI, 0.44–0.77) with more pain occurrence per patient (MD = 1.4; 95% CI, 0.56–2.28; ICC = 0.13; 95% CI, −0.26 to 0.41). There was a discordance in the location of the MTrPs within the muscle sections per patient (κ = −0.46; 95% CI, −0.77 to −0.14). Ultrasonography and palpation concurred moderately to substantially on the quantity of MTrPs and the involved muscle sections but disagreed on the location of the MTrPs within the muscle sections. Ultrasonography has the potential as a chairside diagnostic aid to help clinicians determine an accurate diagnosis, enhance patient experience during examination, and avoid unnecessary treatments that can mitigate the risk of iatrogenic damage. [ABSTRACT FROM AUTHOR]

The clinical success of monolithic lithium disilicate glass-ceramic (LDGC) crowns manufactured with computer-aided design and computer-aided manufacturing (CAD-CAM) technology provided by predoctoral students has not been fully investigated. The purpose of this retrospective clinical study was to evaluate the performance of laboratory-fabricated monolithic posterior LDGC CAD-CAM crowns provided by predoctoral students at the University of Toronto. Specific patient- and provider-related factors were also investigated. A sample of posterior LDGC CAD-CAM crowns (IPS e.max) provided by predoctoral students was evaluated. Crown preparations were made according to specific criteria, and crowns were milled in an in-house laboratory by using the CEREC Bluecam system. The crowns were cemented with Rely-X Unicem (3M ESPE) and Calibra Universal (Dentsply Sirona) resin cements. Clinical assessments of the crowns and supporting periodontal structures were performed following the modified California Dental Association (CDA) criteria. Intraoral photographs and periapical and bitewing radiographs were obtained for further assessment by 2 evaluators. Descriptive statistics, McNemar, t test, log rank (Mantel-Cox) tests, Pearson chi-squared tests, simple logistic regression, odds ratios, and Kaplan Meier survival analyses were performed (α=.05). A total of 189 patients receiving 210 crowns (108 premolar and 102 molar) were examined with a follow-up period of up to 6 years. Altogether, 28 complications were observed (12 technical, 11 biological, and 5 esthetic). No significant association was found between patient age, sex, periodontal condition, tooth type, tooth vitality, cement type, and crown longevity. However, significantly lower survival and success rates were found for mandibular crowns than for maxillary crowns (P =.029). The provider's experience had no significant effect on the clinical performance of LDGC CAD-CAM crowns. The 6-year cumulative survival rate was 93.0%, and the success rate was 86.4%. The ease of use of the CAD-CAM system and clinical performance of LDGC suggest that this technology should be used in the dental school setting by predoctoral students. [ABSTRACT FROM AUTHOR]

Childhood growth hormone deficiency (GHD) is a rare disorder associated with significant burden on both patients and caregivers. Although previous reports have detailed aspects of the burden experienced by patients and their caregivers, there is a paucity of first-hand information on the patient and caregiver journeys from their respective voices. To address this need, an advisory board meeting was conducted on September 30, 2022, with 4 pediatric patients with GHD and their caregivers to discuss their experiences prior to GHD diagnosis, during the diagnostic process, and during ongoing treatment with recombinant growth hormone. Feedback from patients and caregivers was reviewed by pediatric endocrinologists, who provided their own perspectives on the patient and caregiver journeys based on the information reported. Despite the small sample size, important insights were obtained: patients and caregivers reported remarkable growth benefits achieved with treatment, which provided strong motivation to remain adherent to daily injection regimens. Patient and caregiver accounts reflected wide variability between families in time from suspicion to diagnosis and in treatment challenges faced, ranging from practical issues such as handling and administration of medication to broader concerns about treatment access and continuity, as well as key knowledge gaps among patients, caregivers, and clinicians. Recommendations are provided to enhance the patient and caregiver journeys, including increasing development and availability of educational materials, providing opportunities for patient advocacy by clinicians and health care providers, and encouraging institutional improvements to ensure that patients continue to receive uninterrupted treatment during their critical period of growth. • Childhood growth hormone deficiency is a rare cause of short stature. • There is a paucity of information from patients and caregivers on their journey. • Caregivers and patients reported their experiences with diagnosis and treatment. • Endocrinologists provided their perspectives on the patient and caregiver journey. • Recommendations are provided to enhance the patient and caregiver journey. [ABSTRACT FROM AUTHOR]

Purpose: To develop a first trimester prediction model for gestational diabetes mellitus (GDM) using obesity, placental, and inflammatory biomarkers.Methods: We used a first trimester dataset of the ASPRE study to evaluate clinical and biochemical biomarkers. All biomarkers levels (except insulin) were transformed to gestational week-specific medians (MoMs), adjusted for maternal body mass index (BMI), maternal age, and parity. The MoM values of each biomarker in the GDM and normal groups were compared and used for the development of a prediction model assessed by area under the curve (AUC).Results: The study included 185 normal and 20 GDM cases. In the GDM group, compared to the normal group BMI and insulin (P = 0.003) were higher (both P < 0.003). The MoM values of uterine artery pulsatility index (UtA-PI) and soluble (s)CD163 were higher (both P < 0.01) while pregnancy associated plasma protein A (PAPP-A), placental protein 13 (PP13), and tumor-necrosis factor alpha (TNFα) were lower (all P < 0.005). There was no significant difference between the groups in placental growth factor, interleukin 6, leptin, peptide YY, or soluble mannose receptor (sMR/CD206). In screening for GDM in obese women the combination of high BMI, insulin, sCD163, and TNFα yielded an AUC of 0.95, with detection rate of 89% at 10% false positive rate (FPR). In non-obese women, the combination of sCD163, TNFα, PP13 and PAPP-A yielded an AUC of 0.94 with detection rate of 83% at 10% FPR.Conclusion: A new model for first trimester prediction of the risk to develop GDM was developed that warrants further validation. [ABSTRACT FROM AUTHOR]

