Self-determined use of provided powered oral hygiene devices leads to improved gingival health after 1 year: a longitudinal clinical trial.

PURPOSE: Our study aimed to evaluate the long-term concordance and acceptance when using powered devices for everyday oral hygiene routine and gingival health in patients showing papillary bleeding. PATIENTS AND METHODS: Thirty-one participants were recruited at the dental clinic of the University Hospital of Cologne, Germany, over a 6-week duration. At baseline, a standard dental check-up was performed, including oral hygiene indices and documentation of oral hygiene devices used. The study consisted of two consecutive phases: the first (motivational trial) was designed to prove the effectiveness and safety of a microdroplet device and a powered toothbrush compared to dental floss and a manual toothbrush over a period of 4 weeks. The second (observational) phase began with all participants receiving the powered oral homecare devices. Participants were able to use their oral hygiene measures of choice over an unsupervised period of 1 year. All participants were then rescheduled for a routine dental check-up, where oral hygiene indices and oral hygiene devices used were reevaluated. RESULTS: After 1 year, 93.3% of participants stated they performed interdental cleaning on a regular basis (baseline 60.0%). The percentage using a powered toothbrush increased from 41.9% (baseline) to 90.0% after 1 year. Oral hygiene parameters had improved after both the motivational trial and observational phases compared to baseline (papillary bleeding index p = .000; Rustogi Modified Navy Plaque Index p < .05; Quigley-Hein Index p = .000). CONCLUSION: In the long term, participants preferred using powered oral hygiene devices over the gold standard dental floss and manual toothbrush. Improved oral hygiene parameters after 1 year may indicate implementation of newly acquired oral-hygiene skills during the 4-week instruction phase.

Synthesis, characterization and antibacterial activity of juglone encapsulated PLGA nanoparticles.

AIMS: The aim of the study was to examine the effect of different process parameters which including; initial juglone amount, initial poly(d,l-lactide co-glycolide) amount, polyvinyl alcohol volume and polyvinyl alcohol concentration on encapsulation of juglone to poly(d,l-lactide co-glycolide) nanoparticles. METHODS AND RESULTS: The synthesized nanoparticle formulations were analyzed for reaction yield, encapsulation efficiency, particle size, polydispersity, zeta potential and juglone release. In conjunction with the highest encapsulation rate, the highest amount of juglone release was obtained for F4 formulation, which has 281·8 nm particle size, 0·217 polydispersity index, and -19·55 mV zeta potential. After the detailed physicochemical characterization of this formulation, the four different kinetic models were used and it was found that juglone release mechanism controlled by Fickian diffusion method. According to antimicrobial activity results, minimal inhibitory concentration (MIC) values of both F4 and free juglone is higher for Gram negative bacteria than Gram positive bacteria. Inhibition zone diameters in the quantitative methods are found 15 and 16 mm for Staphylococcus aureus, 9 and 7 mm for Bacillus cereus, respectively, for F4 and free juglone. Moreover, the MIC values for qualitative methods were found 31·5 µg ml-1 for two bacteria strains. CONCLUSIONS: It was found that the antibacterial activity of the juglone nanoparticles was higher and longer than the free juglone. Additionally, a similar antimicrobial effect with a lower juglone amount (obtained from controlled release study) indicates that nanoparticle formulation is more effective. SIGNIFICANCE AND IMPACT OF THE STUDY: The use of nanoparticle formulations of juglone in biological systems and applications could be more beneficial than its free form due to its toxicity.

Pocket-depths-related effectiveness of an intrapocket anaesthesia gel in periodontal maintenance patients.

AIM: The aim of this study was to determine the impact of the pocket depth on the effectiveness of an intrapocket anaesthesia gel during SRP in periodontal maintenance patients. Effectiveness was measured by pain levels during SRP via visual analogue scale (VAS) and verbal rating scale (VRS). Secondary endpoint was the evaluation of patients' preferred choice of anaesthesia for SRP. METHODS: A total of 638 patients undergoing the periodontal maintenance programme and with the need for SRP participated in this observational study. After SRP, patients filled in questionnaires to record pain levels experienced and anaesthesia preference for future use. Mann-Whitney U-test was used to analyse intergroup difference in pain perception and anaesthesia choice. RESULTS: Overall, increasing pocket depths were accompanied by higher pain levels, irrespective of maximum or commonest pocket depths (P < 0.05). For SRP procedures, patients definitely prefer the anaesthesia gel (72.4%). CONCLUSIONS: In this study, an effectiveness of local anaesthesia gel (lidocaine/prilocaine) related to pocket depths was found in periodontal maintenance patients during SRP. Increasing pocket depths were accompanied by increasing procedural pain levels. Nevertheless, the anaesthesia gel is well accepted and in the majority of cases was found to be the preferred option for future SRP treatments.

