Two-tailed Significance Level Research Articles

Effect of the treatment of periodontal disease on the outcome of pregnancy

Correlations between periodontitis and its effects on the outcome of pregnancies are actually more focused topics. Maternal motivation for a good oral hygiene and preventive dental treatment must be highlighted tasks during pregnancy care. The authors analysed the effect of the preventive dental treatment during pregnancy and its obstetrical effects. In a prospective randomised study, including pregnant women observed for threatening preterm deliveries, patients with dental examination (n = 71) were compared with patients undergoing dental treatment at the same time (n = 79). Univariate comparisons for categorical variables were assessed by χ2 tests and independent Student's t-tests for continuous variables. ORs were compared with Mantel-Haenszel tests. Multivariable logistic regression was performed to evaluate the factors determining the poor periodontal parameters and gingivitis separately. The two-tailed statistical significance level was set at 5%. In the dental treatment group, the neonatal birth weight was significantly higher than in the non-treated group, in case of patients with periodontitis (2990 ± 582.3 g vs 2568.1 ± 699.1 g, p = 0.005). Also the average age at delivery was significantly higher in the treated vs non-treated groups (37.3 ± 1.9 vs 36.0 ± 2.9 weeks, p = 0.027), and the treatment had a beneficial effect on the prolongation of pregnancy, with a higher level of significance in the gingivitis group vs patients with periodontitis groups (p = 0.02 vs p = 0.043). Dental treatment of expecting women has a beneficial effect on the prolongation of pregnancy by decreasing the rate of prematurity and perinatal complications. Orv Hetil. 2018; 159(24): 978-984.

Effectiveness of monotherapy and combined therapy with calcitonin and minodronic acid hydrate, a bisphosphonate, for early treatment in patients with new vertebral fractures: An open-label, randomized, parallel-group study.

Evidence related to the effectiveness of combination drug therapy for the treatment of osteoporosis is currently considered insufficient. Therefore, this study was performed to clarify the effects of monotherapy, and combination therapy, with a bisphosphonate (minodronic acid hydrate), a bone resorption inhibitor, and calcitonin (elcatonin), which is effective for the alleviation of pain due to vertebral fractures in osteoporotic patients. Study participants comprised of 51 female subjects with post-menopausal osteoporosis, whose main complaint was acute lower back pain caused by vertebral fractures. Subjects were randomly allocated into three groups and then administered with either intramuscular injections of elcatonin at a dose of 20 units weekly, minodronic acid hydrate at a dose of 1mg daily, or a combination of these two drugs. As primary endpoints, time-dependent changes in levels of pain were assessed using a visual analog scale from baseline to 6 months of duration. In addition, we examined the effects of monotherapies, and a combination therapy on bone resorption, with changes in bone mineral density at 4 sites and advanced hip assessment parameters from baseline to 6 months. A two-tailed significance level of 5% was used for hypothesis testing. Elcatonin monotherapy showed some alleviation of pain immediately after any vertebral fractures, which was more than in the minodronic acid hydrate monotherapy group. In addition, the minodronic acid hydrate monotherapy group experienced more effective inhibited bone resorption than the elcatonin monotherapy group. In the combination therapy, the efficacy for alleviating pain and inhibiting bone resorption was equivalent to the effect observed in the elcatonin and minodronic acid hydrate monotherapy groups respectively, with further improved values of bone mineral density observed in the femoral neck and lumbar vertebrae, and in parameters of advanced hip assessment compared with both monotherapy groups. Combination therapy with elcatonin and minodronic acid hydrate appears to be an effective treatment for osteoporosis patients with lower back pain, caused by fresh vertebral fractures.

Inflammation-Related Gene Polymorphisms Associated with Susceptibility to Primary Immune Thrombocytopenia

