Towards an international language for incontinence-associated dermatitis (IAD): design and evaluation of psychometric properties of the Ghent Global IAD Categorization Tool (GLOBIAD) in 30 countries.

BACKGROUND: Incontinence-associated dermatitis (IAD) is a specific type of irritant contact dermatitis with different severity levels. An internationally accepted instrument to assess the severity of IAD in adults, with established diagnostic accuracy, agreement and reliability, is needed to support clinical practice and research. OBJECTIVES: To design the Ghent Global IAD Categorization Tool (GLOBIAD) and evaluate its psychometric properties. METHODS: The design was based on expert consultation using a three-round Delphi procedure with 34 experts from 13 countries. The instrument was tested using IAD photographs, which reflected different severity levels, in a sample of 823 healthcare professionals from 30 countries. Measures for diagnostic accuracy (sensitivity and specificity), agreement, interrater reliability (multirater Fleiss kappa) and intrarater reliability (Cohen's kappa) were assessed. RESULTS: The GLOBIAD consists of two categories based on the presence of persistent redness (category 1) and skin loss (category 2), both of which are subdivided based on the presence of clinical signs of infection. The agreement for differentiating between category 1 and category 2 was 0·86 [95% confidence interval (CI) 0·86-0·87], with a sensitivity of 90% and a specificity of 84%. The overall agreement was 0·55 (95% CI 0·55-0·56). The Fleiss kappa for differentiating between category 1 and category 2 was 0·65 (95% CI 0·65-0·65). The overall Fleiss kappa was 0·41 (95% CI 0·41-0·41). The Cohen's kappa for differentiating between category 1 and category 2 was 0·76 (95% CI 0·75-0·77). The overall Cohen's kappa was 0·61 (95% CI 0·59-0·62). CONCLUSIONS: The development of the GLOBIAD is a major step towards a better systematic assessment of IAD in clinical practice and research worldwide. However, further validation is needed.

Determination of the median effective dose (ED50 ) of spinal chloroprocaine in labour analgesia.

The primary goal of this study was to determine the median effective dose (ED50 ) of spinal chloroprocaine for labour analgesia. Thirty-eight parturients requesting neuraxial analgesia were enrolled. Doses of 1% chloroprocaine were determined by the technique of up-down sequential allocation, with an initial dose of 20 mg and steps of 2 mg. The chloroprocaine spinal dose was given as the spinal component of a combined spinal-epidural, which was then supplemented with an epidural dose of 7.5 µg sufentanil in 7 ml saline. Effective analgesia was defined as a score ≤ 10 mm within 15 min on a 100-mm visual analogue pain scale. Using the isotonic regression estimator method, the ED50 of chloroprocaine for the spinal component of a combined spinal-epidural for labour was calculated to be median (95%CI) 12.0 (9.3-17.0) mg.

Pulpal regeneration and root development after subcutaneous transplantation of cryopreserved immature teeth in rats.

The purpose of this in vivo study was to investigate revascularization and root growth after autotransplantation of cryopreserved immature teeth. Immature molar teeth were extracted in 4-week-old Wistar rats. In the test group, teeth were cryopreserved for 1 week and transplanted subcutaneously to the abdomen. In the control group, teeth were transplanted subcutaneously immediately after extraction. Material was collected in test and control animals at intervals of 1, 2, 4 and 10 weeks post-transplantation and histological and microradiographical examination was performed. Results showed that during the first weeks after transplantation, pulpal repair was similar in both groups although degenerated pulpal tissue was replaced slower in cryopreserved teeth and some differences in types of hard tissue formation were found between test and control teeth. After 10 weeks, the differences in the regenerated pulpal tissue between cryopreserved and control teeth observed during the first weeks were no longer detectable. No root growth was detected microradiographically 10 weeks after transplantation in any of the transplanted teeth. The presence of dentin-like tissue in the pulp cavity of some autotransplanted cryopreserved teeth, suggests survival of pulpal tissue after cryopreservation.

Prospective evaluation of clinical voiding reeducation or voiding school for lower urinary tract conditions in children.

