Quality evaluation of the available Internet information regarding pain during orthodontic treatment

Objective:To investigate the quality of the data disseminated via the Internet regarding pain experienced by orthodontic patients.Materials and Methods:A systematic online search was performed for ‘orthodontic pain’ and ‘braces pain’ separately using five search engines. The first 25 results from each search term–engine combination were pooled for analysis. After excluding advertising sites, discussion groups, video feeds, and links to scientific articles, 25 Web pages were evaluated in terms of accuracy, readability, accessibility, usability, and reliability using recommended research methodology; reference textbook material, the Flesch Reading Ease Score; and the LIDA instrument. Author and information details were also recorded.Results:Overall, the results indicated a variable quality of the available informational material. Although the readability of the Web sites was generally acceptable, the individual LIDA categories were rated of medium or low quality, with average scores ranging from 16.9% to 86.2%. The orthodontic relevance of the Web sites was not accompanied by the highest assessment results, and vice versa.Conclusions:The quality of the orthodontic pain information cited by Web sources appears to be highly variable. Further structural development of health information technology along with public referral to reliable sources by specialists are recommended.     

A comparative biomechanical study for complex tibial plateau fractures: Nailing and compression bolts versus modern and traditional plating

Aim

To compare the biomechanical properties of a newly proposed technique, utilizing intramedullary nailing and compression bolts, for the osteosynthesis of intra-articular proximal tibial fractures with meta–diaphyseal comminution, with modern and conventional plating techniques.

Methods

Fifteen left tibia 4th generation composite Sawbones models (in 3 groups of 5 for each technique) with identically reproduced type VI Schatzker tibial plateau fractures, including meta–diaphyseal dissociation, were used. Three different techniques of osteosynthesis were tested: (a) a new technique that combines intramedullary nailing and compression bolts, (b) internal fixation with a single lateral locking plate and (c) internal fixation with dual buttress plating technique. The model-device constructs were successively subjected to 500 N, 1000 N and 1500 N load levels with five cycles applied at each level on both articular compartments and a final load cycle to failure. Four parameters were recorded for each technique: the average reversible or irreversible displacement in vertical subsidence, the horizontal diastasis of the intra-articular fracture, the average passive construct stiffness and the load to failure.

Results

The new intramedullary nailing technique provided rigid intra-articular osteosynthesis being statistically similar to dual buttress plating for subsidence at medium and higher load levels. At the same time the proposed technique provided statistically equivalent stiffness values to the single lateral locking plate incarnating the rational of biologic fixation. Average load to failure was 1611 N for single lateral locking plates, 2197 N for intramedullary nailing and 4579 N for dual buttress plating. The single lateral locking plate technique had the worse results in interfragmentary displacement while dual buttress plating was superior in stiffness from the other 2 techniques. The mode of failure differed between techniques, with collapse of medial plateau occurring exclusively in the single lateral locking plates group.

Conclusion

The proposed new technique of intramedullary nailing and compression bolts demonstrates a flexural behaviour similar to single lateral locking plates, which complies with the terms and benefits of biological fixation, while at the same time maintains a rigid intra-articular stability similar to the stiff dual buttressing plating technique.     

Day case surgery: to overcome prejudice

Aim-Background

Ambulatory surgery has become the standard method of care for elective operations in many countries. Nevertheless, day surgery in Greece is far from being established as the modality of choice when performing specific operations. The aim of this study was to evaluate the safety and feasibility of day case surgery in selected operations, as well as patient satisfaction.

Methods

Patients were selected last year over a period of twelve months to undergo operations in the setting of ambulatory surgery. Selection criteria were related to social and medical factors; among others, these included the presence of an accompanying adult, elective surgery, and age under 75 years. We performed 142 operations including laparoscopic cholecystectomies, hernia repair and treatment of perianal diseases. Anaesthetic methods comprised general anaesthesia, local anaesthesia and Transversus Abdominis Plane (TAP) block.

Results

No major complications were recorded for any of the selected surgeries, nor any readmissions. The average cost for the total amount of surgeries was reduced by 40%. This cost reduction was mainly due to the limited use of abdominal drains, restricted preoperative examinations and strict anaesthetic protocol. All patients declared satisfaction with the treatment modality that was offered to them.

Conclusions

Following careful and methodic patient selection, day case surgery can reduce the cost of hospitalization and provide patient satisfaction, in addition to being both achievable and safe.     

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.     

α-Synucleinopathy associated with G51D SNCA mutation: a link between Parkinson’s disease and multiple system atrophy?

We report a British family with young-onset Parkinson’s disease (PD) and a G51D SNCA mutation that segregates with the disease. Family history was consistent with autosomal dominant inheritance as both the father and sister of the proband developed levodopa-responsive parkinsonism with onset in their late thirties. Clinical features show similarity to those seen in families with SNCA triplication and to cases of A53T SNCA mutation. Post-mortem brain examination of the proband revealed atrophy affecting frontal and temporal lobes in addition to the caudate, putamen, globus pallidus and amygdala. There was severe loss of pigmentation in the substantia nigra and pallor of the locus coeruleus. Neuronal loss was most marked in frontal and temporal cortices, hippocampal CA2/3 subregions, substantia nigra, locus coeruleus and dorsal motor nucleus of the vagus. The cellular pathology included widespread and frequent neuronal α-synuclein immunoreactive inclusions of variable morphology and oligodendroglial inclusions similar to the glial cytoplasmic inclusions of multiple system atrophy (MSA). Both inclusion types were ubiquitin and p62 positive and were labelled with phosphorylation-dependent anti-α-synuclein antibodies In addition, TDP-43 immunoreactive inclusions were observed in limbic regions and in the striatum. Together the data show clinical and neuropathological similarities to both the A53T SNCA mutation and multiplication cases. The cellular neuropathological features of this case share some characteristics of both PD and MSA with additional unique striatal and neocortical pathology. Greater understanding of the disease mechanism underlying the G51D mutation could aid in understanding of α-synuclein biology and its impact on disease phenotype.