Principles and application of learning theory in child patient management.

General dentists, as well as pediatric dentists, treat many children. Behavior management for children is an integral component of pediatric dental practice. Behavior management techniques have been developed based on empirical evidence indicating the importance of social learning theory to change both the causes and consequences of negative behaviors. This paper addresses the theoretical basis of current approaches in guiding children's behavior during dental settings. The relevance of the theoretical areas to the day-to-day treatment of the patient is emphasized.     

Presentation of 3D isotropic imaging data for optimal viewing.

Three-dimensional (3D) isotropically sampled data facilitates retrospective viewing of arbitrarily aligned image planes and simplifies automated computer analysis of 3D structures. However, compared to acquisitions that employ thick slices, MRI acquisitions with isotropic sampling have a lower signal-to-noise ratio (SNR). A rater study was performed to examine viewer preference for the trade-off between SNR and the partial-volume effect of through-plane averaging. A robust preference for a 5:1 ratio in through-plane to in-plane was found for a typical SNR of 11.     

EEG phase synchronization during hypnosis induction

Hypnosis is a mental state or set of attitudes usually induced by a procedure known as hypnotic induction. In order to provide the basic physiological conditions for potentially successful hypnosis treatment of medical and psychological problems, the determination of a subject's hypnotizability level is important. Currently, the hypnotizability level is determined using different standard subjective tests. To avoid the different drawbacks of these subjective clinical tests, a practical objective method based on the correlation between electroencephalograph (EEG) phase synchronization and hypnosis susceptibility levels is presented in this study. This method can be used by clinicians instead of the traditional subjective methods to classify hypnotizability level. Thirty-two subjects with different hypnosis susceptibility levels contributed to this research. Using statistical analyses, it was concluded that, in highly hypnotizable people, the EEG phase synchronization between different paired channels, located on the frontal lobe, is significantly different from that in subjects with medium or low hypnotizability.     

Surgical method influences specimen margins and biochemical recurrence during radical prostatectomy for high-risk prostate cancer: a systematic review and meta-analysis

Purpose

To perform a meta-analysis comparing the rates of positive surgical margins (PSM) and biochemical recurrence (BCR) between open radical prostatectomy (ORP) and robot-assisted radical prostatectomy (RARP) in patients with high-risk prostate cancer.

Methods

A systematic review was performed on Pubmed, Embase and Scopus databases in August 2016, according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. References retrieved were evaluated using the Newcastle–Ottawa scale and the Black and Down’s tool for quality assessment.

Results

Nine retrospective cohorts comparing ORP and RARP were selected and included in the meta-analysis. All studies reported the PSMs. Patients treated with RARP presented less risk of PSMs (risk difference ?0.04, p 0.02) than those treated with ORP. Five articles reported hazard ratios for BCR-free survival. Patients treated with RARP had less risk of BCR (HR 0.72, 95% CI 0.58–0.89) than those treated with ORP. Reports for PSM assessment were considered of adequate quality, while the studies retrieved for BCR assessment were considered limited because of the heterogeneity of their results.

Conclusion

Patients with high-risk prostate cancer treated with RARP have less risk of having PSM and BCR when compared to those treated with ORP. A strong conclusion is precluded due to the observational nature of the studies retrieved for our analysis.

     

Evaluation of electronic dental anesthesia in children.

OBJECTIVE: The purpose of this study was to determine the effectiveness and acceptance of electronic dental anesthesia in comparison with local anesthesia in restorative procedures in children. STUDY DESIGN: Twenty-eight children, aged 6 to 12 years, participated in the study. Each patient had symmetric teeth requiring class I cavity preparations. One tooth was treated with electronic dental anesthesia; the antimere tooth was treated with local anesthesia. The tooth and the method were selected at random, and the two restorations were performed at the same appointment. Pain was assessed by means of two pain scales, the color scale and the sound, eye, and motor scale. Behavior was assessed through use of the North Carolina Behavior Rating Scale. The ratings of pain and behavior were made at 4 separate intervals (after rubber dam clamp placement, with the handpiece operating adjacent to the tooth, during penetration of the dentin-enamel junction of the tooth, and 5 minutes postoperatively). The recorded values for the steps of the restorations completed with electronic dental anesthesia and local anesthesia were analyzed by means of chi(2) analysis to determine any statistically significant difference between the techniques at a level of P <.05. RESULTS: Although the success rate of electronic dental anesthesia was less than that of local anesthesia, there was no significant difference between the two methods. On the other hand, 53.6% of the patients preferred electronic dental anesthesia, whereas 35.7% preferred local anesthesia. CONCLUSIONS: In restorative dental care in children, electronic dental anesthesia appears to be beneficial in reducing discomfort, as judged from behavioral observations and self-reports.     

