Is Low-level laser therapy and gaseous ozone application effective on osseointegration of immediately loaded implants?

PURPOSE: The purpose of this study was to investigate the effects of biostimulation lasers and ozone therapy on osseointegration of immediately loaded implants. MATERIALS AND METHODS: A total number of 100 implants (DTI Implant Systems) were applied to 25 patients evenly. Temporary crowns were applied to each patient on the same session as the surgery. Implants were divided into four treatment groups (Group 1: low-level laser therapy (LLLT) group, Group 2: ozone therapy group, Group 3: different protocol of ozone therapy group, and Group 4: control group) each with 25 implants. The irradiations were performed with a gallium-aluminum-arsenide diode low-level laser (Laser BTL-4000) to Group 1. Ozone therapy was performed using an ozone generator (OzoneDTA) with an intraoral probe to Group 2 and Group 3. RESULTS: In this study, the overall implant survival rate was 92% after a 6-month observation period. The implant stability quotient values were found significantly higher in Group 1 (LLLT group) and Group 3 (different protocol of ozone therapy group) than the other groups (P < 0.05). There was no significant difference in Group 2 (ozone therapy group) and the control group (P > 0.05). CONCLUSIONS: Our results suggest that both LLLT and ozone therapy with prolonged application time are promising methods to enhance bone healing around immediately loaded implants and increase implant stability; however, there is a need for more studies on this subject for these methods to become routine applications.

The association between the lymphocyte-to-monocyte ratio and coronary artery disease severity in patients with stable coronary artery disease.

OBJECTIVE: Inflammation plays an important role in the pathogenesis of atherosclerosis. The lymphocyte-to-monocyte ratio (LMR) may reflect a systemic inflammatory status. We investigated the association between the LMR and coronary artery disease (CAD) in patients with stable angina pectoris. PATIENTS AND METHODS: A total of 221 consecutive patients who had been routinely referred for coronary angiography, for stable angina pectoris and 72 patients with normal coronary arteries were included in the present study. We analyzed the relation between the LMR and the angiographic severity of CAD. The SYNTAX score (SxS) was used for assessing the severity of coronary atherosclerosis. RESULTS: The neutrophil-to-lymphocyte ratio (N/L ratio), platelet size distribution width (PDW), neutrophil and uric acid levels were significantly higher in the stable angina pectoris group than in the control group. The LMR was significantly lower in the stable angina pectoris group than in the control group (4.5±3.2 vs. 6±2.9, p < 0.001). The MPV/L ratios were similar in both groups. Patients with elevated SYNTAX scores (>32) had lower LMR values (3.2±1.5 vs. 4.6±3, p = 0.002). The monocyte count/HDL-C ratio (MHR) was significantly higher in patients with stable CAD than in the control group (0.015±0.008 vs 0.009±0.004, p < 0.001); however, it was similar in the higher SYNTAX score (>32) and lower SYNTAX score groups (0.018±0.007 vs. 0.014±0.008, p = 0.056). Using multivariate logistic regression analysis, we found that only the LMR was an independent predictor of the high SYNTAX scores in patients with stable angina pectoris. CONCLUSIONS:  The LMR, an inexpensive and easily measurable laboratory variable, is significantly associated with the presence of CAD and high SYNTAX scores in patients with stable angina pectoris.

Stigmatization by nurses against schizophrenia in Turkey: a questionnaire survey.

Individuals who have been diagnosed with schizophrenia face discrimination, exclusion and stigmatization by society. Nurses who work on psychiatric wards frequently face individuals diagnosed with schizophrenia throughout their careers. This study was conducted for the purpose of evaluating nurses' opinions about individuals who had been diagnosed with schizophrenia. A total of 543 nurses working on the psychiatric wards of 27 university hospitals (164), six training and research hospitals (21) and six psychiatric hospitals (358) in Turkey completed the questionnaire. The majority of the nurses stated that schizophrenia is caused by social problems, that they would be able to work with someone who has schizophrenia, that they would not be able to marry someone with schizophrenia, that they would not be bothered by having a neighbour with schizophrenia, that schizophrenia cannot be completely cured, that it can be improved with psychotherapy, that schizophrenic patients are aggressive and that medications used to treat schizophrenia have serious side effects and are addictive. It is important for nurses to avoid stigmatizing patients in order to promote a therapeutic environment--particularly on the wards--and also to improve individual awareness and perceptions in society.