Introduction: In a recent study of 10,011 pregnant women, 95% of miscarriages occurred before routine ultrasound scan at 11-14 weeks. Our study aimed to identify early first trimester parameters which may predict miscarriage before 10 weeks of gestation for in vitro fertilization (IVF) pregnancies.Methods: A cohort of 115 healthy IVF patients with a singleton viable embryo in early first trimester were studied in a tertiary university-affiliated medical center (April 2017-June 2018). Calculations included gestational age (GA); ultrasound evaluation of crown-rump length (CRL), mean gestational sac diameter (GSD) and volume (GSV), mean yolk sac diameter (YSD) and volume (YSV); fetal heart rate (FHR), mean uterine arteries pulsatility index (UtA-PI); and maternal blood placental protein 13 (PP13) levels. Patients were divided into three groups by GA; and early miscarriage versus ongoing pregnancy after GA 10 weeks.Results: Early fetal loss occurred in 14.8% of patients; miscarriage group had higher discrepancy between calculated and measured GA (P < 0.001), lower GSD and GSV (P = 0.005 and P = 0.02, respectively), significantly different YSD and YSV, and lower GSD/YSD and GSV/YSV ratios (P = 0.001 and P = 0.003, respectively). UtA-PI/CRL ratio was higher in patients with miscarriage at GA 46-48 days and GA >48 days (P = 0.034 and P = 0.026, respectively). PP13/CRL ratio was higher in patients with miscarriage at GA >48 days (P = 0.041).Discussion: In IVF pregnancies with live embryo at first ultrasound scan, high UtA-PI/CRL and maternal blood PP13/CRL ratios may indicate impaired placentation preceded early pregnancy loss. A larger cohort is needed to further verify these predictions. [ABSTRACT FROM AUTHOR]

We apply the saddle-point method to derive asymptotic estimates or asymptotic series for the number of partitions of a natural integer into parts chosen from a subset of the positive integers whose associated Dirichlet series satisfies certain analytic properties. This enables grouping in a single statement many cases studied in the literature, as well as a number of new ones. [ABSTRACT FROM AUTHOR]

The aim of the study was to estimate the current incidence and the distribution of etiologies of primary ovarian insufficiency (POI) in a nationwide study. The prevalence of POI in young adult women has recently increased, but the data cited for adolescents are more than three decades old. Data regarding females aged <21 years diagnosed with POI during the years 2000–2016 were collected from all the pediatric endocrinology units in Israel. POI was defined by at least 4 months of amenorrhea in association with menopausal levels of follicle-stimulating hormone. Iatrogenic cases were excluded. For the 130 females aged <21 years included in the study, the distribution of POI etiologies was Turner syndrome/mosaicism in 56 (43%), idiopathic in 35 (27%), and other (developmental, genetic, metabolic, adrenal, and autoimmune) in 39 (30%) females. During the years 2009–2016, compared with 2000–2008, the incidence rate of new POI diagnoses per 100,000 person-years doubled (4.5 vs. 2.0; p value <.0001), and incidence rates of idiopathic and other etiologies increased by 2.6 (p value =.008) and 3.0 (p value =.002), respectively. In contrast, the incidence of Turner syndrome was constant (p value =.2). In the age group of 15–21 years, the current incidence of non-Turner POI in adolescents is one per 100,000 person-years. In this nationwide study, the incidence rate of POI in youth aged <21 years was one tenth of the rate that is commonly cited. A significant increase in the rate of POI in non-Turner females was observed over the last decade. Contributions of environmental and epigenetic factors should be studied. [ABSTRACT FROM AUTHOR]

Bruton's tyrosine kinase (BTK) inhibition is a novel mechanism under investigation for multiple sclerosis (MS). Evobrutinib (EVO) is a highly selective, central nervous system (CNS)-penetrant, covalent BTK inhibitor with the potential to target B and myeloid cells in the periphery and CNS, which could have synergistic effects on neuroinflammation, demyelination and disability accumulation. In a Phase 2 relapsing MS (RMS) trial (NCT02975349), the efficacy and safety profile of EVO 75 mg twice daily (BID; fasted) from the double-blind period (DBP) has remained stable >4 years of treatment (DBP + open-label extension). EvolutionRMS 1 and 2 (NCT04338022/NCT04338061) are multicentre, randomised, double-blind, double-dummy, active comparator-controlled trials. Eligibility criteria included age 18–55 years, RMS as relapsing–remitting (RR) or secondary progressive (SP) MS with superimposed relapses and Expanded Disability Status Scale (EDSS) score 0–5.5. Patients were randomised 1:1 to EVO (45 mg BID) or TERI (14 mg once daily) with food, up to 156 weeks (W). The primary endpoint, annualised relapse rate, will be assessed over a variable trial duration per patient, up to 156W. Secondary endpoints include disability progression/improvement outcomes; Patient Reported Outcome Measurement Information System (PROMIS) physical function/fatigue scores; magnetic resonance imaging outcomes; serum neurofilament light chain; safety and tolerability. The trials enrolled 2285 patients (evolutionRMS 1/2: n=1122/1163) across 52 countries. Baseline mean(±SD)/median age was 37.2(±9.4)/37.2 years and 67.0% were female. Mean(±SD) EDSS was 2.8(±1.3), mean(±SD) time since diagnosis was 4.7(±5.7) years, 96.1/3.9% of patients had RRMS/SPMS, 63.5% were MS treatment-naïve and 98.2% had ≥1 relapse in the year before randomisation. On completion, these trials will provide the most comprehensive clinical evidence to date of the efficacy and safety of EVO as an RMS treatment and among the first for a new class of drugs (BTK inhibitors) for MS. Furthermore, these are the first Phase 3 RMS trials that include both fluid biomarkers and MS-specific patient-reported outcome tools among the hierarchical endpoints to provide a detailed assessment of the impact of BTK inhibitors on overall MS disease. [ABSTRACT FROM AUTHOR]

