Collaborative Enhancement of Consistency and Accuracy in US Diagnosis of Thyroid Nodules Using Large Language Models.

Background Large language models (LLMs) hold substantial promise for medical imaging interpretation. However, there is a lack of studies on their feasibility in handling reasoning questions associated with medical diagnosis. Purpose To investigate the viability of leveraging three publicly available LLMs to enhance consistency and diagnostic accuracy in medical imaging based on standardized reporting, with pathology as the reference standard. Materials and Methods US images of thyroid nodules with pathologic results were retrospectively collected from a tertiary referral hospital between July 2022 and December 2022 and used to evaluate malignancy diagnoses generated by three LLMs-OpenAI's ChatGPT 3.5, ChatGPT 4.0, and Google's Bard. Inter- and intra-LLM agreement of diagnosis were evaluated. Then, diagnostic performance, including accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC), was evaluated and compared for the LLMs and three interactive approaches: human reader combined with LLMs, image-to-text model combined with LLMs, and an end-to-end convolutional neural network model. Results A total of 1161 US images of thyroid nodules (498 benign, 663 malignant) from 725 patients (mean age, 42.2 years ± 14.1 [SD]; 516 women) were evaluated. ChatGPT 4.0 and Bard displayed substantial to almost perfect intra-LLM agreement (κ range, 0.65-0.86 [95% CI: 0.64, 0.86]), while ChatGPT 3.5 showed fair to substantial agreement (κ range, 0.36-0.68 [95% CI: 0.36, 0.68]). ChatGPT 4.0 had an accuracy of 78%-86% (95% CI: 76%, 88%) and sensitivity of 86%-95% (95% CI: 83%, 96%), compared with 74%-86% (95% CI: 71%, 88%) and 74%-91% (95% CI: 71%, 93%), respectively, for Bard. Moreover, with ChatGPT 4.0, the image-to-text-LLM strategy exhibited an AUC (0.83 [95% CI: 0.80, 0.85]) and accuracy (84% [95% CI: 82%, 86%]) comparable to those of the human-LLM interaction strategy with two senior readers and one junior reader and exceeding those of the human-LLM interaction strategy with one junior reader. Conclusion LLMs, particularly integrated with image-to-text approaches, show potential in enhancing diagnostic medical imaging. ChatGPT 4.0 was optimal for consistency and diagnostic accuracy when compared with Bard and ChatGPT 3.5. © RSNA, 2024 Supplemental material is available for this article.

US-based Sequential Algorithm Integrating an AI Model for Advanced Liver Fibrosis Screening.

Background Noninvasive tests can be used to screen patients with chronic liver disease for advanced liver fibrosis; however, the use of single tests may not be adequate. Purpose To construct sequential clinical algorithms that include a US deep learning (DL) model and compare their ability to predict advanced liver fibrosis with that of other noninvasive tests. Materials and Methods This retrospective study included adult patients with a history of chronic liver disease or unexplained abnormal liver function test results who underwent B-mode US of the liver between January 2014 and September 2022 at three health care facilities. A US-based DL network (FIB-Net) was trained on US images to predict whether the shear-wave elastography (SWE) value was 8.7 kPa or higher, indicative of advanced fibrosis. In the internal and external test sets, a two-step algorithm (Two-step#1) using the Fibrosis-4 Index (FIB-4) followed by FIB-Net and a three-step algorithm (Three-step#1) using FIB-4 followed by FIB-Net and SWE were used to simulate screening scenarios where liver stiffness measurements were not or were available, respectively. Measures of diagnostic accuracy were calculated using liver biopsy as the reference standard and compared between FIB-4, SWE, FIB-Net, and European Association for the Study of the Liver guidelines (ie, FIB-4 followed by SWE), along with sequential algorithms. Results The training, validation, and test data sets included 3067 (median age, 42 years [IQR, 33-53 years]; 2083 male), 1599 (median age, 41 years [IQR, 33-51 years]; 1124 male), and 1228 (median age, 44 years [IQR, 33-55 years]; 741 male) patients, respectively. FIB-Net obtained a noninferior specificity with a margin of 5% (P < .001) compared with SWE (80% vs 82%). The Two-step#1 algorithm showed higher specificity and positive predictive value (PPV) than FIB-4 (specificity, 79% vs 57%; PPV, 44% vs 32%) while reducing unnecessary referrals by 42%. The Three-step#1 algorithm had higher specificity and PPV compared with European Association for the Study of the Liver guidelines (specificity, 94% vs 88%; PPV, 73% vs 64%) while reducing unnecessary referrals by 35%. Conclusion A sequential algorithm combining FIB-4 and a US DL model showed higher diagnostic accuracy and improved referral management for all-cause advanced liver fibrosis compared with FIB-4 or the DL model alone. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Ghosh in this issue.

