In vitro, clinical, and microbiological evaluation of a linear oscillating device for scaling and root planing

BACKGROUND: The purpose of this study was to conduct an in vitro and short-term clinical and microbiological evaluation of a linear oscillating device for scaling and root planing (SRP). A comparison was made between conventional ultrasonic scaling (US) and hand scaling (HS) with and without chlorhexidine. METHODS: In vitro, SRP was carried out on human teeth with calculus. Roots and cross-sections thereof were microscopically examined for the efficacy of calculus removal, hard tissue loss, and surface smoothness. In vivo, 11 patients with chronic periodontitis and single-rooted teeth in all quadrants with probing depths of > or =5 mm were selected. One quadrant was treated with linear oscillation and compared to US with chlorhexidine irrigation in the contralateral site. The other arch was treated with HS and compared to HS followed by laser disinfection. One hundred twenty teeth were assessed for clinical attachment level, probing depth, bleeding on probing, and suppuration at baseline and 7, 28, 90, and 180 days. Microbiologically, total numbers of bacteria and six specific periodontal pathogens were determined by quantitative polymerase chain reaction prior to and 1 and 28 days after SRP. Clinical and microbiological data were analyzed statistically with respect to the SRP method, patient specificity, and time effect. RESULTS: In vitro, linear oscillation preserved more root tissues but left more calculus (P <0.05). Significant improvements of all clinical and microbiological parameters were observed for all groups. However, 21 out of 24 tests demonstrated that the clinical microbiological correlations between linear oscillation and control groups did not differ (P <0.05). CONCLUSION: Linear oscillation scaling was clinically acceptable and microbiologically comparable to the control groups despite microscopic remnants of calculus observed in vitro.     

Which quality criteria are important for relatives about a nursing home? A single case study

This single-case study undertakes to determine criteria for quality in nursing homes as deemed important by immediate family members of inhabitants. The design is an explorative, qualitative design with the aim of generating hypotheses. This study consists of two parts: 1. a case study of the selected institution 2. qualitative interviews with the family members of inhabitants. In order to describe the case study of the institution, documents about the nursing home were examined and analysed, observations in the nursing home were made, and experts of the nursing home were interviewed. Six close relatives of five inhabitants are interviewed. The results of these narrative interviews are analysed using coding (Strauss, 1998) in the context of this specific home for care of the elderly. Findings reveal that interviewees differentiate between a first set of criteria for quality of the institution, a second set of criteria for quality of the care and a third set of criteria they view as important for their relative living in the institution. The overruling priority is given to the third set of criteria among which the subjective well-being of the nursing home inhabitant dominates. Even in cases where the institution does not meet the requirements of the family member, the subjective well-being of the inhabitant is the main reason for not moving her/him to another nursing home.     

Identification of Subgroups of Schizophrenia Patients With Changes in Either Immune or Growth Factor and Hormonal Pathways

Schizophrenia is a heterogeneous disorder normally diagnosed using the Diagnostic and Statistical Manual of Mental Disorders criteria. However, these criteria do not necessarily reflect differences in underlying molecular abnormalities of the disorder. Here, we have used multiplexed immunoassay analyses to measure immune molecules, growth factors, and hormones important to schizophrenia in acutely ill antipsychotic-naive patients (n = 180) and matched controls (n = 398). We found that using the resulting molecular profiles, we were capable of separating schizophrenia patients into 2 significantly distinct subgroups with predominant molecular abnormalities in either immune molecules or growth factors and hormones. These molecular profiles were tested using an independent cohort, and this showed the same separation into 2 subgroups. This suggests that distinct abnormalities occur in specific molecular pathways in schizophrenia patients. This may be of relevance for intervention studies that specifically target particular molecular mechanisms and could be a first step to further define the complex schizophrenia syndrome based on molecular profiles.Key words: schizophrenia, subtypes, diagnosis, molecular profiling, immune factors, growth factors     

Does abnormal interhemispheric inhibition play a role in mirror dystonia?

