Feasibility, user experiences, and preliminary effect of Conversation Cards for Adolescents© on collaborative goal-setting and behavior change: protocol for a pilot randomized controlled trial.

BACKGROUND: Adolescents and providers can benefit from practical tools targeting lifestyle modification for obesity prevention and management. We created Conversation Cards for Adolescents© (CCAs), a patient-centered communication and behavior change tool for adolescents and providers to use in clinical practice. The purpose of our study is to (i) assess the feasibility of CCAs in a real-world, practice setting to inform full-scale trial procedures, (ii) assess user experiences of CCAs, and (iii) determine the preliminary effect of CCAs on changing behavioral and affective-cognitive outcomes among adolescents. METHODS: Starting in early 2019, this prospective study is a nested mixed-methods, theory-driven, and pragmatic pilot randomized controlled trial with a goal to enroll 50 adolescents (13-17 years old) and 9 physicians practicing at the Northeast Community Health Centre in Edmonton, Alberta, Canada. Adolescents will collaboratively set one S.M.A.R.T. (specific, measurable, attainable, realistic, timely) goal with their physician to implement over a 3-week period; however, only those randomized to the experimental group will use CCAs to inform their goal. Outcome assessments at baseline and follow-up (3 weeks post-baseline) will include behavioral, affective-cognitive, and process-related outcomes. DISCUSSION: In examining the feasibility, user experiences, and preliminary effect of CCAs, our study will add contributions to the obesity literature on lifestyle modifications among adolescents in a real-world, practice setting as well as inform the scalability of our approach for a full-scale effectiveness randomized controlled trial on behavior change. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03821896.

Cognitive and neural effects of semantic encoding strategy training in older adults.

Prior research suggests that older adults are less likely than young adults to use effective learning strategies during intentional encoding. This functional magnetic resonance imaging (fMRI) study investigated whether training older adults to use semantic encoding strategies can increase their self-initiated use of these strategies and improve their recognition memory. The effects of training on older adults' brain activity during intentional encoding were also examined. Training increased older adults' self-initiated semantic encoding strategy use and eliminated pretraining age differences in recognition memory following intentional encoding. Training also increased older adults' brain activity in the medial superior frontal gyrus, right precentral gyrus, and left caudate during intentional encoding. In addition, older adults' training-related changes in recognition memory were strongly correlated with training-related changes in brain activity in prefrontal and left lateral temporal regions associated with semantic processing and self-initiated verbal encoding strategy use in young adults. These neuroimaging results demonstrate that semantic encoding strategy training can alter older adults' brain activity patterns during intentional encoding and suggest that young and older adults may use the same network of brain regions to support self-initiated use of verbal encoding strategies.

Effect of age on gingival crevicular fluid concentrations of MIF and PGE2.

We used an experimental gingivitis study design to compare crevicular fluid concentrations of Migration Inhibitory Factor (MIF) and Prostaglandin E(2) (PGE(2)) in younger (18 to 30 yrs) and older (46 to 77 yrs) healthy adults. PGE(2) increased after 1 wk in younger participants, whereas it decreased in older individuals after 1 wk of plaque accumulation. A significant interaction between age and time was observed for PGE(2) (p = 0.04). High concentrations of MIF were identified in both age groups at baseline. MIF increased in the younger participants, whereas in the older individuals a decrease over time was observed. MIF concentration was positively correlated with plaque index and gingival index in the older age group. Total counts of bacteria, Parvimonas micra and Prevotella intermedia, were significantly correlated with MIF concentration in older participants. In conclusion, MIF and PGE(2) production in response to bacterial accumulation seems to be modified by age.

The effect of age on prostaglandin-synthesizing enzymes in the development of gingivitis.

BACKGROUND AND OBJECTIVE: The aim of this study was to identify the expression of cyclooxygenase-1, cyclooxygenase-2, cyclooxygenase-3, and microsomal prostaglandin E synthase-1 in young and elderly subjects. MATERIAL AND METHODS: Periodontally healthy subjects were divided into young (18-30 years, n = 7) and elderly (46-77 years, n = 7). A gingival biopsy was taken at baseline. After experimental gingivitis, clinical examination was repeated and a second biopsy was taken. The expression of cyclooxygenase-1, cyclooxygenase-2, cyclooxygenase-3, and microsomal prostaglandin E synthase-1 was analyzed by means of immunohistochemistry. RESULTS: In both healthy age groups, cyclooxygenase-1 and microsomal prostaglandin E synthase-1 were expressed in epithelial cells, endothelial cells and fibroblast-like connective tissue cells. Cyclooxygenase-1 was found in Langerhans' cells of the epithelium. Cyclooxygenase-2 expression was observed in cells exhibiting the morphology of epithelial mitosis cells, and the expression of cyclooxygenase-2 in periodontally healthy elderly subjects was significantly lower (p < or = 0.05). Following experimental gingivitis, cyclooxygenase-1 and microsomal prostaglandin E synthase-1 expression did not change. However, the expression of cyclooxygenase-2 was significantly increased in both age groups (p < or = 0.05). Cyclooxygenase-3 was not detected in any group investigated. CONCLUSION: Cyclooxygenase-1 and microsomal prostaglandin E synthase-1 were expressed constitutively in gingival tissue, and expression was unaffected by age or inflammation states. In contrast, the expression of cyclooxygenase-2 was weaker in elderly subjects. In the course of experimental gingivitis, cyclooxygenase-2 was induced in both age groups.

