Knowledge and practice of behavioral management principles among dentists treating adults with learning disabilities

This study investigated U.K. dentists’ knowledge and practice of behavioral management principles (BMPs) as applied to adults with learning disabilities (AWLD). A postal questionnaire enquired into the dentists’ experience in managing AWLD, utilization of behavioral management techniques, and knowledge of BMPs. The response rate was 41% (N = 53). Two groups were investigated: specialists (dentists registered on the Special Care Dentistry specialists’ list, n = 37) and nonspecialists (dentists not on the list, n = 16). Although specialists treated more AWLD than nonspecialists, both groups of dentists reported they felt highly confident in managing AWLD. However, all dentists’ knowledge of the principles of nonpharmacological BMPs was low. Specialists had a tendency to use a greater range of nonpharmacological behavioral management techniques compared to non‐specialists. These results suggest that dental team members need more training in the theory and practice of BMPs, which might lead to less reliance on costly pharmacological interventions and a clinical experience that is more respectful of the dignity and independence of AWLD.     

Plasma vaspin concentrations are decreased in acute coronary syndrome,but unchanged in patients without coronary lesions

Objective

Previous studies suggested that decreased serum vaspin levels were associated with coronary artery disease (CAD). The present study aimed to investigate the association between plasma vaspin levels and different states of CAD.

Design and methods

A total of 162 patients with coronary angiography (CAG) proved that CAD was enrolled. Additional 103 patients complained with “chest discomfort” with negative CAG, and 60 normal subjects were enrolled in this study. The levels of plasma vaspin, adiponectin, clinical parameters, lipid profile and C reactive protein (CRP) were measured.

Results

The levels of plasma vaspin were significantly lower in the CAD group (0.47 ± 0.63 μg/L) than those in the healthy group and CAG (−) group (all p < 0.001). In CAD group, the pos hoc analysis showed that serum vaspin concentration in acute myocardial infarction group (0.21 ± 0.19 μg/L) was significantly lower than that in the unstable angina pectoris group (0.40 ± 0.37 μg/L) (p = 0.012), and serum vaspin concentration in unstable angina pectoris was significantly lower than that in stable angina pectoris group (0.92 ± 0.94 μg/L) (p = 0.013). The plasma vaspin concentration was also negatively correlated with the severity of CAD (1-vessel: 0.86 ± 0.90 μg/L; 2-vessel: 0.36 ± 0.39 μg/L; 3-vessel: 0.21 ± 0.16 μg/L). The plasma vaspin concentration in CAG (−) group with “chest discomfort” (1.93 ± 2.57 μg/L) was similar to the healthy control group (2.18 ± 3.49 μg/L).

Conclusions

The plasma vaspin concentration correlated to the severity of CAD. Furthermore, plasma vaspin has a value of avoiding patients without CAD from unnecessary CAG.     

Body mass index is the main risk factor for arterial hypertension in young subjects without major comorbidity

BACKGROUND: Analytical statistics revealed a variety of risk factors for hypertension, but the complex interplay between different factors remains to be determined by more powerful statistical techniques. METHODS: Analytical as well as new, explorative statistical methods such as natural segmentation (k-means) and predictive modelling algorithms (C4.5) were used to classify the interactions of the individual risk factors for arterial hypertension in a large cohort of subjects. Fifty-five attributes (subject base, sociodemographic, medical history, laboratory data) were obtained from each of the 3547 participants of a community-based health survey. The study subjects, mean age of 41 years, were free of major comorbidity. RESULTS: Twenty-five percent of the subjects had at least stage 1 hypertension. No clear linear dependency of risk factors with the diagnosis hypertension could be derived by the analytical statistics. In particular, the mutual amplification of different risk factors towards hypertension could not be revealed by these techniques. Explorative analytics however, uncovered body mass index (BMI) as the main single risk factor associated with hypertension. High predictive accuracy was achieved when combinations of certain risk factors including male gender and age were used. CONCLUSIONS: In summary, the survey of risk factors for hypertension using explorative analytics yielded high increases for the correct prediction of arterial hypertension. In this cohort, BMI was the single strongest parameter associated with arterial hypertension.     