The presence of mirror dystonia (dystonic movement induced by a specific task performed by the unaffected hand) in the dominant hand of writer's cramp patients when the nondominant hand is moved suggests an abnormal interaction between the 2 hemispheres. In this study we compare the level of interhemispheric inhibition (IHI) in 2 groups of patients with writer's cramp, one with the presence of a mirror dystonia and the other without as well as a control group. The level of bidirectional IHI was measured in wrist muscles with dual‐site transcranial magnetic stimulation with a 10‐millisecond (short IHI) and a 40‐millisecond (long IHI) interstimulus interval during rest and while holding a pen in 9 patients with mirror dystonia 7 without mirror dystonia, and 13 controls. The group of patients without mirror dystonia did not differ from the controls in their IHI level. In contrast, IHI was significantly decreased in the group of patients with mirror dystonia in comparison with the group without mirror dystonia and the controls in both wrist muscles of both the dystonic and unaffected hand whatever the resting or active condition (P = 0.001). The decrease of IHI level in the group of patients with mirror dystonia was negatively correlated with the severity and the duration of the disease: the weaker the level of IHI, the more severe was the disease and the longer its duration. Interhemispheric inhibition disturbances are most likely involved in the occurrence of mirror dystonia. This bilateral deficient inhibition further suggests the involvement of the unaffected hemisphere in the pathophysiology of unilateral dystonia. © 2013 International Parkinson and Movement Disorder Society     

Anhedonia in obsessive-compulsive disorder: Beyond comorbid depression

Obsessive-compulsive disorder (OCD) has been linked to reward dysfunctions, highlighting a possible role of anhedonia in OCD. Surprisingly, anhedonia in OCD has never been evaluated. Moreover, although nicotine typically has anti-anhedonic effects, anecdotal reports suggest low prevalence rates of smoking in OCD. To address these two phenomena, 113 individuals with OCD completed a battery of questionnaires assessing symptom severity, anhedonia, and smoking. 28.3% of the sample met criteria for clinically significant anhedonia, which correlated with Y-BOCS scores (r=0.44), even when controlling for depressive symptoms. 13.3% of the sample endorsed current smoking, a lower rate than seen in psychiatric disorders (40–90%) and the general adult population (19%). Results highlight high rates of anhedonia and yet reduced prevalence of smoking in OCD. In contrast to the known positive association between anhedonia and smoking, a negative association emerged. Future research is needed to address the unique interface between anhedonia and reward responsiveness in OCD. Potential clinical implications are discussed.     

Encoding of nested levels of acoustic regularity in hierarchically organized areas of the human auditory cortex

Our auditory system is able to encode acoustic regularity of growing levels of complexity to model and predict incoming events. Recent evidence suggests that early indices of deviance detection in the time range of the middle‐latency responses (MLR) precede the mismatch negativity (MMN), a well‐established error response associated with deviance detection. While studies suggest that only the MMN, but not early deviance‐related MLR, underlie complex regularity levels, it is not clear whether these two mechanisms interplay during scene analysis by encoding nested levels of acoustic regularity, and whether neuronal sources underlying local and global deviations are hierarchically organized. We registered magnetoencephalographic evoked fields to rapidly presented four‐tone local sequences containing a frequency change. Temporally integrated local events, in turn, defined global regularities, which were infrequently violated by a tone repetition. A global magnetic mismatch negativity (MMNm) was obtained at 140–220 ms when breaking the global regularity, but no deviance‐related effects were shown in early latencies. Conversely, Nbm (45–55 ms) and Pbm (60–75 ms) deflections of the MLR, and an earlier MMNm response at 120–160 ms, responded to local violations. Distinct neuronal generators in the auditory cortex underlay the processing of local and global regularity violations, suggesting that nested levels of complexity of auditory object representations are represented in separated cortical areas. Our results suggest that the different processing stages and anatomical areas involved in the encoding of auditory representations, and the subsequent detection of its violations, are hierarchically organized in the human auditory cortex. Hum Brain Mapp 35:5701–5716, 2014. © 2014 Wiley Periodicals, Inc.     