The influence of urine osmolality and other easily detected parameters on the response to desmopressin in the management of monosymptomatic nocturnal enuresis in children.

AIM: The aim of this paper was to examine the early morning spot urine osmolality and some other parameters easily detected from home chart recordings and history as predictive of the therapeutic response to desmopressin in children with monosymptomatic nocturnal enuresis. METHODS: Sixty seven monosymptomatic nocturnal enuretic children were included in the study. Age, sex, family history, the number of family members and siblings, existence of urgency symptoms, the history of urinary tract infection, sleep patterns, the number of wet nights per month and bedwetting in the same night were recorded. Additionally, spot morning urine osmolality was examined. All children were given desmopressin for at least 2 months. At the end of the treatment period, patients considered as responders and non-responders were compared in all these parameters. RESULTS: Although there was considerable overlap between groups, lower spot urine osmolality was the only data we found statistically significant as predictive of response to desmopressin. Moreover, male predominance, fewer wet nights per month and bedwetting per night were also associated with a better response. CONCLUSIONS: We believe that it is important to characterize such different subgroups that could be used as predictors of a good response to desmopressin.

Impact of QRS morphology on heart rate turbulence and heart rate variability after cardiac resynchronization therapy in patients with heart failure.

OBJECTIVE: Impairment of heart rate turbulence (HRT) and heart rate variability (HRV) are associated with poor prognosis in chronic heart failure (CHF). Although previous studies have demonstrated that patients with a left bundle branch block (LBBB) have a better outcome with cardiac resynchronization therapy (CRT), the effect of QRS morphology on HRV and HRT is not known. We aimed to evaluate the effect of QRS morphology on HRV and HRT after CRT implantation in patients with CHF. PATIENTS AND METHODS: Patients who had been implanted a CRT device with cardioversion-defibrillation feature were included to the study. Forty-three patients with LBBB (group 1) were compared with 21 patients without LBBB (group 2). HRV and HRT parameters were compared before and one month after CRT implantation. RESULTS: We compared the echocardiographic and electrocardiographic changes in both groups after CRT. Cardiac output (CO) was found to be significantly much more increased in group 1 (1.1 ± 0.4 vs. 0.6 ± 0.4, p = 0.001). Similarly, except SDNN and LF, all HRT and HRV parameters were significantly changed in the patients with LBBB (TO 1.4 ± 0.3 vs. 1.2 ± 0.2, p = 0.001; TS -1.8 ± 0.7 vs. -0.9 ± 0.7, p = 0.001; RMSSD -15.7 ± 9.9 vs. -6.3 ± 6.2, p = 0.001; PNN50 -7.0 ± 4.6 vs. -1.7 ± 1.1, p = 0.001; HF -13.3 ± 6.7 vs. -4.3 ± 3.5, p = 0.001; LF/HF 1.9 ± 0.4 vs. 1.5 ± 0.2, p = 0.001) compared to those without LBBB. Lineer regression analysis showed that the CO (ß = 0.2, t = 2.8, p = 0.007) and QRS configuration (ß = 0.6, t = 0.5, p = 0.001) were independent parameters affecting TO. CONCLUSIONS: HRV and HRT are improved after CRT but these improvements are more remarkable in patients with LBBB. CO, QRS configuration (but not duration) were two independent parameters affecting TO, LF and LF/HF ratio after CRT.

Gastrointestinal manifestations of epidermolysis bullosa. A study of 101 patients.