Highlights • Persistence to therapy may affect patient outcomes in multiple sclerosis (MS). • African-American patients with MS may experience an aggressive disease course. • Treatment retention was higher with fingolimod than with injectable therapies. • Patient satisfaction was higher with fingolimod than with injectable therapies. • Results support first- or second-line fingolimod use in African-Americans with MS. Abstract Background Suboptimal persistence with injectable disease-modifying therapies (iDMTs; interferon beta-1a/b, glatiramer acetate) is common in patients with relapsing forms of multiple sclerosis (MS), reducing the effectiveness of these agents. Adherence to, and persistence with, an effective therapy is important for patient populations at increased risk of rapid disease progression. African-American individuals with multiple sclerosis may experience a more aggressive disease course than Caucasian patients, with a greater risk of developing ambulatory difficulties and other disabilities, and may also have a diminished response to some disease-modifying therapies compared with patients of other ethnicities. Retention on oral fingolimod and on iDMTs was evaluated in a post hoc analysis of data from African-American patients in the parallel-group, 48-week ' P rospective, R andomized, active-controlled, open-label study to E valuate patient retention on F ingolimod versus approved first-line disease modifying th E rapies in adults with R elapsing–remitting M ultiple S clerosis' (PREFER MS). Methods In PREFER MS , patients with relapsing-remitting MS aged 18–65 years with an Expanded Disability Status Scale score ≤6 enrolled at 117 US study sites were treatment-naïve or had received only one iDMT class. Patients were randomized 1:1 (fingolimod 0.5 mg/day:preselected iDMT) using an interactive voice-and-web-response system without blinding, followed up quarterly, and allowed one study-approved treatment switch after 12 weeks, or earlier, for efficacy or safety reasons only. The primary outcome was patient retention on randomized treatment over 48 weeks. In this post hoc analysis of African-American patients in PREFER MS , outcome variables included rate of patient retention on randomized treatment, reasons for discontinuing randomized treatment, patient-reported treatment satisfaction, and safety. Clinical and radiographic outcomes such as annualized relapse rate, brain volume loss, and lesion count changes were also investigated. Results In PREFER MS , 141 of 875 patients (16.1%) randomized to a study drug were African-American. Analysis of data for the full analysis set of 67 patients receiving fingolimod and 69 receiving iDMTs showed that the retention rate over 48 weeks was significantly higher with fingolimod than with iDMTs (80.6% [n = 54] vs 30.4% [n = 21]; between-group difference: 50.2%; 95% confidence interval 35.8–64.6%; p < 0.0001). The most common treatment switch was from an iDMT to fingolimod for injection-related reasons, and patient satisfaction was greater with fingolimod than with iDMTs. Adverse events were consistent with the respective prescribing information for each treatment. Conclusion In PREFER MS, fingolimod was associated with better treatment retention than iDMTs in African-American patients. Optimal outcomes in the management of multiple sclerosis depend on good persistence with treatment, and this is particularly important in patient populations at increased risk of a rapidly progressing disease course. [ABSTRACT FROM AUTHOR]

Objectives To determine the association between the status of menarche (yes/no), the intensity of training and the potential to improve passive joint range of motion (ROM) over a 12-month period of dance training. Design Prospective cohort study. Setting Dance studio. Participants Fifty-nine female dancers aged 12.8 ± 0.5. Main outcome measures The dancers were asked about their dance intensity and screened for anthropometric parameters and passive joint ROM in Grades 7 and 8. Results Along the 12 months of dance training, we found significantly increased ankle-foot en-pointe , hip abduction, and hip external rotation (ER); significantly decreased hip internal rotation (IR); and significant increased hip ER:IR ratio. In Grade 7, 26 dancers (44.1%) reached menarche (Yes menarche); in Grade 8 an additional 23 dancers (39.0%) reached menarche (No/Yes menarche); and 10 dancers (16.9%) had not reached menarche (No menarche). MANOVA (mixed models) with repeated measures to compare joint ROM between the three menarche groups (Yes; No/Yes; No), with h/week dance practice as a co-variant, showed that hip ER, ankle-foot en-pointe , and ER:IR were significantly correlated with h/week in all three menarche groups. Conclusions Most passive joint ROM can be improved over 12 months of dancing around the age onset of menarche. H/week of dance practice is a main factor contributing to improved hip ER, ankle-foot en-pointe and ER/IR ratio. [ABSTRACT FROM AUTHOR]