Clinical performance of non-surgical periodontal therapy in a large Chinese population with generalized aggressive periodontitis.

AIM: This study aimed to evaluate clinical performance of non-surgical periodontal treatment (NSPT) and its influential factors in a large Chinese population with generalized aggressive periodontitis (GAgP). MATERIAL AND METHODS: Longitudinal periodontal examination data of 1,004 GAgP patients (numbers of patients with observation periods 6 weeks~, 3 months~, 6 months~, 1 year~, 3 years~ and >5 years were 203, 310, 193, 205, 70 and 23, respectively) were extracted from a hospital-based electronic periodontal charting record system and analysed by multilevel analysis. RESULTS: Mean probing depth (PD) and attachment loss (AL) reductions at patient level were 1.17 mm and 1.07 mm, respectively. Multilevel analysis demonstrated PD reductions after maintenance were mainly influenced by frequency of supportive periodontal treatment (FSPT), gender, adjunctive systemic use of antibiotics, baseline mobility, tooth type and baseline PD and bleeding index reductions were mainly influenced by FSPT, adjunctive systemic use of antibiotics, baseline AL, baseline mobility, tooth type and baseline PD. CONCLUSION: The clinical performance of NSPT on patients with GAgP was proved in the large Chinese population. Outcomes of NSPT were mainly influenced by FSPT, adjunctive systemic use of antibiotics, baseline mobility, tooth type and baseline PD.

Effectiveness of non-surgical periodontal therapy in a large Chinese population with chronic periodontitis.

AIM: The aim of this study was to evaluate the effectiveness of non-surgical periodontal treatment (NSPT) and its influential factors in a large Chinese population with chronic periodontitis. METHODS: Periodontal examination data of 10,789 patients with at least one periodontal re-evaluation record were extracted from a hospital-based electronic periodontal charting record system. Probing depth (PD) and bleeding index (BI) reductions after NSPT and their influential factors were analysed by multilevel analysis. RESULTS: Mean PD reductions at patient level and site level were 0.62 and 0.65 mm respectively. Mean reductions of percentage of tooth with BI > 1 and BI > 2 were 14.9% and 25.21%. Multilevel analysis demonstrated that PD and BI reductions were mainly influenced by baseline PD, baseline attachment loss (AL), baseline mobility, tooth type and frequency of periodontal maintenance (FPM). Besides, PD reduction was associated with baseline BI for all sites and was associated with gender and smoking status for sites with baseline PD ≥ 5 mm. CONCLUSION: The effectiveness of NSPT on patients with chronic periodontitis was proved in a large Chinese population. Outcomes of NSPT were mainly influenced by baseline PD, baseline AL, baseline mobility, tooth type and FPM.

[Association between FADS1 rs174537 polymorphism and serum proteins in patients with aggressive periodontitis].

OBJECTIVE: To investigate the potential association between FADS1 rs174537 polymorphism and serum proteins in patients with aggressive periodontitis, which may provide benefits for diagnosis and treatment of aggressive periodontitis. METHODS: A total of 353 patients with aggressive periodontitis (group AgP) and 125 matched controls (group HP) were recruited in the study. Genotyping of FADS1 rs174537 and serum biochemical indexes were tested at the study's start. The relationships between the levels of TP, GLB, ALB, A/G and genotyping were analyzed. RESULTS: (1) The detection rate of allele G in group AgP was higher than that in group HP(68.1% vs. 61.2%, P=0.046,OR=1.35,95% CI 1.00-1.83); the detection rate of genotype GG in group AgP was higher than in group HP(45.5% vs. 34.4%,P=0.029, OR=1.60, 95% CI 1.05-2.44). (2) In group AgP, the patients with GG genotype exhibited significantly lower TP, GLB than the patients with GT+TT genotype [(77.08 ± 7.88) g/L vs. (79.00 ± 4.66) g/L, P=0.007; (28.17 ± 7.63) g/L vs.(29.88 ± 3.49) g/L,P=0.007) and the higher A/G(1.72 ± 0.22 vs.1.67 ± 0.22, P=0.040), but there was no significant difference in ALB between the patients with GG genotype and the patients with GT+TT genotype. In group HP, there were no significant differences in TP, GLB, A/G and ALB between individuals with genotype GT+TT and with genotype GG. (3)Compared with individuals with genotype GT+TT in group HP, the AgP patients with genotype GT+TT exhibited significantly higher TP, GLB [(79.00 ± 4.66) g/L vs. (75.20 ± 4.53) g/L, P<0.01; (29.88 ± 3.49) g/L vs.(26.55 ± 2.94) g/L, P<0.01) and the lower A/G(1.67 ± 0.22 vs. 1.88 ± 0.30, P<0.01), but there was no significant difference in ALB. There were no significant differences in TP, GLB, A/G and ALB the between the AgP patients with genotype GG and the healthy subjects with the same genotype either. CONCLUSION: FADS1 rs174537 polymorphism is associated with aggressive periodontitis. The patients with genotype GG in group AgP had relatively lower TP,GLB and higher A/G. Genotype GG might be a risk indicator for aggressive periodontitis by reducing host defense capability and contributing to inflammatory response in the occurrence and development of aggressive periodontitis.