PURPOSE: We conducted a prospective controlled study evaluating the results of a clinical voiding reeducation program (voiding school) for treatment of lower urinary tract conditions in children compared to no treatment. MATERIALS AND METHODS: A total of 38 children with nonneurogenic lower urinary tract conditions were included in the study. Controls, consisting of 15 children on the waiting list for the same program, received no treatment. The clinical voiding reeducation program consisted of instruction on voiding and drinking, individualized voiding diaries, pelvic floor biofeedback training, uroflowmetry, alarm therapy, cognitive therapy and psychological support. Data on voiding, drinking, pelvic floor control, voided volume, uroflow, incontinence and stool habits were gathered before the program, during the program and 6 months after the program. In the control group the same data were gathered. RESULTS: In the study group a positive effect of voiding school was observed in 92% of children, with 42% becoming completely dry, 24% improving from incontinence during the day and night to incontinence during the day or night only, and 26% remaining incontinent. In all patients the number and amount of incontinence episodes decreased. In the control group no differences were observed between the start of study and 6 months later. The study group did significantly better on voided volume and incontinence compared to controls. CONCLUSIONS: In this prospective controlled study a positive effect was noted on voided volume and incontinence with a clinical voiding reeducation program (voiding school).

Tests and diagnostic plots for detecting lack-of-fit for circular-linear regression models.

Regression diagnostics and lack-of-fit tests mainly focus on linear-linear regression models. When the design points are distributed on the circumference of a circle, difficulties arise as there is no natural starting point or origin. Most classical lack-of-fit tests require an arbitrarily chosen origin, but different choices may result in different conclusions. We propose a graphical diagnostic tool and a closely related lack-of-fit test, which does not require a natural starting point. The method is based on regional residuals which are defined on arcs of the circle. The graphical method formally locates and visualizes subsets of poorly fitting observations on the circle. A data example from the food technology is used to point out the before-mentioned problems with conventional lack-of-fit tests and to illustrate the strength of the methodology based on regional residuals in detecting and localizing departures from the no-effect hypothesis. A small simulation study shows a good performance of the regional residual test in case of both global and local deviations from the null model. Finally, the ideas are extended to the case of more than one predictor variable.

Correlation between follicle dimensions recorded by patients at home (SOET) versus ultrasound performed by professional care providers.

INTRODUCTION: Serial measurements of the number of follicles and their growth by ultrasound is a standard way of monitoring fertility treatments using controlled ovarian stimulation. This is stressful for both the patient and the professional. Self-operated endovaginal telemonitoring (SOET) is more patient friendly and less time-consuming. AIM OF THE STUDY: The goal of the study is to see if there's a correlation in the number of follicles and in two- dimensional growth between recordings made using SOET versus measurements performed by a professional sonographer. RESULTS: Three different ultrasound moments were recorded and compared in a total of 15 women. At time A an ultrasound was performed by the patient at home using SOET at the decision time of triggering. At time B an ultrasound was also recorded by the patient, 24 hours later. At time C an ultrasound was performed by a physician using a high end ultrasound device immediately prior to oocyte retrieval, 12 hours later than time B. The correlation in number and two-dimensional size between the different measurement moments was calculated. There is an excellent correlation in follicle count between time B and C. The difference in mean two-dimensional size between different measurement moments was not statistically significant. CONCLUSION: SOET ultrasound correlates well with ultrasound performed by a professional in number of follicles. SOET is a good alternative for monitoring controlled ovarian stimulation in a well-defined population group of normal responders, especially near the end of the ovarian stimulation.

Correlation between saliva and serum concentrations of estradiol in women undergoing ovarian hyperstimulation with gonadotropins for IVF/ICSI.

AIM OF THE STUDY: To examine saliva- and serum concentrations correlation of estradiol (E2) in women undergoing ovarian hyperstimulation for IVF/ICSI. Saliva measurements could simplify stimulation follow up. A 'home' test for E2 could be useful. METHODS: Prospective interventional academic monocentric study at the Centre for Reproductive Medicine of the University Hospital of Ghent, Belgium. Between November 2014 and August 2015 thirty-one patients were included after random selection (inclusion criteria: < 41 years of age, any rank of IVF/ICSI cycle, serum anti- Müllerian hormone concentration ≥ 1 µg/L, treatment completely at the University Hospital.) Measurements took place using immunoassay serum measurements. Estradiol was determined in saliva and serum by LC-MS/MS. At every control, E2 was measured in saliva and serum. Equilibrium analysis on a part of the serum samples took place. Statistic method used is a linear Mixed- Effects model (MIXED) in SPSS. RESULTS: Statistical analysis shows a strong linear relation between serum and salivary E2, (R2 of 0.75). E2 in equilibrium dialysis and E2 in serum were also strong correlated (R2 of 0.85). CONCLUSIONS: Strong correlation between serum and salivary E2 concentrations was found. Equilibrium dialysis showed good correlation with salivary E2. Saliva can be a good surrogate for free E2 in women undergoing ovarian hyperstimulation. This may create an opportunity to develop a point of care test for measuring E2, in purpose to simplify screening for OHSS risk.

