Comparisons of home and daytime ambulatory blood pressure measurements.

BACKGROUND: Home (HBPM) and ambulatory (ABPM) blood pressure measurements have their advantages and disadvantages in diagnosing and managing hypertension. We studied HBPMs and ABPMs in volunteers taking part in a survey. METHODS: Of 366 respondents, 270 provided a total of 5997 triplicate HBPMs (Part 1); 175 also provided data on ABPMs, of which the measurements obtained between 6 am and 10 pm were used in this study (Part 2). RESULTS: Part 1, When all 5997 triplicate HPPMs were considered, 1st readings tended to be significantly higher than those of the 2nd and 3rd for both, systolic and diastolic pressures, but when the consideration was restricted to the very first triplicate of each of the 270 subjects, this was true only for systolic HBPM. Part 2, The ABPMs tended to have a wider range than the corresponding HBPMs, and to be distributed towards higher values. Of the non-parametric indices of (ABPM - corresponding HBPM), (First Quartile, Median, Third Quartile and Maximim) all but the minima had positive values. CONCLUSIONS: In triplicate HBPMs, the first measurement is usually but not always the highest. Increasing the number of triplicates provided by each subject increases the chance of discriminating between measurements in the triplicates. ABPMs tended to be higher than the corresponding HBPMs.

Formation of a functional thymus initiated by a postnatal epithelial progenitor cell.

The thymus is essential for the generation of self-tolerant effector and regulatory T cells. Intrathymic T-cell development requires an intact stromal microenvironment, of which thymic epithelial cells (TECs) constitute a major part. For instance, cell-autonomous genetic defects of forkhead box N1 (Foxn1) and autoimmune regulator (Aire) in thymic epithelial cells cause primary immunodeficiency and autoimmunity, respectively. During development, the thymic epithelial rudiment gives rise to two major compartments, the cortex and medulla. Cortical TECs positively select T cells, whereas medullary TECs are involved in negative selection of potentially autoreactive T cells. It has long been unclear whether these two morphologically and functionally distinct types of epithelial cells arise from a common bi-potent progenitor cell and whether such progenitors are still present in the postnatal period. Here, using in vivo cell lineage analysis in mice, we demonstrate the presence of a common progenitor of cortical and medullary TECs after birth. To probe the function of postnatal progenitors, a conditional mutant allele of Foxn1 was reverted to wild-type function in single epithelial cells in vivo. This led to the formation of small thymic lobules containing both cortical and medullary areas that supported normal thymopoiesis. Thus, single epithelial progenitor cells can give rise to a complete and functional thymic microenvironment, suggesting that cell-based therapies could be developed for thymus disorders.

Er:YAG laser treatment in supportive periodontal therapy.

OBJECTIVE: To assess clinical and microbiological outcomes of an Er:YAG laser in comparison with sonic debridement in the treatment of persistent periodontal pockets in a prospective randomized controlled multicentre study design. MATERIAL AND METHODS: A total of 78 patients in supportive periodontal therapy with two residual pockets were included, 58 were available for the whole follow-up period. Root surfaces were instrumented either with a sonic scaler (Sonicflex(®) 2003 L) or with an Er:YAG laser (KEY Laser(®) 3). Clinical attachment levels (CAL), Probing depths (PD), Plaque control record (PCR) and Bleeding on probing (BOP) were assessed at baseline, 13 and 26 weeks after treatment. In addition, microbiological analysis was performed employing a DNA diagnostic test kit (micro-IDent(®) Plus). RESULTS: Probing depths and CAL were significantly reduced in both groups over time (p < 0.05), without significant differences between the groups (p > 0.05). BOP frequency values decreased significantly within both groups (p < 0.05), with no difference between the laser and the sonic treatment (p > 0.05). PCR frequency values did not change during the observation period (p > 0.05). Microbiological analysis failed to expose any significant difference based on treatment group or period. CONCLUSION: Employing both sonic and laser treatment procedures during supportive periodontal care, similar clinical and microbiological outcomes can be expected.

Effect of in-office tooth bleaching on the microhardness of six dental esthetic restorative materials.