[Clinical and putative periodontal pathogens' features of different sites with probing depth reduction after non-surgical periodontal treatment of patients with aggressive periodontitis].

OBJECTIVE: To evaluate the differences of clinical parameters and putative periodontal pathogens in sites of different probing depth (PD) reduction after non-surgical periodontal treatment in patients with aggressive periodontitis (AgP). METHODS: Clinical examinations including plaque index, probing depth (PD), attachment level (AL) and bleeding index (BI), and full-mouth periapical photographs were collected from 20 patients with AgP. All the patients received non-surgical periodontal treatment, including oral hygiene instruction, supra-gingival scaling, subgingival scaling and root planing (SRP) and were followed up for 6 months post-therapy. Gingival crevicular fluids (GCF) were collected at 1 site in each quadrant before and at the end of 6 months post-therapy. Six kinds of putative periodontal pathogens and 6 kinds of short chain fatty acids (SCFAs) were detected in the GCF samples. RESULTS: The baseline clinical parameters of PD, AL and BI, the baseline concentration of succinic acid, acetic acid, propionic acid and butyric acid, and the prevalence of Treponema denticola were significantly higher in sites with PD reduction more than 2 mm sites compared with PD reduction no more than 2 mm sites [(7.7 ± 1.2) mm vs. (5.1 ± 1.8) mm, (6.3 ± 1.9) mm vs. (4.5 ± 2.2) mm, 3.8 ± 0.4 vs. 3.3 ± 0.8, 1.66 mmol/L vs. 1.10 mmol/L, 31.67 mmol/L vs.17.78 mmol/L, 3.31 mmol/L vs.1.95 mmol/L, 84.6% vs. 56.1%, P<0.05]. However, there were no significant differences in the clinical parameters, the 6 kinds of putative periodontal pathogen detection and SCFAs concentration between the 2 groups at the end of 6 months post-treatment. In sites with PD>5 mm at the end of 6 months post-therapy, all were found with red complex bacteria infection. CONCLUSION: The baseline clinical parameters are important factors in predicting PD reduction after non-surgical periodontal treatment in patients with AgP. In sites with deep pockets after non-surgical periodontal treatment, the active control of red complex bacteria is recommended.

[Radiographic evaluation of ridge preservation after molar tooth extraction: a controlled clinical trial].

OBJECTIVE: To compare the bone dimensional changes following tooth extraction alone with extraction plus ridge preservation (using deproteinized boving bone mineral Bio-Oss® and bioresorbable collagen mambrane Bio-Gide®) in periodontal compromised extraction sockets. METHODS: Eighteen molars of sixteen subjects requiring tooth extraction because of periodontal destruction were enrolled in this study. The subjects were assigned to the control group (extraction alone, EXT) or to the test group (ridge-preservation procedure with Bio-Oss® and Bio-Gide, RP). Parallel periapical X-rays and cone-beam computed tomography (CBCT) scans were taken immediately after tooth extraction alone or plus ridge-preservation (baseline) and 6 months later. The changes of horizontal ridge width and vertical ridge height were assessed. RESULTS: At the central buccal aspect, the ridge height increased 2.9 mm in RP group, and reduced 1.0 mm in EXT group. At the distal buccal aspect, the ridge height increased 1.45 mm in RP group, and reduced 1.45 mm in EXT group. The differences between the groups reached statistical significance (P<0.05). The mean ridge width increased at the 1 mm below the crest (the horizontal ridge width was measured with grafting material at three levels at 1 mm below the most coronal aspect of the crest,HW1), which amounted to 3.40 to 5.80 mm in RP group, and 1.45 to 2.90 mm in EXT group. The mean ridge increased at the 4 mm below the crest (the horizontal ridge width was measured with grafting material at three levels at 4 mm below the most coronal aspect of the crest,HW4), which amounted to 0.40 to 3.50 mm in RP group, and reduced 0.10 to increased 0.15 mm in EXT group. The test group and the control group were not significantly different (P>0.05). CONCLUSION: The ridge-preservation approach using Bio-Oss® in combination with Bio-Gide® can significantly increase vertical ridge height and horizontal ridge width after tooth extraction compared with extraction alone in periodontal compromised molars.

