A randomized controlled trial to assess the pain associated with the debond of orthodontic fixed appliances

Objective: To determine patient experience of pain during treatment with fixed orthodontic appliances, expectations of pain during debond and whether biting on a soft acrylic wafer during debond decreases pain experience. Design: Multicentre randomized controlled trial. Setting: Three UK hospital based orthodontic departments: Mid-Staffordshire NHS Foundation Trust, Birmingham Dental Hospital and University Hospital of North Staffordshire. Materials and methods: Ninety patients were randomly allocated to either the control (n = 45) or wafer group (n = 45). A visual analogue scale-based questionnaire was completed pre-debond to determine pain experience during treatment and expectations of pain during debond. The appliances were debonded and those in the wafer group bit on a soft acrylic wafer. A second questionnaire was completed post-debond to assess the pain experienced. Results: Biting on an acrylic wafer significantly reduced the pain experienced when debonding the posterior teeth (P≤0·05). Thirty-nine per cent found the lower anterior teeth the most painful. The expected pain was significantly greater than that actually experienced (P≤0·0001). Greater pain during treatment correlated with increased expectations and increased actually experienced pain (P≤0·0001). Conclusions: Biting on a soft acrylic wafer during debond of the posterior teeth reduces the pain experienced. The lower anterior teeth are the most painful. The pain expected is significantly greater than actually experienced. Patients who had greater pain during treatment expected and experienced greater pain at debond

Health-related quality of life of patients after mechanical valve replacement surgery for rheumatic heart disease in a developing country

Objective: To evaluate the health-related quality of life (HRQoL) of people in Fiji (n=128) undergoing heart valve replacement (VR) surgery for rheumatic heart disease (RHD), conducted by Open Heart International. Methods: Patients who had undergone surgery from 1991 to 2009 (n=72) and patients undergoing surgery for the years 2010-2012 (n=56) were surveyed prospectively, preoperatively and/or postoperatively (the mean follow-up time 5.9 years) using the standard recall Short-Form 36, V.2 (SF-36v2) HRQoL Survey. Results: The sample had a mean age of 26.7 years and 56% (n=72) were women. Preoperative HRQoL is impaired but by early postoperative (1 year) there is significant improvement across all domains (p2 years), all HRQoL domains, except for mental health, were significantly better than preoperative (p=0.066 ). Predictors of less improved HRQoL included having an isolated mitral valve replacement (MVR) (for six of eight health domains, p<0.05), older age (three domains; role- physical, vitality and bodily pain, p<0.05) and male gender (in the role-emotional domain, p<0.05). Conclusions: This first investigation of the HRQoL of people in a developing country after VR surgery for RHD found significant improvement from surgery with this improvement generally sustained. The lack of improvement in mental health requires further exploration as does the influence of an isolated MVR, age and gender

Effects of Pro-Inflammatory Cytokines on the Production of Soluble Fractalkine and ADAM17 by HepG2 Cells

Background and Aims: Soluble fractalkine is increased in the liver during times of injury; however the effect of pro-inflammatory cytokines in this process is currently unknown. The aim of this study was to determine whether pro-inflammatory cytokines elevated in patients with hepatocellular carcinoma influence fractalkine shedding from HepG2 cells and whether ADAM 17 was involved in this process. Methods: In vitro experiments were performed in the human hepatocellular carcinoma cell line HepG2. Soluble fractalkine was detected using an ELISA.ADAM17 expression was investigated using quantitative real time (reverse transcription)-polymerase chain reaction and flow cytometry. Short interfering RNA transfection was used to down-regulate ADAM17 expression. Results: Soluble fractalkine was present in supernatants of HepG2 cells, and was significantly increased by interleukin-1 beta(p ≤ 0.005) and tumour necrosis factor-alpha (p ≤ 0.043), but not by interleukin-6 (p ≥ 0.316). This corresponded to minor increases in ADAM 17 protein, but not ADAM 17 mRNA, following the same treatments. However, the down-regulation of ADAM17 protein did not affect fractalkine shedding. Conclusions: This study showed that soluble fractalkine is up-regulated under inflammatory conditions associated with hepatocellular carcinoma development, but ADAM 17 does not appear to be responsible for regulating this process.</p