Does the use of a visualised decision board by undergraduate students during shared decision-making enhance patients' knowledge and satisfaction? - A randomised controlled trial.

OBJECTIVES: Aim of this RCT was to evaluate whether the added use of a decision board (DB) during shared decision-making improves patients' knowledge as for different treatment options and overall satisfaction with the consultation. METHODS: Forty-nine undergraduate students were trained in shared decision-making (SDM) and evaluated by an Objective Structured Clinical Examination (OSCE). According to their test results, all participants were randomly allocated to either the test- (DB) or the control-group (Non-DB). Both groups performed SDM with patients showing a defect in a posterior tooth (Class-II defect). Prior to the interview, patients of the DB group were given the decision aid for review. In the Non-DB group, patients were consulted without additional aids. After treatment decision, a questionnaire was completed by all patients to measure knowledge (costs, survival rate, characteristics and treatment time) and overall satisfaction with the consultation. Fifty DB patients and 31 Non-DB patients completed the questionnaire. RESULTS: DB patients (n = 50) demonstrated a statistically significant increase in knowledge compared to the Non-DB group (n = 31) (Mann-Whitney U-test; DB group = 10.04; Non-DB group = 4.16; P = 0.004). There was no significant difference between groups regarding satisfaction with the consultation (t-test; P > 0.05). CONCLUSIONS: During the shared decision-making process, the use of a decision board yielding information about Class-II treatment options leads to a significantly higher patient knowledge compared to knowledge gained through consultation alone. It is therefore desirable to provide DBs for dental diagnoses with several treatment options to increase transparency for the patient.

Transforming growth factor-beta1 is a potent inhibitor of interleukin-1beta action in whole ovarian dispersates.

Transforming growth factor beta1 (TGFbeta1) acts as an inhibitor of the actions of interleukin-1beta (IL-1beta) in various organ systems. In order better to understand the inter|P-actions between these polypeptides in the ovary, we evaluated the effect of TGFbeta1 co-treatment on various IL-1beta-mediated actions in cultures of whole ovarian dispersates. Treatment with IL-1beta enhanced media accumulation of nitrites (4.8-fold), prostaglandin E2 (PGE2, 3. 9-fold) and lactate (2.0-fold), and enhanced glucose consumption (2. 1-fold). Treatment with TGFbeta1 alone did not significantly affect any of these parameters. However, the addition of TGFbeta1 inhibited IL-1beta-stimulated nitrite (100%), PGE2 (44%) and lactate (78%) accumulation and inhibited IL-1beta-stimulated glucose consumption (74%) in a dose-dependent manner. The addition of TGFbeta1 also suppressed the steady-state levels of IL-1beta-stimulated IL-1beta, type I IL-1 receptor and IL-1 receptor antagonist transcripts (98, 67 and 83% inhibition respectively). These data suggest that TGFbeta1 is capable of inhibiting several IL-1beta-stimulated endpoints. Since IL-1 has been identified as a possible proinflammatory mediator of ovulation and TGFbeta has been implicated as a promotor of fibrosis and healing, we speculate that IL-1 and TGFbeta might play antagonistic roles in the normal ovulatory sequence.

The effects of delta wave sleep interruption on pain thresholds and fibromyalgia-like symptoms in healthy subjects; correlations with insulin-like growth factor I.

OBJECTIVE: To assess the effects of delta wave sleep interruption (DWSI) on pain thresholds and fibromyalgia-like symptoms. To examine the potential correlations between DWSI and serum insulin-like growth factor 1 (IGF-1). METHODS: Thirteen healthy volunteers were subjected to 3 consecutive nights of DWSI (Group 1). Pain thresholds were measured by dolorimetry and symptoms by visual analog scale. Six subjects not undergoing DWSI served as dolorimetry and symptom controls (Group 2). Serum IGF-1 was measured by competitive binding radioimmunoassay before and after DWSI. RESULTS: No significant differences in pain thresholds as a function of condition (baseline, DWSI, recovery) or overnight change were detected between or within groups (p>0.05). Morning mean dolorimeter scores were lower than evening scores in both groups during all 3 conditions, and were lower in Group 1 than in Group 2 during DWSI. Group 1 subjects had higher composite symptom scores during DWSI (p< or =0.005), attributed largely to increases in fatigue. Serum levels of IGF-1 from Group 1 subjects showed no significant change after DWSI (p>0.05). CONCLUSION: In our study subjects, 3 nights of DWSI caused no significant lowering of pain thresholds compared with a control group. Subjects appeared to have lower pain thresholds in the mornings, and DWSI appeared to augment this effect. Symptoms were more apparent during DWSI, but were primarily related to fatigue. IGF-1 was not altered by 3 nights of DWSI. The low levels of IGF-1 seen in patients with fibromyalgia syndrome may result from chronic rather than acute DWSI, or may be dependent on factors other than disturbances of delta wave sleep.

