Measuring health outcomes of adolescents: report from a pilot study

There is a need to understand the practicality, validity and reliability of using utility measures with children and adolescents. We designed a pilot study in order to help guide the selection of an appropriate health-related quality-of-life (HRQoL) questionnaire for adolescents to be used in the context of a large randomised controlled trial (RCT) of family therapy versus standard treatment for adolescents aged 11–17 years. The pilot study was carried out on a school sample of adolescents in the same age range as the RCT. Adolescents were asked to fill in three HRQoL questionnaires: the standard EQ-5D, the licensed Health Utilities Index HUI, and the child-friendly version of the standard EQ-5D: the EQ-5D for youth (EQ-5D-Y). This report explores the problems with the language and concepts embodied within those HRQoL questionnaires and open discussion regarding how we can value the health of adolescents for cost-utility analysis in a larger study.     

Influence of Preoperative Mechanical Allodynia on Predicting Postoperative Pain after Root Canal Treatment: A Prospective Clinical Study

IntroductionOdontogenic pain can manifest as pulpal pain, periapical pain (mechanical allodynia), or both. This study aimed to assess the changes in the intensity of mechanical allodynia (MA) and to identify predictors of postoperative pain after root canal treatment (RCT).MethodsIn total, 579 consecutive patients who required RCT were enrolled; we included patients with asymptomatic pulpal diagnoses to avoid any effects of preoperative spontaneous pain on postoperative pain and to evaluate MA independently. Using a visual analog scale (VAS), patients separately indicated the intensity of spontaneous pain, tenderness to percussion, and pain on biting; these measurements were performed before treatment (preoperative pain), at the beginning of each visit (postpreparation pain), and daily for 1 week after RCT (postobturation pain). For analytical purposes, patients were subdivided into 2 groups based on the intensity of preoperative MA (none to mild [VAS <4] or moderate to severe [VAS ≥4]) to evaluate changes in MA and predictive factors of moderate to severe postoperative pain. A generalized estimating equation, repeated-measures analysis of variance, and logistic regression analysis were used.ResultsAlthough the intensity of MA was significantly higher in the moderate to severe group after the initiation of RCT (P < .05), 93% of them experienced alleviation in MA, and 30% of patients in the none to mild group experienced an increase in MA. After adjusting for clinical variables, moderate to severe preoperative MA and the presence of necrotic pulp were significantly correlated with moderate to severe postoperative pain with an odds ratio of 4.107 and 0.286, respectively.ConclusionsModerate to severe preoperative MA was a predictive factor of postoperative pain in patients undergoing RCT.     

Morphology of Mandibular First Molars Analyzed by Cone-beam Computed Tomography in a Korean Population: Variations in the Number of Roots and Canals

Introduction

The aim of this study was to determine the root and canal morphology of the mandibular first molars in a Korean population of Mongolian origin by retrospective analysis of a large number of cone-beam computed tomography (CBCT) images.

Methods

A total of 976 subjects with bilateral mandibular first molars were examined by using in vivo CBCT methods. The number and configuration of roots, the number of root canals, and the canal configuration based on Vertucci's classification were determined.

Results

Overall, 25.82% of examined molars had 3 roots, 73.51% had 2 roots, and 0.67% had 1 root. The incidence of fourth canal was 50.36%. A right-sided predominance was noted for extra distal roots (P < .001), whereas a left-sided predominance was observed for extra distal canals (P < .001). No significant sex-related differences were shown for their prevalence. The bilateral prevalence rate was 69.13% for extra distal roots and 78.08% for extra distolingual (DL) canals. In the mesial roots, type IV canal was the most frequent (76.86% for 2-rooted molars and 72.96% for 3-rooted molars). In the distal roots, type l was the most common (66.62% for 2-rooted molars and 99.40%–100% for 3-rooted molars). The incidence of 2 canals in distobuccal roots, first reported in this study, was 0.15%.

Conclusions

Among mandibular first molars, there is a high prevalence of a separate DL root and/or a separate DL canal, and such molars commonly have 4 canals in the Korean population. CBCT is a useful tool for determining root and canal morphology.     

The weight-specific adolescent instrument for economic evaluation (WAItE): psychometric evaluation using a Rasch model approach

Quality of Life Research - The Weight-specific Adolescent Instrument for Economic evaluation (WAItE) is a 7-item condition-specific tool assessing the impact of weight status on seven dimensions of...     