[Analysis of serum IgG titers to Aggregatibacter actinomycetemcomitans serotype c in aggressive periodontitis patients].

OBJECTIVE: To analyze the serum IgG titers to Aggregatibacter actinomycetemcomitans(Aa) and associated factors in patients with aggressive periodontitis (AgP). METHODS: Venous blood samples were collected from 62 AgP patients and 45 periodontal healthy controls, unstimulated whole saliva and pooled subgingival plaque samples of AgP patients were also collected for the detection of Aa (PCR method). Serum IgG titers to Aa serotype c were measured by enzyme-linked immunosorbnent assay (ELISA). RESULTS: The detection rates of serum IgG to Aa serotype c in the AgP patients and the healthy controls were both 100%. The AgP patients exhibited significantly higher IgG titers to Aa serotype c than the healthy controls (11.1±1.9 vs. 9.1±1.8, P<0.01). There was no significant difference in serum IgG levels to Aa serotype c and in the prevalence of high-responding patients to Aa serotype c between the incisor-first molar type AgP patients and generalized AgP patients. Serum IgG titers to Aa serotype c in the Aa-positive AgP patients (the patients who were Aa-positive in subgingival plaque or saliva) were significantly higher than those of the Aa-negative patients (11.9±1.3 vs. 10.7±2.1, P<0.05). CONCLUSION: Serotype c was the main serotype of Aa in Chinese patients with AgP. Serum IgG responses in generalized AgP patients were comparable to those in incisor-first molar type AgP patients.

[Clinical effect of different sequences of debridement-antibiotic therapy in treatment of severe chronic periodontitis].

OBJECTIVE: To evaluate the feasibility of full-mouth debridement (subgingival scaling and root planning, SRP) by 2 times within 1 week and compare the clinical effects of different sequences of debridement-antibiotic usage in patients with severe chronic periodontitis (CP). METHODS: A double-blinded, placebo-controlled, randomized clinical trial was conducted in 30 severe CP patients (14 males and 16 females, 40.5 ± 8.4 years old on average from 35 to 60) receiving 3 different sequences of debridement-antibiotictherapy: Group A, antibiotic usage (metronidazole, MTZ, 0.2 g, tid, 7 d; amoxicillin, AMX 0.5 g, tid, 7 d) was started together with SRP (completed by 2 times in 7 d); Group B, antibiotic usage (MTZ 0.2 g, tid, 7 d; AMX 0.5 g, tid, 7 d) was started 1 d after SRP(completed by 2 times in 7 d); Group C, SRP alone[probing depth (PD), bleeding index (BI) and tooth mobility] was examined. The average full-mouth probing depth, the average full-mouth proximal probing depth (pPD), the percentage of sites with PD>5 mm (PD>5 mm%), the percentage of sites with proximal PD>5 mm (pPD>5 mm%), the average bleeding index (BI) and the percentage of sites with bleeding on probing (BOP%) were calculated. Clinical examinations were performed at baseline and 2 months post therapy. RESULTS: (1) Compared with baseline conditions, all the subjects showed clinical improvements in all the parameters evaluated 2 months post therapy, P<0.05. (2) Significant difference were observed in the average PD changes between Group A [(2.15 ± 0.42) mm], Group B [(1.76 ± 0.29) mm] and Group C [(1.57 ± 0.33) mm], P<0.05. No significant difference was observed in the average PD changes between Group B and Group C, P=0.354. Significant differences were observed in the average pPD changes between Group A [(2.45 ± 0.43)mm] and Group C[(1.90 ± 0.48) mm], P<0.05. No significant difference was observed in BI and BOP% changes between Group A,Group B and Group C. CONCLUSION: For patients with severe chronic periodontitis, it is safe and feasible to receive full-mouth SRP by 2 times within 1 week. The short-term (2 months) advantages in PD changes are observed in patients receiving SRP and antibiotic usage at the same time comparing with patients using antibiotics after SRP or SRP alone.

[Relationship between volatile fatty acids and Porphyromonas gingivalis and Treponema denticola in gingival crevicular fluids of patients with aggressive periodontitis].

