Topical metronidazole application as an adjunct to scaling and root planing

AIM: This study was carried out to investigate the effect of 2 applications of a metronidazole 25% dental gel as adjunctive therapy to subgingival scaling with root planing. METHOD: 59 of the original collective of 64 patients with adult periodontitis were observed for a 9-month period. This randomised single-blind study was carried out in split-mouth design. Each patient had to have at least 2 pockets with a probing depth of > or =5 mm in each quadrant. The clinical parameters, pocket probing depth (PPD), attachment level (AL) and bleeding on probing (BOP), were recorded at all teeth on days 0, 91, 175 and 259; in addition, subgingival plaque samples taken from 45 patients were analysed by means of dark-field microscopy. Therapy comprised subgingival scaling and root planing (SRP) of all quadrants and additional application of metronidazole 25%, dental gel in 2 randomly selected quadrants (SRP+Metro). Treatment was confined to teeth with a baseline PPD of > or =5 mm. Average PPD and AL and the incidence of BOP were computed for all pockets with a baseline PPD of > or =5 mm, and the 2 methods compared. The main efficacy variable for evaluation of the 2 treatments was the difference in PPD on day 259. RESULTS: Comparison of the 2 treatments revealed a statistically significant improvement in the clinical parameters for both treatment methods over the study period. Between baseline and day 259, significant differences in PPD (SRP+Metro: from 6.00 to 4.63 mm, SRP: from 6.02 to 4.83 mm) and BOP (SRP+Metro: from 67 to 31%, SRP: from 64 to 36%) were observed between the 2 treatment groups. Evaluation according to different patient groups demonstrated significant advantages of the combined therapy in previously-untreated patients, especially in female probands. Dark-field microscopy revealed a shift in the bacterial flora towards "healthy conditions". CONCLUSIONS: The results show that only minor advantages are to be gained from the application of a metronidazole 25% dental gel as adjunctive therapy to subgingival scaling. The distinctly better results of combined therapy in previously-untreated patients calls for more thorough investigation.     

The IMAGEN study: reinforcement-related behaviour in normal brain function and psychopathology

A fundamental function of the brain is to evaluate the emotional and motivational significance of stimuli and to adapt behaviour accordingly. The IMAGEN study is the first multicentre genetic-neuroimaging study aimed at identifying the genetic and neurobiological basis of individual variability in impulsivity, reinforcer sensitivity and emotional reactivity, and determining their predictive value for the development of frequent psychiatric disorders. Comprehensive behavioural and neuropsychological characterization, functional and structural neuroimaging and genome-wide association analyses of 2000 14-year-old adolescents are combined with functional genetics in animal and human models. Results will be validated in 1000 adolescents from the Canadian Saguenay Youth Study. The sample will be followed up longitudinally at the age of 16 years to investigate the predictive value of genetics and intermediate phenotypes for the development of frequent psychiatric disorders. This review describes the strategies the IMAGEN consortium used to meet the challenges posed by large-scale multicentre imaging-genomics investigations. We provide detailed methods and Standard Operating Procedures that we hope will be helpful for the design of future studies. These include standardization of the clinical, psychometric and neuroimaging-acquisition protocols, development of a central database for efficient analyses of large multimodal data sets and new analytic approaches to large-scale genetic neuroimaging analyses.     

Two-year clinical evaluation of resinous restorative systems in non-carious cervical lesions

This controlled clinical trial evaluated the 2-year clinical performance of a one-bottle etch-and-rinse adhesive and resin composite system (Excite/Tetric Ceram) compared to a resin-modified glass ionomer cement (RMGIC) (Vitremer/3M) in non-carious cervical lesions. Seventy cervical restorations (35 resin composite - RC- restorations and 35 RMGIC restorations) were placed by a single operator in 30 patients under rubber dam isolation without mechanical preparation. All restorations were evaluated blindly by 2 independent examiners using the modified USPHS criteria at baseline, and after 6, 12 and 24 months. Data were analyzed statistically by Fisher's exact and McNemar tests. After 2 years, 59 out of 70 restorations were evaluated. As much as 78.8% retention rate was recorded for RC restorations, while 100% retention was obtained for RMGIC restorations. Fisher's exact test showed significant differences (p=0.011) for retention. However, there were no significant differences for marginal integrity, marginal discoloration, anatomic form and secondary caries between the RC and RMGIC restorations. The McNemar test detected significant differences for Excite/TC between baseline and the 2-year recall for retention (p=0.02), marginal integrity (p=0.002) and anatomic form (p=0.04). Therefore, the one-bottle etch-and-rinse bonding system/resin composite showed an inferior clinical performance compared to the RMGIC.     

