The present study investigated to what extent a systematic evaluation of electronic condylar motion recordings leads to reproducible results in different examiners. The study was based on the ...anonymized condylar motion recordings of 20 patients (Cadiax compact II system). These were recruited consecutively from the examinations in a center specializing in diagnosing and managing temporomandibular disorders (TMD). Four trained practitioners independently evaluated the identical movement recordings of all patients after calibration. The evaluation was based on the previously published evaluation system. The results were recorded digitally in a database. The findings were then compared, and the matching values were determined (Fleiss' Kappa). The evaluation, according to Fleiss' Kappa, showed that the consistency of the assessment of the findings among the examiners is excellent (mean value 0.88, p < 0.00001). The study shows that calibrated dentists achieved reproducible results using this evaluation system and computer-assisted reporting. Good reproducibility confirms the reliability of systematic evaluation of clinical motion analysis. The ambiguities uncovered and eliminated in the study should avoid misunderstandings in the future. Both factors establish the prerequisites for applying condylar motion analysis in clinical practice.
ABSTRACT The arrival directions of TeV-PeV cosmic rays show weak but significant anisotropies with relative intensities at the level of one per mille. Due to the smallness of the anisotropies, ...quantitative studies require careful disentanglement of detector effects from the observation. We discuss an iterative maximum-likelihood reconstruction that simultaneously fits cosmic-ray anisotropies and detector acceptance. The method does not rely on detector simulations and provides an optimal anisotropy reconstruction for ground-based cosmic-ray observatories located in the middle latitudes. It is particularly well suited to the recovery of the dipole anisotropy, which is a crucial observable for the study of cosmic-ray diffusion in our Galaxy. We also provide general analysis methods for recovering large- and small-scale anisotropies that take into account systematic effects of the observation by ground-based detectors.
Assessing pain in mechanically ventilated critically ill patients is a great challenge. There is a need for an adequate pain measurement tool for use in conscious sedated patients because of their ...questionable communicative abilities. In this study, we evaluated the use of the Behavioral Pain Scale (BPS) in conscious sedated patients in comparison with its use in deeply sedated patients, for whom the BPS was developed. Additionally, in conscious sedated patients, the combination of the BPS and the patient-rated Verbal Rating Scale (VRS-4) was evaluated.
We performed a prospective evaluation study in 80 nonparalyzed critically ill adult intensive care unit patients. Over 2 mo, nurses performed 175 observation series: 126 in deeply sedated patients and 49 in conscious sedated patients. Each observation series consisted of BPS ratings (range 3-12) at 4 points: at rest, during a nonpainful procedure, at retest rest, and during a routine painful procedure. Patients in the conscious sedated state also self-reported their pain using the 4-point VRS-4.
BPS scores during painful procedures were significantly higher than those at rest, both in deeply sedated patients (5.1 4.8-5.5 vs 3.4 3.3-3.5, respectively) and conscious sedated patients (5.4 4.9-5.9 vs 3.8 3.5-4.1, respectively) (mean 95% confidence interval). For both groups, scores obtained during the nonpainful procedure and at rest did not significantly differ. There was a strong correlation between nurses' BPS ratings and conscious sedated patients' VRS-4 ratings during the painful procedure (r(s) = 0.67, P < 0.001). At rest and during nonpainful procedures, 98% of the observations were rated as acceptable pain (VRS 1 or 2) by both nurses and patients. During painful procedures, nurses rated the pain higher than patients did in 16% of the observations and lower in 12% of the observations.
The BPS is a valid tool for measuring pain in conscious sedated patients during painful procedures. Thus, for noncommunicative and mechanically ventilated patients, it may be regarded as a bridge between the observational scale used by nurses and the VRS-4 used by patients who are able to self-report pain.
The dermal sheath (DS) is a population of mesenchyme-derived skin cells with emerging importance for skin homeostasis. The DS includes hair follicle dermal stem cells, which exhibit self-renewal and ...serve as bipotent progenitors of dermal papilla (DP) cells and DS cells. Upon aging, stem cells exhibit deficiencies in self-renewal and their number is reduced. While the DS of mice has been examined in considerable detail, our knowledge of the human DS, the pathways contributing to its self-renewal and differentiation capacity and potential paracrine effects important for tissue regeneration and aging is very limited. Using single-cell RNA sequencing of human skin biopsies from donors of different ages we have now analyzed the transcriptome of 72,048 cells, including 50,149 fibroblasts. Our results show that DS cells that exhibit stem cell characteristics were lost upon aging. We further show that
,
,
and
regulate DS stem cell characteristics. Finally, the DS secreted protein Activin A showed paracrine effects on keratinocytes and dermal fibroblasts, promoting proliferation, epidermal thickness and pro-collagen production. Our work provides a detailed description of human DS identity on the single-cell level, its loss upon aging, its stem cell characteristics and its contribution to a juvenile skin phenotype.