One hundred one patients with EB were evaluated by a combination of prospective and retrospective review, and analyzed regarding the nature, incidence, and prevalence of their gastrointestinal (GI) manifestations. Involvement of the GI tract is a well-known extracutaneous manifestation of dystrophic EB, but it also occurred in more than one-half and one-third, respectively, of those with junctional and simplex EB. Most of the serious consequences, such as esophageal strictures and microstomia, occurred in recessive dystrophic EB but were also seen, although infrequently, in the junctional and simplex forms. The majority of patients with dysphagia had an esophageal stricture, and the cervical esophagus was the most common location. The onset of dysphagia generally occurred in the first decade of life, in patients much younger than previously recognized. Diagnostic endoscopy did not reveal lesions which could not have been detected radiographically. Lower GI complaints were common, especially constipation and perianal blistering, and affected all types of EB. These complaints contributed substantially to management problems but they did not correlate with colonic pathology and appeared to reflect anal or perianal disease.

Detection of oxidative DNA damage in oesophageal biopsies of patients with reflux symptoms and normal pH monitoring.

BACKGROUND: Gastro-oesophageal reflux has been shown to induce oxidative DNA damage. AIM: To determine whether oxidative DNA damage, detected in oesophageal biopsies by simple immunohistochemical staining, correlates with gastro-oesophageal reflux disease as determined by pH monitoring. METHODS: The study included 47 patients with reflux symptoms who had oesophageal biopsy and 24-h pH monitoring studies performed within 3 months of each other with no variation in treatment in the time between the two procedures. Sections of formalin-fixed and paraffin-embedded oesophageal biopsies were stained for 8-hydroxy-2'-deoxyguanosine using the standard immunoperoxidase method. Positive nuclear immunoreactivity was considered to indicate oxidative DNA damage. RESULTS: Seven (33%) of the 21 cases with normal 24-h pH monitoring results were negative for oxidative DNA damage, compared with only two (8%) of the 26 cases with abnormal 24-h pH results (P=0.058, two-sided Fisher's exact test). Five of the patients with normal 24-h pH results had oesophageal biopsies performed within 24 h of the monitoring procedure and, of these, four (80%) were positive for oxidative DNA damage, including a case in which both biopsy and 24-h pH monitoring were performed on the same day whilst the patient was on proton pump inhibitor therapy. All cases with normal 24-h pH results and positive oxidative DNA damage showed features of reflux on routine morphological evaluation. CONCLUSIONS: Oxidative DNA damage can occur in the absence of acid reflux and despite adequate antisecretory therapy. This may indicate that other agents, such as bile, can induce oxidative DNA damage in an acid-suppressed environment. The significant discordance between oxidative DNA damage and 24-h pH results makes the determination of oxidative DNA damage a poor surrogate marker for 24-h pH monitoring.

The endoscopic management of esophageal strictures.

Endoscopic dilation for symptomatic esophageal strictures is an effective and easily performed procedure in the palliation of benign as well as malignant esophageal strictures. This article describes the advantages and disadvantages of the various types of esophageal dilators as well as the techniques used in dilation. Precautions, complications, long-term outcome, and the special circumstances related to difficult dilations also are discussed.

An automated intelligent diagnostic system for the interpretation of umbilical artery Doppler velocimetry.

The objective is to develop an automated intelligent diagnostic system for the interpretation of umbilical artery velocity waveforms. An ultrasound instrument with pulsed-wave Doppler is connected to a microcomputer by means of a frame grabber. After data acquisition, umbilical Doppler velocimetry is handled as a pattern recognition (feature extraction and classification) and decision-making problem. Automated image processing (enhancement, smoothing/ thresholding and edge detection) and analysis are used for feature extraction. Six waveform indices obtained by feature extraction are used as input layer to vector quantization which classifies waveforms into six groups. A clinical decision is assigned to each group by the medical expert. Our system is trained by 278 and 380 waveform images of 94 normal and 157 high risk pregnancies, respectively. The system was tested with 193 and 61 images of normal and risky pregnancies; it was demonstrated that sensitivity and specificity of the system are 54.1% and 80.3%, respectively.

Condition of vehicles in Saudi Arabia.