OBJECTIVE: Short chain fatty acids (SCFAs), such as succinic acid, acetic acid, propionic acid, butyric acid, etc. are metabolic product of putative periodontal pathogens, which play significant roles in periodontitis. The aim of this study was to analyze the relationship between Porphyromonas gingivalis (P. gingivalis), Treponema denticola (T. denticola), and the concentration of SCFAs in gingival crevicular fluid (GCF) of patients with aggressive periodontitis (AgP). METHODS: GCF was sampled from 4 sites per individual in 20 patients with AgP and 14 healthy controls. Concentrations of SCFAs, including succinic acid, acetic acid, propionic acid, butyric acid, and isovaleric acid in the supernant of GCF were analyzed by high performance capillary electrophoresis (HPCE), P. gingivalis and T. denticola in the deposit of the same GCF were detected by PCR with their electrophoretic band quantified. RESULTS: The concentrations of succinic acid, acetic acid, propionic acid, butyric acid, and isovaleric acid, the prevalence and PCR band quantity of P. gingivalis and T. denticola in GCF were all significantly higher in patients with AgP than that of healthy controls. In patients with AgP, butyric acid concentration was significantly higher in P. gingivalis positive sites than negative sites [2.87 (0.99, 4.36) mmol/L vs. 0.33 (0.00, 1.44) mmol/L, P<0.05], the concentrations of succinic acid, acetic acid, propionic acid, butyric acid, and isovaleric acid were positively correlated with PCR band quantity of P. gingivalis (r value was 0.334, 0.548, 0.411, 0.493, 0.273, respectively, P<0.05); the concentrations of SCFAs were significantly higher in T. denticola positive sites than negative sites: succinic acid, 1.67 (1.15, 2.11) mmol/L vs. 0.80 (0.48, 1.06) mmol/L; acetic acid, 31.95 (23.77, 43.13) mmol/L vs.12.51 (7.57, 15.69) mmol/L; propionic acid, 11.86 (6.55, 14.98) mmol/L vs. 2.82 (1.71, 7.03) mmol/L; butyric acid, 3.45 (2.41, 4.78) mmol/L vs. 0.54 (0.00, 1.56) mmol/L; isovaleric acid, 2.23 (1.05, 3.85) mmol/L vs. 0.62 (0.00, 2.33) mmol/L. The concentrations of succinic acid, acetic acid, propionic acid, butyric acid were positively correlated with PCR band quantity of T. denticola (r value was 0.443, 0.702, 0.625, 0.557, respectively, P<0.05). CONCLUSION: SCFAs concentrations reflect the quantity of P. gingivalis and T. denticola in patients with AgP, and may be an indicator to the disease progression in patients with AgP.

[Predictive model for post-treatment tooth loss of patients with aggressive periodontitis].

OBJECTIVE: To establish a predictive model for long-term tooth loss of patients with aggressive periodontitis (AgP) after periodontal treatment. METHODS: Patients diagnosed as AgP in Department of Periodontology, Peking University School and Hospital of Stomatology, who were re-evaluated 3 to 11 years after periodontal treatment were enrolled (n=85). Logistic regression was performed to select background, periodontal and radiographic factors which were related to long-term post-treatment tooth loss. A predictive model was built and analyzed by receiver operator characteristic (ROC) curve. RESULTS: After periodontal treatment, 55 teeth from 22 patients lost further. High prevalence of baseline bone loss, root abnormality, and residual severe bleeding sites, as well as poor compliance to maintenance were detected as risk factors in the predictive model. ROC analysis found the sensitivity and specificity of the model could reach up to 80% simultaneously. CONCLUSION: Predictive model for post-treatment tooth loss of patients with AgP is an important adjunct in clinical practice.

Value of Multimodal Data From Clinical and Sonographic Parameters in Predicting Recurrence of Hepatocellular Carcinoma After Curative Treatment.

OBJECTIVE: The objective of the work described here was to assess the value of the combination of pre-operative multimodal data-including clinical data, contrast-enhanced ultrasound (CEUS) information and liver stiffness measurement (LSM) based on 2-D shear wave elastography (SWE)-in predicting early (within 1 y) and late (after 1 y) recurrence of hepatocellular carcinoma (HCC) after curative treatment. METHODS: We retrospectively included 101 patients with HCC who met the Milan criteria and received curative treatment. The multimodel data from clinical parameters, LSM by 2-D SWE and CEUS enhancement patterns were collected. The association between different variables in HCC recurrence was accessed using a Cox proportional hazard model. On the basis of the independent factors of early recurrence, models with different source variables were established (Clinical Model, CEUS-Clinical Model, SWE-Clinical Model, CEUS-SWE-Clinical Model). The goodness-of-fit of models was evaluated and the performance trends of different models were calculated by time-dependent area under the curve (AUC). RESULTS: Two-dimensional SWE, CEUS enhancement patterns and clinical parameters (spleen length, multiple tumors, α-fetoprotein, albumin and prothrombin time) were independently associated with early recurrence (all p values <0.05). Multiple tumors and a decrease in albumin independently contributed to the late recurrence. The model fit of CEUS-SWE-Clinical Model was superior to other models in predicting early recurrence (all p values <0.05). The AUCs of the CEUS-Clinical Model were higher from 2 mo to 7 mo, while the SWE-Clinical Model had higher AUCs from 9 mo to 12 mo. CONCLUSION: CEUS enhancement patterns and 2-D SWE were independent predictors of HCC early recurrence as the two factors contributed to the predictive performance at different times. The multimodal model, which included diverse data in predicting early HCC recurrence, had the best goodness-of-fit.

