A new biopsychosocial and clinical questionnaire to assess juvenile idiopathic arthritis: JAB-Q.

OBJECTIVE: To create a new multidimensional questionnaire for the assessment of juvenile idiopathic arthritis (JIA) patients in standard clinical practice and study the validity and reliability of this questionnaire. METHODS: The Juvenile Arthritis Biopsychosocial and Clinical Questionnaire (JAB-Q) was created using the Delphi technique and consensus conference following an initial literature search. The questionnaire has three parts including a clinician form, child form and parent form. This is a patient/parent-centered outcome tool, which helps us to evaluate the biopsychosocial aspects of the patient, including disease activity, posture, functional and psychosocial status, fatigue, and performance in school. From January 2015 to January 2018, 6-18 years old children with JIA were enrolled in the study. The previously validated questionnaires were also applied to each participant to validate the JAB-Q: Juvenile Idiopathic Disease Arthritis Score (JADAS) and Childhood Health Assessment Questionnaire (CHAQ), and the Family Impact Questionnaire (FIS). The same questionnaire was re-administered after one week to assess the test-retest reliability in randomly selected 50 children and their parents. RESULTS: A group of experts were invited to the Delphi survey. After the Delphi tours, the final form of the questionnaire containing three parts as clinician form, child form and parent form was created. This tool was applied to 310 JIA patients and their parents. The children and parents easily handled the JAB-Q and filled the forms in around 10-15 min. The validity of the clinician, child and parents' forms were assessed by the JADAS, CHAQ, and FIS, respectively. The validity of these three scales were determined as moderate. In addition, the test-retest reliability of the clinician, child and parents' forms were considerably high. CONCLUSION: JAB-Q is a valid and reliable multidimensional biopsychosocial outcome tool that can be used routinely in clinical practice of pediatric rheumatology. The main advantage of this tool is incorporation of patients' and parents' perspectives separately while providing a practical and standard setting for the clinician's evaluation. However, further validation of this tool in an independent cohort is needed to improve its applicability.

Caries detection with DIAGNOdent and ultrasound.

OBJECTIVE: The objective of this study was to evaluate the repeatability of 2 nondestructive caries detection methods, ultrasound (ULS) and DIAGNOdent, for the detection of approximal caries lesions, and to evaluate 2 tips provided for the DIAGNOdent. STUDY DESIGN: White/brown-spot lesions (n = 42) were captured by a digital camera, and measured by test methods and confocal laser scanning microscope (CLSM). Intra- and inter-observer reliability, accuracy, and Cohen's kappa and Spearman's rho statistics were used. RESULTS: At DIAGNOdent, intra-observer agreements were 78.5%, 66.7% for A tip and 59.5%, 47.6% for B for 2 examiners, respectively. Accuracy of both tips was 50% for the first examiner; 45.3% for A and 47.6% for the B tip for the second examiner. All ULS measurements were accurate, reliable, and positively and significantly correlated between examiners. CONCLUSION: The A tip of the DIAGNOdent was found to be better than the B tip for the detection of enamel caries. All DIAGNOdent and ULS measurements were positive and significantly correlated for both examiners. Both methods demonstrated high repeatability and accuracy.

The Tinnitus Handicap Inventory: a study of validity and reliability.

Our aim was to compose a Turkish version of the Tinnitus Handicap Inventory (THI). Each of two individuals independently translated and retranslated the English version of the THI, and it was adapted by an expert team. The Turkish version of the THI was completed by 110 tinnitus patients. We assessed the internal consistency and reliability of the Turkish version by Cronbach's alpha. We assessed test-retest reliability with a second investigation in 21 patients. We assessed construct validity by analyzing the patients according to their age and to tinnitus duration. Internal validity was tested by multi-item analysis, to assess item convergence and discriminant validity. We obtained high internal consistency and reliability with the Cronbach's alpha coefficient (0.88) and high intraclass correlation coefficient (ICC, 0.78-0.90). Test-retest correlation coefficient scores were highly significant. The Turkish version of the THI is a highly consistent and reliable measure that can be used in evaluating symptoms in tinnitus patients.

