Age-related increases in parathyroid hormone may be antecedent to both osteoporosis and dementia

<p>Abstract</p> <p>Background</p> <p>Numerous studies have reported that age-induced increased parathyroid hormone plasma levels are associated with cognitive decline and dementia. Little is known about the correlation that may exist between neurological processing speed, cognition and bone density in cases of hyperparathyroidism. Thus, we decided to determine if parathyroid hormone levels correlate to processing speed and/or bone density.</p> <p>Methods</p> <p>The recruited subjects that met the inclusion criteria (n = 92, age-matched, age 18-90 years, mean = 58.85, SD = 15.47) were evaluated for plasma parathyroid hormone levels and these levels were statistically correlated with event-related P300 potentials. Groups were compared for age, bone density and P300 latency. One-tailed tests were used to ascertain the statistical significance of the correlations. The study groups were categorized and analyzed for differences of parathyroid hormone levels: parathyroid hormone levels <30 (n = 30, mean = 22.7 ± 5.6 SD) and PTH levels >30 (n = 62, mean = 62.4 ± 28.3 SD, p ≤ 02).</p> <p>Results</p> <p>Patients with parathyroid hormone levels <30 showed statistically significantly less P300 latency (P300 = 332.7 ± 4.8 SE) relative to those with parathyroid hormone levels >30, which demonstrated greater P300 latency (P300 = 345.7 ± 3.6 SE, p = .02). Participants with parathyroid hormone values <30 (n = 26) were found to have statistically significantly higher bone density (M = -1.25 ± .31 SE) than those with parathyroid hormone values >30 (n = 48, M = -1.85 ± .19 SE, p = .04).</p> <p>Conclusion</p> <p>Our findings of a statistically lower bone density and prolonged P300 in patients with high parathyroid hormone levels may suggest that increased parathyroid hormone levels coupled with prolonged P300 latency may become putative biological markers of both dementia and osteoporosis and warrant intensive investigation.</p

Bone-anchored titanium implants for auricular rehabilitation: case report and review of literature

CONTEXT AND OBJECTIVE: Osseointegrated implants have acquired an important role in the prosthetic rehabilitation of patients with craniofacial defects. The main indications are lack of local tissue for autogenous reconstruction, previous reconstruction failure and selection of this technique by the patient. This paper presents a clinical case and discusses indications and advantages of the osseointegrated implant technique for retention of auricular prostheses. TYPE OF STUDY: Case report, Universidade Federal de São Paulo (UNIFESP). METHODS: A female patient received three auricular implants after surgical resection of a hemangioma in her left ear. The time taken for osseointegration of the temporal bone was three months. After fabrication of the implant-retained auricular prosthesis, the patient was monitored for 12 months. RESULTS: The clinical parameters evaluated showed good postoperative healing, healthy peri-implant tissue, good hygiene and no loss of implants. Good hygiene combined with thin and immobile peri-implant soft tissues resulted in minimal complications. Craniofacial implant integration appears to be site-dependent; increasing age affects osseointegration in the temporal bone. The frequency of adverse skin reactions in peri-implant tissues is generally low. CONCLUSION: The surgical technique for rehabilitation using implant-retained auricular prostheses seems to be simple. It is associated with low rates of adverse skin reactions and long-term complications. Prostheses anchored by osseointegrated implants seem to provide better retention than do prostheses supported on spectacle frames, less risk of discoloration through the use of adhesives and better esthetic results than do prostheses anchored in the surgical cavityCONTEXTO E OBJETIVO: Os implantes osseointegrados adquiriram papel importante na reabilitação protética de pacientes com defeitos craniofaciais. As principais indicações são ausência local de tecidos para reconstrução autógena, falha anterior de reconstrução e opção do paciente. Este artigo apresenta um caso clínico e discute as indicações e vantagens da técnica de implantes osseointegrados para a retenção de próteses auriculares. TIPO DE ESTUDO E LOCAL: Relato de caso clínico, Universidade Federal de São Paulo (UNIFESP). MÉTODOS: Paciente do sexo feminino recebeu três implantes na região auricular após ressecção cirúrgica de hemangioma na orelha esquerda. O tempo de osseointegração no osso temporal foi de três meses. Após a confecção de prótese auricular implanto-suportada, a paciente foi observada por 12 meses. RESULTADOS: Os parâmetros clínicos analisados mostraram boa cicatrização pós-operatória, saúde dos tecidos adjacentes ao implante, boa higiene e nenhuma perda de implantes. A boa higiene combinada a pouca espessura e imobilidade dos tecidos moles perimplantares resulta em poucas complicações. A integração dos implantes craniofaciais parece variar conforme o local, e a idade avançada afeta a osseointegração no osso temporal. A frequência de reações adversas cutâneas nos tecidos perimplantares é geralmente baixa. CONCLUSÃO: A técnica cirúrgica para a reabilitação com próteses auriculares implanto-suportadas parece ser simples e está associada a baixos índices de reações cutâneas adversas e complicações no longo prazo. As próteses ancoradas por implantes osseointegrados parecem proporcionar melhor retenção do que as próteses suportadas nas armações de óculos, menor possibilidade de descoloração pelo uso de adesivos e melhores resultados estéticos do que as próteses ancoradas na cavidade cirúrgica.Universidade Federal de São Paulo (UNIFESP) Department of Otorhinolaryngology and Head and Neck SurgeryUniversidade Paulista Faculty of Dentistry Department of StomatologyUniversidade Federal de São Paulo (UNIFESP) Santo Amaro University School of DentistryUniversidade Federal de São Paulo (UNIFESP) Santo Amaro University Department of StomatologyUniversity of Gothenburg Department of Anatomy and Cell BiologyUniversity of Gothenburg Department of OtolaryngologyUNIFESP, Department of Otorhinolaryngology and Head and Neck SurgeryUNIFESP, Santo Amaro University School of DentistryUNIFESP, Santo Amaro University Department of StomatologySciEL