Postcoital contraception: present and future options.

PURPOSE: This article reviews information on currently available postcoital contraceptives, and discusses recent advances in postcoital contraception, mostly notably RU 486. METHODS: Postcoital contraceptives, or "morning after pills," are currently available in the form of high dose estrogens, oral contraceptives, danazol and intrauterine devices. These methods are plagued by high incidences of side effects and less than optimal success rates. RESULTS: Currently, their primary use in the adolescent age group is for victims of sexual assault, but they may also be used as back-up for consensual unprotected intercourse. RU 486, best known as a first trimester abortifacient, has a number of potential uses, including that of a postcoital contraceptive. Two recently published studies from the UK showed RU 486 to have a very low pregnancy rate and fewer side effects when compared with current methods. RU 486 may someday replace high doses of oral contraceptives as the method of choice for postcoital contraception.

PIP: Postcoital contraceptives are available for adolescent use in the US. They include combination oral contraceptives (OCs), high dose estrogens, danazol, and IUDs. Mifepristone (RU-486) is currently not available in the US but is used in France, the UK, and Sweden. Postcoital contraception is especially important for adolescents who have a very high pregnancy rate due to poor contraceptive use. Administration of 2-5 mg ethinyl estradiol (EE) for 5 days beginning within 72 hours of unprotected intercourse yields pregnancy rates ranging from 0-0.92%. EE-related side effects include nausea, vomiting, sore breasts, and irregular menstrual bleeding. DES should not be used, since it is associated with reproductive tract anomalies and vaginal cancers in exposed offspring. Conjugated estrogens have not been used in adolescents for postcoital contraception. The Yuzpe regimen consists of 2 tablets of a combined OC with 200 mg EE and 2 mg dl-norgestrel administered within 72 hours of unprotected intercourse followed by the same dose 12 hours later. Common side effects are nausea and vomiting. Its pregnancy rate is 1.8%. Levonorgestrel-containing OCs can also be used. Administration of 800-1200 mg danazol up to 120 hours after unprotected intercourse protects against pregnancy in about 98% of cases. Copper IUDs have a high efficacy rate when used as postcoital contraception (99.9%), but public opinion, medicolegal considerations, financial costs, and potential for infection impede IUD as a postcoital contraceptive in the US. RU-486 is best known as an abortifacient. It is also a potential postcoital contraceptive. Two UK studies find that RU-486 used as a postcoital contraceptive has a very low pregnancy rate and fewer side effects than the Yuzpe regimen and danazol. It is much more costly than currently used postcoital contraceptives (600 mg of RU-486 cost US$ 68, while Ovral costs US$ 0.48-2.24). Nevertheless, RU-486 may replace the higher doses of OCs as a postcoital contraceptive method.

Adverse effects of fertility drugs.

Ovulation-induction agents are commonly used in the treatment of infertility in patients with or without ovulatory disturbances. These agents include clomifene, bromocriptine, gonadotrophin preparations and gonadotrophin-releasing hormone (GnRH) and its analogues. Each agent is associated with its own specific adverse effects. Although many of these adverse effects are benign and self-limited, some, in particular those effects associated with gonadotrophins, may be life-threatening. Commonly noted adverse effects encountered with the use of pharmacological agents to treat infertility include the following. Clomifene has been associated with hot flushes, multiple gestation, visual disturbances, cervical mucus abnormalities and luteal phase deficiency. Similarly, most of the adverse symptoms associated with bromocriptine are short-lived, such as nausea and postural hypotension. On the other hand, gonadotrophin therapy, even when used appropriately, may lead to the ovarian hyperstimulation syndrome (which is occasionally life-threatening) and a high incidence of multiple gestation. Pulsatile GnRH therapy maybe accompanied by similar adverse effects to those of gonadotrophins, but with a far lower incidence. With regards to the long term safety of these medications, the relationship between fertility drugs and epithelial ovarian cancer is controversial, and causality has yet to be proven. Indeed, a working knowledge of the many adverse effects associated with these medications is essential to any physician prescribing ovulation induction agents, in order to ensure maximum patient safety, compliance and understanding.