Levels of interleukin-8 during tooth movement.

A host-derived neutrophil-activating cytokine interleukin-8 (IL-8) is secreted mainly by monocytes and is considered to be important in regulating alveolar bone resorption during tooth movement. The aim of this study was to evaluate the levels of IL-8 during mechanical forces on periodontal tissues at different stages of orthodontic therapy. Ten canine teeth of patients having different Angle classifications were selected for the study. After the premolars were extracted, the maxillary/mandibular canines were tipped distally. Gingival crevicular fluid was sampled from mesial and distal gingival crevices of each canine separately at baseline and one hour, 24 hours, six days, 10 days, and 30 days after the application of the force. An enzyme-linked immunosorbent assay for quantitative detection of IL-8 was used. Although there was an increase in the concentration of IL-8 at tension (mesial) sites after one hour, 24 hours, six days, and 10 days, a decrease was observed at 30 days. Pressure (distal) sites did not demonstrate such an increase at any period except at 10 days. However, the concentration of IL-8 at both sites showed a similar decrease and approached each other at day 30. We concluded that local host response toward the orthodontic forces might lead an increase in IL-8 and neutrophil accumulation, and this may be one of the triggers for bone remodeling processes.

The effect of dental profile on daily functions of the elderly.

The aim of the study was to evaluate statistically dentition and its effect on daily functions for a group of elderly volunteers. The study was conducted on 144 elderly people (86 males, 58 females) living in different nursing homes in Ankara, Turkey. Their ages varied between 60 and 100 years. Data assessed as dentition variables were number of teeth remaining and prosthesis use. Nearly 55% of the residents were edentulous and removable prosthesis users. The mean number of remaining teeth in subjects aged 60-69 was highest for all age groups in both sexes. The level of education and dental insurance of these subjects were also correlated with the dentition of elderly subjects. We found a statistically significant increase in the number of removable prosthesis users among educated and insured subjects. Functional capacity was better when the subjects had more remaining teeth or a removable prostheses. It is revealed by this study that healthy and good dentition prevents the decline of daily function and improves the social interaction and general well being of the elderly.

Validation of 2001 Partin tables in Turkey: a multicenter study.

OBJECTIVE: Although Partin tables were developed in United States to predict the stage of prostate cancer preoperatively, they are used by many clinics throughout the world assuming that these figures apply to their population as well. However the predictive value of current Partin tables, which was updated in 2001, has not been validated in most of the countries as well as in Turkey. Therefore, we evaluated the validity of 2001 Partin tables, for the ability to predict the pathological stage in Turkish patients. PATIENTS AND METHODS: The clinical and pathological findings of 1043 patients who have had radical prostatectomy were assessed. Serum PSA values, clinical stage, biopsy Gleason score and the pathological features of the radical prostatectomy specimens were collected from each clinic and evaluated. The predictive value of Partin nomogram and pathological findings of prostatectomy specimens were compared and analyzed according to Receiver Operating Characteristics (ROC) analysis. RESULTS: Median age of the patients was 60 (45-74). In the presented study, percentage of patients with clinical stage T1c was 43%. Patients with Gleason score of 2-4 in biopsy constituted 23.4% of the study group. In the present study, the ratio of the patients with serum PSA higher than 10 ng/ml was 39.6%. Organ confined disease, seminal vesicle involvement, lymph node metastases ratios were 64.7%, 10.3%, 1.8% respectively. Area Under Curve (AUC) values for organ confined disease, seminal vesicle involvement and lymph node involvement were calculated as 0.665, 0.733 and 0.759 respectively. CONCLUSION: It appears that Partin tables have a reasonable predictive value for the final pathological features like organ confined disease, seminal vesicle and lymph node involvement in Turkish patients. This multicenter study showed that current Partin tables could also be used in Turkish patients with comparable accuracy.