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

The speech outcome of definitive obturators constructed using two different impression techniques

En Abstract Objectives The aim of this study was to evaluate the accuracy of two different impression techniques through the assessment of the performance of the two definitive obturators fabricated by each technique. Patients A total of six partially edentulous patients with unilateral maxillary surgical defects were selected from those admitted at the Prosthodontic Department, Faculty of Dentistry, Alexandria University. Methods For every patient, two hollow bulb obturators were constructed, each using a different impression technique. Three patients started with the open face tray impression technique and the other three started with the altered cast impression technique. Each patient was given one obturator at a time and was instructed to use it for 2 months. All patients were subjected to the following: (a) a preprosthetic evaluation, (b) an evaluation 2 months after the insertion of the first obturator, and (c) an evaluation 2 months after the insertion of the second obturator. During each session, speech and swallowing were evaluated. Results Regarding the three formant frequencies of the vowel /a/, there was a statistically significant improvement only in F1 between the altered cast and the preprosthetic phase and between the altered cast and the open face impression techniques, whereas concerning vowel /e/, there was a statistically significant improvement in F2 in favor of the altered cast impression technique. The degree of nasality in the vowels and the plosives were significantly improved in the altered cast technique. However, there was no significant improvement in the nasality between the two techniques with regard to oral and nasal sentences. There was an observed improvement in the competence and the shape of the velopharyngeal valve with the obturator than without the obturator. Conclusion The altered cast technique caused statistical improvement in the nasality of vowels and plosives as compared with the open face impression technique. Both treatment modalities caused general improvement in the patient’s satisfaction and in swallowing with no statistically significant difference between them

Production of enantiomerically pure D-Phenylglycine using Pseudomonas aeruginosa 10145 as biocatalyst

Different bacterial strains were screened to detect nitrilase and/or nitrile hidratase/amidase activities towards benzonitrile, to be used as biocatalyst to produce enantiomerically pure non-proteinogenic amino acids using amino nitriles as starting material. The best biocatalyst found was Pseudomonas aeruginosa 10145, which showed high enzyme activities. Whole cells were used as catalyst for the transformation of 2-phenyl-2-amino-acetonitrile for the corresponding D-phenylglycine. The percentage conversion was followed by chiral HPLC. After 1 hour reaction 18% of 2-phenyl-2-amino-acetonitrile was converted into D-phenylglycine with an enantiomeric excess of over 95%. When an inducer was added to the media, an increase in nitrile hydrolyzing activities was detected, hence leading to total conversion of (R)-2-phenyl-2-amino-acetonitrile to the corresponding amino acid in 30 min reaction. The isolated yield of the target product was 50% and its characterization was performed by polarimetry, chiral HPLC, IR-FT spectroscopy and GC-MS