Saudi Arabia has experienced an enormous growth in its motorization rate since 1970, and there has been a resultant increase of nearly 600 percent in traffic fatalities. The fatality rate (per 100,000 vehicles) has been found to be at least three times higher than that of most developed countries. One of the factors which may be contributing to the serious accident problem in Saudi Arabia is the poor condition of some of the vehicles. The main goal of this study was to investigate the socioeconomic determinants of vehicle condition, using data gathered in Saudi Arabia. Detailed information on the condition of vehicles and the characteristics of drivers were collected by roadside surveys in the Eastern Province. The results from 508 surveys indicated that: 1. The condition of vehicles was three to four times as bad as in some other states. 2. There was a strong relationship between driver characteristics and vehicle condition. Drivers who were poor, uneducated, and drove without a license were more likely to have unsafe vehicles than their counterparts who were rich, educated and had driver's licences. 3. On the average trucks and vehicles used for public transportation and the movement of goods, and vehicles owned by companies and the government, were in worse condition than other vehicles. 4. There were significant differences among certain makes of vehicles.

Prophylactic antibiotic use in pediatric burn units.

Prophylactic antibiotic use in childhood burns is controversial. The efficiency of antibiotic prophylaxis in 77 pediatric burn patients was evaluated. Forty-seven patients received prophylactic antibiotics (Group AP), while 30 patients received no prophylaxis (Group NP). Age, wound depth, day of admission, mechanism of burn injury, type of dressings were similar for both groups (p > 0.05). Wound infection rates were 21.3 % in Group AP and 16.7 % in Group NP (p > 0.05). S. aureus, Enterobacter spp., P. aeruginosa, and E. coli were the most common microorganisms. Patients with wound colonization and infection had a larger burned total body surface area (BTBSA) in both groups (p < 0.01). Eight patients had clinical sepsis. All but one of the septic patients were from Group AP. Associated infections of the upper and lower respiratory tract (16), urinary tract (7), and otitis media (2) were more common in Group AP. One patient died from sepsis in Group AP. Hospital stays were longer in Group AP (21.7 +/- 16.4 vs. 13.5 +/- 10 days; p < 0.05). Antibiotic prophylaxis in childhood burns does not reduce the rate of wound infection. Age, wound depth and BTBSA are not critical variables for prophylaxis. Reinforcing the use of culture-specific antibiotics for more beneficial and cost-effective results in the treatment of childhood burns is recommended.

Color stability of different denture teeth materials: an in vitro study.

The aim of this in vitro study was to compare the color stability of commercially available porcelain, reinforced acrylic, and conventional acrylic denture teeth materials used in removable prostheses. Two brands of porcelain (Unilux-Enta Lactona-Holland and Vivoperl-Ivoclar-Liechtenstein), 2 brands of reinforced acrylic (Optodent-Bayer-Germany and Ivolek-Ivoclar-Liechtenstein), and 2 brands of conventional acrylic (Isodent-Güney Dis Deposu-Turkey and Samed-Turkey), were made, for a total of 6 different denture teeth groups. Denture teeth were subjected to 3 staining solutions (filtered coffee, tea, and cola) and distilled water. From each group of denture teeth, 4 sets of maxillary anterior denture teeth were immersed in each of the 4 solutions. The color values of denture teeth were measured colorimetrically with the Gardner XL 20 Tristimulus Colorimeter (Gardner Lab. Inc., Bethesda, Maryland, USA). Color changes were characterized in the CIEL*a*b* color space. Color change values were determined after 1 day, 1 week, 2 weeks, and 4 weeks. The color difference values were calculated and then evaluated by two-way ANOVA statistically. The filtered coffee solution was found to be more chromogenic than the other 2 staining solutions, while porcelain denture teeth materials were more color stable. Assuming the color change of deltaE* < 1.0 as a discernible limit and deltaE* = 3.3 as an acceptable value, the filtered coffee, tea, and cola had slight staining effects on all 6 groups of denture teeth.

Cytotoxicity of provisional crown and bridge restoration materials: an in vitro study.

