Widespread intra-axonal signal fraction abnormalities in bipolar disorder from multicompartment diffusion MRI: Sensitivity to diagnosis, association with clinical features and pharmacologic treatment.

Despite diffusion tensor imaging (DTI) evidence for widespread fractional anisotropy (FA) reductions in the brain white matter of patients with bipolar disorder, questions remain regarding the specificity and sensitivity of FA abnormalities as opposed to other diffusion metrics in the disorder. We conducted a whole-brain voxel-based multicompartment diffusion MRI study on 316 participants (i.e., 158 patients and 158 matched healthy controls) employing four diffusion metrics: the mean diffusivity (MD) and FA estimated from DTI, and the intra-axonal signal fraction (IASF) and microscopic axonal parallel diffusivity (Dpar) derived from the spherical mean technique. Our findings provide novel evidence about widespread abnormalities in other diffusion metrics in BD. An extensive overlap between the FA and IASF results suggests that the lower FA in patients may be caused by a reduced intra-axonal volume fraction or a higher macromolecular content in the intra-axonal water. We also found a diffuse alteration in MD involving white and grey matter tissue and more localised changes in Dpar. A Machine Learning analysis revealed that FA, followed by IASF, were the most helpful metric for the automatic diagnosis of BD patients, reaching an accuracy of 72%. Number of mood episodes, age of onset/duration of illness, psychotic symptoms, and current treatment with lithium, antipsychotics, antidepressants, and antiepileptics were all significantly associated with microstructure abnormalities. Lithium treatment was associated with less microstructure abnormality.

Biologically oriented preparation technique for surgically extruded teeth: A clinical report.

Surgical extrusion allows a ferrule to be obtained without the use of orthodontic extrusion or the need to remove hard and soft tissues. However, after the healing period, the soft tissue of the extruded tooth might become thinner, creating an unesthetic gingival margin. Unlike other preparation techniques, the biologically oriented preparation technique provides increased long-term gingival thickness. This article describes the treatment of 3 patients with teeth with no ferrule that were surgically extruded and restored with the biologically oriented preparation technique .

Guided Endodontics for Managing Severely Calcified Canals.

Endodontic treatment of teeth with pulp canal obliteration presents a challenge given the high likelihood of procedural errors and complications during treatment. These drawbacks can be avoided by using a personalized 3-dimensional (3D) guide designed by overlaying a cone-beam computed tomographic scan with an intraoral scan of the patient. This 3D guide enables the clinician to obtain a straight access to the obliterated root canal.This article described guided endodontics in managing 7 severely obliterated teeth using both virtually designed 3D guides and a customized 1-mm-diameter cylindrical bur. This treatment approach was demonstrated to be safe and fast and can be considered as a predictable technique for the location of calcified canals, thus minimizing complications.

Extrusión quirúrgica para la restauración del diente altamente comprometido: seguimiento a 3 años / Surgical extrusion to restore highly compromised tooth: 3-year follow-up

INTRODUCCIÓN: Un ferrule de 2 mm a 3600 asegura la supervivencia a largo plazo del diente restaurado. Sin embargo, existen situaciones clínicas donde el ferrule es insuficiente. Existen básicamente 3 opciones de tratamiento para la obtención de ferrule sin invadir el espacio biológico: el alargamiento de corona quirúrgico, la extrusión ortodóntica rápida y la extrusión quirúrgica. CASO CLÍNICO: EL presente caso clínico describe la restauración de un premolar inferior sin ferrule por medio de la extrusión quirúrgica, el retratamiento de conductos, y la colocación de poste y corona. CONCLUSIÓN: La extrusión quirúrgica permite, de manera altamente predecible restaurar dientes sin ferrule con raíces largas y periodontalmente sanos, sin comprometer los tejidos periodontales ni necesidad de aparatología ortodóntica

INTRODUCTION: A 2-mm ferrule over 3600 ensures a long-term survival of the restored tooth. However, there are clinical situations in which ferrule is insufficient. Thus, there are 3 treatment options to obtain ferrule without invading the biological width: surgical crown lengthening, rapid orthodontic extrusion and surgical extrusion. CLINICAL CASE: The present clinical case describes the restoration of a lower premolar without ferrule by means of surgical extrusion, root canal re-treatment, and post and crown. CONCLUSION: Surgical extrusion allows predictably the restoration of long, periodontally healthy teeth with no ferrule, without compromising the periodontal tissues or the need for orthodontic appliances

Defining patient communication needs during hospitalization to improve patient experience and health literacy.