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Grafting of cell-seeded alginate capillary hydrogels into a spinal cord lesion site provides an axonal bridge while physically directing regenerating axonal growth in a linear pattern. However, without an additional growth stimulus, bridging axons fail to extend into the distal host spinal cord. Here we examined whether a combinatory strategy would support regeneration of descending axons across a cervical (C5) lateral hemisection lesion in the rat spinal cord. Following spinal cord transections, Schwann cell (SC)-seeded alginate hydrogels were grafted to the lesion site and AAV5 expressing brain-derived neurotrophic factor (BDNF) under control of a tetracycline-regulated promoter was injected caudally. In addition, we examined whether SC injection into the caudal spinal parenchyma would further enhance regeneration of descending axons to re-enter the host spinal cord. Our data show that both serotonergic and descending axons traced by biotinylated dextran amine (BDA) extend throughout the scaffolds. The number of regenerating axons is significantly increased when caudal BDNF expression is activated and transient BDNF delivery is able to sustain axons after gene expression is switched off. Descending axons are confined to the caudal graft/host interface even with continuous BDNF expression for 8 weeks. Only with a caudal injection of SCs, a pathway facilitating axonal regeneration through the host/graft interface is generated allowing axons to successfully re-enter the caudal spinal cord. Statement of Significance Recovery from spinal cord injury is poor due to the limited regeneration observed in the adult mammalian central nervous system. Biomaterials, cell transplantation and growth factors that can guide axons across a lesion site, provide a cellular substrate, stimulate axon growth and have shown some promise in increasing the growth distance of regenerating axons. In the present study, we combined an alginate biomaterial with linear channels with transplantation of Schwann cells within and beyond the lesion site and injection of a regulatable vector for the transient expression of brain-derived neurotrophic factor (BDNF). Our data show that only with the full combination axons extend across the lesion site and that expression of BDNF beyond 4 weeks does not further increase the number of regenerating axons. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to test and expand the Motivation of Marathoners Scale (MOMS) model (Masters et al., 1993). Methods The MOMS questionnaire was distributed to 306 male and female marathon runners (age range: 20–77 years) with experience in marathon running (range: 1–44 runs). A confirmatory factor analysis (CFA) revealed that the original model failed to fit the data. Hence, exploratory factor analysis (EFA) was performed to test the best factorial solution for the current data, and a subsequent CFA was performed on the revised factorial structure. Then, a series of EFAs using maximum likelihood factor extraction method were performed. Results The best structure solution for model-data fit resulted in 11 factors: psychological coping—emotional-related coping, psychological coping—everyday-life management, life meaning, self-esteem, recognition, affiliation, weight concerns, general health orientation—reduced disease prevalence and longevity, general health orientation—keep fit, competition, and personal goal achievement. Conclusion This study provides a sound and solid framework for studying motivation for physically demanding tasks such as marathon runs, and needs to be similarly applied and tested in studies incorporating physical tasks which vary in mental demands. [ABSTRACT FROM AUTHOR]

Computed tomography angiography (CTA) offers a rapid means of evaluating the vasculature of the head and neck in patients presenting with acute onset of neurologic symptoms and blunt trauma to the head and neck. CTA is noninvasive, easy to acquire, and offers excellent detail in identifying site and nature of the lesion. The learning objectives of this article are to review normal anatomy and variants, recognize CTA appearance of vascular pathologies, describe typical parameters used for acquiring the study, and recognize common pitfalls. [ABSTRACT FROM AUTHOR]

Objectives The purpose of the study was to evaluate performance quality of shoulder plyometric exercises, and examine the relationship to scapular muscle activation during an intense exercise bout. Design Observational study. Setting University laboratory. Participants 32 healthy university students (male/female: 14/18) volunteers. Main outcome measures Subjects performed 10 plyometric exercises. Surface EMG of upper (UT), middle (MT) and lower (LT) trapezius and serratus anterior (SA) was registered. A quality assessment questionnaire was administered at the beginning and end of the exercise bout. Muscle activation at the beginning and end was evaluated by t-test. Mixed repeated measures ANOVA was conducted to test the effects of criterion-quality, time, muscles, exercises, and their interactions. Results Increased EMG activation was noted in 34/40 cases, (21/40 significant (p < 0.05) changes). Quality assessment revealed a decline in the ability to maintain initial position (43% of subjects), failure to keep a consistent and symmetrical arc of motion (62% of subjects), and performance with trick movements (48% of subjects). Inability to keep a consistent arc of motion was significant in 4 exercises. Conclusions The novel questionnaire may aid quality assessment during plyometric exercises. Ability to keep a consistent arc of motion was the most sensitive marker of decline of performance quality. [ABSTRACT FROM AUTHOR]

Background: Over the past years it has been recognized that insulin resistance (IR) is an independent risk factor for the development of diabetes, whereas its association with cardiovascular events remains controversial. The aim of our study was to explore the association between IR per se and cardiovascular events among patients with preexisting coronary artery disease. Methods: The mean follow-up period of this prospective study was 6.2 years. Metabolic and inflammatory parameters were analyzed from stored frozen plasma samples obtained at baseline from 2938 patients aged 45 to 74 years. The homeostatic index of IR (HOMA-IR) was calculated according to the homeostasis model assessment. Results: New major cardiovascular events (fatal and nonfatal myocardial infarction and sudden death) were recorded in 108 (11.1%) patients from the lowest IR tertile, in 147 (14.7%) from the intermediate tertile, and in 166 (17.2%) from the highest tertile (P = .0002). The linear trend for total and cardiac death across the tertiles of HOMA-IR was significant as well (P = .02 and P = .009, respectively). The highest age-adjusted rates for major cardiovascular events and new diabetes were found among patients within the top tertile of HOMA-IR (57% and 130% higher rates, respectively, tertile 3 vs tertile 1, P < .0001 for both). Multivariable analysis identified HOMA-IR (tertile 3 vs tertile 1) as an independent predictor of increased risk of major cardiovascular events and new diabetes with hazard ratios (95% CI) of 1.4 (1.1-1.8) and 1.5 (1.1-2.0), respectively. Conclusions: Insulin resistance per se is an independent risk factor for cardiovascular events and new diabetes in patients with preexisting coronary artery disease. [Copyright &y& Elsevier]