[Clinical evaluation of periodontal intrabony defects treated with a reconstituted bovine porous bone mineral containing bone morphogenetic proteins].

OBJECTIVE: To compare the outcomes of bovine porous bone mineral (BPBM) containing bone morphogenetic proteins (BMP) and BPBM alone in periodontal intra-bony defects. METHODS: In the study, 22 intrabony defects of 9 patients with periodontitis were recruited. All the patients had at least one pair of intrabony defects of ≥3 mm. The split-mouth and single blind methods were used. The defects were randomly assigned to BPBM containing BMP (test) or BPBM alone (control). After debridement, the intrabony defects were treated by bone graft. Assessments at baseline and after 6 months included plaque index, attachment level, probing pocket depth, bleeding indexes on probing and gingival recession. The early wound-healing, adverse effects and patients' perceptions were also recorded. RESULTS: The gain in clinical attachment was (3.0±1.2) mm in the test group and (3.2±1.1) mm in the control group. The pocket reduction was (3.4±1.5) mm in the test group and (2.8±1.0) mm in the control group. The reduction of bleeding index was 1.9±1.3 in the test group and 2.3±0.8 in the control group. There was no statistical difference between the test group and control group (P>0.05). CONCLUSION: Both treatment modalities led to similar significant clinical improvements.

[A short-term clinical evaluation of periodontal treatment with an Er:YAG laser for patients with chronic periodontitis: a split-mouth controlled study].

OBJECTIVE: To compare the short-term clinical effects following non-surgical periodontal treatment with Er:YAG laser or with combination of ultrasonic subgingival scaling and root planing with hand instrument (SRP) for patients with chronic periodontitis. METHODS: In the study, 17 patients with chronic periodontitis were randomly treated in a split-mouth design with Er:YAG laser (test group) or a combination of ultrasonic subgingival scaling and root planing with hand instrument (control group). The degree of discomfort experienced during the treatment was graded by the patient using visual analogue scale (VAS) immediately after the completion of test and control treatment procedures. The following clinical parameters were recorded by a calibrated and blinded examiner: plaque index (PLI), bleeding index (BI), probing depth (PD) and attachment loss (AL). RESULTS: The mean VAS score of Er:YAG laser treatment [3 (2, 4.5)] was significantly lower than that of control treatment [5 (4, 6), P=0.013]. Both the groups showed significant reduction of PLI, PD, AL and BI values 2 months and 4 months after treatment. For sites with PD≥4 mm at baseline, the sites treated with Er:YAG laser demonstrated mean PD change from (5.6±1.1) mm to (3.6±1.1) mm and to (3.4±1.0) mm at the end of 2 months and 4 months respectively and demonstrated mean AL change from (5.1±1.5) mm to (3.9±1.6) mm and to (3.8±1.7) mm at the end of 2 months and 4 months respectively, meanwhile the BI value showed significant decrease, P=0.000; the sites treated with conventional SRP demonstrated mean PD change from (5.6±1.1) mm to (3.8±1.1) mm and (3.5± 1.0) mm at the end of 2 months and 4 months respectively and demonstrated mean AL change from (4.8±1.6) mm to (3.8±1.6) mm and (3.6±1.8) mm at the end of 2 months and 4 months respectively, and the BI value also showed significant improvement. No statistical difference for all clinical parameters were found between the two treatment groups. CONCLUSION: The present results indicate that non-surgical periodontal therapy with Er:YAG laser is safe and effective, and Er:YAG laser therapy could be used for patients who was sensitive to pain.

Multilevel Analysis of Non-surgical Periodontal Treatment of Patients with Generalised Aggressive Periodontitis.