Familial schwannomatosis: exclusion of the NF2 locus as the germline event.

BACKGROUND: Schwannomatosis is a recently recognized disorder, defined as multiple pathologically proven schwannomas without vestibular tumors diagnostic of neurofibromatosis 2 (NF2). Some investigators have questioned whether schwannomatosis is merely an attenuated form of NF2. METHODS: The authors identified eight families in which a proband met their diagnostic criteria for schwannomatosis. Archived and prospectively acquired tumor specimens were studied by mutational analysis at the NF2 locus, loss of heterozygosity analysis along chromosome 22, and fluorescent in situ hybridization analysis of NF2 and the more centromeric probe BCR. Linkage analysis could be performed in six of eight families. RESULTS: Clinical characterization of these kindreds showed that no affected family member harbored a vestibular tumor. Molecular analysis of 28 tumor specimens from 17 affected individuals in these kindreds revealed a pattern of somatic NF2 inactivation incompatible with our current understanding of NF2 as an inherited tumor suppressor gene syndrome. Linkage analysis excluded the NF2 locus in two kindreds, and showed a maximum lod score of 6.60 near the more centromeric marker D22S1174. CONCLUSIONS: Schwannomatosis shows clinical and molecular differences from NF2 and should be considered a third major form of neurofibromatosis. Further work is needed to identify the inherited genetic element responsible for familial schwannomatosis.

Molecular study of frequency of mosaicism in neurofibromatosis 2 patients with bilateral vestibular schwannomas.

Neurofibromatosis 2 (NF2) is a severe autosomal dominant disorder that predisposes to multiple tumours of the nervous system. About half of all patients are founders with clinically unaffected parents. The purpose of the present study was to examine the extent to which mosaicism is present in NF2 founders. A total of 233 NF2 founders with bilateral vestibular schwannomas (BVS) were screened by exon scanning. NF2 mutations were detected in the blood samples of 122 patients (52%). In 10 of the 122 cases, the ratio of mutant to normal alleles was obviously less than 1, suggesting mosaicism. Tumour specimens were available from 35 of the 111 subjects in whom no mutation could be detected in blood specimens. Mutational analysis by exon scanning detected typical NF2 mutations in 21 of the 35 tumours. In nine subjects, the alterations found in tumours could be confirmed to be the constitutional mutation based on finding of identical mutations in pathologically and/or anatomically distinct second tumours. In six other subjects with only a single tumour available, allelic loss of the NF2 gene was found in addition to the mutation in each tumour, suggesting that either the mutation or the deletion of the NF2 gene is probably the constitutional genetic alteration. Our results suggest that failure to find constitutional mutations in blood specimen from these 15 patients was not because of the limitation of the applied screening technique, but the lack of the mutations in their leucocytes, best explained by mosaicism. Extrapolating the rate (15/35 = 43%) of mosaicism in these 35 cases to the 111 NF2 founders with no constitutional NF2 mutations found in their blood, we inferred 48 mosaic subjects (111 x 0.429). Adding the 10 mosaic cases detected directly in blood specimens, we estimate the rate of mosaicism to be 24.8% (58/233) in our cohort of 233 NF2 founders with bilateral vestibular schwannomas.

Osseointegrated implants in patients treated for generalized chronic periodontitis and generalized aggressive periodontitis: 3- and 5-year results of a prospective long-term study.