Background: Several studies have shown that periodontal diseases are associated with hypertension (HT). However, heterogeneity among populations, diagnosis criteria, and shared risk factors represent some difficulties in terms of interpretation. Therefore, the aim of this study was to determine the magnitude of the association between periodontal diseases and HT.Methods and Results: A systematic review and meta-analysis, including studies published up to June 2016, have been performed. Sixteen studies assessing the association between periodontal diseases and HT have been included. The meta-analysis considering all included studies (moderate to severe periodontitis) showed that the presence of HT was associated with the presence of periodontal diseases (OR, 1.50; 95% CI, 1.27-1.78). To reduce potential bias, a stratified analysis has been performed illustrating the impact of inclusion criteria and adjustments on the magnitude of the association. Interestingly, when only studies with secure diagnosis of severe periodontitis and HT were considered, an OR=1.64 (95% CI, 1.23-2.19) has been measured.Conclusions: Periodontal diseases are associated with a higher risk of HT especially for severe periodontitis. However, no conclusions could be made regarding the causative involvement of periodontal diseases mainly due to the reduced number of available prospective studies and remaining questions regarding underlying biological mechanisms. [ABSTRACT FROM AUTHOR]

Résumé L’allergie à la pêche est une allergie alimentaire fréquente, notamment sur le pourtour méditerranéen. Les réactions systémiques à l’ingestion de ce fruit sont le plus souvent dues à une sensibilisation vis-à-vis de l’allergène majeur Pru p 3, une protéine de transport des lipides. Nous décrivons une série de 6 patients présentant une allergie confirmée à la pêche avec réaction systémique mais présentant des IgE sériques spécifiques pêche et allergènes majeurs négatives ou à des taux très bas. Ce travail montre qu’il existe des allergies à la pêche cliniquement prouvées et pour lesquelles la biologie moléculaire actuellement disponible n’est pas une aide au diagnostic. Certains allergènes connus et pouvant entraîner des réactions sévères, comme les thaumatin-like proteins ou la peamacleine pourraient être recherchés chez les patients présentant ce tableau clinico-biologique. Allergy to peach is a frequent food allergy, especially in the Mediterranean area. Systemic reactions after ingestion of this fruit are due mostly to sensitization to the major allergen Pru p 3, a lipid transfer protein. Here, we describe a series of 6 peach-allergic patients who presented with a systemic reaction to peach but who were found to have a negative serum peach-specific IgE assay and also negative or very low serum levels of IgE to the known major recombinant peach allergens. These results show that there are some patients clinically allergic to peach but for whom the currently available molecular biological assays do not help establish the diagnosis. Thaumatin-like proteins and peamaclein are two recently identified peach allergens, which may also be responsible for severe allergic reactions. When serum assays for these two allergens become available, they may aid in making the diagnosis in cases such as ours. [ABSTRACT FROM AUTHOR]

Background The management of subclinical cortisol-secreting adenomas (SCSAs) is controversial, and available evidence to assess the superiority of an operative versus a nonoperative approach is lacking. The aim of this work was to report the postoperative results and the long-term outcomes for patients with incidentally diagnosed SCSAs and to compare the results with those of patients who underwent an operation for cortisol-secreting adenomas (CSAs). Methods From 1994–2011, 107 consecutive patients underwent laparoscopic unilateral adrenalectomy for either an SCSA ( n = 39) or a CSA ( n = 68). Preoperatively, all patients underwent standardized clinical, hormonal, and imaging assessments. Patients were followed up for ≥2 years with serial assessments of body weight, blood pressure, and glycated hemoglobin, HbA1c. Results Operative resection of SCSAs and CSAs did not significantly differ regarding operative time, conversion rate, overall operative and medical morbidity, and duration of stay. For SCSAs, the comparison between preoperative status and 2-year assessment showed a median weight loss of 6% ( P < .001), a decrease in the median HbA1c of 15% ( P < .001), and an improvement or normalization of blood pressure in 50% of the patients. The same significant beneficial metabolic effects of the operation with even greater improvement were observed in patients with CSAs. Conclusion Laparoscopic unilateral adrenalectomy for SCSA is associated with low morbidity, no mortality, and significant improvement of various aspects of metabolic syndrome. Until additional evidence from prospective randomized controlled studies is obtained, laparoscopic unilateral adrenalectomy should be considered a valid option in the care of patients with SCSA. [ABSTRACT FROM AUTHOR]

We provide essentially optimal, effective conditions to ensure that, when available, the Halberstam–Richert upper bound for the mean value of a non-negative multiplicative function actually furnishes the true order of magnitude. This is applied, in particular, to short sums of multiplicative functions over arithmetic progressions, to exponential sums with multiplicative coefficients, and to strong law of large numbers with multiplicative weights. [ABSTRACT FROM AUTHOR]

Up to 40% of ankle sprains can result in chronic ankle instability (CAI). The prevalence of CAI and its association with body mass index (BMI) and height in the general young adult population has not been reported. The database records of young adults before recruitment into mandatory military service were studied. Information on the disability codes associated with CAI was retrieved. Logistic regression models were used to assess the association between the BMI and body height with various grades of CAI severity. The study cohort included 829,791 subjects (470,125 males and 359,666 females). The prevalence was 0.7% for mild CAI and 0.4% for severe instability in males and 0.3% and 0.4%, respectively, for females ( p < .001). An increased BMI was associated with ankle instability in males (overweight, odds ratio [OR] 1.249, p < .001; obese, OR 1.418, p < .001) and females (overweight, OR 1.989 p < .001; obese, OR 2.754, p < .001). The body height was associated with an increased risk of CAI when the highest height quintile was compared with the lowest height quintile in both males (OR 2.443, p < .001) and females (OR 1.436, p < .001) for all levels of instability severity. The present study has shown a greater prevalence of CAI among males than females in a general healthy young adult population. CAI was associated with an increased BMI and greater body height for all grades of instability severity. [ABSTRACT FROM AUTHOR]