INTRODUCTIONPrimary immune thrombocytopenia (ITP) is an acquired autoimmune disease characterized by a reduced platelet count and an increased risk of bleeding. Although immense research has improved our understanding of ITP and led to impressive therapeutics, the pathogenesis is still not completely clear and a large subset of patients are refractory to first- and second-line therapies.In this study, we investigated the involvement of a cluster of inflammation-related genes, including CD24, FCRL3, CD226, IL2, IRF5, ITGAM, NLRP3, CARD8, PTPN22, SH2B3, STAT4, TNFAIP3, and TRAF1 genes.METHODSIn this case-control study, 261 ITP inpatients (92 males and 169 females) with a mean age of 39.59 ± 17.52 years were recruited from Qilu Hospital, Shandong University between January 2007 to April 2016. In addition, 154 healthy participants (60 males and 94 females) with a mean age of 44.82 ± 13.63 years were enrolled as a control group. Inflammation-related single nucleotide polymorphism (SNP) genotyping was performed on the Sequenom MassARRAY iPLEX platform. SNPs included CD24 rs8734/rs52812045, FCRL3 rs11264799, rs7528684, rs945635, rs3761959, CD226 rs763361, IL2 rs6822844, IRF5 rs2004640, rs2280714, rs10954213, ITGAM rs1143679, NLRP3 rs35829419, rs4353135, rs10754558, CARD8 rs2043211, PTPN22 rs33996649, rs1310182, SH2B3 rs3184504, STAT4 rs7574865, rs10181656, TNFAIP3 rs6920220, rs10499194, rs2230926, rs5029939, TRAF1 rs10818488. SPSS (Ver 22.0, Chicago, IL) was used to perform statistical analysis. The results of genotyping were analyzed with t or ¦Ö2 tests. A Fisher’s exact test was performed when expected frequencies were less than 5. Univariate and multivariate analyses were then performed by non-conditional logistic regression adjusting for age and gender. P values < 0.05 were considered significant. The two-tailed significance level was set at 0.05.RESULTSGenotype frequencies of these inflammation-related SNPs in healthy controls were consistent with the Hardy-Weinberg equilibrium (p > 0.05). Genotype distributions in ITP patients and controls are detailed in Table 1. Statistical analysis revealed a significant difference in TNFAIP3 rs10499194 and CD24 rs52812045 between patients and controls (Table 1). Genotype frequencies of other SNPs were not significantly different (p > 0.05). However, when allelic frequencies were compared, significant differences were not found in any genotyped SNPs (p > 0.05).ITP is classified by duration into newly diagnosed (less than 3-month duration), persistent (3- to 12-month duration) and chronic (1-year duration). According to ordinal logistic regression, the genotype frequency of IRF5 rs2004640 was significantly different between the 3 ITP phases. Compared with heterozygous carriers, homozygous carriers of major allele were found in higher frequency in newly diagnosed patients. The OR for GG vs. GT was 0.472 (95%CI = 0.289-0.770, p = 0.003).Patients with clinically relevant bleeding who require mandated treatment or additional therapeutic intervention are defined as having severe ITP. The inflammation-related SNPs were not significantly different between severe and non-severe patients (p > 0.05).Interestingly, genotype frequency distribution of CARD8 rs2043211 was significantly higher in refractory patients than in non-refractory patients (OR = 4.191, 95%CI = 1.026-14.567, p = 0.040), while allelic frequencies were not significantly different. We also compared corticosteroid-sensitive and corticosteroid-resistant ITP patients. We found that the genotype frequency of NLRP3 rs4353135 was significantly different between the two groups, and heterozygous genotype was more frequent in corticosteroid-sensitive patients (OR = 0.413, 95%CI = 0.203-0.841, p = 0.015). No significant difference was observed in other polymorphisms.CONCLUSIONSOur study identifies SNPs that differ based on the presence of ITP (TNFAIP3 rs10499194 and CD24 rs52812045), the phase of ITP (IRF5 rs2004640), refractoriness (CARD8 rs2043211), and corticosteroid sensitivity (NLRP3 rs4353135) in Chinese Han population. These important findings may lead to more tailored treatment strategies for ITP patients. Further study will dissect how these SNPs exert their roles to affect the pathogenesis of ITP. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Effectiveness of elcatonin for alleviating pain and inhibiting bone resorption in patients with osteoporotic vertebral fractures.

Elderly patients with osteoporotic vertebral fractures often experience severe pain that reduces their quality of life (QOL). Calcitonin, a bone resorption inhibitor, has been reported to alleviate pain in such patients; however, few clinical studies have demonstrated this effect. The objective of this study was to compare changes in pain scores, activities of daily living (ADL), QOL, bone resorption, bone mineral density (BMD), and fracture healing among patients with new vertebral fractures who received different treatment modalities. We conducted an open-label, multicenter, randomized, parallel control group study comprising 107 female patients ≥55years old with acute back pain from vertebral fracture. All subjects received either intramuscular injections of elcatonin, a derivative of calcitonin, or an oral nonsteroidal antiinflammatory drug (NSAID) combined with an active vitamin D3 (VD3) analogue for 6months. The pain was assessed using a visual analogue scale, and ADL and QOL were assessed using questionnaires. BMD was measured using dual-energy X-ray absorptiometry. A two-tailed significance level of 5% was used. The elcatonin IM group had significantly higher QOL score at 2weeks and later, and significantly lower VAS and ADL scores than those in the NSAID+VD3 group at 1month and later. The elcatonin IM group had significantly reduced TRACP-5b levels compared with those in the NSAID+VD3 group at 3months and later and significantly higher percent changes in BMD than the NSAID+VD3 group. These results suggest that elcatonin significantly alleviated pain, inhibited bone resorption, and improved ADL, QOL, and BMD compared with NSAID+VD3.