OBJECTIVES: The aim of this in vitro study was to evaluate the effect of the in-office bleaching technique on the microhardness of six dental esthetic restorative materials. METHODS: Four composite resins (a hybrid, a flowable, a micro-hybrid and a nano-hybrid), an ormocer and a ceramic were tested, after the use of an in-office bleaching product. Fourteen specimens of each composite and the ormocer were fabricated and randomly divided into two groups of seven samples each. One group was polished and the other group remained unpolished. For the ceramic, seven polished samples were fabricated. Two samples of each group were used as negative controls. The specimens were bleached for 15, 30 and 45min. Five Knoop microhardness measurements were made on each sample, for each of the following periods tested: before bleaching, after 15, 30 and 45min of bleaching, 24h and 1 month after the bleaching procedure. Data were analyzed by the repeated measures analysis of variance with three between factors and one within. RESULTS: The differences in the microhardness values between the bleached and the control samples for the composites and the ceramic, were not statistically significant (hybrid: p=0.264; flow: p=0.584; micro-hybrid: p=0.278; nano-hybrid: p=0.405; ceramic: p=0.819). For the ormocer, although bleaching did not have any significant effect on the unpolished samples (p=0.115), it caused an increase on microhardness of the polished samples. SIGNIFICANCE: Bleaching with 38% hydrogen peroxide does not reduce the microhardness of the restorative materials tested. Therefore, no replacement of restorations is required after bleaching.

Effect of dentifrice containing 5000 ppm fluoride on non-cavitated fissure carious lesions in vivo after 2 weeks.

PURPOSE: This randomized clinical trial compared the ability of two dentifrices, one containing 5000 ppm fluoride (Duraphat) and the other 1450 ppm fluoride (Caries Protection, control) to reverse non-cavitated fissure carious lesions. METHODS: 30 adults having occlusal lesions with DIAGNOdent values between 10 and 20 were randomly assigned to two groups of 15 participants each. DIAGNOdent measurements were performed after cleaning the teeth with cleaning brushes and after additional cleaning using an airflow device. The participants were instructed to brush their teeth three times a day for 3 minutes after the meals with a 2 cm line of their assigned dentifrice. After a period of 2 weeks, the teeth were cleaned again with the airflow device and laser fluorescence measurement was performed. RESULTS: The group using the dentifrice containing 5000 ppm showed a significantly higher decrease in laser fluorescence (21%) over the test period than the control group (4%; P< 0.001; repeated measures ANOVA). The decrease in laser fluorescence in the test group was significant (P< 0.001; Wilcoxon signed-rank test). The difference between cleaning the teeth with cleaning brushes and additional cleaning with airflow before DIAGNOdent measurement was not statistically different (P> 0.05; Wilcoxon signed-rank test).

Clinical evaluation of the measuring accuracy of ROOT ZX in primary teeth.

OBJECTIVE: The aim of this study was to assess the accuracy of an electronic device (Root ZX; Morita, Tokyo, Japan) for measuring the root canal length in primary teeth. STUDY DESIGN: The pulp tissue was removed from 71 nonrestorable teeth scheduled to be extracted under general anesthesia, and the root canals (n = 105) were irrigated (H(2)O(2), 3%; NaOCl, 1%). Subsequently, the length was determined clinically with the electronic device prior to extraction. Treatments were performed by 2 dentists (42 and 63 root canals). After extraction, the real length was recorded and the 2 measurements were compared. RESULTS: Measurements were affected significantly by the dentists (P < .01; chi(2)). However, regression analysis revealed sufficient accuracy of the device, with a tendency to estimate the root canal length just short (x = -0.98 +/- 1.75 mm) of the apex. These results were not influenced by tooth type, root canal type, status of the periapex, or clinical condition (P > .05; chi(2)). CONCLUSION: Root ZX can be strongly recommended for clinical implementation of endodontics in primary teeth, particularly when treating fidgety children.

Does harvesting connective tissue grafts from the palate cause persistent sensory dysfunction? A pilot study.

OBJECTIVE: The use of connective tissue grafts is a proven, effective treatment modality. This study examines whether harvesting connective tissue grafts from the palate causes persistent sensory dysfunction. METHODS AND MATERIALS: Fourteen patients who had received at least 1 graft were included. Neurosensory tests at the palate performed postoperatively included minimal 2-point discrimination, soft-touch discrimination, pin-tactile discrimination, and thermal discrimination. Measurements were taken at 3 sites each: 5, 10, and 15 mm from the palatal tissue margin at canines, premolars, and first molars. RESULTS: Eight patients had 1 graft, and 6 patients had 2 grafts harvested from their palate. Twelve patients had never noticed any dysfunction. Two patients reported a persistent numbness or a rough palatal surface. Statistically significant differences between donor sites and nondonor sites were shown by 2-point discrimination 5 mm from the margin of canines (6.57 mm +/- 3.79 mm at donor sites and 4.71 mm +/- 4.14 mm at nondonor sites, P = .01). Repeated-measures analysis of variance showed statistically significant differences between donor sites and nondonor sites for measurements taken 5 and 10 mm from the margin of all included teeth (P = .02). CONCLUSIONS: Some sensory changes can occur after graft harvesting from the palate.