The long-term effectiveness of hysteroscopic treatment of menorrhagia and leiomyomas.

One hundred fifty-six of 177 patients admitted to the St. Luke's/Roosevelt Hospital Center between November 1973 and November 1988 for hysteroscopic treatment of menorrhagia and/or uterine leiomyomas were followed for long-term complications and necessity for repeat surgery. Ninety-four patients underwent submucous resection alone and 62 patients underwent endometrial ablation with or without submucous resection. Among the submucous-resection group, 24.5% reported late postoperative problems and 15.9% underwent further surgery. After 9 years of followup, 83.9% of the patients had not required further surgery. Among the ablation group, 22.5% experienced recurrence of increased bleeding and 8.1% had another surgical procedure. After 6 years of follow-up, 91.3% of the patients had not required further surgery. Twenty-one patients became pregnant after submucous resection, with 18 infants delivered. No patients who underwent endometrial ablation became pregnant. This modality of treatment appears to be effective over the long term, although effectiveness appears to diminish with time.

Mandibular osteotomy and hyoid bone advancement for obstructive sleep apnea: a case report.

A 24-year-old man with obstructive sleep apnea syndrome and secondary daytime somnolence and nocturnal arrhythmias underwent palatopharyngoplasty. When he did not improve significantly, he underwent a new surgical procedure combining hyoid bone and mandibular horizontal sliding osteotomy.

Mapping local blood flow of human brain by CT scanning during stable xenon inhalation.

Non-invasive methods are described for estimating local cerebral blood flows (LCBF) and partition coefficients (L lambda) during inhalation of 35% stable xenon gas (Xes) in oxygen during CT scanning. After denitrogenation by 100% oxygen breathing, 35% Xes is breathed for 7-8 minutes to minimize subanesthetic effects. Mean changes in brain Hounsfield units extrapolated to 15 minutes were 7.7 units for white matter and 5.3 units for gray matter. They were measured from volumes 80 cubic mm (10 mm2 area x 8 mm), or larger with an EMI 1010 scanner at 1 minute intervals. These data were used for computing LCBFs and L lambdas. Irradiation measured at the center of brain slices was 1 rad per minute. To calculate L lambdas about 6 exposures are necessary, thereafter, each 1 minute scan provides LCBF measurements for 2 adjacent 8 mm slices. Reproducibility for LCBF was r = 0.85 (P less 0.001). Mean L lambdas were 0.86 +/- 0.08 for gray and 1.34 +/- 0.10 for white matter. Normative mean flows (mls/100 g brain/min) were: basal ganglia = 79.6 +/- 9.3, cortex = 82.3 +/- 8.5, white matter = 29.2 +/- 5.9, midbrain tegmentum = 94.3 +/- 14.8, cerebellar cortex = 80.1 +/- 10.9, dorsal pons = 89.3 +/- 4.7, brachium pontis = 35.0 +/- 4.2. Subject finger exercises produced increases of LCBF in contralateral pre-central and post-central gyri. Eye closure decreased flow values limited to the visual system. Gray matter flow values diffusely decreased in non-REM sleep but increased above normal in REM sleep. Cerebral infarction and hemorrhage resulted in zones of zero flow with borders having reduced lambdas and low flows attributed to edema.

Normal human sleep: regional cerebral hemodynamics.

Measurements of regional cerebral blood flow (rCBF) by the xenon 133 inhalation method along with polygraph recordings were made serially during relaxed wakefulness and different stages of nocturnal sleep in 18 right-handed normal volunteers. During stage I-II sleep the fast flow (Fg) values declined significantly, more in the brainstem-cerebellar (BSC) regions than in hemispheric regions. During stage III-IV sleep, Fg further declined diffusely in both hemispheric (-28%) and BSC (-29%) regions. During awakening from stage IV sleep to alpha-frequency wakefulness, BSC flow values increased more than hemispheric flow values. During REM sleep, regional Fg values increased diffusely in both hemispheric (+41%) and BSC (+47%) regions compared with wakefulness. There was a significant inverse correlation between the increase in end-tidal partial pressure for carbon dioxide and the reduction in bihemispheric Fg during sleep. Cerebral vasomotor responsiveness to carbon dioxide is decreased during both REM and non-REM sleep.

