Evaluation of a new fluorescence-based device in the detection of incipient occlusal caries lesions

The aim of this in vitro study was to evaluate the performance of various contemporary detection tools at incipient occlusal caries. Thirty eight freshly extracted posterior teeth with non-cavitated occlusal caries were subjected to clinical examination and coding according to ICDAS criteria (n?=?38). Standardized fluorescence images were taken with VistaProof (Dürr Dental, Bietigheim-Bissingen, Germany). Furthermore, the teeth were calculated with a laser fluorescence pen device (DIAGNOdent pen, Kavo, Biberach, Germany). In all detection methods, assessment of caries was performed twice (with 1-week interval) by two calibrated examiners. Finally, the caries lesions were validated in tooth sections by histological examination. The intra-examiner and inter-examiner kappa coefficient, sensitivity, and specificity were determined for all detection methods at enamel lesions (D1 threshold). Degrees of agreement of each method with the histological status were calculated using receiver operating characteristic statistics and the area under curve (Az values). The kappa intra-examiner/inter-examiner coefficient values (mean?±?SD) were 0.74?±?0.04/0.73?±?0.07, 0.87?±?0.04/0.82?±?0.07, and 0.91?±?0.06/0.83?±?0.08 for clinical examination, DIAGNOdent pen, and VistaProof, respectively. The sensitivity for ICDAS was 0.80–0.86, for DIAGNOdent pen was 0.66–0.75, and for the VistaProof device was 0.97. The specificity for all the detection methods were 0.5 (0.02–0.99). The accuracy value for ICDAS was 0.76–0.81, for DIAGNOdent pen 0.66–0.71, and for the VistaProof device 0.92–0.95. The Az values (mean?±?SD) were 0.431?±?0.187, 0.583?±?0.215, and 0.486?±?0.207 for ICDAS, DIAGNOdent pen, and VistaProof examination, respectively. No significant differences in Az values were noted among the methods. All detection methods were presented with high inter-examiner and intra-examiner agreement. The new VistaProof device showed the best sensitivity, while DIAGNOdent pen demonstrated the worst one. Specificities were the same for all detection methods. Moreover, they presented the same performance in detection of incipient occlusal caries.     

Does Pregnancy-Associated Breast Cancer Imply a Worse Prognosis? A Matched Case-Case Study

Zusammenfassung

Hintergrund: Die Auswirkungen einer Schwangerschaft auf die Prognose des Mammakarzinoms werden in der Literatur kontrovers diskutiert. Wir haben eine gepaarte Fall-Fall-Studie konzipiert, in der schwangerschaftsasso-ziierte Mammakarzinom (SAM)-Fälle entsprechend ihres Stadiums, Alters und Jahr der Diagnosestellung mit Mammakarzinom-Patientinnen gepaart wurden. Patientinnen und Methoden: 39 aufeinanderfolgende SAM-Fälle wurden mit 39 prämenopausalen Fällen von Brust-krebs gepaart. Univariate und multivariate Überlebens-analysen mit Anpassung an Stadium, Grad, Östrogen-rezeptorstatus und Alter zum Zeitpunkt der Diagnose wurden durchgeführt. Ergebnisse: Hinsichtlich des Gesamtüberlebens deutete die univariate Analyse auf ein längeres Gesamtüberleben für nicht-SAM-Fälle vs. SAM-Fälle hin. Gleichzeitig war ein fortgeschritteneres Stadium ein Prädiktor für ein kürzeres Überleben. Die multivariate Analyse bestätigte die unabhängige ver-schlechternde Auswirkung einer Schwangerschaft. Inter-essanterweise ergab eine genestete Post-hoc-Analyse der SAM-Fälle Hinweise auf ein kürzeres Gesamtüberleben für das dritte Trimester. Die oben erwähnten Ergebnisse für das Gesamtüberleben konnten desweiteren bei der Untersuchung des rezidivfreien Überlebens reproduziert werden. Schlussfolgerung: Mit ihrem gepaarten Fall-Fall-Design deutet die vorliegende Studie darauf hin, dass Schwangerschaft ein schlechter Prognosefaktor beim Mammakarzinom ist.     

Brain volume dynamics in multiple sclerosis. A case-control study

ABSTRACT

Objectives: In this study, we aimed to explore the extent and clinical relevance of brain volume dynamics in relapsing remitting multiple sclerosis (RRMS).

Methods: Sixty-three patients with RRMS with a disease duration of about 5 years (36 women, mean age 39.9 ± 9.4 years; mean EDSS1.4 ± 1.2, mean relapse rate 0.98 ± 1.17) and 50 healthy control individuals (24 women, mean age 39.1 ± 10.2 years) were recruited and imaged on a MRI scanner by using post-gadolinium high-resolution3D T1W sequences. Cross-sectional and longitudinal volumetric data were obtained by using SIENA(X) and FIRST software.

Results: Patients showed significantly lower subcortical volumes compared to healthy controls. Interestingly, the educational level predicted the rate of right thalamus atrophy. The mean annualized percentage of brain volume change (aPBVC) was ?0.92% (±1.64%) and was presented in higher rates during the first five years after MS diagnosis.

Conclusion: Brain atrophy mainly involved subcortical grey matter structures and was more conspicuous during the first years of MS diagnosis. The buffering role of education in atrophy was also corroborated by this study.     

Management of Urinary Symptoms Associated with Fibroids

Uterine fibroids are the most common benign tumours in women of reproductive age. Fibroids are linked with a variety of lower urinary tract symptoms (LUTS). Direct pressure on the bladder, but also vascular, neurogenic and hormonal changes have been proposed as underlying pathophysiological mechanisms. There is conflicting evidence in the literature regarding the association between LUTS and fibroid volume and position. Conservative management with bladder retraining, supervised pelvic floor muscle training with or without drug therapy might be used as first line. In the presence of persistent symptoms, conventional urodynamics or ideally videourodynamics might be considered before more invasive treatment. Counselling of patients prior to uterine artery embolisation, myomectomy or hysterectomy could be challenging, as it is difficult to estimate the effect of fibroid reduction or removal on LUTS.