Analysis of failure and clinical outcome after unsuccessful medial patellofemoral ligament reconstruction in young patients

Purpose

Reconstruction of the medial patellofemoral ligament (MPFL) has become a popular procedure for patients with patellofemoral instability. Nevertheless, complication rates of up to 26 % have been reported. This study presents the analysis of failure and clinical outcome of subsequent revision surgery in young patients following unsuccessful medial patellofemoral ligament reconstruction.

Methods

Nineteen consecutive patients with unsuccessful MPFL reconstruction underwent revision surgery. Pre-operative assessment included physical examination, radiographs and magnetic resonance imaging to assess the MPFL graft, trochlear dysplasia, tibial tubercle–trochlear groove (TT-TG) distance, patella alta and femoral tunnel positioning. Evaluation also included the detection of cartilage injuries as well as visual analog scale (VAS), knee function scores and patient satisfaction. Each complication was analysed and an appropriate revision procedure was performed according to the identified technical or untreated anatomical risk factor.

Results

The average age at the time of the index operation was 20.2 years (range, 16–27 years). The average age at the time of the primary MPFL reconstruction was 18.4 years (range, 15–25). Three main reasons for failure after MPFL reconstruction could be identified: failure to consider additional risk factors, intra-operative technical errors and inappropriate patient selection. In five patients severe trochlear dysplasia and in two patients concomitant excessive femoral anteversion as additional risk factors were detected. Seven patients experienced medial retinacular pain with limited flexion due to technical errors caused in three patients by anterior placement of the femoral tunnel and in four others by overtensioning of the MPFL graft. Four patients with patellofemoral pain were found to have ICRS grade III or IV cartilage injuries. The median postoperative Kujala scores improved from 57 (34 – 73) pre-operatively to 83 (49 – 94), the median knee function improved from 5 (range, 2 – 6) pre-operatively to 8 (range, 3 – 10). Median VAS scores improved from 4 (2 – 7) to 2 (0 – 5). A total of 78.9 % of patients were satisfied or very satisfied, 15.8 % were partially satisfied and one patient (5.3 %) was not satisfied with the result after revision surgery.

Conclusion

Failure to consider additional risk factors, technical intra-operative errors and inappropriate patient selection were identified as reasons for revision surgery after MPFL reconstruction. Identifying the potential causes of failure can help to treat and possibly prevent future complications.     

Prospective evaluation of intra-observer variability of the hydronephrosis index in sonographic examination of 44 patients with acute renal colic

Purpose

The aim of our prospective designed study was to confirm the intra-observer agreement of assessments of the hydronephrosis index (HI) with a sonographic technique that potentially provides additional information in patients with acute renal colic (ARC).

Methods

Sonographic measurement of HI and valuation of common clinical criteria were performed in 44 consecutive patients presenting with unilateral stone-related ARC. HI of colic side was recorded twice in predefined time intervals. Intra-observer agreement was evaluated with the Spearman’s rank correlation/rho (ρ) for attributive-metric characteristics. Data of HI-measurement on the colic side were compared with data of the unaffected side using t test.

Results

Intra-observer agreement was significant for HI in the colic side (ρ = 0.918, p < 0.001) and in the unaffected side (ρ = 0.826, p < 0.001). The mean HI between colic and unaffected side differed significantly on the first evaluation (85.2 vs. 93.7, respectively; p < 0.001) and on the second evaluation (85.1 vs. 93.6, respectively; p < 0.001) as well.

Conclusions

The HI method is a slightly feasible examination method in patients presenting with stone-related renal colic. Moreover, it offers a solid discrimination between obstruction and non-obstruction. Our prospective trial illustrates HI as a reproducible method with a high-grade intra-observer agreement. However, potential change of values under medical expulsive therapy and coherency with the functionality of the obstructed kidney may lead to bias and therefore remain to be analyzed. Further studies to specify exact thresholds for this method and to state our findings are required.