OC-036 International Assessment of Outcome of Upper GI Haemorrhage at Weekends: Abstract OC-036 Table 1

Introduction Weekend admissions have been associated with higher mortality. For upper gastrointestinal haemorrhage (UGIH) some studies show significantly increased mortality and less early endoscopy while the UK UGIH audit reported no difference. We studied whether out of hours (OOH) admissions were sicker and/or had higher mortality. Methods Prospective study over 12 months (from March 2014) from 2 UK and 2 international centres. Admission time, demographics, pulse, BP, lab results, endoscopy findings, further procedures and 30 d mortality were recorded. 3 pre-endoscopy scores (Glasgow Blatchford (GBS), AIMS65 and admission Rockall scores) and 2 post-endoscopy scores (PNED and full Rockall scores) were determined. Chi-squared, Fisher’s exact and Kruskal-Wallis tests were used as appropriate. A two-tailed significance level of 5% was used. Results 2118 pconsecutive atients, 60% male, median age 66 years were seen. There were no significant differences in mortality, need for endoscopic therapy, surgery/embolisation or rebleeding in both UK and non-UK centres. There were no differences in comorbidity, mean ASA 2.3, pulse or BP although weekday admissions had a lower Hb (110 g/l vs 118 g/l (weeknight) vs 117 g/l (weekend) p 2118 consecutive patients admitted March 2014-March 2015 from Glasgow (600), Truro (544), Odense (541) and Singapore (433). Data shown are mean [95% CI] or number (%). Conclusion There is no difference in mortality in patients admitted with UGIH OOH compared to weekday admissions. The severity of UGIH was not related to time of admission. Similar findings were noted in the 2 UK centres and internationally. Disclosure of Interest None Declared

A randomized clinical trial to determine the effectiveness of CO-oximetry and anti-smoking brief advice in a cohort of kidney transplant patients who smoke: study protocol for a randomized controlled trial.

BackgroundThe cardiovascular risk in renal transplant patients is increased in patients who continue to smoke after transplantation.The aim of the study is to measure the effectiveness of exhaled carbon monoxide (CO) measurement plus brief advisory sessions, in comparison to brief advice, to reduce smoking exposure and smoking behavior in kidney transplant recipients who smoke. The effectiveness will be measured by: (1) abandonment of smoking, (2) increase in motivation to stop smoking, and (3) reduction in the number of cigarettes smoked per day.Methods/designDesign: a randomized, controlled, open clinical trial with blinded evaluation.Scope: A Coruña Hospital (Spain), reference to renal transplantation in the period 2012–2015.Inclusion criteria: renal transplant patients who smoke in the precontemplation, contemplation or preparation stages according to the Prochaska and DiClemente’s Stages of Change model, and who give their consent to participate.Exclusion criteria: smokers attempting to stop smoking, patients with terminal illness or mental disability that prevents them from participating.Randomization: patients will be randomized to the control group (brief advisory session) or the intervention group (brief advisory session plus measuring exhaled CO). The sample target size is n = 112, with 56 patients in each group. Allowing for up to 10 % loss to follow-up, this would provide 80 % power to detect a 13 % difference in attempting to give up smoking outcomes at a two-tailed significance level of 5 %. Measurements: sociodemographic characteristics, cardiovascular risk factors, treatment, rejection episodes, infections, self-reported smoking habit, drug use, level of dependence (the Fagerström test), stage of change (Prochaska and DiClemente’s Stages of Change model), and motivation to giving up smoking (the Richmond test).Response: the effectiveness will be evaluated every 3, 6, 9 and 12 months as: pattern of tobacco use (self-reported tobacco use), smoking cessation rates, carbon monoxide (CO) levels in exhaled air measured by CO-oximetry, urinary cotinine tests, nicotine dependence (Fagerström test), motivational stages of change (Prochaska and DiClemente’s stages) and motivation to stop smoking (the Richmond test).Analysis: descriptive statistics and linear/logistic multiple regression models will be performed. Clinical relevance will be measured as relative risk reduction, absolute risk reduction and the number needed to treat.Ethics: informed consent of the patients and Ethical Review Board was obtained (code 2011/061).DiscussionTobacco is a modifiable risk factor that increase the risk of morbidity and mortality in kidney transplant recipients. If effectiveness of CO-oximetry is confirmed to reduce tobacco exposure, we would have an intervention that is easy to use, low cost and with great implications about cardiovascular risk prevention in these patients.Trial registrationCurrent Controlled Trials ISRCTN16615772.EudraCT number: 2015-002009-12.