Intraoperative monitoring of a patient with craniovertebral junction meningioma

Intraoperative monitoring is considered as a useful tool to prevent neurological damage during different neurosurgical procedures. Somatosensory evoked potentials (SEP) allow simultaneous assessment of several cortical and sub cortical centers. In this case presentation, we report intraoperative monitoring of an elderly patient with craniovertebral junction meningioma. Tibial SEP responses were elicited by stimulation of the tibial nerve; the recordings were visually analyzed for the presence of the main peaks P40-N50, peak to peak amplitudes, peak latencies and compared to baseline recordings throughout the procedure. During decompression from the medial aspect of the medulla SEP responses were lost for a brief period of time. Surgeons achieved total tumor removal and the patient left the operating room without any neurological deficit.     

Design of a cafeteria tray for use by stroke survivors

Survivors of a stroke present varying types and degrees of neurological impairments and functional deficits. They often have difficulty using one side of their body and may require assistive devices such as canes and walkers. As a result, carrying a standard cafeteria tray can pose a challenge to these individuals. Our goal was to design a cafeteria tray that could be easily used with one hand. User interviews of stroke survivors offered client needs that guided the entire design process. It was important to the stroke survivors that the device required intuitive understanding of use, effectively transported food using only one hand, supported the weight of a meal, and had a pleasing design to promote discreteness by avoiding a "disabled" appearance.     

The impact of shock wave therapy at varied energy and dose levels on functional and structural changes in erectile tissue

OBJECTIVES: Only minimal literature exists on consequences of shock wave therapy (SWT) on erectile function in treatment of Peyronie's disease (PD). This study was undertaken to define SWT impact at varied energy/dose levels at different time points on functional and structural changes in erectile tissue. METHODS: In 45 rats 2000 shock waves (sw) at 2 BAR were applied to the penis weekly sorted by one, two, and three sessions (high-dose/energy level, HD-1, HD-2, HD-3). Each group was followed for 1, 7, or 28 d before measuring intracavernosal pressure (ICP) and mean arterial pressure (MAP). Fifteen control animals (C1, C7, C28) underwent anesthesia alone. Another 15 animals were exposed to three SWT sessions applying 1000 sw at 1 BAR and analyzed identically (low-dose/energy level, LD-3-1, -7, -28). Terminal deoxynucleotidyl transferase biotin-dUTP nick-end labeling assay was used to define the apoptotic index (AI) and Masson's trichrome (MT) staining was prepared to evaluate smooth muscle-to-collagen ratios. RESULTS: ICP/MAP ratios for all C groups displayed a mean of 64%. All SWT groups demonstrated significantly reduced ICP/MAP ratios compared to their corresponding C groups (p<0.05). The LD-3 groups showed a trend toward improved ICP/MAP ratios. LD-3-28 demonstrated significant recovery compared to HD-3-28 (55+/-8% vs. 41+/-10%, p=0.004), but remained reduced compared to C28 (63+/-5%, p=0.03). No statistical differences were seen for MT staining in SWT groups compared to C (p>0.05). AIs for the LD-3 groups were significantly lower compared to the HD-3 groups (p<0.001), but all AIs were significantly increased compared to C groups (p<0.01). CONCLUSIONS: Overall, at both energy/dose levels, SWT resulted in a time- and treatment-dependent reduction of ICP/MAP ratios, which might be mediated partly through apoptosis and collagenization of corporal smooth muscle.     

The medical management of Peyronie's disease

There are a wide variety of medical treatments that are available to the practicing urologist, including oral agents, topical creams and gels with or without iontophoresis, intralesional injection therapy, radiation therapy, extracorporeal shockwave therapy, and laser therapy. Medical management of Peyronie's disease might be a valuable treatment option for this debilitating disorder, especially in the early symptomatic stages of the disease. Although no single modality has been demonstrated to have superior efficacy, intralesional therapy appears to confer some benefit. Multicenter, large-scale, randomized, controlled studies are necessary to fully establish the efficacy of the available treatments. Until such trials are conducted, a rational approach involving combination therapy is the most appropriate method to treat these patients. In this Review, the current medical treatment options available for the management of Peyronie's disease are discussed and a management algorithm is proposed.