BACKGROUND: The successful use of osseointegrated implants in periodontally healthy patients has been documented in numerous longitudinal studies in recent years. However, the extent to which these positive results apply to periodontally diseased patients remains unclear. The aim of the present prospective longitudinal study of partially edentulous patients treated for generalized chronic periodontitis and generalized aggressive periodontitis was a clinical, microbiological, and radiographic comparison of teeth and implants and assessment of the implant success rate. METHODS: Five partially edentulous patients treated for generalized aggressive periodontitis (GAgP) and 5 treated for generalized chronic periodontitis (GCP) were enrolled in this study. The GAgP patients received 36 implants, and the GCP patients 12 implants. The teeth were examined 2 to 4 weeks before extraction of the non-retainable teeth (baseline), and 3 weeks after insertion of the final abutments (second examination). All further examinations were performed during a 3-month recall schedule over a 5-year period for the GAgP patients and over a 3-year period for the GCP patients. At each session clinical parameters were recorded at teeth and implants and the composition of the subgingival microflora was determined by dark-field microscopy and DNA analysis. Intraoral radiographs of the teeth and implants were taken for control purposes at baseline; after insertion of the superstructure; and 1, 3, and 5 years later. RESULTS: The clinical findings indicated healthy periodontal and peri-implant conditions in both patient groups throughout the study. However, an increased probing depth and an attachment loss were recorded in the GAgP patients after the third year (P<0.001). The distribution of the microorganisms revealed no significant differences between the patient groups or between implants and teeth. Moderate bone loss at teeth and implants was registered in both groups. The success rates recorded were 100% in the GCP patients and 88.8% (maxilla: 85.7%; mandible: 93.3%) in the GAgP patients. CONCLUSIONS: The 3-year and 5-year follow-ups show that osseointegrated implants may be successful in oral rehabilitation of partially edentulous patients treated for generalized aggressive periodontitis and generalized chronic periodontitis. However, as no significant differences were recorded between conditions at teeth and at implants, progression of the disease cannot be ruled out.

Microbiological characteristics of subgingival microbiota in adult periodontitis, localized juvenile periodontitis and rapidly progressive periodontitis subjects.

OBJECTIVE: To describe the prevalence of the cultivable subgingival microbiota in periodontal diseases and to draw attention to the polymicrobial nature of periodontic infections. METHODS: The study population consisted of 95 patients, 51 females and 44 males, aged 14-62 years. Twenty-nine patients exhibited adult periodontitis (AP), six localized juvenile periodontitis (LJP), and 60 rapidly progressive periodontitis (RPP). Two to four pooled bacterial samples were obtained from each patient. Samples were collected with sterile paper points from the deepest periodontal pockets. The samples were cultured under anaerobic and microaerophilic conditions using selective and non-selective media. Isolates were characterized to species level by conventional biochemical tests and by a commercial rapid test system. RESULTS: Prevotella intermedia and Capnocytophaga spp. were the most frequently detected microorganisms in all diagnostic groups. Porphyromonas gingivalis and Peptostreptococcus micros were found more frequently in AP and RPP patients, while Actinobacillus actinomycetemcomitans and Eikenella corrodens were associated with AP, LJP and RPP patients. The other bacterial species, including Actinomyces spp., Streptococcus spp. and Eubacterium spp., were detected at different levels in the three disease groups. CONCLUSIONS: The data show the complexity of the subgingival microbiota associated with different periodontal disease groups, indicating that the detection frequency and levels of recovery of some periodontal pathogens are different in teeth affected by different forms of periodontal disease.

Proactive interference, accessibility bias, and process dissociations: valid subjective reports of memory.

Proactive interference was assessed with a variant of the process-dissociation procedure, which separates effects of habit (accessibility bias) and recollection (discriminability). In three cued-recall experiments, proactive interference was shown to be an effect of bias rather than an effect on actual remembering. Divided attention, age, and study duration selectively influenced the recollection parameter, whereas training probability selectively influenced the habit parameter. Furthermore, in Experiments 2 and 3, subjective reports of remembering were highly correlated with, and nearly identical to, objective estimates of recollection gained from the process-dissociation procedure. The authors discuss the relevance of the results to theories of proactive interference and argue that older adults' greater susceptibility to interference effects is sometimes caused by an inability to recollect rather than by an inability to inhibit a preponderant response.

The parental origin of new mutations in neurofibromatosis 2.

Neurofibromatosis 2 (NF2) is an autosomal dominant disorder characterized by schwannomas and meningiomas that develop after inactivation of both copies of the NF2 gene. Approximately half of all patients with NF2 have unaffected parents and the disease results from new mutations at the NF2 locus. Loss of heterozygosity (LOH) in tumor specimens due to deletions covering the normal NF2 allele can be used to infer the haplotypes surrounding underlying mutations and determine the allelic origin of new mutations. We studied 71 sporadic NF2 patients using both LOH and pedigree analysis and compared the parental origin of the new mutation with the underlying molecular change. In the 45 informative individuals, 31 mutations (69%) were of paternal and 14 (31%) were of maternal origin (P=0.016). Comparison with corresponding constitutional mutations revealed no correlation between parental origin and the type or location of the mutations. However, in 4 of 6 patients with somatic mosaicism the NF2 mutation was of maternal origin. A slight parent of origin effect on severity of disease was found. Further clinical and molecular studies are needed to determine the basis of these unexpected observations.