Prospective evaluation of the long-term effects of clinical voiding reeducation or voiding school for lower urinary tract conditions in children.

INTRODUCTION: Although the short-term effects of urotherapy as a treatment strategy for lower urinary tract (LUT) conditions have been well documented, the long-term effects remain largely unknown. A better insight into the long-term effects of urotherapy could improve the clinical guidelines for children with incontinence. OBJECTIVE: This study aimed to investigate the long-term effects (i.e., from 6 months to 2 years) from a clinical voiding reeducation program among children with LUT conditions. STUDY DESIGN: This study was a prospective continuation of the follow-up study of Hoebeke et al. (2011). Thirty-eight children (mean age 9 years) with LUT conditions completed an extensive clinical voiding reeducation program (VS). Data on medication, voiding, drinking, pelvic floor tone, uroflowmetry, and incontinence were recorded 2 years after the VS. These data were compared with the outcomes at 6 months follow-up and at intake before voiding school. RESULTS: Six months after voiding school, 22 children continued having daytime incontinence (ID) and/or enuresis (EN). Six of them became dry at 2 years. Conversely, 16 children were dry at 6 months, of which eight relapsed at 2 years. Whereas all parameters significantly improved 6 months after VS, further improvements from 6 months to 2 years could only be noticed for the proportion of children suffering from overactive bladder (92% at intake, 55% at 6-month follow-up and 18% at 2-year follow-up) (Figure). Fluid intake and pelvic floor tone improved after 6 months, but showed a significant relapse after 2 years (P = 0.013, P = 0.031, respectively). DISCUSSION: Hoebeke et al. (2011) concluded that results continued to improve after VS. No further improvements could be noticed 2 years after VS, although individual shifts were present. The results of the present study underline the value of long-term follow-up to detect those needing ongoing treatment to prevent relapse. Fluid intake and pelvic floor tone deteriorated from 6 months to 2 years. It could be hypothesized that inadequate fluid intake, possibly leading to decreased voided volumes, may be seen as an indicator for upcoming incontinence relapse. It could be stated that adequate fluid intake and pelvic floor tone may play a role in remaining continent for the long term. Study limitations should be considered. The study population was heterogeneous and rather small. Together with other missing values, this could have influenced the results. CONCLUSION: Close individual, long-term follow-up after clinical voiding reeducation in children is recommended in order to timely detect and prevent potential relapse.

Using a resin-modified glass ionomer as an occlusal sealant: a one-year clinical study.

The authors compared the retention and clinical performance of a resin-modified glass ionomer, or RMGI, restorative and a light-cured resin sealant. The first permanent molars on one side of the dental arch in 50 children were sealed with an RMGI, and the same teeth on the other side were sealed with a resin sealant. At baseline, six months after placement and one year after placement, examiners documented sealant retention, secondary caries, marginal discrepancy and marginal staining. In general, the RMGI appeared to wear markedly. At one year, the retention of the RMGI was significantly less than the resin, but the RMGI had significantly fewer marginal discrepancies. There were no significant differences in caries development or marginal discoloration.

In vitro corrosion behavior and microstructure examination of a gallium-based restorative.

Concerns of mercury toxicity have led to the development of gallium-based restorative materials to replace dental amalgam. A new gallium-based dental restorative, Galloy, was compared with a high-copper amalgam, Permite, for anodic polarization behavior in deoxygenated Ringer's solution and by immersion testing in normal Ringer's solution at 37 degrees C. Corrosion products were analyzed using energy dispersive X-ray spectrometry and transmission electron diffraction. The data from both sources were consistent with the presence of alpha-Ga2O3 and SnO2 as the primary corrosion products of Galloy. Anodic polarization behavior of Galloy- and Permite-coupled specimens suggests that coupling Galloy with the more noble Permite amalgam may cause accelerated electrochemical corrosion and that Galloy is more corrosion prone than Permite.

Bond strength of resin cements to microfilled composites.

