Early diagnosis of temporomandibular joint arthritis in children with juvenile idiopathic arthritis. A systematic review.

AIM: Asymptomatic TMJ arthritis in juvenile idiopathic arthritis (JIA) patients may cause damage and deformity of the joint. The clinical manifestation of early-stage TMJ arthritis is not characteristic. Clinical findings commonly appear in a late stage of TMJ involvement, but they can also be masked by antirheumatic therapy. The absence of clinical symptoms, and the lack or insufficient clinical signs do not provide reliable information about the TMJ involvement. The aim of the study was to conduct a systematic review of the evidence for clinical symptoms and signs of early-stage TMJ arthritis, as well as for correlation between clinical parameters and TMJ abnormalities imaging in JIA patients. METHODS: Study design: A systematic review of papers published from 1998 to 2019 regarding early clinical and imaging findings of TMJ arthritis in JIA patients. RESULTS: The search resulted in 292 studies. Eleven publications were included in the review. CONCLUSION: Clinical signs and symptoms do not allow to detect the early stage of TMJ arthritis in JIA patients. To monitor individual orofacial development, periodic TMJ clinical examination should be a part of an evaluation of JIA children's growth. There is a need to develop clinical management guidelines, as well as diagnosis standards of clinical and imaging TMJ examination for JIA children, considering their developmental age.

Does the addition of oxaliplatin to preoperative chemoradiation benefit cT4 or fixed cT3 rectal cancer treatment? A subgroup analysis from a prospective study.

BACKGROUND: Whether there is any benefit derived from adding oxaliplatin to fluoropyrimidine-based preoperative chemoradiation is currently unknown in cases of advanced cT3 or cT4 tumours. Our aim was to evaluate this issue by analysing a randomized trial, which compared two schedules of preoperative treatment (chemoradiation vs. 5 × 5 Gy with 3 cycles of consolidation chemotherapy) for cT4 or fixed cT3 rectal cancer. PATIENTS AND METHODS: Delivery of oxaliplatin was mandatory to the first part of the study. For the second part, its delivery in both treatment-assigned groups was left to the discretion of the local investigator. We analysed a subgroup of 272 patients (136 in the oxaliplatin group and 136 in the fluorouracil-only group) from institutions that had omitted oxaliplatin in the second part of the study. RESULTS: Circumferential resection margin negative (CRM-) status rate was 68% in the oxaliplatin group and 70% in the fluorouracil-only group, p = 0.72. The pathological complete response rate (pCR) was correspondingly 14% vs. 7%, p = 0.10. Following multivariable analysis, when comparing the CRM- status in the oxaliplatin group to the fluorouracil-only group, the odds ratio was 0.79 (95 CI 0.35-1.74), p = 0.54; there being no interaction between concomitant chemoradiation and 5 × 5 Gy with consolidation chemotherapy; pinteraction = 0.073. For pCR, the corresponding results were 0.47 (95 CI 0.19-1.16), p = 0.10, pinteraction = 0.84. CONCLUSION: No benefit was found of adding oxaliplatin in terms of CRM nor pCR rates for either concomitant or sequential settings in preoperative radiochemotherapy for very advanced rectal cancer.

Long-course oxaliplatin-based preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for cT4 or fixed cT3 rectal cancer: results of a randomized phase III study.