Objectives
The benefit from positioning the maxillary casts with the aid of face-bows has been questioned in the past. Therefore, the aim of this study was to investigate the reliability and validity ...of arbitrary face-bow transfers compared to a process solely based on the orientation by means of average values. For optimized validity, the study was conducted using a controlled, randomized, anonymized, and blinded patient simulator study design.
Material and methods
Thirty-eight undergraduate dental students were randomly divided into two groups; both groups were applied to both methods, in opposite sequences. Investigated methods were the transfer of casts using an arbitrary face-bow in comparison to the transfer using average values based on Bonwill’s triangle and the Balkwill angle. The “patient” used in this study was a patient simulator. All casts were transferred to the same individual articulator, and all the transferred casts were made using type IV special hard stone plaster; for the attachment into the articulator, type II plaster was used. A blinded evaluation was performed based on three-dimensional measurements of three reference points.
Results
The results are presented three-dimensionally in scatterplots. Statistical analysis indicated a significantly smaller variance (Student’s
t
test,
p
< 0.05) for the transfer using a face-bow, applicable for all three reference points.
Conclusions
The use of an arbitrary face-bow significantly improves the transfer reliability and hence the validity.
Clinical relevance
To simulate the patient situation in an individual articulator correctly, casts should be transferred at least by means of an arbitrary face-bow.
Purpose: To investigate whether depth-gauge burs in veneer preparations influence preparation depth in a randomized, controlled, single-blinded trial and whether inexperienced operators can perform ...adequate veneer preparations.Methods: Participants were 20 undergraduate dental students with no prior veneer preparation experience. The instruments used were the “Laminate Veneer System” (LVS), “Keramik-Veneers. de” (KVD), and a “Freehand” group (FH) for reference. All participants prepared three educational acrylic resin maxillae and three mandibular central incisors mounted in typodonts in patient simulators. The objectives were to achieve a preparation depth of 0.6 mm (tooth 11) and 0.4 mm (tooth 31). The sequences of the instruments used and prepared teeth were randomized. The measurements were performed using a laser triangulation coordinate-measuring machine. The data were stratified according to tooth location.Results: The preparation depths of both depth-gauge-instrument-groups LVS and KVD achieved the objectives significantly better than did the instruments from the “Freehand” group (P < 0.001). The differences between the depth gauge groups were insignificant, although the maximum preparation depths were smaller in the KVD group. Regarding the prepared teeth, the preparation depths in the mandibular incisors were lower, and the differences were smaller.Conclusions: The use of special depth-gauge burs for initial veneer preparation leads to significantly lower preparation depths than “Freehand” preparations. The tapered instruments resulted in a lower incidence of extreme preparation depths. The inexperienced operators performed veneer preparation remarkably well.
Various experiments show that the arrival directions of multi-TeV cosmic rays show significant anisotropies at small angular scales. It was recently argued that this small scale structure may arise ...naturally by cosmic ray diffusion in a large-scale cosmic ray gradient in combination with deflections in local turbulent magnetic fields. We show via analytical and numerical methods that the non-trivial power spectrum in this setup is a direct consequence of Liouville's theorem and can be related to properties of relative diffusion.
Idiopathic condylar resorption (ICR), though a rare event, is associated with severe detrimental sequelae for the patient. To date, the etiology remains unknown, and treatment strategies are highly ...controversial. Therefore, the aim of this study is to present an analysis of the consensus- and evidence-based approach to ICR by a German interdisciplinary guideline project of the AWMF (Association of the Scientific Medical Societies in Germany). Following a systematic literature search, including 56 (out of an initial 97) publications, with a predominantly low level of evidence (LoE), two independent working groups (oral and maxillofacial surgery and interdisciplinary, respectively) voted on a draft comprising 25 recommendations in a standardized anonymized and blinded Delphi procedure. While the results of the votes were relatively homogeneous, the interdisciplinary phase required a significantly higher number of rounds (
< 0.001). Most of the controversial recommendations were related to initial imaging (with consensus on CT/CBCT as the current diagnostic standard for imaging), pharmacotherapy (no recommendation due to lack of evidence), discopexy (no recommendation possible due to low LoE) and timing of orthognathic surgery (with consensus on two-staged procedures after invasive TMJ surgery, except for single-stage procedures if combined with total joint reconstruction). Overall, the Delphi procedure resulted in an interdisciplinary guideline offering the best possible evidence- and consensus-based expertise to date in the diagnosis and treatment of ICR.
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