The in vitro bond strengths of three resin cements and a light-cured and a laboratory-processed micro-filled composite were measured. Effects of two surface treatments, and three bond enhancers were analyzed. Resin cements were bonded to sandblasted composite substrates, stored at 37 degrees C in 100% humidity overnight, and debonded in tension. An analysis of variance revealed significant differences among bond strengths. Overall, the composite substrate had the largest effect on bond strength, followed by bond enhancer, cement and, finally, surface treatment. Mean bond strengths ranged from 0.9 to 13.6 MPa. A combination of Concept, Dual Cement, phosphoric acid and Silane produced the lowest mean bond strength (0.9 MPa), while EOS, Dual Cement, hydrofluoric acid, and Heliobond produced the highest recorded mean bond strength (13.6 MPa). In general, the highest bonds were produced using the light-cured composite (EOS), the acrylic monomer (Special Bond II) or the dimethacrylate monomer (Heliobond), the adhesive cement (CR Inlay Cement), and surface treatment with hydrofluoric acid (Comp-Etch). Most of the bond failures (86%) with the laboratory-cured microfilled composite were adhesive. With the light-cured composite, 69% of the failures were mixed adhesive-cohesive types.

Antibacterial effects of glass ionomers.

Glass ionomer cements have been shown to possess antimicrobial activity. Proposed mechanisms of action include acidity and fluoride. It was the purpose of this study to determine the antimicrobial effect of 11 glass ionomer cements, their individual powder and liquid components and one resin-bonded liner containing high fluoride ionomer glass against Streptococcus mutans #6715. The role of fluoride and pH in the antibacterial activity was also studied. Using agar diffusion assay methodology, the following results were obtained. All of the glass ionomer cements were inhibitory against S. mutans. The antibacterial cements and slurries that were tested for fluoride, released the ion in excess of reported minimum inhibitory values. The antimicrobial activity of the liquid components, that were tested for the effects of pH changes, was totally lost when the pH was adjusted to 5. The resin bonded liner was inactive against S. mutans and did not release inhibitory concentrations of fluoride. These results indicate that freshly-mixed glass ionomer cements are antimicrobial against S. mutans and that the mechanism of action is probably a function of both fluoride and pH although additional factors may be involved.

Antibacterial effects of light-cured liners.

Light-cured liners and glass ionomers have recently been introduced and it has not been established if they are antimicrobial. This study determined the effectiveness of several light-cured liners against Streptococcus mutans #6715. Fluoride release and pH determination tests were performed to define their antibacterial activity. After evaluation with agar diffusion methodology, two of the light-cured glass ionomers were considered inhibitory. These two liners released fluoride into the agar in excess of the minimum inhibitory value of 20 ppm. The other four materials released fluoride below reported inhibitory values, failed to lower the pH below 4.0 and were ineffective against Streptococcus mutans. The findings suggested that light-cured glass ionomers react similarly to conventionally-cured glass ionomers regarding antibacterial activity against Streptococcus mutans. It also indicated that antibacterial activity was dependent upon a lower pH. Fluoride release may not be as important to the mechanism of action; however, it cannot be ruled out.

Bond strength of resin cements to a hybrid composite.

Tensile bond strengths among three resin inlay cements and a light-cured and a post-cured hybrid composite prepared with two different surface treatments and three different bond-enhancing liquids were measured in vitro. The resin cements were bonded to sandblasted hybrid composite, stored at 37 degrees C in 100% humidity overnight, and debonded in tension. Interfacial bond strengths were affected most by the type of pre-bond surface treatment. Hydrofluoric acid produced weaker bond strengths than surface treatment with phosphoric acid. Post-cured Herculite XRV produced weaker bond strengths than the light-cured Herculite XRV. Porcelite cement produced the highest bond strengths. Of the surface enhancers, the acrylic monomer (Special Bond II) produced the highest bond strengths, regardless of which cement or surface preparation was used. Fracture analysis revealed mostly adhesive failures with hydrofluoric acid treatment in both light-cured and post-cured Herculite.

Fluoride release from light-cured liners.

This study compared the relative amounts and patterns of fluoride release from six commercially available light-cured liners in artificial saliva over a 28-day period. Cavalite and two Zionomer products released relatively small amounts of fluoride. Timeline and XR Ionomer released the highest cumulative total of fluoride over time. During the last time interval (14-28 days), Timeline released the greatest amount of fluoride. Patterns of fluoride release for all materials were similar with the largest proportion of the total fluoride release being in the first 24-48 hours, followed by a dramatic reduction in release rate.

A comparative study of fluoride release from glass-ionomer cements.