Value of technetium scintigraphy and iodine uptake measurement during follow-up of differentiated thyroid cancer.

UNLABELLED: Measurement of serum thyroglobulin (Tg) levels and I-131 whole body scintigraphy (WBS) are used in the follow-up of patients with differentiated thyroid cancer (DTC). This study was designed to evaluate the significance of persistent I-131 uptake in the thyroid bed in patients with DTC following surgery and/or radioactive iodine ablation. Tc-99m thyroid scintigraphy (TS) and I-131 thyroid uptake (IU) were also performed to determine their clinical impact on patient management. PATIENTS AND METHODS: Sixty-two non-metastatic patients (14 men, 48 women) with a mean age of 44 years (range: 16-75) who had undergone surgical thyroidectomy for DTC were evaluated prospectively. All patients had undergone technetium and iodine scintigraphy (IS). Although serum Tg levels were measured in all patients, IU was available in 36. RESULTS: Tg values were in the range of 0.2-24 ng/ml (median: 0.2 ng/ml) when patients were in the hypothyroid state. I-131 WBS detected residual tissue in the neck in 30 patients (48%); however TS was positive in only 12 (19%). I-131 uptake in the thyroid bed ranged from 0 to 14% (median: 0.1%). Twelve of 13 patients with positive IS and negative TS had uptake values < or = 0.3% (p < 0.00001). When IU values were < or = 0.3%, 54% of our patients did not have any uptake in the thyroid bed on TS or IS, whereas when IU was > 0.3%, 80% of patients had neck uptake on both TS and IS (p < 0.00001). CONCLUSION: The results of this study demonstrate that the concordance of IS and TS depends on the IU level after suspension of replacement therapy. Measurements of IU and TS are of considerable value in evaluating patient response to therapy and will substantially reduce the need for repetitive radioiodine scans and unnecessary treatment doses in patients with undetectable Tg values.

Clinical evaluation of a polyacid-modified resin composite-based fissure sealant: two-year results.

A 24-month clinical study was carried out to evaluate and compare the retention rate, marginal integrity and caries preventing effects of a polyacid-modified resin composite based fissure sealant, Dyract Seal, to that of a resin based fluoride fissure sealant, Delton FS+. Fifty-three patients (27 female and 26 male), 7 to 10 years old, were included in the study. At baseline, a total of 192 permanent first molars were sealed with either fissure sealant (n=96, each), using invasive technique. The sealed teeth were evaluated at post-operative 3, 6, 12 and 24 months with respect to evaluation parameters. The data were analyzed with the Chi-Square tests where alpha=0.05. There were no statistically significant differences between fissure sealants as regards to retention and prevention of caries for all periods of the evaluation (p>0.05). However, regarding marginal integrity of the sealants, Delton FS+ gave significantly better results than Dyract Seal for the 3-, 6- and 12-month evaluations, respectively (p<0.05). In conclusion, the use of Dyract Seal on permanent molars with invasive technique was found to be clinically comparable to Delton FS+ for the 24-month evaluation period.

The expression of p53, p16 proteins and prevalence of apoptosis in oral squamous cell carcinoma. Correlation with mode of invasion grading system.