BACKGROUND: In order to play an active role in their health care, patients need information and motivation. Current delivery systems limit patients' involvement because they do not routinely provide them with enough details of their own clinical results, conditions and other important clinical data. The purpose of this study was to identify, from the perspective of patients, which topics matter the most, who should be communicating them, and when and how should they be provided. METHODS: We conducted a qualitative, phenomenological study analysing the content of subjective experiences, feelings and behaviours. We organized two focus groups with 13 participants and 15 in-depth interviews. Transcripts of the focus groups and interviews were checked for accuracy and then entered into Atlas ti™ v7.5.13 qualitative software. Two independent researchers performed a qualitative inductive content analysis to classify the data in two levels: themes and categories. RESULTS: The qualitative analysis provided 377 units of meaning synthesized into 22 categories and six themes: hospitalization procedure, Health Literacy relating to the patient's condition, information content, satisfaction, professional-patient relationship, and patient proactivity. Patients described which information they wished for, when they needed it, and who would provide it, usually related to actions such as admission, discharge or diagnostic tests. Oral information was more difficult to comprehend than the written kind, as patients can check written information several times if needed. Nurses were the most available professionals, and patients found easier to relate to them and ask them questions. Moreover, patients identified physicians as those professionals responsible for providing clinical information. CONCLUSIONS: Our results showed that patients suffered from poor Health Literacy regarding their personal condition, as they were unable to describe the symptoms, the type of tests being performed or their results, and some of them also had difficulties in naming the specific disease or comorbidities they had. During the hospitalization process, patients were in good shape to come with doubts and actively asked for more information. Healthcare organizations and professionals were offered the chance to ensure the correct communication and comprehension to their patients.

Lesión endo-periodontal: curación a tres años / Endo-periodontal lesion: a 3-year healing process

Las lesiones endo-periodontales pueden suponer un reto en el diagnóstico. Las imágenes radiolúcidas de furca acompañadas de sondajes profundos y aislados son compatibles con fracturas verticales, perforaciones o causas puramente endodónticas, es decir, abscesos periapicales crónicos con exacerbación por el surco gingival. Las perforaciones son complicaciones que afectan al pronóstico de la endodoncia y que desencadenan defectos periodontales. En el presente caso clínico se describe el retratamiento ortógrado con el sellado de una perforación en el tercio coronal de un primer molar inferior. Después de tres años de control, se observa curación radiográfica de ambas lesiones y una reducción de 6 mm en el sondaje periodontal

Diagnosis of endo-periodontal lesion can be challenging. Furcal radiolucencies accompanied with deep and isolated probings are compatible with vertical root fractures, perforations or with endodontic causes, that is to say, chronic periapical abscess exacerbated through the gingival sulcus.Perforations are complications that affect the prognosis of the root canal treatment and induce periodontal defects. The present case describes an orthograde root canal retreatment with a perforation sealing in the coronal third of a first lower molar. Three years after, a radiographic healing of both lesions and a reduction of 6mm periodontal probing is observed

Developmental competence of heifer oocytes selected using the brilliant cresyl blue (BCB) test.

The aim of this study was to evaluate the usefulness of the brilliant cresyl blue (BCB) test in the selection of more competent heifer oocytes for in vitro embryo production (IVEP). IVEP from selected BCB heifer oocytes was compared to IVEP from morphologically selected heifer (control group) and cow oocytes. BCB staining determines the activity of glucose-6-phosphate dehydrogenase (G6PD), an enzyme synthesized in growing oocytes but with less activity in grown oocytes. Six hundred and fifty seven heifer cumulus-oocyte complexes (COC) were classified morphologically as Grade 1-3 and exposed to 26 microM of BCB and classified as: blue (or grown) oocytes (BCB+) or unstained oocytes or growing oocytes (BCB-). Grade 1-3 heifer oocytes showed significantly different percentages of BCB+ oocytes (78.6, 66.2, and 51.1%, respectively; P<0.05). The diameter of BCB+ oocytes was significantly higher than BCB- oocytes (152.6+/-5.8 microm and 147+/-5.9 microm, respectively; P<0.001). The percentage of BCB+ oocytes reaching the blastocyst stage was significantly higher than those of BCB- and control heifer oocytes (12.3, 1.6, and 5.2%, respectively; P<0.05), but lower than those of cow oocytes (30.0%; P<0.05). In conclusion, heifer oocytes selected by the BCB test (BCB+) are larger and more competent for IVEP than control heifer oocytes. However, fewer heifer oocytes selected using the BCB test develop to blastocyst stage compared to cow oocytes.

Susceptibility patterns of enteroaggregative Escherichia coli associated with traveller's diarrhoea: emergence of quinolone resistance.

Enteroaggregative Escherichia coli (EAggEC) isolates were identified as a cause of traveller's diarrhoea in 50 (9%) of 517 patients and their antimicrobial susceptibility was determined. Molecular epidemiological characterisation and investigation of the mechanisms of acquisition of quinolone resistance among nalidixic acid-resistant EAggEC strains was performed. Seventeen (34%) of 50 patients needed antimicrobial therapy, because of persistence of symptoms in nine cases and the severity of symptoms in eight cases. Ampicillin and tetracycline resistance was high, whereas chloramphenicol and co-trimoxazole showed moderate activity and amoxicillin plus clavulanic acid, nalidixic acid and ciprofloxacin showed very good activity. Resistance to nalidixic acid was demonstrated in three isolates, two from patients who had travelled to India. In all three strains the resistance was linked to mutations in the gyrA gene alone or in both gyrA and parC genes. Although ciprofloxacin shows excellent in-vitro activity and could be useful in the treatment of traveller's diarrhoea in patients travelling abroad, it may not be useful in patients who have journeyed to India or to Mexico.