Anti-fibrinolytics for mucosal bleeding in adults with life-limiting illnesses: a systematic review.

Introduction: Patients with life-limiting illnesses are at increased risk of mucosal bleeding. Usual management includes anticipatory planning and sedation, alongside anti-fibrinolytics, despite a lack of evidence for their use. Anti-fibrinolytic agents (tranexamic acid and aminocaproic acid) produce effective haemostasis in different clinical settings.

Co-localization of the sodium-glucose co-transporter-2 channel (SGLT-2) with endothelin ETA and ETB receptors in human cardiorenal tissue.

Unlabelled: Endothelin (ET) receptor antagonists are being investigated in combination with sodium-glucose co-transporter-2 inhibitors (SGLT-2i). These drugs primarily inhibit the SGLT-2 transporter that, in humans, is thought to be mainly restricted to the renal proximal convoluted tubule, resulting in increased glucose excretion favouring improved glycaemic control and diuresis. This action reduces fluid retention with ET receptor antagonists.

Inducible apelin receptor knockdown reduces differentiation efficiency and contractility of hESC-derived cardiomyocytes.

Aims: The apelin receptor, a G protein-coupled receptor, has emerged as a key regulator of cardiovascular development, physiology, and disease. However, there is a lack of suitable human in vitro models to investigate the apelinergic system in cardiovascular cell types. For the first time we have used human embryonic stem cell-derived cardiomyocytes (hESC-CMs) and a novel inducible knockdown system to examine the role of the apelin receptor in both cardiomyocyte development and to determine the consequences of loss of apelin receptor function as a model of disease.

Advance care planning ahead of life-altering clinical deterioration in secure settings: Do not wait until a crisis.

All professionals involved in someone's care should be equipped to support individuals, and the people close to them, to understand how their health is likely to change, consider the burdens and likely outcomes of treatment options and make realistic, informed recommendations to guide future care. This can be particularly challenging in forensic mental health, when it covers cardiopulmonary resuscitation alongside recommendations about acute hospital admission and medical escalation within and outside of hospital settings. Some clinicians question whether or not the harms of raising the spectre of invasive ventilation and potential mortality risks unnecessary anxiety and psychological harm amongst detained patients.

Establishing better biological models to understand occlusion. I: TM joint anatomic relationships.

Belief in and rejection of a relationship of occlusion and temporomandibular joint (TMJ) condyle-fossa position with normal and abnormal function are still contentious issues. Clinical opinions can be strong, but support in most published data (mostly univariate) is problematic. Distribution overlap, low sensitivity and specificity are a common basis to reject any useful prediction value.

Dentistry-based approaches to sleep-disordered breathing, algorithms, and multidisciplinary perspectives.

Sleep disorders affect more than 20 percent of the U.S. population, but less than 7 percent have been medically diagnosed.

Education in sleep disorders in US dental schools DDS programs.

Introduction: Medical school surveys of pre-doctoral curriculum hours in the somnology, the study of sleep, and its application in sleep medicine/sleep disorders (SM) show slow progress. Limited information is available regarding dentist training. This study assessed current pre-doctoral dental education in the field of somnology with the hypothesis that increased curriculum hours are being devoted to SM but that competencies are still lacking.

Dental attrition models predicting temporomandibular joint disease or masticatory muscle pain versus asymptomatic controls.

Aims: To determine whether patients with temporomandibular joint disease or masticatory muscle pain can be usefully differentiated from asymptomatic controls using multifactorial classification tree models of attrition severity and/or rates.

Methods: Measures of attrition severity and rates in patients diagnosed with disc displacement (n = 52), osteoarthrosis (n = 74), or masticatory muscle pain only (n = 43) were compared against those in asymptomatic controls (n = 132). Cross-validated classification tree models were tested for fit with sensitivity, specificity, accuracy and log likelihood accountability.