OBJECTIVE: Inactivation of p53 and p16 tumor suppressor genes, and apoptosis which is crucial in carcinogenesis have commonly been studied in oral squamous cell carcinoma (OSCC). However, their prognostic value has not yet been clearly established. METHODS: This study was conducted in the Department of Oral Pathology, Faculty of Dentistry, Gazi University, Ankara, Turkey during the period 2002 to 2003 on formalin-fixed paraffin embedded tissue specimens of 12 lip and 18 intraoral primary squamous cell carcinoma cases. The expression of p53 and p16 proteins were studied by immunohistochemistry, and the apoptosis by TdT-mediated dUTP-biotin nick end-labeling (TUNEL) methods. The possible prognostic value of p53, p16 expression and apoptotic index (AI) value in OSCC were examined on the basis of their correlation with mode of invasion (MI) grading system. RESULTS: Seven lip (58%) and 9 intraoral cancer (50%) cases showed p53 positivity; where 5 lip (42%) and 15 intraoral cancer (83%) cases showed loss of p16 protein. P53 positive cases increased parallel to MI grade where the AI value decreased. There was not any correlation either between p16 expression and MI grade or AI value. The mean AI value was found as 1,884. Apoptotic index values were higher in invasive site of tumors, and it was statistically significant in MI grade 2 OSCC cases. Apoptotic index value of both central and invasive sites were lowest in MI grade 4 cases. CONCLUSION: The present findings revealed that p53 mutations alone, may play a role in pathogenesis of lip cancers but not in intra OSCC. P16 may have a greater role in the development of intra OSCC. P53 positivity and low AI value may be a predictor of poor prognosis in OSCC.

Evaluation of intense neuromuscular blockade caused by rocuronium using posttetanic count in male and female patients.

STUDY OBJECTIVE: To establish the relationship between train-of-four (TOF) nerve stimulation and the number of posttetanic twitches (posttetanic count [PTC]) during neuromuscular blockade caused by rocuronium in males and females. DESIGN: Prospective, observational, clinical comparison. SETTING: Operating room of a university hospital. PATIENTS: 60 ASA physical status I and II patients (30 women and 30 men), aged 18 to 60 years, who were scheduled for elective orthopedic surgery and ear, nose, throat surgery with a planned duration of 2 hours. INTERVENTIONS; During fentanyl, propofol, and nitrous oxide (N(2)O) anesthesia, neuromuscular blockade was evaluated with accelerometry of the thumb using TOF and posttetanic twitch stimulation (PTTS) of the ulnar nerve in patients who received rocuronium 1 mg.kg(-1). MEASUREMENTS AND MAIN RESULTS: The first responses to PTTS were seen at mean times of 34.9 and 37.7 minutes after rocuronium injection in male and female patients, respectively (NS). The average interval between the appearance of a posttetanic response and the first response to TOF stimulation (T1) was not significantly different between male and female patients (15.4 +/- 4.8 min (SD) vs. 15.9 +/- 4.9 min, respectively). There was a significant negative correlation between PTC and the time to first response to TOF nerve stimulation (r = -0.83; p = 0.0001). Gender did not have a statistically significant effect on this relation (F = 0.9; p = 0.34). The intervals from administration of rocuronium to the first appearances of T1 and T2 were not significantly different between the two groups, but the intervals to the first appearances of T3 and T4 were significantly longer in female patients. CONCLUSIONS: Even though the times from initial administration of rocuronium 1 mg.kg(-1) to the first appearances of T3 and T4 are significantly longer in female patients, the intervals to the first detectable responses to PTTS and TOF are not significantly different between females and males. Gender has no significant effect on the relation between PTC and the time to T1.

Comparative clinical study of connective tissue graft and two types of bioabsorbable barriers in the treatment of localized gingival recessions.