OBJECTIVE: To investigate various factors affecting the clinical outcome of nonsurgical periodontal treatment and evaluate the treatment effects of adjunctive amoxicillin and metronidazole (AMX + MET) in patients with generalised aggressive periodontitis (GAgP). METHODS: Forty-two patients with GAgP were recruited and randomly assigned to three groups: scaling and root planing (SRP) only, AMX + MET after SRP, and AMX + MET during SRP. The patients were assessed every 2 months post-therapy. Periodontal clinical and subgingival microbiological parameters were analysed at baseline and 6 months post-therapy. The impacts of different covariates on pocket probing depth (PD) reduction were evaluated. RESULTS: A multilevel analysis revealed that 58% of the variability in PD reduction was attributed to site-level parameters, 27.3% to patient-level parameters and 18.7% to tooth-level parameters. Greater PD reduction can be expected at initially deeper PD sites and sites with intrabony defects, and in patients with adjunctive use of AMX + MET. Persistent Tannerella forsythia infection and tooth mobility after treatment were negatively associated with PD reduction. CONCLUSION: The clinical outcomes of nonsurgical periodontal treatment were mainly influenced by site-level parameters, and adjunctive use of AMX + MET can lead to better clinical results in patients with GAgP in a short time.

Influence of CYP1A1 rs1048943 on Short- and Long-term Outcomes of Non-surgical Periodontal Therapy for Generalised Aggressive Periodontitis.

Objective: To investigate the influence of CYP1A1 rs1048943 on short- and long-term outcomes of nonsurgical periodontal therapy (NSPT) for generalised aggressive periodon- titis (GAgP). Methods: The CYP1A1 rs1048943 polymorphisms of 224 GAgP patients were genotyped by time-of-flight mass spectrometry. A total of 125 patients received NSPT and subsequent followup for 3 months. Of the 125 patients, 81 were followed for at least 3 years. Clinical periodontal parameters were collected at baseline and at the follow-up visits. Negative binomial regression was used to analyse the association between the number of teeth lost during the 3-year observation period and CYP1A1 rs1048943 genotypes. Results: The mean probing depth (PD) and percentage of sites with Bleeding Index (BI) ≥ 3 were all significantly greater in CYP1A1 rs1048943 G allele carriers than non-carriers at 3 months and 3 years after treatment (P < 0.05). In the PD ≥ 7 mm subgroup, the mean PD was significantly higher in G allele carriers than non-carriers at the 3-year follow-up (P < 0.05). The other clinical parameters did not show a similar trend (P > 0.05). Furthermore, the changes of percentage of sites with BI ≥ 3 were significantly smaller in G allele carriers than non-carriers at 3 months and 3 years after treatment (P < 0.05). GAgP patients with the GG genotype had lost more over the 3-year follow-up period compared with patients with the AA genotype (P < 0.05). Conclusion: These data indicated that the CYP1A1 rs1048943 AG/GG genotypes may influence the short- and long-term outcomes of NSPT in GAgP patients.

Influence of local anesthesia on the outcomes of non-surgical periodontal treatment.

BACKGROUND: There is limited evidence of the effects of local anesthesia (LA) on outcomes of non-surgical periodontal treatment (NSPT), in particular among the Chinese. This retrospective cohort study aimed to evaluate the effects of LA on short-term treatment outcomes of NSPT and to determine under what circumstances LA should be prescribed to improve these outcomes. METHODS: Data from periodontal examinations of 3980 patients were used. The data were from 3-month re-evaluation records of an electronic periodontal charting record system in the Department of Periodontology of Peking University School and Hospital of Stomatology from June 2008 to January 2015. Descriptive analyses included changes in probing depth (PD) and the Mazza bleeding index (BI). Two-level (patient and tooth) logistic regression models and three-level (patient, tooth, and site) linear regression models were constructed to analyze the influence of LA on PD for all teeth/sites and teeth/sites with an initial PD ≥ 5 mm. Decreases in PD and BI at sites under LA using the initial PD were also compared. RESULTS: A significantly higher mean decrease in PD after NSPT was found in the LA group than in the no local anesthesia (NLA) group (0.98 vs. 0.54 mm, t = 24.12, P < 0.001). A significantly higher probability of decreases was found in the LA group in BI (percentages of teeth with BI > 1 and BI > 2) for all teeth (16.7% vs. 13.8%, t = 3.75, P < 0.001; 34.7% vs. 28.1%, t = 6.73, P < 0.001) and PD for teeth with PD ≥ 5 mm (32.3% vs. 17.3%, t = 28.48, P < 0.001). The difference in PD between the LA and NLA groups increased as the initial PD increased. The difference between the two groups was 0.12 to 0.22 mm for sites with a baseline PD < 7 mm; however, it increased to 0.41 to 1.37 mm for sites with a baseline PD ≥ 7 mm. CONCLUSIONS: LA improved the decrease in PD after NSPT. Root debridement at sites with initial PD ≥ 7 mm should be performed under routine LA.

[Detection of 3 anaerobic microorganisms in saliva and subgingival plaque of patients with periodontitis].

