Treatment compliance in patients with aggressive periodontitis – a retrospective case-control study

Objective: To investigate if differences according to discontinuation of treatment could be identified between patients with aggressive periodontitis and chronic periodontitis at two specialist clinics of periodontology irrespective of the effects of background factors.

Materials and methods: This is a retrospective case-control study. The variables were registered from dental records. The population consisted of patients referred to two specialist clinics of periodontology during three years. A study group was included consisting of 234 patients with a diagnosis of aggressive periodontitis. A control group with a diagnosis of chronic periodontitis was randomly selected.

Results: In total, 234 patients (4% of the referrals) with a diagnosis of aggressive periodontitis were referred to the two periodontal clinics during a period of three years. Forty-two per cent of the non-compliant patients were smokers compared to 31% for the compliers and this difference was statistically significant. Patients with aggressive periodontitis interrupted their periodontal treatment significantly more frequently (46%) compared to those patients with chronic periodontitis (34%). The non-compliant patients had significantly deeper periodontal pockets at baseline as well as significantly more sites with bleeding at probing. In a stepwise logistic regression analysis, aggressive periodontitis, smoking and the relative frequency of sites with periodontal pockets >4?mm at baseline were the remaining variables with a significant influence on the incidence of interrupting ongoing periodontal treatment.

Conclusions: The patient group with aggressive periodontitis interrupted the periodontal treatment significantly more often irrespective of background factors and risk factors, which may be regarded as a major health problem.     

Neural Substrates of Psychotic Depression: Findings From the Global ECT-MRI Research Collaboration

Psychotic major depression (PMD) is hypothesized to be a distinct clinical entity from nonpsychotic major depression (NPMD). However, neurobiological evidence supporting this notion is scarce. The aim of this study is to identify gray matter volume (GMV) differences between PMD and NPMD and their longitudinal change following electroconvulsive therapy (ECT). Structural magnetic resonance imaging (MRI) data from 8 independent sites in the Global ECT-MRI Research Collaboration (GEMRIC) database (n = 108; 56 PMD and 52 NPMD; mean age 71.7 in PMD and 70.2 in NPMD) were analyzed. All participants underwent MRI before and after ECT. First, cross-sectional whole-brain voxel-wise GMV comparisons between PMD and NPMD were conducted at both time points. Second, in a flexible factorial model, a main effect of time and a group-by-time interaction were examined to identify longitudinal effects of ECT on GMV and longitudinal differential effects of ECT between PMD and NPMD, respectively. Compared with NPMD, PMD showed lower GMV in the prefrontal, temporal and parietal cortex before ECT; PMD showed lower GMV in the medial prefrontal cortex (MPFC) after ECT. Although there was a significant main effect of time on GMV in several brain regions in both PMD and NPMD, there was no significant group-by-time interaction. Lower GMV in the MPFC was consistently identified in PMD, suggesting this may be a trait-like neural substrate of PMD. Longitudinal effect of ECT on GMV may not explain superior ECT response in PMD, and further investigation is needed.     

Patterns of Pretreatment Diagnostic Assessment in Patients Treated with Stereotactic Body Radiation Therapy (SBRT) for Non-Small Cell Lung Cancer (NSCLC): Special Characteristics in the COVID Pandemic and Influence on Outcomes

The pandemic raised a discussion about the postponement of medical interventions for non-small cell lung cancer (NSCLC). We analyzed the characteristics of pretreatment diagnostic assessment in the pandemic and the influence of diagnostic assessment on outcomes. A total of 96 patients with stereotactic body radiation therapy (SBRT) for NSCLC were included. The number of patients increased from mean 0.9 (2012–2019) to 1.45 per month in the COVID era (p < 0.05). Pandemic-related factors (contact reduction, limited intensive care unit resources) might have influenced clinical decision making towards SBRT. The time from pretreatment assessment (multidisciplinary tumor board decision, bronchoscopy, planning CT) to SBRT was longer during the COVID period (p < 0.05). Reduced services, staff shortage, or appointment management to mitigate infection risks might explain this finding. Overall survival, progression-free survival, locoregional progression-free survival, and distant progression-free survival were superior in patients who received a PET/CT scan prior to SBRT (p < 0.05). This supports that SBRT guidelines advocate the acquisition of a PET/CT scan. A longer time from PET/CT scan/conventional staging to SBRT (<10 vs. ≥10 weeks) was associated with worse locoregional control (p < 0.05). The postponement of diagnostic or therapeutic measures in the pandemic should be discussed cautiously. Patient- and tumor-related features should be evaluated in detail.     

Differentiation of radicular cyst and granulomas using computerized tomography

Abstract The purpose of this investigation was to study periapical lesions by means of computerized tomography to ascertain if this noninvasive method could be of value in distinguishing between radicular cysts and granulomas. Periapical radiographs were taken of the teeth of 60 human cadavers. Periapical radiolucencies were seen in conjunction with 33 teeth. Based on the periapical radiographs, an oral radiologist (J.P.) attempted to select 4 granulomas and 4 cysts from the 33 radiolucencies. Computerized tomography was performed on the root tips and the periapical lesions of these 8 teeth. The roots and periapical lesions were then surgically removed and prepared histologically for microscopic examination. In the tomographs, 7 of the periapical lesions had a cloudy appearance with a density similar to each other and to the surrounding soft tissue. In the eighth lesion a homogeneous dark area with a distinctly lower density could be distinguished from surrounding cloudy areas. Histologically, the dark area was shown to be an epithelialized cyst cavity. The other 7 lesions were granulomas. Thus, a cyst could be differentiated from periapical granulomas by computerized tomography because of a marked difference in density between the content of the cyst cavity and granulomatous tissue.     

Aerosol-Induced Tuberculosis in Subhuman Primates and the Course of the Disease After Intravenous BCG Vaccination

Suitability of the rhesus monkey (Macaca mulatta) as an experimental host for evaluation of vaccines against airborne infection with Mycobacterium tuberculosis strain H37Rv was investigated. Nonvaccinated monkeys were exposed to estimated doses of 12, 25, or 49 units of H37Rv in a modified Henderson apparatus, and the course of the disease was followed by chest X rays, skin testing with purified protein derivative, body-weight determinations, and autopsy 8 weeks postinfection. These animals developed progressive and extensive tuberculosis with pathological changes proportional to the infecting dose. Four of seven monkeys vaccinated intravenously with 1 mg of live BCG 8 weeks prior to challenge with 40 units of H37Rv had no gross evidence of disease at autopsy 13 weeks postinfection; the other three monkeys had minimal disease. These data demonstrated that (i) reproducible and progressive infection could be induced in rhesus monkeys infected in a manner which simulated natural infection of man and (ii) a high level of resistance to infection could be induced by BCG vaccine in the rhesus monkey, which in nature is highly susceptible to tuberculous infection.     

Demonstration of an atypical pre- ß-lipoprotein in human serum

An atypical pre-β-lipoprotein of human serum has been detected by agarose gel electrophoresis in four patients, three of whom were siblings. This lipoprotein differed from the pre-β lipoprotein previously observed with this technique by sedimenting on ultracentrifugation at density 1.006.