Topical metronidazole application as an adjunct to scaling and root planing.

AIM: This study was carried out to investigate the effect of 2 applications of a metronidazole 25% dental gel as adjunctive therapy to subgingival scaling with root planing. METHOD: 59 of the original collective of 64 patients with adult periodontitis were observed for a 9-month period. This randomised single-blind study was carried out in split-mouth design. Each patient had to have at least 2 pockets with a probing depth of > or =5 mm in each quadrant. The clinical parameters, pocket probing depth (PPD), attachment level (AL) and bleeding on probing (BOP), were recorded at all teeth on days 0, 91, 175 and 259; in addition, subgingival plaque samples taken from 45 patients were analysed by means of dark-field microscopy. Therapy comprised subgingival scaling and root planing (SRP) of all quadrants and additional application of metronidazole 25%, dental gel in 2 randomly selected quadrants (SRP+Metro). Treatment was confined to teeth with a baseline PPD of > or =5 mm. Average PPD and AL and the incidence of BOP were computed for all pockets with a baseline PPD of > or =5 mm, and the 2 methods compared. The main efficacy variable for evaluation of the 2 treatments was the difference in PPD on day 259. RESULTS: Comparison of the 2 treatments revealed a statistically significant improvement in the clinical parameters for both treatment methods over the study period. Between baseline and day 259, significant differences in PPD (SRP+Metro: from 6.00 to 4.63 mm, SRP: from 6.02 to 4.83 mm) and BOP (SRP+Metro: from 67 to 31%, SRP: from 64 to 36%) were observed between the 2 treatment groups. Evaluation according to different patient groups demonstrated significant advantages of the combined therapy in previously-untreated patients, especially in female probands. Dark-field microscopy revealed a shift in the bacterial flora towards "healthy conditions". CONCLUSIONS: The results show that only minor advantages are to be gained from the application of a metronidazole 25% dental gel as adjunctive therapy to subgingival scaling. The distinctly better results of combined therapy in previously-untreated patients calls for more thorough investigation.

Schwann cell-onion bulb tumor of the trigeminal nerve: hyperplasia, dysplasia or neoplasia?

Onion bulbs are concentric lamellar structures formed by Schwann or perineurial cells, which may be seen in several generalized or localized diseases of the peripheral nerve. There is debate regarding the pathogenesis of localized tumefactions displaying these microscopic structures. We report the fifth case, to our knowledge, of a Schwann cell-onion bulb tumor, which arose in the trigeminal nerve of a child with an unclassifiable, probably distinct, neurocutaneous syndrome; we also provide evidence for a neoplastic or hamartomatous origin. Molecular studies failed to establish an abnormality in the NF1, NF2, PMP22, or Connexin 32 genes. Similar and previously reported cases are discussed, as well as other onion bulb-forming entities.

Clonal analysis of a case of multiple meningiomas using multiple molecular genetic approaches: pathology case report.

OBJECTIVE: Multiple meningiomas are uncommon brain tumors occurring concurrently in several intracranial locations in the same patient. In the present study, we determined the clonality, methylation status of deoxyribonucleic acid, and relationship of genetic alterations in eight meningiomas from one female patient. METHODS: Six molecular genetic techniques, including two methylation-based clonality assays and one transcription-based clonality assay, methylation analysis of CpG islands by methylation-specific polymerase chain reaction, loss of heterozygosity, microsatellite instability, and mutational analysis of the NF2 gene on chromosome 22, were used in comparative investigations on clonality and genetic alterations. RESULTS: The presence of clonal tumor cells was demonstrated by 1) loss of the same copy of chromosome 22 in all eight tumors; 2) transcription of the human AR gene from the same allele in six of eight tumors; 3) a common unmethylated allele at the AR locus in all eight tumors; and 4) the identical single-basepair insertion mutation in exon 9 of the NF2 gene in six of eight tumors. In addition, loss of a copy of the X chromosome in one tumor nodule and microsatellite instability in another nodule were observed. CONCLUSION: Taken together, this case of multiple meningiomas was most likely monoclonal in origin. Loss of chromosome 22 was an early event during the development of multiple meningiomas and was followed by mutations at the NF2 locus. Later events, including loss of the X chromosome, variation of AR gene expression, or microsatellite instability, may also have played a role in the development of multiple meningiomas in this patient.