Objective To determine the effect of nutritional supplementation on height, weight, and body mass index (BMI) in short and lean prepubertal children. Study design A prospective, randomized, double-blinded, placebo-controlled trial of nutritional supplementation at the endocrinology department of a tertiary pediatric medical center of healthy, lean, short, prepubertal children 3-9-years-old. Anthropometry measurements were measured at 6 months. Results Two hundred participants (149 boys) entered the study and 171 (85.5%) completed the intervention period. Baseline characteristics including age, sex, height-SDS, weight-SDS, BMI-SDS, and dietary caloric and protein intakes were similar in the formula and placebo groups. 'Good' consumers (intake of =50% of the recommended dose) in the formula group significantly improved height-SDS (P < .001) and weight-SDS (P = .005) with no change in BMI-SDS compared with 'poor' consumers and the placebo group. In the formula-treated group a positive correlation was found between the amount of formula consumed per body weight and the gain in height-SDS (r = 0.44, P < .001) and weight-SDS (r = 0.35, P = .002); no significant correlations were found in the placebo group. No serious adverse events were reported during the study. Conclusions Nutritional intervention with the formula was found to be a feasible, effective, and safe approach for promoting the physical growth of short and lean prepubertal children. [ABSTRACT FROM AUTHOR]

Abstract: We investigate the asymptotic behaviour of the number of those integers with squarefree kernel . Using a double saddle-point method, we obtain an asymptotic formula with remainder that holds, for any given , uniformly in the domain . This depends on the saddle-point parameters, defined as the solutions of a transcendental system and for which explicit estimates are provided. This result is in turn exploited to obtaining various explicit estimates for . For instance, writing and , where stands for the -th iterated logarithm, we show that for some function . We also define an explicit function such that, as , More precise formulae describe quantitatively the transition phase between the two behaviours the latter occurring if and only if . Other consequences of the main formulae are : (i) the exact determination of the size of the factor lost by application of a Rankin type bound; (ii) the derivation of precise formulae for the local behaviour of with respect to both variables, e.g. (iii) the complete solution of a problem of Erdős and de Bruijn related to the sum and (iv) a new, refined, and heuristically optimal, form of the conjecture. This last application is detailed in a forthcoming work in collaboration with C.L. Stewart. [Copyright &y& Elsevier]

Abstract: The calcaneus is the most frequently fractured tarsal bone. Compartment syndrome (CS) complicates fractures and other injuries and is most commonly described in association with the lower leg. The long-term sequelae of CS of the foot can include toe clawing, permanent loss of function, persistent pain, muscle atrophy, contracture, painful warts, weakness, and sensory disturbances. The incidence and clinical significance of untreated CS after calcaneal fractures were questioned. All compliant patients treated by us for a calcaneus fracture underwent a physical examination and medical interview: 47 (49 fractures) were included in the final cohort (36 males, 11 females, mean age 49 ± 14.5 years, mean follow-up 23 ± 16 months). Missed CS sequelae were diagnosed by the presence of claw toes and plantar sensory deficits. The functional outcome and pain at rest and during activity were scored. Five patients (10%) had missed CS, and their functional score was significantly lower than for those without CS (52 ± 21.5 versus 77.4 ± 22 for no CS, p < .05). All missed CS cases were diagnosed in patients with a Sanders type 3 or 4 fracture. Intra-articular fracture was a significant factor associated with developing CS sequelae (p = .045). Untreated CS can cause muscle and nerve injury and contribute to a poor functional outcome. Because CS is more likely to develop after highly comminuted intra-articular fractures, these patients warrant close monitoring for CS development. Early detection and treatment might result in fewer late disabling sequelae of this injury. [Copyright &y& Elsevier]

Objective: The aim of this study was to assess the effects of bite splint (BS) treatment termination in patients treated for temporomandibular disorder (TMD) and sleep bruxism (SB). Study Design: This longitudinal single-cohort study assessed 30 patients (29.5 ± 7.8 years old, 86.7% women) who were successfully treated with BS for SB and TMD for 30 days to 6 months prior to termination of the use of BS. The Research Diagnostic Criteria for TMD Axes I and II, Sleep Assessment Questionnaire, Beck Depression Inventory, and BiteStrip were used to assess TMD signs and symptoms, sleep disorders, depression, and SB at baseline and after 15 days of BS disuse. Results: TMD symptoms, including the disability points, characteristic pain intensity, and present pain at rest, increased significantly (P < 0.05). After 15 days of BS termination, there were no significant differences in SB and depression levels, sleep quality, and TMD signs. Conclusions: In patients with TMD and SB, BS treatment cessation is not recommended. [ABSTRACT FROM AUTHOR]

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Abstract: Purpose: To investigate how breast cancer patients referred to in-patient rehabilitation at Mösseberg Rehabilitation Centre (MRC) in Sweden perceive their life situation, and if their life satisfaction and mental health have changed three months later. Method: This prospective study is based on 46 women, all of them in working age. Three validated questionnaires were used, the Life Satisfaction (Li-Sat 11) scale, the Maastricht Questionnaire and the Shirom-Melamed Burnout Questionnaire (SMBQ). Results: Statistically significant improvements for the variables physical and mental health were seen in the measurements made using the Li-Sat 11 scale. The SMBQ survey showed a statistically significant improvement in the composite results for the indices involved. Likewise, the Maastricht Questionnaire showed statistically significant improvements in health status with respect to feelings of exhaustion and fatigue. Conclusion: More effective treatments have resulted in an increase in the number of breast cancer survivors and in the demand for rehabilitation. This study shows improvements in health and satisfaction with health, but cannot conclude this result as only an effect of the rehabilitation programme. Since only a few studies have until now shed light on the benefits of in-patient rehabilitation following a breast cancer diagnosis, there is an urgent need for continued research in this area. [Copyright &y& Elsevier]