Association between human papillomavirus infection and cytological abnormalities during early follow-up of invasive cervical cancer

Considering the limitations of cytology for detection of residual cervical cancer after radiotherapy, the aim of this study was to evaluate the frequency and viral load of high-risk HPV in cervical and vaginal samples during the early follow-up of patients treated for invasive cervical cancer and correlate the results with cytological examination. Conventional cytology and hybrid capture test were performed on cervical and vaginal samples of 52 women with invasive cervical carcinoma 3 months after therapy. High-risk HPV was detected in 46.1% of the samples and the median and the range of the ratio relative light unit (RLU)/cutoff (CO) (estimated viral load) in positive samples was 1.71 (1-2120.03). No significant difference was observed in viral frequency and in median of the ratio RLU/CO between samples of patients at different stages (I-III) and between cervical samples, from patients treated by exclusive radiotherapy with or without chemotherapy, and vaginal samples, from patients who underwent to hysterectomy and radiotherapy with or without chemotherapy. Cytological abnormalities were more frequent significantly in samples with HPV than in samples without HPV. The viral load was also higher significantly in samples with cytological abnormalities when compared with the samples without cytological abnormalities. In conclusion, HPV detection methods may be useful during the early follow-up as a complement to conventional cytology for the diagnosis of residual cervical cancer after radiotherapy.     

Measurement of renal volume using respiratory-gated MRI in subjects without known kidney disease: intraobserver, interobserver, and interstudy reproducibility

ObjectiveSince renal volume is to be considered in managing renal diseases, a reproducible technique is needed. Our aim was to estimate intraobserver, interobserver, and interstudy reproducibility of renal volume measurement in subjects without known kidney disease using magnetic resonance (MR) imaging.Materials and methodsWe studied 20 patients (age range 33–82 years) without known renal disease using 1.5-T MR imaging with a respiratory-gated two-dimensional coronal balanced steady state free precession sequence. Each patient repeated the study after 1 h. Two readers independently segmented the area of both kidneys of the first study, subtracting cysts. After 1 week, the first reader segmented the second study and repeated the segmentation of the first study. The volume of each kidney was obtained by multiplying the renal area on each slice by the slice thickness and summing all the partial volumes. Reproducibility was assessed by Bland-Altman and Wilcoxon statistics. The coefficient of repeatability (CoR) was summed to the absolute value of bias; the ratio between this sum and the mean of the two data sets was used as a measure of variability while its complement to 100% was used as a measure of reproducibility.ResultsAcquisition time was 2–3 min. Segmentation time was 20–25 min. Intraobserver variability results in a CoR of 7 ml and in a reproducibility of 95%, interobserver variability 8.8–9.8 ml and 87–88%, interstudy variability 9.8–10.6 ml and 91–93%, respectively. Considering both the effect of observer and the repetition of the study, the reproducibility was 83–87%.ConclusionRenal volume measurement by MR imaging is highly reproducible.     

Cortical correlates of an attentional bias to painful and innocuous somatic stimuli in children with recurrent abdominal pain

Recurrent abdominal pain (RAP) is a common gastrointestinal problem during childhood. It is not only a pediatric health problem, but may represent a risk factor for chronic pain, psychosomatic symptoms, and psychopathological problems later in life. Alterations in central pain processing and an attentional bias to potentially aversive somatic sensations could contribute to the unfavorable outcome of RAP during childhood. Fourteen children with RAP and 15 control children (age: 10-15 year) participated in an attentional task. Children had to respond to rare targets (tones) and ignore frequent either painful (pain threshold) or non-painful mechanical stimuli delivered at the hand. Event-related cortical potentials in response to the somatic stimuli and the tones were measured and stimulus intensity ratings, reaction time and number of errors were obtained. Painful as compared to non-painful stimuli elicited significantly larger N1, P2 and P3 components of the somatosensory-evoked potential (SEP) in all children. The RAP children responded with a significantly larger P3 to both painful and non-painful stimuli. No group differences were found for the auditory-evoked potentials. Perceived stimulus and pain intensity, reaction time and number of errors did not differ between groups. Similar to findings in adults with functional gastrointestinal disorders (FGIDs), children with RAP did not show somatic hyperalgesia as revealed by unaltered pain thresholds and middle latency pain-evoked SEPs. However, they displayed an attentional bias to painful and non-painful (innocuous) somatic stimuli as indicated by an enhanced P3. This may represent an important mechanism not only for the maintenance of RAP, but also for the development of psychosomatic symptoms.     

Nursing program assessment and evaluation: evidence-based decision making improves outcomes

The authors explore how an evidence-based decision-making process improved National Council Licensure Examination passing rates for a bachelor of science in nursing program. The process is one that may be applicable to other nursing programs despite differences in school mission, philosophy, and student population. The essential components of a nursing program that contribute to student success are examined. Lessons learned and opportunities for more comprehensive pertinent assessment methods are discussed.