Sage extract rich in phenolic diterpenes inhibits ultraviolet-induced erythema in vivo.

The leaves of sage (Salvia officinalis L., Lamiaceae) contain high amounts of phenolic diterpenes such as carnosol and carnosic acid. These compounds display antioxidant and anti-inflammatory effects in vitro. Here, we have investigated the anti-inflammatory potency of a sage extract (SE) rich in phenolic diterpenes in vivo using the ultraviolet (UV) erythema test. In a prospective randomised double-blind placebo-controlled study, test areas on the backs of 40 healthy volunteers were irradiated with the 1.5-fold minimal erythema dose. Subsequently, the test areas were treated occlusively with 2% SE in a hydrophilic ointment, compared to 1% hydrocortisone and 0.1% betamethasone as positive controls, and the vehicle alone as placebo. Erythema values were measured photometrically prior to irradiation and after 48 hours. Compared to placebo, SE significantly reduced the ultraviolet-induced erythema, to a similar extent as hydrocortisone. These data suggest that SE might be useful in the topical treatment of inflammatory skin diseases.

Intravenously administered immunoglobulin in the treatment of childhood Guillain-Barré syndrome: a randomized trial.

OBJECTIVE: To determine the optimal treatment for childhood Guillain-Barré syndrome (GBS). METHODS: We performed a randomized, multicenter study of GBS according to international diagnostic criteria. In study 1 (early treatment), children able to walk unaided for 5 meters were randomized for 1 g/kg intravenously administered immunoglobulin (IVIG) over 2 days or no treatment. The primary outcome measure was the degree of disability at nadir. In study 2 (treatment for severe GBS), children unable to walk 5 meters unaided were randomized for 1 g/kg IVIG over 2 days or 0.4 g/kg IVIG over 5 days. The primary outcome measure was the number of days needed to regain the ability to walk unaided. Children randomized for no treatment in study 1 could enter study 2 if loss of unaided walking occurred. RESULTS: Ninety-five children with GBS were registered in 40 months. Twenty-one children were randomized in study 1 and 51 in study 2 (5 after deterioration in study 1). Twenty-eight children were not randomized for various reasons. Eleven of 21 patients in study 1 lost the ability to walk unassisted and 6 were bedridden, with no statistically significant difference between the children initially randomized for treatment versus no treatment. Recovery occurred faster in the group randomized for early treatment. In study 2, recovery did not differ significantly between the children treated for 2 days versus 5 days (median time to unaided walking: 19 days vs 13 days). Secondary transient deterioration in the disability score occurred more frequently in the group with the 2-day regimen than in the group treated for 5 days (5 of 23 patients vs 0 of 23 patients). Multivariate analysis with Cox regression showed that disease severity at the nadir was the only prognostic factor for recovery. CONCLUSIONS: Treatment with IVIG before loss of unaided walking did not give rise to a less severe course, but recovery occurred somewhat faster. However, given the small number of patients, the power of this conclusion is low. For treatment after loss of unaided walking, there was no significant difference in the effectiveness of 2 g/kg IVIG administered over 2 days versus 5 days. Early "relapses" occurred more frequently after the shorter treatment regimen.

Antibody to streptococcal cysteine proteinase as a seromarker of group A Streptococcal (Streptococcus pyogenes) infections.

Serological tests are commonly employed to aid the diagnosis of Streptococcus pyogenes infections, particularly when non-suppurative sequelae are suspected. Conventional laboratory practice is to measure antibody levels to various combinations of the extracellular group A Streptococcus (GAS) antigens streptolysin O (SLO), DNase B, streptokinase and hyaluronidase. Antibody to the extracellular cysteine proteinase streptococcal pyrogenic exotoxin B (SPE B) and its precursor zymogen is also produced in response to GAS infections. An indirect hemagglutination test for antibody to zymogen/SPE B was established and evaluated in serum samples from 168 patients with proven (n = 27) or suspected GAS (n = 141) infections, which were also screened for antibodies using the 4 conventional tests. For comparison, sera from 56 patients infected with a variety of other pathogens, as well as sera from 16 patients infected with either S. agalactiae or S. pneumoniae and 34 sera from healthy subjects, were tested. Statistical analysis confirmed that antibody to zymogen/SPE B is a serological marker that can discriminate GAS infections. It can be ranked with the anti-SLO titer, currently the most widely used test, as a marker of an antecedent GAS infection.