There are numerous materials used to provide temporary coverage for teeth while permanent restorations are being fabricated. The biocompatibility of these materials is important for the protection of teeth and gingiva, but there is little information on this subject. This study aimed to examine possible time-dependent toxic effects of provisional crown and bridge restoration materials, manipulated intraorally or extraorally, on epithelia cells. A total of 20 discs, 4 sample discs from each product having dimensions of 4 mm diameter and 2 mm thickness, were prepared. After sterilization, toxicity of these discs was evaluated in the Madin Darby Bovine Kidney (MDBK) cell line. Morphological cell changes were observed microscopically at the 3rd, 6th, 12th, and 24th hours by the filter diffusion test method. After the 3rd hour, Artglass and Structur produced cytotoxic symptoms. Temdent had the least toxic effects at the end of the 12th hour. However, after the 24th hour, the toxic values were similar for all materials. The results of this study show that although the toxicity response of chemically and light curing materials had changed in different time periods, all of them had the same toxic effects at the end of the 24th hour.

Viral hepatitis. The new ABC's.

Hepatitis may be caused by hepatitis A virus, hepatitis B virus, hepatitis C virus (classic non-A non-B viral hepatitis), hepatitis D virus (delta agent), and hepatitis E virus (epidemic non-A non-B viral hepatitis). Cytomegalovirus, Epstein-Barr virus, and herpes simplex virus may also occasionally cause hepatitis. Some forms of hepatitis carry the risks of chronic infection, cirrhosis, or hepatocellular carcinoma. Treatment options for viral hepatitis are limited and, in many cases, still under investigation. Prophylaxis is available for many forms of hepatitis and should be offered to those at risk.

Osseointegration of fiber-reinforced composite implants: histological and ultrastructural observations.

OBJECTIVES: The aim of this study was to evaluate the bone tissue response to fiber-reinforced composite (FRC) in comparison with titanium (Ti) implants after 12 weeks of implantation in cancellous bone using histomorphometric and ultrastructural analysis. MATERIALS AND METHODS: Thirty grit-blasted cylindrical FRC implants with BisGMA-TEGDMA polymer matrix were fabricated and divided into three groups: (1) 60s light-cured FRC (FRC-L group), (2) 24h polymerized FRC (FRC group), and (3) bioactive glass FRC (FRC-BAG group). Titanium implants were used as a control group. The surface analyses were performed with scanning electron microscopy and 3D SEM. The bone-implant contact (BIC) and bone area (BA) were determined using histomorphometry and SEM. Transmission electron microscopy (TEM) was performed on Focused Ion Beam prepared samples of the intact bone-implant interface. RESULTS: The FRC, FRC-BAG and Ti implants were integrated into host bone. In contrast, FRC-L implants had a consistent fibrous capsule around the circumference of the entire implant separating the implant from direct bone contact. The highest values of BIC were obtained with FRC-BAG (58±11%) and Ti implants (54±13%), followed by FRC implants (48±10%), but no significant differences in BIC or BA were observed (p=0.07, p=0.06, respectively). TEM images showed a direct contact between nanocrystalline hydroxyapatite of bone and both FRC and FRC-BAG surfaces. CONCLUSION: Fiber-reinforced composite implants are capable of establishing a close bone contact comparable with the osseointegration of titanium implants having similar surface roughness.

Effect of light curing type on cytotoxicity of dentine-bonding agents.

AIM: To compare the cytotoxic effects of dentine-bonding agents (DBAs) polymerized with two different curing units at 24 h and 72 h on L-929 cells. METHODOLOGY: Disc-shaped test samples of light-activated DBAs were prepared according to manufacturers' instructions and cured with either conventional quartz tungsten halogen or light-emitting diode light curing units (LCUs). After curing, the samples were transferred into a culture medium for 24 h. Eluates were obtained and pipetted onto L-929 mouse fibroblast cultures (3 x 10(4) cells per well), incubated for evaluation after 24 and 72 h. After both incubation periods, measurements were performed by an dimethylthiazol diphenyltetrazolium assay. The degree of cytotoxicity for each sample was determined according to the reference value represented by the cells with a control (culture without sample). Statistical significance was determined by a three-way analysis of variance followed by the Mann-Whitney U-test. RESULTS: No significant three-factor interaction occurred amongst LCUs, DBAs and time factors (P = 0.955). LCUs and DBAs had a significant two-factor interaction (P < 0.001). In general, the test materials cured with the light-emitting diode LCU demonstrated higher cell survival rates when compared with the those cured with the quartz tungsten halogen. CONCLUSIONS: Differential toxic effects of the DBAs cured with the quartz tungsten halogen or the light-emitting diode on the fibroblast cells may prove to be very important when suitable DBAs or LCUs are used for operative restorations.