Improved interaction models of temporomandibular joint anatomic relationships in asymptomatic subjects and patients with disc displacement with or without reduction.

Aims: To consider temporomandibular joint (TMJ) anatomic interactions in order to refine hard tissue models differentiating (1) joints diagnosed with disc displacement with reduction (DDwR) or without reduction (DDw/oR) from asymptomatic joints (Normals), and (2) DDwR joints from DDw/oR joints.

Methods: TMJ tomograms of 84 women with unilateral DDwR and 78 with unilateral DDw/oR were compared against each other and against those of 42 female Normal joints through the use of 14 linear and angular measurements, 8 ratios, and 34 interactions. A classification tree model for each comparison was tested for fit with sensitivity, specificity, accuracy, and log likelihood and compared to logistic regression models.

Multifactorial comparison of disk displacement with and without reduction to normals according to temporomandibular joint hard tissue anatomic relationships.

Statement Of Problem: There is disagreement about the predictive value of temporomandibular joint tomographic anatomy in the diagnosis of internal derangements.

Purpose: This study aimed to identify multifactorial temporomandibular hard tissue relationships that differentiate disk displacement with reduction and disk displacement without reduction from normals.

Material And Methods: Temporomandibular joint tomograms from females diagnosed with unilateral disk displacement with (n=84) or without (n=78) reduction were compared to 42 asymptomatic normal joints with the use of 14 linear and angular measurements and 8 ratios.

Multifactorial modeling of temporomandibular anatomic and orthopedic relationships in normal versus undifferentiated disk displacement joints.

Statement Of Problem: There is persistent dispute about the diagnostic value of hard tissue anatomic relationships in predicting temporomandibular joint disorders and normals.

Purpose: The goal of this study was identification of multifactorial temporomandibular hard tissue relationships that differentiate asymptomatic normal joints.

Material And Methods: Central section lateral tomograms of 162 female temporomandibular joints with pooled diagnoses of unilateral disk displacement with and without reduction were compared to 42 female asymptomatic normal joints using 14 linear and angular measurements and 8 ratios.

Multifactorial analysis of differences in temporomandibular joint hard tissue anatomic relationships between disk displacement with and without reduction in women.

Statement Of Problem: Without multifactorial models, it is difficult to resolve whether hard tissue tomographic relationships can distinguish differences between temporomandibular joint (TMJ) internal derangement diagnoses.

Purpose: The purpose of this study was to use multifactorial models to examine whether there are hard tissue anatomic and orthopedic characteristics that distinguish temporomandibular joints with disk displacement with reduction from disk displacement without reduction.

Material And Method: .

Analysis of occlusal variables, dental attrition, and age for distinguishing healthy controls from female patients with intracapsular temporomandibular disorders.

Statement Of Problem: Confusion about the relationship of occlusion to temporomandibular disorders (TMD) persists.

Purpose: This study attempted to identify occlusal and attrition factors plus age that would characterize asymptomatic normal female subjects.

Methods And Material: A total of 124 female patients with intracapsular TMD were compared with 47 asymptomatic female controls for associations to 9 occlusal factors, 3 attrition severity measures, and age using classification tree, multiple stepwise logistic regression, and univariate analyses.

Quantification and validation of predictive values of occlusal variables in temporomandibular disorders using a multifactorial analysis.

Statement Of Problem: A consensus is lacking on the association between occlusal variables and temporomandibular disorders (TMDs).

Purpose: This study estimated the maximum potential power of occlusal variables to differentiate patients with TMD from asymptomatic normal adult subjects.

Material And Methods: The occlusal characteristics in 2 sets of female patients with intracapsular TMD (1993, n = 257, and 1998, n = 124) differentiated into disk displacement and osteoarthrosis subdiagnoses were compared with asymptomatic female controls (n = 51 and 47) with multiple logistic regression analysis.

A multiple stepwise logistic regression analysis of trauma history and 16 other history and dental cofactors in females with temporomandibular disorders.