BACKGROUND: Improvements in local control are required when using preoperative chemoradiation for cT4 or advanced cT3 rectal cancer. There is therefore a need to explore more effective schedules. PATIENTS AND METHODS: Patients with fixed cT3 or cT4 cancer were randomized either to 5 × 5 Gy and three cycles of FOLFOX4 (group A) or to 50.4 Gy in 28 fractions combined with two 5-day cycles of bolus 5-Fu 325 mg/m(2)/day and leucovorin 20 mg/m(2)/day during the first and fifth week of irradiation along with five infusions of oxaliplatin 50 mg/m(2) once weekly (group B). The protocol was amended in 2012 to allow oxaliplatin to be then foregone in both groups. RESULTS: Of 541 entered patients, 515 were eligible for analysis; 261 in group A and 254 in group B. Preoperative treatment acute toxicity was lower in group A than group B, P = 0.006; any toxicity being, respectively, 75% versus 83%, grade III-IV 23% versus 21% and toxic deaths 1% versus 3%. R0 resection rates (primary end point) and pathological complete response rates in groups A and B were, respectively, 77% versus 71%, P = 0.07, and 16% versus 12%, P = 0.17. The median follow-up was 35 months. At 3 years, the rates of overall survival and disease-free survival in groups A and B were, respectively, 73% versus 65%, P = 0.046, and 53% versus 52%, P = 0.85, together with the cumulative incidence of local failure and distant metastases being, respectively, 22% versus 21%, P = 0.82, and 30% versus 27%, P = 0.26. Postoperative and late complications rates in group A and group B were, respectively, 29% versus 25%, P = 0.18, and 20% versus 22%, P = 0.54. CONCLUSIONS: No differences were observed in local efficacy between 5 × 5 Gy with consolidation chemotherapy and long-course chemoradiation. Nevertheless, an improved overall survival and lower acute toxicity favours the 5 × 5 Gy schedule with consolidation chemotherapy. CLINICAL TRIAL NUMBER: The trial is registered as ClinicalTrials.gov number NCT00833131.

Attitudes of medical staff in delivering women's opinion.

PURPOSE: The growing competitiveness between various health centres in the scope of offered medical services is accompanied by growth of patients' expectations concerning the quality of the abovementioned services. That is why knowledge of the patients' needs and expectations concerning medical services may significantly contribute to the improvement in the quality of the services to be rendered. The aim of the study was to analyse the evaluation of attitudes of medical staff by delivering women. MATERIAL AND METHODS: Self-invented questionnaire was used in order to examine the patients for the purposes of present research. The obtained results were subject to statistical analysis by means of chi-square test for uniformity. A 5% inference error risk was assumed and p < 0.05 was considered as statistically significant. RESULTS: It has been proved that that largest percentage of delivering women was referred to as "Ms". 93.33% of the interviewed delivering women obtained complete information from the medical staff. However, no significant interrelation between the information the delivering women obtained from the medical staff and their age. Level of education and place of residence was proved. CONCLUSIONS: The study shows that the delivering women with a university degree evaluated the medical staff's attitude as positive more frequently than the women with primary or secondary level of education. The research indicates that in contacts with the delivering women and when informing the delivering women. The delivery block medical staff must pay particular attention to the women without higher education.

Variations in concentration of fluoride in blood plasma of pregnant women and their possible consequences for amelogenesis in a fetus.

The aim of the study was to assess the fluoride exposure of pregnant women living in Poznan (Poland) by examination of fluoride levels in blood plasma. The subjects of the study were 31 pregnant women aged 22-34 years in the course of regular pregnancy. Data concerning the sources of fluoride exposure such as diet, oral hygiene measures and topical application of fluoride procedures, were collected from each individual with a questionnaire. Samples of blood plasma were drawn in the 28th, 33rd week of pregnancy and during delivery. The analysis evaluating the fluoride concentration in the samples was carried out with the use of fluoride electrode ORION (model 96-09). The data were statistically analyzed using the program Statistica for Windows. Mean value of fluoride concentration in the samples of blood plasma from the 28th week of pregnancy was lower than the mean concentration detected in the 33rd week of pregnancy (3.29 and 3.73mumol/l, respectively). These values suggest that apart from drinking water, there were other important sources of fluoride in the examined sample. The results indicate that a reliable assessment of fluoride exposure in a given population cannot be based solely on the concentration of fluoride in drinking water. Relatively high levels of fluoride in blood plasma of examined women suggest that there is no need for fluoride supplementation in this group of patients.

Rational or uncommitted? Depression and indecisiveness in interpersonal decision making.

