3D osteoarthritic changes in TMJ condylar morphology correlates with specific systemic and local biomarkers of disease

SummaryObjectiveTo assess 3D morphological variations and local and systemic biomarker profiles in subjects with a diagnosis of temporomandibular joint osteoarthritis (TMJ OA).DesignTwenty-eight patients with long-term TMJ OA (39.9 ± 16 years), 12 patients at initial diagnosis of OA (47.4 ± 16.1 years), and 12 healthy controls (41.8 ± 12.2 years) were recruited. All patients were female and had cone beam CT scans taken. TMJ arthrocentesis and venipuncture were performed on 12 OA and 12 age-matched healthy controls. Serum and synovial fluid levels of 50 biomarkers of arthritic inflammation were quantified by protein microarrays. Shape Analysis MANCOVA tested statistical correlations between biomarker levels and variations in condylar morphology.ResultsCompared with healthy controls, the OA average condyle was significantly smaller in all dimensions except its anterior surface, with areas indicative of bone resorption along the articular surface, particularly in the lateral pole. Synovial fluid levels of ANG, GDF15, TIMP-1, CXCL16, MMP-3 and MMP-7 were significantly correlated with bone apposition of the condylar anterior surface. Serum levels of ENA-78, MMP-3, PAI-1, VE-Cadherin, VEGF, GM-CSF, TGFβb1, IFNγg, TNFαa, IL-1αa, and IL-6 were significantly correlated with flattening of the lateral pole. Expression levels of ANG were significantly correlated with the articular morphology in healthy controls.ConclusionsBone resorption at the articular surface, particularly at the lateral pole was statistically significant at initial diagnosis of TMJ OA. Synovial fluid levels of ANG, GDF15, TIMP-1, CXCL16, MMP-3 and MMP-7 were correlated with bone apposition. Serum levels of ENA-78, MMP-3, PAI-1, VE-Cadherin, VEGF, GM-CSF, TGFβ1, IFNγ, TNFα, IL-1α, and IL-6 were correlated with bone resorption

Service provision for women undergoing termination of pregnancy: progress in Wales, UK

Background. This audit established a recent picture of termination of pregnancy services in Wales, UK using the Royal College of Obstetricians and Gynaecologists' Guidelines as a baseline. The context of abortion is rapidly changing and services need to be adaptable to meet women's needs. Methods. A questionnaire survey was sent to all National Health Service (NHS) Trusts in Wales; 10 out of 13 responded. Results. In the nine Trusts performing abortions in Wales, medical abortions accounted for 57% and surgical abortions for 43%. Doctors in training were involved in six Trusts. All but one Trust complied with referral times. Five Trusts provided a dedicated clinic. Written information provided prior to abortion varied in accessibility and quality. Choice of abortion within gestation bands was limited in some Trusts with some only providing medical termination. Essential abortion aftercare was performed by Trusts, whereas follow-up and counselling were less comprehensive. Discussion. Trusts are willing to adapt to new methods of working with an increasing number of medical terminations, although this advantage was offset by a lack of choice of abortion methods offered by some Trusts. Doctors in training should be offered exposure to abortion procedures in all Trusts as this has been shown elsewhere to improve attitudes. Providing dedicated abortion clinics, quality written information and comprehensive abortion aftercare should improve compliance with the guidelines. Conclusion. Overall, in Wales there is compliance with national guidelines, although for a number of the guideline recommendations, there remains room for improvement

The digestive performance of mammalian herbivores: why big may not be that much better

1. A traditional approach to the nutritional ecology of herbivores is that larger animals can tolerate a diet of lesser quality due to a higher digestive efficiency bestowed on them by comparatively long ingesta retention times and lower relative energy requirements. 2. There are important physiological disadvantages that larger animals must compensate for, namely a lower gut surface : gut volume ratio, larger ingesta particle size and greater losses of faecal bacterial material due to more fermentation. Compensating adaptations could include an increased surface enlargement in larger animals, increased absorption rates per unit of gut surface, and increased gut motility to enhance mixing of ingesta. 3. A lower surface : volume ratio, particularly in sacciform forestomach structures, could be a reason for the fact that methane production is of significant scope mainly in large herbivores and not in small herbivores with comparably long retention times; in the latter, the substrate for methanogenesis – the volatile fatty acids – could be absorbed faster due to a more favourable gut surface : volume ratio. 4. Existing data suggest that in herbivores, an increase in fibre digestibility is not necessarily accompanied by an increase in overall apparent dry matter digestibility. This indicates a comparative decrease of the apparent digestibility of non-fibre material, either due to a lesser utilization of non-fibre substrate or an increased loss of endogenous/bacterial substance. Quantitative research on these mechanisms is warranted in order to evaluate whether an increase in body size represents a net increase of digestive efficiency or just a shift of digestive focus