Orofacial pain in young adults and associated childhood and adulthood factors: results of the population study, Wales, United Kingdom

Abstract – Objectives: The aim of the study was to investigate the prevalence of orofacial pain (OFP) among young adults (30–31 years old) and to determine the effect of childhood and adulthood risk factors on the occurrence of OFP. Methods: Prospective cohort study to investigate dental and social effects of malocclusion and effectiveness of orthodontic treatment was conducted in Wales, United Kingdom. At 20‐year follow‐up 337 subjects aged 30–31 participated (74% from previous follow‐up aged 19–20 and 33% from the baseline) and were asked about OFP. Results: The prevalence of OFP was 23% (95% CI: 19%, 28%). Childhood factors, socio‐demographic, lifestyle, health behavior factors, history of orthodontic treatment and tooth wear were not associated with OFP. Participants with OFP were more likely to report that their teeth did not fit together properly [odds ratio (OR) = 12.4, 95% CI: 2.7–56.5) and reported previous trauma to the jaws (2.3; 1.3–4.2). Both diurnal and nocturnal teeth clenching and grinding were significantly associated with OFP (3.1; 1.4–7.1). Participants with frequent headaches had increased risk of having OFP (3.7; 1.6–8.4) while having reported 4–10 types of pain in other parts of the body other than the head, was associated with OR = 9.2 (3.7–23.0). An increased tendency to have OFP was seen in those individuals with higher levels of psychological distress (2.3; 1.4–3.9), high score on Life Event Inventory (2.6; 1.3–5.3), depressive symptoms (2.2; 1.2–4.0) and stress (2.2; 1.2–4.0). High self‐esteem associated with lower risk of OFP (0.5; 0.3–0.9). Conclusions: This study shows that OFP is frequently reported by young adults aged 30–31 and supports a multifactorial etiology with factors from many domains, including local mechanical factors, psychological and co‐morbidities. However, none of the childhood factors considered in this study were associated with OFP in adulthood.     

Applying Non-synchronized E-learning to the Nursing Clinical Ladder System

The time and spatial constraints of face-to-face learning often affect nursing staff’s inclination to enroll in ladder system training classes. Hence, their competence in clinical care may be unable to meet the requirements of the hospitals they work at. The e-learning mechanism offers a way to overcome such constraints. However, the differences in learners’ achievement and satisfaction between traditional face-to-face and non-synchronized e-learning classes in the nursing clinical ladder system have not been thoroughly investigated. In this study, 155 nursing personnel serving at the case hospital, enrolled in N1/N2 ladder courses, were invited to participate as the subjects. The results showed that those who attended face-to-face learning classes reported higher satisfaction but achieved less in class than those in the e-learning class. The factors which influence the subjects’ satisfaction with e-learning were investigated and summarized.     

Phase II Trial of Erlotinib and Capecitabine for Patients with Previously Untreated Metastatic Colorectal Cancer

BackgroundThis Simon 2-stage phase II trial was designed to document antitumor activity of capecitabine in combination with erlotinib in patients with previously untreated metastatic colorectal cancer (CRC).Patients and MethodsTime to tumor progression, objective response rate, and time to treatment failure were to be assessed. Secondary objectives included determination of toxicity. This trial was closed prematurely because of slower-than-expected accrual. Thirteen patients were enrolled, and all are off protocol treatment at the time of this report.ResultsNotably, 4 subjects discontinued therapy because of adverse events. Of 10 evaluable patients, 1 attained a complete response, 1 attained a partial response, 3 had stable disease, and 5 had progressive disease. Median time to disease progression was 21 weeks, with a range of 8–85 weeks. Overall survival ranged from 12 weeks to 182 weeks, with a median of 76 weeks.ConclusionThe toxicities and challenge to complete accrual observed in this trial are consistent with the experience of others attempting to develop erlotinib as part of combination treatment for advanced CRC.     

Relationship of high school and college sports participation with alcohol,tobacco, and illicit drug use: A review

This study provides an exhaustive review of 34 peer-reviewed quantitative data-based studies completed on high school and college sports involvement and drug use. The studies reviewed suggest that participation in sport is related to higher levels of alcohol consumption, but lower levels of both cigarette smoking and illegal drug use. Additional research is needed in this domain to further elucidate the relationship between these variables.     

Smoothened is a master regulator of adult liver repair

When regenerative processes cannot keep pace with cell death, functional epithelia are replaced by scar. Scarring is characterized by both excessive accumulation of fibrous matrix and persistent outgrowth of cell types that accumulate transiently during successful wound healing, including myofibroblasts (MFs) and progenitors. This suggests that signaling that normally directs these cells to repair injured epithelia is deregulated. To evaluate this possibility, we examined liver repair during different types of liver injury after Smoothened (SMO), an obligate intermediate in the Hedgehog (Hh) signaling pathway, was conditionally deleted in cells expressing the MF-associated gene, αSMA. Surprisingly, blocking canonical Hh signaling in MFs not only inhibited liver fibrosis but also prevented accumulation of liver progenitors. Hh-sensitive, hepatic stellate cells (HSCs) were identified as the source of both MFs and progenitors by lineage-tracing studies in 3 other strains of mice, coupled with analysis of highly pure HSC preparations using flow cytometry, immunofluorescence confocal microscopy, RT-PCR, and in situ hybridization. The results identify SMO as a master regulator of hepatic epithelial regeneration based on its ability to promote mesenchymal-to-epithelial transitions in a subpopulation of HSC-derived MFs with features of multipotent progenitors.     

Endoscopic Skull Base Surgery

Endoscopic skull base surgery has undergone rapid advancement in the past decade moving from pituitary surgery to suprasellar lesions and now to a myriad of lesions extending from the cribriform plate to C2 and laterally out to the infratemporal fossa and petrous apex. Evolution of several technological advances as well as advances in understanding of endoscopic anatomy and the development of surgical techniques both in resection and reconstruction have fostered this capability. Management of benign disease via endoscopic methods is largely accepted now but more data is needed before the controversy on the role of endoscopic management of malignant disease is decided. Continued advances in surgical technique, navigation systems, endoscopic imaging technology, and robotics assure continued brisk evolution in this expanding field.     

Gazing at the Future

Jerry Bryant has advanced Parkinson’s disease. Ten years ago, he became my patient. Last spring, he became my solace and inspiration.