Esophageal dysphagia.

This paper is a review of esophageal anatomy, physiology and pathophysiology. The diagnosis and therapy of benign and malignant esophageal strictures are discussed including the specifics of esophageal dilation and tumor ablation procedures. The diagnosis and therapy of esophagitis in the immunocompromised (HIV, chemotherapy, transplant recipient) host is discussed. The pathophysiology and treatment of achalasia and esophageal spasm are reviewed. Finally, current concepts of the pathophysiology and therapy of gastroesophageal reflux disease. Emphasis is placed on the dual sphincter theory of gastroesophageal junction competence and the need for maintenance anti-secretory therapy.

Clinical applications of esophageal manometry and pH monitoring.

In summary, GERD patients are usually well managed using a careful medical history, endoscopy, and empirical trials of antireflux medications. Extended esophageal pH monitoring is unnecessary in most patients but can be of considerable value in managing patients with typical or atypical symptoms who are refractory to standard therapy for GERD. Furthermore, the test can be useful in documenting abnormal reflux in an individual without esophagitis being evaluated for antireflux surgery. The test is done with compact, portable data loggers, miniature pH electrodes, and computerized data analysis. The pH electrode should be positioned 5 cm above the manometrically defined upper limit of the LES, and patients should undergo the test on an unrestricted diet. In terms of data analysis, the total percentage time of pH < 4 provides as much information as any other scheme of quantifying esophageal acid exposure, but symptom association is essential when evaluating atypical or sporadic symptoms. Enthusiasm for 24-h pH monitoring must, however, be tempered with an analysis of its proven clinical utility in patient management with its utility rightfully compared with that of an empirical trial of anti-reflux therapy. Ambulatory pH monitoring is probably most useful in examining patients without typical reflux symptoms or patients who have either partially or completely failed a trial of anti-reflux therapy. To date, there have not been any prospective, controlled clinical trials evaluating these uses. Suggested clinical indications for ambulatory pH monitoring are listed in Table 5 (53).

Circadian periodicity of the time of onset of acute lower gastrointestinal bleeding.

We investigated the chronobiological parameters of acute gastrointestinal (GI) bleeding in 51 patients able to time-specify the onset of bleeding within 30 min of occurrence. Bleeding was determined to be either from the upper or lower GI tract. The upper GI bleeding group consisted of 32 patients (22 male, 10 female) who bled from peptic ulcer disease (16), Mallory-Weiss tear (4), gastritis (3), esophageal varices (3), gastric neoplasm (2), Dieulafoy's lesion (1), and unknown (3). The lower GI bleeding group consisted of 19 patients (9 male, 10 female) who bled from diverticulosis coli (5), hemorrhoids (2), arteriovenous malformations (2), colonic polyps (2), cecal ulcer (1), antibiotic-associated colitis (1), and unknown (6). Rhythmicity was evaluated by inferential statistics. The time of onset of lower GI bleeding (34 episodes) displayed significant circadian periodicity (p = 0.014) with its peak at 1100 h. Single cosinor analysis revealed: MESOR-1.42 (95% CI = 0.86- 1.97); amplitude = 1.22 (0.44-1.99); phase angle = -165.12 (-201.66 -128.58). Upper GI bleeding (42 episodes) displayed no circadian periodicity (p = 0.46). When both upper and lower GI bleeding were evaluated together, no circadian rhythm was evident (p = 0.07). We conclude that there is a circadian periodicity in the time of onset of only acute lower GI bleeding with its peak at 1100 h. The pacemaker of this periodicity remains unknown.