BACKGROUND: Localized buccal recessions occur in more than 60% of individuals; therefore, there is a need for predictable root coverage techniques. The objective of the present study was to evaluate the clinical effectiveness of the guided tissue regeneration (GTR) procedure versus connective tissue graft (CTG) in the treatment of localized gingival recessions over a 12-month postoperative period. METHODS: Thirty bilateral matched pairs of localized buccal recessions in 22 patients were treated with CTG and GTR in this study. For the GTR procedure, two types of bioabsorbable barriers, polylactide/polyglycolide acid (PLGA) and solvent dehydrated duramater allograft (SDDA) membranes, were used and CTG was obtained from the palatal mucosa. The selected pairs of teeth were randomly assigned to one of three groups (10 pairs per group): group 1, PLGA (10 recessions) or CTG (10 recessions); group 2, SDDA (10 recessions) or CTG (10 recessions); or group 3, PLGA (10 recessions) or SDDA (10 recessions). Statistical analysis evaluated both intra- and intergroup measurements. The height of gingival recession (GR), width of keratinized tissue (KT), clinical attachment level (CAL), and probing depth (PD) were assessed at baseline and at 6, 9, and 12 months following surgery. RESULTS: The amount of root coverage was 74.3%, 69.6%, and 86.3% with PLGA, SDDA, and CTG, respectively. The gain in KT was significant in the CTG group (P<0.05). No significant differences were observed among the three groups with respect to PD and CAL. CONCLUSIONS: Results of this study indicate that all techniques led to an improvement of all clinical parameters except PD from baseline. However, CTG increased KT considerably compared to GTR. The final esthetic results were similar for the two membranes and connective tissue graft.

The early tissue response to titanium and LactoSorb screws.

Fractures of the maxillofacial region are common in the elderly people. Titanium and LactoSorb screws are the widely accepted materials for use in the maxillofacial fractures. This study was undertaken to evaluate the early tissue response following the insertion of both titanium and LactoSorb screws composed of 82% PLLA and 18% PGA in an elderly animal model. In this study, 22 titanium and 22 LactoSorb screws were applied to calvaria of 44 guinea pigs that were 10-11 months old. Animals were sacrificed on postoperative days 3, 7, 14, 30 and 60. Screws were retrieved with surrounding bone tissue and the specimens were prepared for routine histologic examination. All the specimens were evaluated by light microscopy. Histometric analysis revealed that there was no significant difference between LactoSorb and titanium screws for the new bone formation. The biodegradation of LactoSorb screws was not complete by the end of day 60. In conclusion, both materials were well tolerated and induced bone formation without causing adverse tissue response in an elderly animal model. Our results suggest that both LactoSorb and titanium miniplates and screws can be used safely, regardless of the increasing age. However, LactoSorb may be the first choice as it does not require a second operation for removal and has late biodegradation in elderly that keeps its support for a relatively longer time during fracture healing.

Scintigraphic evaluation of salivary gland dysfunction in patients with thyroid cancer after radioiodine treatment.

PURPOSE: Sialadenitis is a well-recognized adverse effect of high-dose radioactive iodine treatment. This study was undertaken to determine whether Tc-99m pertechnetate salivary gland scintigraphy may be used for objective assessment of salivary gland function in patients with thyroid cancer treated with I-131. PATIENTS AND METHODS: The study group consisted of 71 patients (16 men, 55 women) with a mean age of 44 years (range, 16 to 73 years). Twenty-six (37%) patients were not given any radioiodine, and 18, 16, and 11 patients received doses of 100, 150, or 200 mCi (or higher), respectively. Parotid and submandibular glands were evaluated based on a four-grade scoring system. Correlation between the type of surgery, administered dose, time since therapy, subjective symptoms, and findings of salivary gland scintigraphy were evaluated. RESULTS: Subjective symptoms were questioned in 39 of the 45 patients who received radioactive iodine treatment. Fifty-four percent (21 of 39) of the patients reported xerostomia, of whom 86% (18 of 21) showed salivary gland dysfunction. Objective salivary gland dysfunction was observed in 69% (31 of 45) of patients. In 81% of the patients, the parotid glands were affected; in 13% of the patients, the submandibular glands were affected; and in 6%, both were affected ( < 0.000001). The frequency of salivary gland dysfunction showed a dose dependence to cumulative activity ( = 0.007). A greater complication rate was observed in patients with total thyroidectomy compared with subtotal surgery, although the correlation was not significant ( = 0.625). CONCLUSIONS: Parenchymal damage to the salivary glands induced by radioactive iodine treatment can be evaluated by salivary gland scintigraphy. The impairment is worse in the parotid glands and increases with the total dose.