Clinical presentation and blood gas analysis of multiple trauma patients for prediction of standard coagulation parameters at emergency department arrival.

Trauma-induced coagulopathy (TIC) in multiple trauma patients is a potentially lethal complication. Whether quickly available laboratory parameters using point-of-care (POC) blood gas analysis (BGA) may serve as surrogate parameters for standard coagulation parameters is unknown. The present study evaluated TraumaRegister DGU® of the German Trauma Society for correlations between POC BGA parameters and standard coagulation parameters. In the setting of 197 trauma centres (172 in Germany), 86,442 patients were analysed between 2005 and 2012. Of these, 40,129 (72% men) with a mean age 46 ± 21 years underwent further analysis presenting with direct admission from the scene of the accident to a trauma centre, injury severity score (ISS) ≥ 9, complete data available for the calculation of revised injury severity classification prognosis, and blood samples with valid haemoglobin (Hb) measurements taken immediately after emergency department (ED) admission. Correlations between standard coagulation parameters and POC BGA parameters (Hb, base excess [BE], lactate) were tested using Pearson's test with a two-tailed significance level of p < 0.05. A subgroup analysis including patients with ISS > 16, ISS > 25, ISS > 16 and shock at ED admission, and patients with massive transfusion was likewise carried out. Correlations were found between Hb and prothrombin time (r = 0.497; p < 0.01), Hb and activated partial thromboplastin time (aPTT; r = -0.414; p < 0.01), and Hb and platelet count (PLT; r = 0.301; p < 0.01). Patients presenting with ISS ≥ 16 and shock (systolic blood pressure < 90 mmHg) at ED admission (n = 4,329) revealed the strongest correlations between Hb and prothrombin time (r = 0.570; p < 0.01), Hb and aPTT (r = -0.457; p < 0.01), and Hb and PLT (r = 0.412; p < 0.01). Significant correlations were also found between BE and prothrombin time (r = -0.365; p < 0.01), and BE and aPTT (r = 0.327, p < 0.01). No correlations were found between Hb, BE and lactate lactate. POC BGA parameters Hb and BE of multiple trauma patients correlated with standard coagulation parameters in a large database analysis. These correlations were particularly strong in multiple trauma patients presenting with ISS > 16 and shock at ED admission. This may be relevant for hospitals with delayed availability of coagulation studies and those without viscoelastic POC devices. Future studies may determine whether clinical presentation/BGA-oriented coagulation therapy is an appropriate tool for improving outcomes after major trauma.

Workplace bullying and general health status among the nursing staff of Greek public hospitals.

BackgroundThe arduous emotional and physical nurses’ work, the gradual nursing staff cutbacks and the lack of recognition that nurses feel regarding their skills and overall capabilities are some of the factors that act of bullying between nursing staff and management, between nurses and patients/families or even among nurses themselves. Workplace bullying has physical and psychological effects on worker-victims and, by extension, patients themselves. The purpose of this study was to investigate the relationship between the phenomenon of workplace bullying and general health status among the nursing staff of Greek public hospitals.MethodsA cross-sectional study was conducted on a convenience sample of 841 members of the nursing staff working in five major hospitals of the 1st Regional Health Authority of Attica, located in Athens. The response rate was 84.1 %. The respondents completed the Negative Acts Questionnaire (NAQ) and the General Health Questionnaire (GHQ-12) and also their demographic characteristics. The appropriate permissions were obtained by the Hospitals’ Ethics Committees and the questionnaire’s authors. Data were collected from March to July 2013. Data analysis was performed with IBM SPSS 21.0 and included t test, χ2 test and regression analysis. The two-tailed significance level was set ≤0.05.Results30.2 % of the respondents reported that they had been psychologically harassed in their workplaces during the preceding 6 months. Statistical analysis revealed that relative to other respondents, respondents who had received support from their families and friends enjoyed better health but respondents who perceived their work environments more negatively because of work-related bullying suffered from worse general health.ConclusionsWorkplace bullying among nursing staff is a major concern in Greece. Support systems play a crucial role in addressing the negative effects of bullying and they should be taken into account when designing prevention and troubleshooting policies about bullying.