Isolating the contributions of familiarity and source information to item recognition: a time course analysis.

Recognition memory may be mediated by the retrieval of distinct types of information, notably, a general assessment of familiarity and the recovery of specific source information. A response-signal speed-accuracy trade-off variant of an exclusion procedure was used to isolate the retrieval time course for familiarity and source information. In 2 experiments, participants studied spoken and read lists (with various numbers of presentations) and then performed an exclusion task, judging an item as old only if it was in the heard list. Dual-process fits of the time course data indicated that familiarity information typically is retrieved before source information. The implications that these data have for models of recognition, including dual-process and global memory models, are discussed.

Separating habit and recollection in young and older adults: effects of elaborative processing and distinctiveness.

An extension of L. L. Jacoby's (1991) process-dissociation procedure was used to examine the effects of aging on recollection and automatic influences of memory (habit). Experiment 1 showed that older adults were impaired in their ability to engage in recollection but did not differ from young adults in their reliance on habit. Elderly adults were also less able to exploit distinctive contextual information to enhance recollection. Experiments 2 and 3 showed that with more supportive conditions, older adults were able to benefit from distinctive contextual information. Quantitative and qualitative deficits in recollective abilities are interpreted within a dual-process model of memory. The problem of distinguishing between a deficit in recollection and a deficit in inhibitory processes in older adults (e.g., L. Hasher & R. T. Zacks, 1988) and the importance of this distinction for purposes of repairing memory performance are discussed.

Merlin: the neurofibromatosis 2 tumor suppressor.

In recent years, it has become clear that the ERMs occupy a crucial position as protein linkers that both respond to and participate in reorganization of membrane-cytoskeletal interactions. With the identification of new binding partners, the ERMs are also implicated in linked regulation of the activities of particular membrane proteins. Thus, they reside at a junction in a complex web of interactions that must respond to stimuli from both outside and inside the cell. As expected from its structural motifs, merlin behaves in a manner similar to the ERM proteins, but with some notable differences. Chief among these is the absence of intramolecular interaction to mask intermolecular interaction domains in isoform 2. The full range of merlin's intermolecular interactions remains to be delineated, but it can be expected from the comparison to ERMs that merlin also sits within a web of interactions that may involve multiple partners and signaling pathways, some of which it shares with the ERMs. Defining merlin's tumor suppressor function will likely require identifying those differences that are peculiarly important in the target cell types of NF2. However, the fact that inactivation of merlin in the mouse by targeted mutagenesis produces a variety of malignant tumors with a high rate of metastasis [33] suggests that merlin's suppression of tumor formation may involve different partners and pathways in different cell types and genetic backgrounds. Consequently, the disruptions due to merlin inactivation in the progression of malignant mesothelioma may represent a tumor suppressor role operating by a different pathway than that in schwannoma or meningioma.

The basis of informed consent for BMT patients.

During recent decades the doctrine of informed consent has become a standard part of medical care as an expression of patients' rights to self-determination. In situations when only one treatment alternative exists for a potential cure, the extent of a patient's self-determination is constrained. Our hypothesis is that for patients considering a life-saving procedure such as bone marrow transplant (BMT), informed consent has little meaning as a basis for their right to self-determination. A longitudinal study of BMT patients was undertaken with four self-administered questionnaires. Questions centered around expectations, knowledge, anxiety and factors contributing to their decision to undergo treatment. Although the informed consent process made patients more knowledgeable about the treatment, their decision to consent was largely based on positive outcome expectations and on trust in the physician. Informed consent relieved their anxieties and increased their hopes for survival. Our conclusion was that the greatest value of the informed consent process lay in meeting the patients' emotional rather than cognitive needs. When their survival is at stake and BMT represents their only option, the patient's vulnerability puts a moral responsibility on the physician to respect the principle of beneficence while not sacrificing the patient's right to self-determination.

Ironic effects of repetition: measuring age-related differences in memory.

Four experiments examined ironic effects of repetition, effects opposite to those desired (cf. D. M. Wegner, 1994). For an exclusion task, participants were to respond "yes" to words heard earlier but "no" to words that were read earlier. Results from young adults given adequate time to respond showed that false alarms to earlier-read words decreased with their repetition. An opposite, ironic effect of repetition was found for elderly adults--false alarms to earlier-read words increased with repetition. Younger adults forced to respond quickly or to perform a secondary task while reading words showed the same ironic effect of repetition as did elderly adults. The process-dissociation procedure (L. L. Jacoby, 1991, 1998) was used to show that factors that produce ironic effects do so by reducing recollection while leaving effects of repetition on familiarity unchanged.