Ultrasound evaluation of clobetasol propionate 0.05% foam application in psoriatic and healthy skin: a pilot study

The aim of the present study was to evaluate through ultrasound imaging the response to treatment of twice and once daily application of clobetasol propionate 0.05% foam on psoriatic skin as well as the atrophogenic potential of once daily application of the foam on healthy skin. The study included a total of 40 participants, 30 affected by Psoriasis vulgaris and 10 healthy volunteers. Patients with psoriasis were branched in two groups of 15 subjects: in the first group, clobetasol propionate 0.05% foam was applied twice daily for up to 2 weeks on targeted plaques, in the second group, it was applied once daily for up to 4 weeks. Ten healthy adult volunteers were instructed to apply the foam to a 4 × 4 cm area on the volar aspect of the forearm once daily for 4 weeks. Ultrasound evaluation was performed in all treated areas using a 20-MHz B-mode high-resolution system (EasyScan Echo^®, Business Enterprise, Trapani, Italy). At the end of the study, ultrasound showed a reduction of psoriatic skin thickness, with values equal to those of adjacent healthy skin, in all treated plaques. No differences in treatment efficacy between the two groups of patients with psoriasis were observed. As regards the healthy group, no ultrasound variations in skin thickness were observed at the end of the study. Ultrasound imaging, allowing an objective and reproducible measurement of skin thickness, is a useful technique for a noninvasive evaluation both of the efficacy of psoriasis treatment and of the potential side effects of topical corticosteroids.     

Brain microstructure of subclinical apathy phenomenology in healthy individuals

Although apathy has been extensively studied in relation to neuropsychiatric disorders, it is still unclear whether, in healthy people, it should be considered as a physiological phenomenon or whether it is a risk factor for progression to clinical disturbances. Here, we investigated subclinical apathy phenomenology and its brain microstructural correlates in healthy individuals. We submitted 72 participants to a comprehensive clinical assessment, a high‐resolution structural MRI and a diffusion tensor imaging scan protocol. Data of individual microstructural (mean diffusivity and fractional anisotropy) variations were processed across genders in relation to the Apathy Rating Scale score. In females, subclinical apathy phenomenology was associated with microstructural variation of the bilateral thalami, the anterior thalamic radiation, the forceps major, and the corona radiate. These are white matter areas mostly connecting the thalami to the frontal and occipital cortices, regions that are known to be implicated in the expression of apathy in clinical samples. No significant relationship with brain microstructure was found in males who showed a positive correlation between subclinical apathy and somatic phenomenology of depression. In conclusion, our results show that in healthy individuals subclinical apathy phenomenology is associated with different mechanisms across genders, and raise the issue about whether brain microstructural changes associated with subclinical apathy in healthy females could be a precocious marker useful in the prediction of progression to more severe apathetic conditions. Hum Brain Mapp 34:3193–3203, 2013. © 2012 Wiley Periodicals, Inc.     

健康人双大脑脚各向异性值及面积：弥散张量成像研究

Diffusion tensor imaging was performed in 105 volunteers free of central nervous system lesions.No differences were found in fractional anisotropy between the left and right cerebral peduncles among subjects(P > 0.05).The lower limit value of fractional anisotropy was 0.36,and the asymmetry ratio was 0.77.The area and lower limit value of the cerebral peduncles were 0.90 cm2 and 0.83,respectively.These results will be useful in evaluating the diagnosis of Wallerian degeneration following cerebral infarction.     

A prospective study of high resolution ultrasound in brachial plexopathies – Correlation with electrophysiological measurements

ObjectivesTo evaluate the diagnostic role of ultrasound in brachial plexopathies.MethodsWe included 59 healthy subjects (HS) and 42 patients consecutively referred with clinical suspicion of brachial plexopathy from October 2015 to May 2016. Patients underwent routine electrodiagnostic testing (EDx) as reference standard and a blinded standardised ultrasound examination of the brachial plexus as index test with cross-sectional area (CSA) as the ultrasound parameter of choice.ResultsSeventeen patients were diagnosed by EDx with brachial plexopathy, ten with mononeuropathies, and ten had normal EDx. Five had a cervical radiculopathy. In 11 (64%) out of the 17 patients with EDx diagnosed plexopathy, we found at least one abnormal level on ultrasound. Six (60%) out of ten normal EDx patients had a normal ultrasound examination at all levels. Ultrasound identified the same abnormal level(s) as EDx in eight (73%) of the 11 patients who had both abnormal EDx and ultrasound results. Mean CSA was higher in the plexopathy group compared to HS at the level of the C6 root (p = .022), the middle trunk (p = .027), and the medial cord (p = .003).ConclusionUltrasound examination showed abnormalities in patients with brachial plexopathies in good agreement with EDx.SignificanceUltrasound may be an important supplement to electrodiagnostics in evaluating brachial plexopathies.