Delay in Normalization of Disrupted Sleep-Wake Cycle in Mice as a Bipolar Disorder-Prone Animal Model (Bipolar Disorder-Prone Animal Model)

MethodsZZTwenty-two male mice (age of five weeks, weight 28–30 gm) underwent three days of light-dark cycle disruption and 10 days of recovery phase. Sleep and wake state were checked every five minutes during the entire experimental period. After recovery phase, quinpirole (0.5 mg/kg, s.c.) was injected into the mice and open field locomotor activities were checked. Five days after the open field test, immobility time during the last 4 min in 6 min of forced swimming test was measured. Animals which recovered sleep-wake cycle within six days after light-dark cycle disruption were assigned to the early recovery group (n=14), and those that failed to recover in six days were assigned to the delayed recovery group (n=8). The locomotor activities and the immobility times of the two groups were compared by Mann-Whiney U test at two-tailed significance level of 0.05.

Surveying the Relationship between Teacher's Emotional Intelligence and Self - Efficacy in First Region of Tabriz Education Department

The nature of this study is correlation. We determined the amount of the sample size with the used of Cochran sampling method which the statistical sample is 254 of these small trading company employees which have been selected through the simple random sampling method. To gathering of data, we used questionnaire. In order to analyze the data resulted from collected questionnaires deductive and descriptive statistical methods are used, and to display some statistical data we used column diagram and in deductive level to test the hypothesis of the research we used Pearson correlation coefficients. Findings show that in two-tailed significance level, the significance level of test (0.000) is small than 0.05. In other words, there is a positive relationship between teacher’s emotional intelligence their dimensions (self-awareness, self-regulation, motivation, empathy and social skills) and self-efficacy at in first region of Tabriz education department.

Shock State

Some patients with drug reaction with eosinophilia and systemic symptoms (DRESS) are probably admitted in intensive care unit (ICU), but data concerning their clinical features at admission are scarce. Therefore, in the present study, we used a clinical network of French intensivists to study the clinical features and evolution of DRESS patients hospitalized in ICU. A national, retrospective, multicenter study collected DRESS cases hospitalized in ICU for DRESS from 2000 to end of 2011. All files were analyzed through the RegiSCAR scoring system as "no," "possible," "probable," or "definite" DRESS. Patients were included only if they had a probable or definite DRESS. Demographic, hemodynamic, biological, and infectious data were recorded. Twenty-one patients were included. Hospital mortality was 10 (47%) of 21, and 16 of 21 patients had on admission a shock state necessitating vasopressor agents. Echocardiographic ejection fraction in shock patients was depressed (47% ± 13%). Mechanical ventilation was required in 13 of 21 cases. Hepatic failure was observed in 11 of 21 cases, acute renal failure in 18 of 20 cases, and lactic acidosis in 12 of 20 patients. Initial bacteriology was negative in all patients. Human herpesvirus reactivations were found in five of 15 cases. In conclusion, shock without bacteriological documentation associated with multiple organ failure is the most common presentation of DRESS at admission in ICU and is associated with a higher mortality than previously described.

Sensitivity and Responsiveness of Health Utility Indices (HUI2 and HUI3) Among Type 2 Diabetes Patients

Purpose: To assess the sensitivity and responsiveness of HUI2 and HUI3 among Type 2 diabetes patients. Methods: This cross-sectional study was conducted in two purposively selected Nigerian tertiary hospitals. Six hundred and thirty-eight (638) adult patients were surveyed following their consent using the HUI2 and HUI3 (HUI23S4En.40Q) questionnaire. Patients’ clinical characteristics such as age, comorbidity, severity of disease, and utilization of hospital resources were postulated a priori to be associated significantly with utility scores of HUI2 and HUI3. Student’s t-test and bivariate analyses were conducted to determine the diabetes-severity discriminatory ability of HUI2 and HUI3. The analyses were conducted with SPSS 14.0. A two-tailed significance level of 0.05 was used. Results: Older patients had lower quality of life than younger patients. The overall health deficit of increasing age for HU13 was -0.2950 and that of overall HUI2 was -0.1553. The respondents without eye problem had higher quality of life than those with eye problem, in both HUI3 and HUI2 utility scores. Stroke was the most important patients’ characteristic that negatively affected HRQOL. Patients with duration of diabetes > 4 years had lower quality of life scores than their counterparts (≤ 4years). Conclusion: Health Utility Index Mark 2 and Mark 3 were sufficiently sensitive and responsive to diabetes severity among Type 2 diabetes patients.