Two studies were run which tested the prediction that clinically depressed persons, known for difficulties in making a decision, would process predecisional information relevant to an interpersonal choice in a more impartial, less biased way than non-depressed persons. Both studies provided confirmation for this hypothesis. In each case, the depressed group focused less on specific alternatives, asked more criterion-based questions, and made decisions on the basis of information which was more evenly distributed over alternatives, thus conforming less to biasing, dominance structuring processes, than non-depressed participants. The depressed and non-depressed participants did not differ, however, in evaluative aspects of their decisions, suggesting a relative independence of affective and informational aspects of predecisional processes. The question arises; are depressed patients less biased and hence more rational when making decisions or are they just indifferent and uncommitted? The data have been discussed with reference to research on effortful versus automatic information processing in depression.

The effect of chronic carbamazepine, valproic acid and phenytoin medication on the periodontal condition of epileptic children and adolescents.

Periodontal condition was studied in 84 epileptic 8-18 year-old patients who had been undergoing antiepileptic drug (AEP) treatment for a period of at least 3 years. They were diagnosed as suffering from partial seizures (simplex or complex) or general tonic-clonic fits and were treated with therapeutic oral doses of phenytoin (PHT) and carbamazepine (CBZ) or valproic acid (VPA) in mono- or polytherapy. All patients received a drug dosage to ensure adequate plasma concentration and satisfactory seizure control. The Gingival Index (GI), Sulcus Bleeding Index (SBI) and Plaque Index (Pl-I) were individually scored. The control group contained 30 age-matched healthy children and adolescents. The GI and SBI indices were higher in epileptics than in controls. Only the Pl-I was similar in both groups. Gingival enlargement was found in 30% of the epileptic patients. There was no definite plasma concentration-dependent increase in the incidence of gingival overgrowth.

[Assessment of early stages of mineralization of dental plaque in scanning microscopy]. / Ocena wczesnych stadiów mineralizacji pøytki nazebnej w skaningowym mikroskopie elektronowym.

The purpose of the study was determination of the mineralization stage of the dental plaque set down on a foil during 6 days of exposure in oral cavity. The observed regularities of the time and mode of deposition of supragingival tartar agreed with the observations of other authors of this tartar in oral cavity. Evaluation of the results of the study indicated that the experimental material obtained in this way is suitable for the study of early stages of dental plaque mineralization.

[Effect of local application of NaF on the content of calcium, phosphorus and fluorine in young dental calculus]. / Wplyw miejscowego stosowania NaF na zawartosc wapnia, fosforu i fluoru w mlodym kamieniu nazebnym.

The purpose of the study was determination of changes in the content of calcium, phosphorus and fluorine in young dental calculus developing in vivo in case of not using a rinsing solution of 1% NaF or after its use. The studied material comprised tartar deposited on a foil fastened to the lower incisor in 6 women aged 23-28 years. They were divided into two groups of 3 women in each, one of the groups had a high tendency for mineralization of tartar, while in the other group this tendency was small. The study was carried out in two stages. In the first, control, stage at the time of foil wearing the women rinsed mouth with a placebo solution, in the experimental stage they used 1% sodium fluoride solution for this purpose. The analysis of the superficial distribution of various elements showed a greater density of impulses in the case of calcium and fluorine, and lower density in the case of phosphorus in the deposits formed in the experimental stage as compared to the control stage. Using X-ray microanalysis a statistically significant rise was found of the concentration of calcium and fluorine, and reduced content of phosphorus in the deposits formed after NaF application. The per cent in weight of fluorine in young supragingival tartar from the control stage was 0.2-3.1, while in the experimental stage it rose to 3.0-27.7. The statistical analysis showed that the rise of fluorine content in tartar in cases with low tendency for mineralization of tartar (group II) was statistically significantly higher than in the group with a high tendency for tartar development (group I). The Ca/F ratio calculated on the basis of the results in the control stage was 1.35 to 2.68. After application of fluoride rinsing solution this value rose to 1.96 to 4.34 in the studied women.