Residual Acetabular Dysplasia in the Reduced Hip

BackgroundResidual acetabular dysplasia occurs in up to a third of patients treated successfully for developmental dysplasia of the hip (DDH) and has been found to be a significant risk factor for early hip osteoarthritis (OA).DiscussionAge at the time of initial reduction and the initial severity of DDH have been linked to residual acetabular dysplasia. An anteroposterior pelvic radiograph is the main diagnostic modality, but MRI also provides valuable information, particularly in equivocal cases. The literature supports intervening when significant residual acetabular dysplasia persists at 4–5 years of age, and common surgical indications include acetabular index (AI) > 25°–30°, lateral center–edge angle (LCEA) < 8°–10°, and a broken Shenton’s line on radiographs; and a cartilaginous acetabular angle (CAI) > 18°, cartilaginous center–edge angle (CCE) < 13°, and/or the presence of high-signal intensity areas on MRI. Surgical options include redirectional pelvic osteotomies and reshaping acetabuloplasties, which provide comparable radiographic and clinical results.ConclusionRAD is common after treatment of DDH and requires regular follow-up for diagnosis and appropriate management to decrease the long-term risk of OA. Long-term outcomes of patients treated with pelvic osteotomies are generally favorable, and the risk of OA can be decreased, although the risk of total hip replacement in the long-term remains.     

A comparison of parenteral and electronic dental anesthesia during operative procedures in children

The effectiveness of electronic dental anesthesia (EDA) for pain control during restorative procedures was compared with local anesthesia (LA) in 108 pediatric patients aged 6-12. One tooth was treated with LA and another with EDA at the same appointment. The pain levels during restorative treatment were assessed using a color scale. Behavior also was assessed using sound, eye, and motor (SEM) scale. Although the success rate of EDA was less than that of LA, there was no significant difference between the two methods. On the other hand, 63% of the patients preferred EDA while 27.8% preferred LA. These results suggest that EDA is an effective nondrug pain control technique for amalgam restorations in primary and permanent molars for some patients.     

Hippocampus,caudate nucleus and entorhinal cortex volumetric MRI measurements in discrimination between Alzheimer’s disease,mild cognitive impairment,and normal aging

Background

Structural neuroimaging MR volumetric changes can predict progression of MCI to AD. Early effective treatment of MCI has been shown to delay institutionalization and improve cognition and behavioral symptoms.

Aim of the work

To evaluate the role of volumetric MRI to identify a pattern of regional atrophy characteristic in differentiation between Alzheimer’s disease, Mild Cognitive Impairment, and Normal elderly control.

Material and methods

The regional ethics committee approved the study and written informed consent was obtained from all participants. Between April 2012 and May 2013, prospective study was conducted on 25 patients (18 males and 7 females) and 15 healthy elderly controls (9 males and 6 females) referred to the Radiodiagnosis Department from the Neuropsychiatry Department that had clinical manifestations of suspected cognitive impairment, we used the Mini Mental State Examination (MMSE) as a measure of general cognitive function and the total learning from the Auditory Verbal Total Learning Test (AVTOT) as a measure of memory performance. One year follow up of patients was done to assess the disease progress.

Results

Twenty-five patients were included in this study {Alzheimer disease (10 cases), MCI (15 cases)} and 15 healthy elderly controls. Mean MMSE scores were significantly lower in patients with Alzheimer’s disease compared with MCI and control cases (P < 0.001). Positive correlation (except left caudate nucleus) between gray matter volume reduction in MCI and AD in relation to elderly control and MMSE score was observed. The Auditory Verbal Learning Test (AVTOT) was significantly lower in patients with Alzheimer’s disease compared with MCI and control cases (P < 0.001). No significant differences were found between groups as regards age, sex, education or dominant hand. Significant gray matter volume reductions were found in both AD and MCI compared to healthy elderly control however no significant differences were found among MCI patients or AD patients. Sensitivity, specificity, PPV and NPV of caudate nucleus and hippocampal volume reduction in AD and MCI in relation to elderly control were higher than entorhinal cortex.

Conclusion

Semi-automated MR volumetric measurements can be used to determine atrophy in hippocampus, caudate nucleus and entorhinal cortex which aided in discrimination of healthy elderly control subjects from subjects with AD and MCI and predict clinical decline of MCI leading to increase the efficiency of clinical treatments, delay institutionalization and improve cognition and behavioral symptoms.