Setting Properties and Cytotoxicity Evaluation of a Premixed Bioceramic Root Canal Sealer

Introduction This study investigated the setting time and micohardness of a premixed calcium phosphate silicate–based sealer (EndoSequence BC Sealer; Brasseler USA, Savannah, GA) in the presence of different moisture contents (0–9 wt%). The moisture content that produced the most optimal setting properties was used to prepare set EndoSequence BC Sealer for cytotoxicity comparison with an epoxy resin–based sealer (AH Plus; Dentsply Caulk, Milford, DE). Methods Standardized disks were created with BC Sealer, AH Plus, Pulp Canal Sealer EWT (positive control) (SybronEndo, Orange CA), and Teflon (Small Parts Inc., Miami Lakes, FL; negative control). Disks were placed in Transwell Inserts, providing indirect contact with MC3T3-E1 cells. Succinate dehydrogenase activity of the cells was evaluated over a 6-week period using MTT ((3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay. Cytotoxicity profiles of BC Sealer and AH Plus were fitted with polynomial regression models. The time for 50% of the cells to survive ( T 0.5 ) was analyzed using the Wald statistic with a two-tailed significance level of 0.05. Results BC Sealer required at least 168 hours to reach the final setting using the Gilmore needle method, and its microhardeness significantly declined when water was included in the sealer ( P = .004). All set sealers exhibited severe cytotoxicity at 24 hours. The cytotoxicity of AH Plus gradually decreased and became noncytotoxic, whereas BC Sealer remained moderately cytotoxic over the 6-week period. A significant difference ( P < .001) was detected between T 0.5 of BC Sealer (5.10 weeks; 95% confidence interval [CI], 4.69–5.42, standard error [SE] = 0.09) and T 0.5 of AH Plus (0.86 weeks; 95% CI, 0.68–1.05; SE = 0.18). Conclusions Further studies are required to evaluate the correlation between the length of setting time of BC Sealer and its degree of cytotoxicity.

Are atypical depression, borderline personality disorder and bipolar II disorder overlapping manifestations of a common cyclothymic diathesis?

The constructs of atypical depression, bipolar II disorder and borderline personality disorder (BPD) overlap. We explored the relationships between these constructs and their temperamental underpinnings. We examined 107 consecutive patients who met DSM-IV criteria for major depressive episode with atypical features. Those who also met the DSM-IV criteria for BPD (BPD+), compared with those who did not (BPD-), had a significantly higher lifetime comorbidity for body dysmorphic disorder, bulimia nervosa, narcissistic, dependent and avoidant personality disorders, and cyclothymia. BPD+ also scored higher on the Atypical Depression Diagnostic Scale items of mood reactivity, interpersonal sensitivity, functional impairment, avoidance of relationships, other rejection avoidance, and on the Hopkins Symptoms Check List obsessive-compulsive, interpersonal sensitivity, anxiety, anger-hostility, paranoid ideation and psychoticism factors. Logistic regression revealed that cyclothymic temperament accounted for much of the relationship between atypical depression and BPD, predicting 6 of 9 of the defining DSM-IV attributes of the latter. Trait mood lability (among BPD patients) and interpersonal sensitivity (among atypical depressive patients) appear to be related as part of an underlying cyclothymic temperamental matrix.

A Randomized Controlled Trial of a Supported Employment Program for Persons With Long-Term Mental Illness in Hong Kong

A Randomized Controlled Trial of a Supported Employment Program for Persons With Long-Term Mental Illness in Hong Kong

Diffusionsgewichtete MRT zur Funktionsdiagnostik der Glandula submandibularis

To investigate the feasibility of diffusion-weighted (DWI) echo-planar imaging (EPI) to depict the submandibular glands and to measure different functional conditions. Twenty-seven healthy volunteers were examined. Diffusion weighted sequence was performed prior to stimulation. Exactly 30 seconds after a commercially available lemon juice was given orally, the diffusion weighted sequence was repeated. All examinations were performed by using a 1.5-T superconducting system with a 30 mT/m maximum gradient capability and maximum slew rate of 125 mT/m/sec (Magnetom Symphony, Siemens, Erlangen, Germany). The lower part of the circularly polarized (CP) head coil and a standard two-element CP neck array coil were used. The flexibility of the neck array coil allowed positioning the N1 element (upper part of the coil) right next to the submandibular gland. The axial diffusion-weighted EPI (echo planar imaging) sequence was performed using a matrix of 119 x 128, a field of view of 250 x 250 mm (pixel size 2.1 x 1.95 mm), a section thickness of 5 mm with an interslice gap of 1 mm. The b factors used were 0 sec/mm(2), 500 sec/ mm(2) and 1000 sec/mm(2). Apparent diffusion coefficiant (ADC) maps were digitally transferred to MRIcro (Chris Rorden, Universitiy of Nottingham, Great Britain). After detecting the submandibular glands a region of interest (ROI) was placed manually exactly within the boarder of both submandibular glands, excluding the external carotid artery on ADC maps. These procedures were performed on all ADC slices the submandibular glands could be differentiated in before and after oral stimulation. For statistical comparison of results, a student's t-test was performed with an overall two-tailed significance level of p = 0.05. The visualization of the submandibular glands using the diffusion-weighted EPI sequence was possible in all of the 27 volunteers. Prior to oral stimulation an ADC of 1.31 x 10(-3) mm(2)/sec (95 % CI, 1.39 x 10(-3) mm(2)/sec, 1.44 x 10(-3) mm(2)/sec) was calculated which increased to 1.41 x 10(-3) mm(2)/sec (95 % KI, 1.39 x 10(- 3) mm(2)/sec, 1.44 x 10(-3) mm(2)/sec) 30 seconds after stimulation. This increase proved to be significant (p < 0.001). Diffusion-weighted echo-planar MR imaging allows non-invasive quantification of functional changes in the submandibular gland.