Introduction: Studies of computer-aided learning (CAL) in orthodontics have documented both objective and subjective outcomes; however, to date, no studies have attempted to correlate these 2 outcome measures. Methods: The main objective outcome measured was performance on a written test covering material in the orthodontic diagnosis electronic tutorial (ODET) administered to 92 fourth-year undergraduate dental students. The main subjective outcome measured was a 12-statement questionnaire to elicit students'' perception of the ODET and CAL as teaching modalities. Results: In the male and female subgroups, a statistically significant difference in mean lecture test scores favoring women (72.46%) over men (67.08%) was observed (P = 0.05). This difference was not observed for mean ODET test scores (P = 0.52). Although responses to the questionnaire were mostly positive, the students are not prepared to replace lectures with CAL tutorials. Responses showed that male students preferred self-instruction as a mode of learning more than female students did (P = 0.05). When linking objective and subjective outcomes, the mean ODET test score had a statistically significant (P = 0.025), but weak, positive correlation (r = 0.243) with self-reported time spent reviewing the ODET but not with any other statement in the questionnaire. Conclusions: Despite a difference in lecture test scores between male and female students, there was no difference in mean ODET test scores between the 2 subgroups. This might be explained by sex differences: male students preferred self-instruction more than female students did. Improved performance on the ODET test was noted for students who reported longer times spent reviewing the tutorial. Because students are not prepared to replace lectures with CAL tutorials, from their perspective, the ODET should continue to be used with traditional modes of learning. [Copyright &y& Elsevier]

Abstract: This chapter focuses on the interdisciplinary discussion between cognitive psychologists and neuroscientists on how actions, the results of decision processes, are implemented. After surveying the approaches used in action implementation research, we analyze the contributions of these different approaches in more detail. Topics covered include expertise research in sports science, knowledge structures, neuroscientific research on motor imagery and decision making, computational models in motor control, robotics, and brain–machine interfaces. This forms the basis for discussing central issues for interdisciplinary research on action implementation from different viewpoints. In essence, most findings show the need to abandon serial frameworks of information processing suggesting a step-by-step pattern from perception, evaluation, and selection to execution. Instead, an outlook on new approaches is given, opening a route for future research in this field. [Copyright &y& Elsevier]

Abstract: This chapter presents a theoretical framework, which is supported by empirical evidence, where changes in human performance are accounted for by changes in mental representation structure (MRS). More specifically, the knowledge base, represented in the form of mental representations, controls the perceptual, cognitive, and motor systems when interacting with the environment. Once this interaction induces pressure, changes in the MRS lead to respective changes in the function of attention, anticipation, long-term working memory, the control system, and the motor systems. Such changes can be detected via both overt and covert behavior of the human system. This chapter presents the theoretical frameworks and accompanies them with graphical illustrations. [Copyright &y& Elsevier]

Abstract: A unified conceptual framework, which integrates the structural components of human performance, such as emotional processes (i.e., feelings, mood), cognitive processes and structures (e.g., knowledge architecture, long-term working memory), motor processes (coordination, endurance), and the neurophysiologic basis of these structural components (i.e., activation of cortical areas) is introduced. Recent developments in the cognitive, neurological, expertise, and emotion sciences provide a sound evidence for this conceptualization. The unified conceptual framework enables a better understanding of human performance, and allows generating applications, which share scientific validity. [Copyright &y& Elsevier]

Background: Elevated C-reactive protein (CRP) levels are related to increased coronary risk in healthy subjects and in patients with acute coronary syndromes. The aims of the present study were to assess the following: (1) the association between CRP and subsequent coronary risk in patients with chronic coronary heart disease (CHD), (2) the effect of long-term bezafibrate treatment on CRP levels, and (3) to evaluate the consequences of change in CRP level over time on subsequent risk. Methods: Patients with chronic CHD (n = 3122) were recruited to a secondary prevention study that assessed the efficacy of bezafibrate versus placebo. C-reactive protein was measured in plasma samples collected at prerandomization and after 2 years of follow-up. Mean follow-up time was 6.2 years. Primary end point was fatal and nonfatal myocardial infarction and sudden cardiac death. Results: Increased baseline CRP levels were associated with increased risk (hazard ratios [HRs] per unit of log-transformed CRP level change) of myocardial infarction (HR 1.17, 95% CI 1.03-1.33), the primary end point (HR 1.19, 95% CI 1.06-1.34), total death (HR 1.19, 95% CI 1.02-1.40) and cardiac death (HR 1.28, 95% CI 1.04-1.59). After 2 years, CRP levels increased by 3.0% (from a mean level of 3.44 mg/L) in the bezafibrate group and by 3.7% (from 3.49 mg/L) in the placebo group. C-reactive protein levels after 2 years were associated with increased subsequent cardiovascular risk. Conclusions: Baseline CRP and 2-year CRP levels were associated with subsequent risk of myocardial infarction and death in patients with chronic CHD. Bezafibrate did not reduce CRP levels as compared with placebo. [Copyright &y& Elsevier]