OBJECTIVE: To investigate the prevalence of 3 anaerobic microorganisms including Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf) and Treponema denticola (Td) in saliva and pooled subgingival plaque of different types of periodontitis and compare the detections of three microorganisms between saliva and pooled subgingival plaque sample from the same patient, and analyze the relationship between prevalence of these pathogens in saliva and periodontal parameters. METHODS: Non-stimulated saliva samples and pooled subgingival plaque samples were collected from 50 patients with aggressive periodontitis (AgP), 48 patients with chronic periodontitis (CP) and 25 subjects with no periodontitis, and three microorganisms including Pg, Tf and Td were detected in these samples by PCR method. RESULTS: Prevalence of three microorganisms in pooled subgingival plaque and saliva samples of AgP patients and CP patients were significantly higher than subjects with no periodontitis (P<0.01). The prevalence of Pg in Subgingival plaque and saliva was as follows: AgP, 100% vs 100%; CP, 93.8% vs 93.8%; Subjects with no periodontitis, 32% vs 48%. The prevalence of Tf in Subgingival plaque and saliva was as follows: AgP, 96% vs 88%; CP, 97.9% vs 89.6%; Subjects with no periodontitis, 32% vs 24%. The prevalence of Td in Subgingival plaque and saliva was as follows: AgP, 94% vs 86%; CP, 89.6% vs 70.8%; Subjects with no periodontitis, 12% vs 16%. The agreement between saliva and pooled subgingival plaque samples of these three microorganisms from the same patient was high. The presence of three microorganisms in saliva was all associated with bleeding index of gingiva, and odds ratio of Pg was 13.5 (P<0.01). CONCLUSION: Pg, Tf and Td were widely distributed in saliva and subgingival plaque of patients with AgP and CP. Presence of Pg, Tf and Td in saliva was related to periodontal parameters of gingiva, and saliva could be used as a promising sample for oral detection of these 3 microorganisms.

[Correlation analysis between plasma levels of 25-hydroxy vitamin D3 and osteocalcin in patients with aggressive periodontitis].

OBJECTIVE: To explore the relationship between plasmatic 25-hydroxy vitamin D3 (25OHD3) level and plasmatic osteocalcin level in patients with aggressive periodontitis (AgP). METHODS: Thirty four AgP patients and 29 healthy controls were included in this study. 25OHD3 and osteocalcin levels in plasma were measured using commercially available radioimmunoassay kits. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were measured using a standard hospital analytical technique. RESULTS: Plasmatic 25OHD3 level was significantly higher in AgP patients than that in healthy controls (8.65 microg/L vs 3.10 microg/L; P<0.01). Osteocalcin level was also significantly higher in AgP patients than that in healthy subjects (1.0 microg/L vs 0.8 microg/L; P=0.028). AST level was significantly lower in AgP patients than that in healthy controls(20.0 U/L vs 23.0 U/L). No correlations between the plasmatic levels of 25OHD3 and osteocalcin were detected in AgP patients or in healthy controls (r=0.271, P=0.12; r=-0.356, P=0.58). CONCLUSION: Plasmatic 25OHD3 and osteocalcin concentrations were not correlated but might be influenced by AgP.

[Relationship between herpesviruses and periodontal pathogenic bacteria in subgingival plaque].

OBJECTIVE: To evaluate the prevalence rates of human cytomegalovirus(HCMV) and Epstein-Barr virus-1(EBV-1) in subgingival plaque and analyze the relationship between herpesviruses, periodontal pathogenic bacteria and periodontal clinical parameters in Chinese patients with aggressive periodontitis(AgP). METHODS: A total of one hundred and twenty subgingival plaque samples were collected from 89 AgP patients and 31 healthy subjects. HCMV and EBV-1 were detected using nested polymerase chain reaction(PCR).Contemporaneously, 8 periodontal pathogenic bacteria including Actinobacillus actinomycetemcomitans(Aa), Porphyromonas gingivalis(Pg), Tannerella forsythensis(Tf), Prevotella intermedia(Pi), Campylobacter rectus(Cr),Fusobacterium nucleatum(Fn), Treponema denticola(Td), Prevotella nigrescens(Pn) were detected by 16S rRNA based PCR. RESULTS: HCMV was more frequently detected in AgP patients (43.8%) than in healthy controls (12.9%, P<0.01). The prevalence rates of HCMV and EBV-1 in AgP patients with 6-8 kinds of bacteria detected were 54.4% and 17.4%, respectively, significantly higher than those with 3-5 kinds of bacteria detected (P<0.05). CONCLUSION: The prevalence rates of HCMV and EBV was higher in AgP patients than in healthy controls. Herpesviruses and periodontal pathogenic bacteria may cooperate synergistically in the development of AgP, which could be considered as a pathogenetic consortium in future investigation of periodontaltitis.