The sample size required for intervention studies on fracture prevention can be decreased by using a bone resorption marker in the inclusion criteria: prospective study of a subset of the Nagano Cohort, on behalf of the Adequate Treatment of Osteoporosis (A-TOP) Research Group

In drug developments for osteoporosis, large-scale and longterm fracture prevention studies have been required. We investigated whether or not it was possible to reduce the sample size and observation period under new selection criteria for an osteoporotic fracture-prevention study. A Poisson regression model was used to identify independent risks for incident vertebral fracture in 515 postmenopausal women who had had no intervention for osteoporosis; this group was a subset of Nagano Cohort participants. The total observation period for this group was 2,577 person-years, and a total of 146 new vertebral fractures were observed. Risk assessment for incident vertebral fracture among numerical covariates revealed that the following items showed significant independent risks for incident fractures; namely, baseline age (hazard ratio [HR]; 1.84; 95% confidence interval (CI), 1.44-2.35; P < 0.001), number of preexisting vertebral fractures (HR, 1.28; 95% CI, 1.17-1.40; P < 0.001), baseline lumbar bone mineral density (LBMD) (HR, 0.79; 95% CI, 0.71-0.88; P < 0.001), and urinary excretion of deoxypyridinoline (DPD) (HR, 1.18; 95% CI, 1.03-1.35; P = 0.016). Because the initial urinary excretion of DPD was found to be a risk for incident vertebral fracture, in addition to the conventional risks, we assessed whether or not the sample size or observation period could be reduced by the incorporation of the urinary excretion of DPD into the selection criteria of a fracture-prevention study. The assessment of sample size was calculated, using the log rank test, at a two-tailed significance level of 5% and with a power of 80%. When osteoporotic patients with preexisting fracture were selected (conventional criteria), the 3-year probability of vertebral fracture was estimated as 14.3% in the present population. On the other hand, the new vertebral fracture rate during 3 years in the osteoporotic patients with preexisting fracture plus high urinary DPD (HR, above 1.0); (new selection criteria) was estimated as 23.2%. When the HR between test drug and placebo was changed from 0.4 to 0.8, the required sample size for any level of HR showed a 40% reduction for the new selection criteria compared to the conventional criteria. Therefore, the addition of urinary DPD level to the selection criteria is useful to reduce sample size in an osteoporosis fracture-prevention study.

MR-Sialographie: Optimierung und Bewertung ultraschneller Sequenzen mit paralleler Bildgebung und oraler Stimulation

Purpose: To optimise a fast sequence for MR-sialography and to compare a parallel and non-parallel acquisition technique. Additionally, the effect of oral stimulation regarding the image quality was evaluated. Material and Methods: All examinations were performed by using a 1.5-T superconducting system. After developing a sufficient sequence for MR-sialography, a single-shot turbo-spin-echo sequence (ss-TSE) with an acquisition time of 2.8 sec was used in transverse and oblique sagittal orientation in 27 healthy volunteers. All images were performed with and without parallel imaging technique. The assessment of the ductal system of the submandibular and parotid gland was performed using a 1 to 5 visual scale for each side separately. Images were evaluated by four independent experienced radiologists. For statistical evaluation, an ANOVA with post-hoc comparisons was used with an overall two-tailed significance level of P=.05. For evaluation of interobserver variability, an intraclass correlation was computed and correlation >.08 was determined to indicate a high correlation. Results: All parts of salivary excretal ducts could be visualised in all volunteers, with an overall rating for all ducts of 2.26 (SD ′ 1.09). Between the four observers a high correlation could be obtained with an intraclass correlation of 0.9475. A significant influence regarding the slice angulations could not be obtained (p = 0.74). In all healthy volunteers the visibility of excretory ducts improved significantly after oral application of a Sialogogum (p < 0.001; η 2 = 0.049). The use of parallel imaging technique did not lead to an improvement of visualisation, showing a significant loss of image quality compared to an acquisition technique without parallel imaging (p<0.001; η 2 =0.013), Conclusion: The optimised ss-TSE MR-sialography seems to be a fast and sufficient technique for visualisation of excretory ducts of the main salivary glands, with no elaborate post-processing needed. To improve results of MR-sialography, it is reasonable to use an oral Sialogogum.