Sleep apnea, narcolepsy, and dreaming: regional cerebral hemodynamics.

Regional cerebral flow after inhalation of xenon 133 as well as polysomnography were recorded during daytime sleep and the awake state in patients with narcolepsy and sleep apnea. Brainstem-cerebellar (BSC) gray matter blood flow (Fg) values in the awake state were reduced below normal (p less than 0.05) in both narcolepsy and sleep apnea; in sleep apnea, bihemispheric Fg values were also reduced in the awake state. After sleep onset, Fg paradoxically increased in narcolepsy but decreased further in sleep apnea. Maximal regional Fg changes occurred in BSC regions in both groups of patients. Oral administration of methylphenidate hydrochloride (Ritalin) increased resting Fg values in awake narcoleptics, particularly in BSC regions, but attentuated Fg increases during sleep onset. Regional Fg values during visual dreaming or hypnagogic hallucinations in narcoleptics were maximally increased in right parietooccipital regions. In narcoleptics, impaired control of sleep-wake and REM mechanisms is attentuated by methylphenidate. In patients with sleep apnea, brainstem functional activity is low in the awake state but becomes critically reduced during sleep, culminating in apnea-stimulated arousal followed by repetitive cycles as sleep recurs.

[Specific immune response and immunoglobulin production in intestinal infections. III. Intestinal antibodies and immunoglobulins in the dynamics of dysentery infection]. / Spetsificheskii immunnyi otvet i produktsiia immunoglobulinov pri kishechnykh infektsiiakh. Soobshchenie III. Antitela i immunoglobuliny kishechnika v dinamike dizenteriinoi infektsii

Coproimmunoglobulins and specific coproantibodies were studied in 98 adult patients and 32 children in the course of infection caused by Sh. sonnei, and in 102 healthy individuals of various age. The concentrations of IgA, and, to a lesser extent, of the IgG and IgM proved to be significantly higher in the patients than in the healthy persons. Locally synthesized secretory IgA made up the main part of the total amount of the IgA in feces. The titres of specific coproantibodies were significantly higher in patients than in healthy persons; these antibodies, as identified by Coombs test with monospecific antiglobulin sera, mainly belonged to the secretory IgA. The local immune response to Sh. sonnei was more intensive in adults than in children. In adults the increase in the secretory IgA was revealed at the earlier stages of the disease, and specific antibodies were found more frequently and in higher titres than in children. The lesser intensity of local immune response in children apparently depends on a lesser maturity of the IgA system providing the local defence.

[Study of human secretory immunoglobulin A. I. Obtaining monospecific antiserum to human secretory immunoglobulin A]. / Izuchenie sekretornogo immunoglobulina A cheloveka. Soobshchenie I. Poluchenie monospetsificheskoi antisyvorotki k sekretornomu immunoglobulinu A cheloveka

A method of obtaining monospecific antiserum to the human secretory IgA is described. Immunochemically pure secretory IgA (isolated from human colostrum by fractionation with ammonium sulfate and gel-filtration on Sephadex G-200) was used for immunization of rabbits or sheep. Heterologous antibodies were removed by adsorption with commercial gamma globulin, normal serum, the serum of a patient suffering from A-myeloma with the IgA polymere and purified lactoferrin. Monospecific antiserum to the secretory IgA gave a reaction of complete immunological identity with the secretory IgA and a free secretory component.

[Specific immune response and immunoglobulin production in intestinal infections. II. Methodological aspects of studying immunoglobulins in digestive tract secretions]. / Spetsificheskii immunnyi otvet i produktsiia immunoglobulinov pri kishechnykh infektsiiakh. Soobshchenie II. Metodicheskie osobennosti issledovaniia immunoglobulinov v sekretakh pishchevaritel'nogo trakta

Application of radial immunodiffusion for the study of immunoglobulins in the digestive tract secretion is described. Sensitivity of the method is increased by high dilution of antisera; precipitation rings should be recorded in the stained plates. To quantitate both serum and secretory IgA it is suggested that the secretions should be studied in parallel with two antisera--against the alpha-chain (to determine the total IgA) and against SC (to determine the secretory IgA). It is recommended to calculate the amount of immunoglobulins per 1 mg of high-molecular protein precipitable by trichloracetic acid.