The outbreak of COVID-19 from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world with tremendous morbidity and mortality in the elderly. In-hospital treatment addresses the multifaceted nature of the illness including initial viral replication, cytokine storm, and endothelial injury with thrombosis. We identified nine reports of early treatment outcomes in COVID-19 nursing home patients. Multi-drug therapy including hydroxychloroquine with one or more anti-infectives, corticosteroids, and antithrombotic anti-blood clotting agents can be extended to seniors in the nursing home setting without hospitalization. Data from nine studies found hydroxychloroquine-based multidrug regimens were associated with a statistically significant > 60% reduction in mortality. Going forward, we conclude that early empiric treatment for the elderly with COVID-19 in the nursing home setting (or similar congregated settings with elderly residents/patients e.g. LTF or ALF) has a reasonable probability of success and acceptable safety. This group remains our highest at-risk group and warrants acute treatment focus prior to symptoms worsening. Given the rapidity and severity of SARS-CoV-2 outbreaks in nursing homes, in-center treatment of acute COVID-19 patients is a reasonable strategy to reduce the risks of hospitalization and death. If elderly high-risk patients in such congregated nursing home type settings are allowed to worsen with no early treatment, they may be too sick and fragile to benefit from in-hospital therapeutics and are at risk for pulmonary failure, life-ending micro-thrombi of the lungs, kidneys etc. The issue is timing of therapeutics, and we argue that early treatment before hospitalization, is the right time and can potentially save lives, especially among our higher-risk elderly populations hit hardest by severe illness and death from COVID-19. We must reiterate, we are talking about 'early' treatment before the disease is far along in the disease sequelae where the patient then needs hospitalization and aggressive interventions. We are referring to the initial days e.g. day one, post infection when symptoms emerge or there is strong clinical suspicion. This early therapeutic option deserves serious and urgent consideration by the medical establishment and respective decision-makers. Doctors must be allowed their clinical discretion in how they optimally treat their patients. Doctors must be brave and trust their skilled judgements and do all to save the lives of their patients. We therefore hypothesize that early outpatient ambulatory treatment, once initiated as soon as symptoms begin in high-risk positive persons, would significantly reduce hospitalizations and prevent deaths. Specifically, the provision of early multi-drug sequenced therapy with repurposed drugs will reduce hospitalization and death in elderly patients being cared for in long-term-care facilities. The most important implications of our hypothesis are: 1) hospitalizations and deaths would be reduced 2) transmission would be reduced due to the mitigation of symptoms and 3) recovery following infection and treatment provides for natural exposure immunity that is broad based, durable, and robust (helping towards natural immunity within the population). The end result is reduced strain on hospitals and systems that would allow for other non-COVID illnesses to receive care. [ABSTRACT FROM AUTHOR]

Living with a physical disability (PD) withholds serious health problems that can be significantly alleviated through participation in regular exercise. Gyms offer a legitimized and safe exercise environment, however people with PD are limited in their opportunities to integrate within gyms. In this scoping review, the current knowledge on barriers and facilitators of gym-based exercise among people with PD were reviewed to gain a domain specific understanding of exercise participation in this population. Potential agents of change who may foster equal exercise opportunities for individuals with PD were mapped. Exercise barriers and facilitators, and agents of change were identified at the personal, social, and environmental levels. Lack of gym accessibility lack of social support, and oppressive attitudes within gyms were the most reported barriers to gym-based exercise participation. Enhanced opportunities to interact with others within gym settings and committing to exercise were identified as main facilitators of exercise participation in people with PD. The findings presented herein point to the necessity of multi-level actions to enhance the current low exercise participation of people with PD, specifically in gyms. These actions can be employed by people with PD, as well as by local community members, gym managements, healthcare providers, and policy makers to create more inclusive gym environments that meet the needs of people with PD. Strategies for enhancing the integration of people with PD within gym settings are offered. [ABSTRACT FROM AUTHOR]

Purpose: Non-contrast CT ASPECTS (NCCTasp) has an established role in determining eligibility for mechanical thrombectomy in centers without ready access to perfusion or DWI. Moreover, it has been suggested that CTA source ASPECTS (CTAasp) may be superior to NCCTasp in predicting final infarct volume (FIV). In this study, we hypothesized that CTA maximum intensity projection ASPECTS (MIPSasp) would be superior compared to both NCCTasp and CTAasp in predicting FIV as measured by DWI.Materials and Methods: In 41 consecutive patients with MCA territory infarcts, NCCTasp, CTAasp and MIPSasp were visually assessed by 2 neuroradiologists. Disagreements were adjudicated by a third neuroradiologist, and the reconciled data used for all further analysis. MR-DWI was used as the standard for FIV determination. Receiver operating characteristic curve analysis was used to compare the area under the curve for all three CT-based methods in predicting FIV ≥70 ml.Results: MIPSasp (AUC: 0.98, CI: 0.88-1.00) were statistically better than NCCTasp (AUC: 0.87, 95% CI: 0.72-0.95; p=0.01) in predicting FIV ≥70 ml. MIPSasp were also superior to CTAasp (AUC: 0.9, CI: 0.79-.98; p˂0.05). Optimal test performance for predicting FIV ≥70 ml for MIPSasp was ≤6 (sensitivity=100%, specificity=91.4%; Youden's J=0.98).Conclusion: Our preliminary study suggests that a novel CTA-MIPS derived ASPECTS better predicts large MCA territory infarcts compared to CTA source and non-contrast ASPECTS. Thus, MIPSasp may be a promising technique for future studies aimed at improving ischemic stroke treatment in centers using ASPECTS for stroke management. [ABSTRACT FROM AUTHOR]

We describe the case of a 6-year-old boy who developed myelin oligodendrocyte glycoprotein antibody (MOG-Ab) associated demyelinating syndrome, after initially presenting with aseptic meningitis. Magnetic resonance imaging showed cerebral and spinal lesions consistent with acute disseminating encephalomyelitis. Rapid clinical improvement occurred after intravenous high dose methylprednisolone. A small number of cases with MOG-Ab associated demyelinating syndrome presenting as aseptic meningitis have previously been reported in adults, but to our knowledge, this is the first pediatric case of this new clinical phenotype. [ABSTRACT FROM AUTHOR]