MR-Sialographie: Optimierung und Bewertung ultraschneller Sequenzen mit paralleler Bildgebung und oraler Stimulation

To optimise a fast sequence for MR-sialography and to compare a parallel and non-parallel acquisition technique. Additionally, the effect of oral stimulation regarding the image quality was evaluated. All examinations were performed by using a 1.5-T superconducting system. After developing a sufficient sequence for MR-sialography, a single-shot turbo-spin-echo sequence (ss-TSE) with an acquisition time of 2.8 sec was used in transverse and oblique sagittal orientation in 27 healthy volunteers. All images were performed with and without parallel imaging technique. The assessment of the ductal system of the submandibular and parotid gland was performed using a 1 to 5 visual scale for each side separately. Images were evaluated by four independent experienced radiologists. For statistical evaluation, an ANOVA with post-hoc comparisons was used with an overall two-tailed significance level of P =.05. For evaluation of interobserver variability, an intraclass correlation was computed and correlation >.08 was determined to indicate a high correlation. All parts of salivary excretal ducts could be visualised in all volunteers, with an overall rating for all ducts of 2.26 (SD +/- 1.09). Between the four observers a high correlation could be obtained with an intraclass correlation of 0.9475. A significant influence regarding the slice angulations could not be obtained (p = 0.74). In all healthy volunteers the visibility of excretory ducts improved significantly after oral application of a Sialogogum (p < 0.001; eta (2) = 0.049). The use of a parallel imaging technique did not lead to an improvement of visualisation, showing a significant loss of image quality compared to an acquisition technique without parallel imaging (p < 0.001; eta (2) = 0.013). The optimised ss-TSE MR-sialography seems to be a fast and sufficient technique for visualisation of excretory ducts of the main salivary glands, with no elaborate post-processing needed. To improve results of MR-sialography, it is reasonable to use an oral Sialogogum.

Toxicity of chemical components of ambient fine particulate matter (PM 2.5) inhaled by aged rats.

The toxicity of two important chemical components of fine ambient particulate matter (PM 2.5)-ammonium bisulfate (ABS) and elemental carbon (C)-was studied using aged (senescent) rats. The study tested the hypotheses that fine particle exposure can damage lungs and impair host defenses in aged rats and that ozone would potentiate the toxicity of these particles. Ammonium bisulfate aerosols were generated by nebulization of dilute aqueous solutions. Elemental carbon was generated from an aqueous suspension of carbon black. Carbon and ABS mixtures were generated by nebulization of a suspension of carbon black in a dilute aqueous solution of ABS. Rats were exposed, nose-only, for 4 h a day, three consecutive days a week, for 4 weeks. The rats were exposed to one of six atmospheres: (1) purified air; (2) C, 50 microg m(-3), 0.3 microm mass median aerodynamic diameter (MMAD); (3) ABS, 70 microg m(-3), 0.3 microm MMAD; (4) O3, 0.2 ppm; (5) ABS + C, 0.46 microm MMAD; and (6) ABS + C + O3, 0.45 microm MMAD. Data were analyzed using ANOVA and Tukey multiple comparison tests; a two-tailed significance level of 0.05 was used. The nuclei of lung epithelial and interstitial cells were examined to determine the labeling of the DNA of dividing cells by 5-bromo-2-deoxyuridine and to identify the location of injury-repair-related cell replication. Increased labeling of both epithelial and interstitial lung cells occurred following all pollutant exposures. Although epithelial cells are most likely impacted by inhaled particles first, the adjacent interstitial cells were the cells that showed the greatest degree of response. Exposure to the ABS + C + O3 mixture resulted in losses of lung collagen and increases in macrophage respiratory burst and phagocytic activities that were statistically significant. Our results demonstrate that ozone can increase the toxicity of inhaled particles (or vice versa), and suggest that detailed study of mixtures could provide a more comprehensive understanding of the mechanisms by which inhaled pollutants adversely affect human health.