The simultaneous contribution of 11 occlusal factors, dental attrition severity, orthodontic history, trauma (motor vehicle accident [MVA] and non-MVA), and age in defining two independent large populations of females diagnosed with five mutually exclusive temporomandibular disorders was tested through multiple stepwise logistic regression analysis. Non-MVA trauma was significant in both groups in defining disc displacement (DD) with and without reduction, and osteoarthrosis (OA) (both primary and following DD). Anterior open bite was also a significant factor in defining OA in both groups.

Impact of TMJ radiographs on clinician decision making.

Objectives: This study examined the influence of lateral and frontal temporomandibular joint tomograms on the initial diagnosis and treatment plan of patients having facial or preauricular pain or temporomandibular joint disorders.

Study Design: Five or six general dentists, all with experience in treating patients with disorders of the temporOmandibular joint, examined records of 105 patients from a university-based orofacial pain clinic. The examiners proposed a diagnosis and treatment plan for each patient without the benefit of tomograms.

Efficacy of TMJ radiographs in terms of expected versus actual findings.

Objectives: The purpose of this study was to measure the amount of new information contributed by temporomandibular joint tomograms beyond that anticipated by the patient's clinical presentation.

Study Design: The results of a clinical examination and history, including a video of patient interview, and dental casts of 105 patients with a temporomandibular disorder were presented to a panel of general dentist evaluators with some experience in temporomandibular disorders. These evaluators then described the radiographic findings they anticipated.

The degree to which dental attrition in modern society is a function of age and of canine contact.

Dental attrition ranked according to a validated severity scale correlated with age as a proxy for functional wear in 148 asymptomatic subjects. Anterior, posterior, mediotrusive, laterotrusive, and total attrition severity was analyzed. The geometric contribution of canine attrition to the variance of posterior attrition was also tested through correlations, and the time span required to record a statistically significant difference in attrition using the scale was determined.

Histologic characteristics of the lateral pterygoid muscle insertion to the temporomandibular joint.

This study used low-power light microscopy to examine the histologic organization of the lateral pterygoid muscle interface with the temporomandibular joint. The sample included parasagittal sections of 20 intact temporomandibular joints from young adults (mean age 26.2 years) at autopsy.

Relationship of articular soft tissue contour and shape to the underlying eminence and slope profile in young adult temporomandibular joints.

This study examined whether the overall shape of the articular soft tissue overlying the posterior slope and articular eminence of the temporal bone could be predicted by the underlying osseous contour in a histologic model of 51 central sagittal sections of young adult temporomandibular joints. Articular soft tissue and bone contours were traced, and osseous landmarks identified on the basis of joint geometry. Soft tissue thickness measurements were made under low power light microscopy.

Contour mapping of the TMJ temporal component and the relationship to articular soft tissue thickness and disk displacement.

The osseous architecture of central sagittal histologic sections of the temporal component of 51 temporomandibular joints of young adults at autopsy was studied to determine if this predicted the thickness of the overlying articular soft tissue and disk displacement. Geometric groupings of fossa-eminence shapes were generated using a hierarchical cluster analysis of the osseous fossa-eminence sigmoid curve, size, and slope. Six cluster groups were evolved and tested for relationship to soft tissue thickness measured at the eminence crest, mid-point of the eminence slope, closed pack location of the condyle, the inflection point, and the depth of the fossa.

The articular-synovial lining tissue system in temporomandibular joints of young adults.

The histologic character of the articular surfaces and synovial tissues in the temporomandibular joints of 20 young adults was described. Each joint compartment had a continuous connective-tissue lining that was fibrous on the articular surfaces, went through a transition, and was continuous with the lining tissue in the recesses. Areolar synovial tissue was found only in the upper posterior recess of the temporomandibular joint, fibrous synovial tissue was predominantly found in the upper anterior and lower posterior recesses, and an intermediate type of synovial tissue was found in the lower anterior recess.