This study compared the amounts and patterns of fluoride release from 11 commercially available glass-ionomer cements into artificial saliva over an 84-day period. The results indicated that the materials differed in the amount of fluoride released, and that Miracle Mix released the highest cumulative total of fluoride over the test period. Along with old Fuji II, Miracle Mix also released the most fluoride during the last time interval (56 to 84 days). All of the materials released the greatest proportion of their cumulative total fluoride in the first 24 hours after mixing.

Fracture strength of Class I versus Class II restored premolars tested at the marginal ridge. I. Standard preparations.

Two groups of maxillary premolars with Class I cavities were prepared with one marginal ridge thickness to a width of 1.0 mm. One group was restored with amalgam and the other group with composite resin. Two groups of Class II cavities also were prepared and restored with amalgam and composite resin. The teeth in the four treatment groups were subjected to a centric load at the marginal ridge until fracture occurred. A two-factor analysis of variance revealed a statistically significant difference between the class of preparation (Class I preparations were weaker than were Class II preparations) but differences in strength between restorative materials (composite resin versus amalgam) and the interaction effect (class of preparation x restorative materials) were not found to be statistically significant (alpha = .05). A Newman-Keuls sequential range test found no statistically significant differences in strength between groups (alpha = .05). Fracture patterns were observed under scanning electron microscope. Fractures extended into the enamel and into the material in the Class I composite resin, Class I amalgam, and Class II composite resin restorations. Fractures extended only into the material in Class II amalgam restorations.

Compomers, reattachment method expand restoration capabilities.

The purpose of this article is to review one new material and one new technique being used in restorative dentistry today. Compomers, new fluoride-releasing resin restorative materials, are compared to conventional glass ionomers in terms of classification, physical properties, and clinical usage. Compomers are not true glass ionomer materials since the acid/base setting reaction, charactheristic of conventional glass ionomers, does not occur. As a consequence, their physical properties of translucency, coefficient of thermal expansion, and strength more closely resemble composite resins than conventional glass ionomers. These differences in physical properties have clinical implications in their usage. In terms of new techniques, clinical and laboratory data now exist to support the method of reattachment of fractured tooth fragments using only dentin bonding agents, in cases where the tooth fragment is available. This method can restore up to 50 percent of the original strength of intact teeth. The technique advocates the use of acid etching and enamel and dentin bonding, without any tooth preparation. In vitro studies have achieved total (100 percent) restoration of intact teeth by bonding a porcelain veneer to the tooth after the reattachment.

Competency-based education at the Indiana University School of Dentistry.

This article discusses competency-based education at Indiana University School of Dentistry (IUSD). Competency-based education is not a new concept in health education, but is relatively new to dental education. The authors hope that this article will help Indiana dentists understand a process that will radically alter the way we teach dentistry at IUSD.

Are EUS-FNA and EBUS-TBNA specimens reliable for subtyping non-small cell lung cancer?

With endosonography, the diagnosis and staging of non-small cell lung cancer (NSCLC) increasingly relies on small samples. The discrimination between squamous and non-squamous subtypes is now important for therapy tailoring. We analyzed the agreement between fine needle aspirates obtained by endosonography and matched biopsy samples for subtyping NSCLC. Patients with a positive endoscopic fine needle aspirate and a matched biopsy were identified. The level of diagnostic agreement was estimated with biopsy samples as golden standard. In 951 patients investigated with endosonography, we identified 92 with NSCLC on the positive fine needle aspirate and on the matched biopsy. Squamous cell carcinoma was diagnosed in 34 (37%) and 44 (48%) of fine needle aspirate and biopsy samples; while non-squamous carcinoma was diagnosed in 58 (63%) and 48 (52%) respectively. The agreement between needle aspirate and biopsy for the subtyping of NSCLC was 76% (kappa=0.52). In cases with cell block preparation, the agreement for subtyping was 96% (kappa=0.91) vs 69% (kappa=0.39) in cases without cell blocks. Therefore, the diagnostic agreement between endosonographic fine needle aspirates and biopsy specimens for subtyping NSCLC is moderate with a disagreement in 1 out of 4 patients. However, cell block preparation increased the agreement and thus the reliability of the fine needle specimens obtained during endosonography, for subtyping NSCLC considerably. In conclusion, for patients with NSCLC in whom subtyping is relevant, a diagnostic technique yielding larger samples (FNA with cell block preparation or biopsies) should be preferred.