Effectiveness of three different types of educational methods on implementation of proper oral hygiene behaviour prior to orthodontic treatment.

OBJECTIVE: The aim of this study was to compare three teaching methods' time and personnel requirements, and their effects on plaque and gingival indices. METHODS: This study was a single-blind randomized controlled trial on fixed orthodontic appliance candidates (n = 90), assigned into a control group (n = 30) and two different study groups (n = 30 each). The control group received standard printed educational material and was assisted with verbal information. The study groups either received video-assisted or hands-on training about fixed orthodontic appliance and oral hygiene. The time requirements for all three educational interventions was recorded during the initial visit. The adequacy of oral hygiene was documented through plaque and gingival indices during the initial visit and eighth week of the treatment. The continuous variables were analyzed using 1-way ANOVA. Tukey HSD and Student t-tests were used for post-hoc comparisons (α?#8197;= 0.05). Also, a chi-square test was used for the analysis of categorical variables. RESULTS: Standard education failed to maintain the plaque and gingival indices at the eighth week of the treatment. Although both video-assisted and hands-on training took a considerable amount of time, they served well in preserving both of the indices at the eighth week. The longer the educational intervention was, the better the preservation of the plaque and gingival indices. CONCLUSION: Educational intervention, either with video-assisted or hands-on programs, provided better results in oral hygiene depending on the time and personnel constraints of the orthodontist.

Effectiveness of three different types of educational methods on implementation of proper oral hygiene behaviour prior to orthodontic treatment

ABSTRACT Objective: The aim of this study was to compare three teaching methods' time and personnel requirements, and their effects on plaque and gingival indices. Methods: This study was a single-blind randomized controlled trial on fixed orthodontic appliance candidates (n = 90), assigned into a control group (n = 30) and two different study groups (n = 30 each). The control group received standard printed educational material and was assisted with verbal information. The study groups either received video-assisted or hands-on training about fixed orthodontic appliance and oral hygiene. The time requirements for all three educational interventions was recorded during the initial visit. The adequacy of oral hygiene was documented through plaque and gingival indices during the initial visit and eighth week of the treatment. The continuous variables were analyzed using 1-way ANOVA. Tukey HSD and Student t-tests were used for post-hoc comparisons (α?#8197;= 0.05). Also, a chi-square test was used for the analysis of categorical variables. Results: Standard education failed to maintain the plaque and gingival indices at the eighth week of the treatment. Although both video-assisted and hands-on training took a considerable amount of time, they served well in preserving both of the indices at the eighth week. The longer the educational intervention was, the better the preservation of the plaque and gingival indices. Conclusion: Educational intervention, either with video-assisted or hands-on programs, provided better results in oral hygiene depending on the time and personnel constraints of the orthodontist.

RESUMO Objetivo: O objetivo do presente estudo foi comparar a duração e os pré-requisitos de equipe de três métodos de orientação ao paciente, e seus efeitos sobre os índices de placa e de sangramento gengival. Métodos: Esse foi um estudo controlado aleatório cego em candidatos (n=90) a tratamento ortodôntico fixo, que foram divididos em um grupo controle (n=30) e dois grupos de estudo (n= 30 cada). O grupo controle recebeu material educacional impresso e foi orientado com informações verbais. Os grupos de estudo receberam treinamento em formato de vídeo ou treinamento hands-on sobre o tratamento com Ortodontia fixa e higiene bucal. O tempo necessário para cada um dos três tipos de treinamento foi registrado durante a visita inicial. A qualidade da higiene bucal foi avaliada por meio dos índices de placa e de sangramento gengival durante a visita inicial e na oitava semana de tratamento. As variáveis contínuas foram analisadas utilizando-se one-way ANOVA. Os testes HSD de Tukey e t de Student foram utilizados para comparações post-hoc (α?#8197;= 0,05), e o teste qui-quadrado foi utilizado para análise das variáveis categóricas. Resultados: O método de ensino convencional fracassou em manter os índices de placa e de sangramento gengival até a oitava semana de tratamento. Apesar de tanto o método de treinamento com vídeos e de treinamento hands-on demandarem um tempo considerável, eles conseguiram manter ambos os índices até a oitava semana. Quanto mais longa a orientação realizada, melhor foi a manutenção dos índices de placa e de sangramento gengival. Conclusão: Tanto o método de treinamento com vídeo quanto no formato hands-on obtiveram melhores resultados de higiene bucal, mas dependem do tempo e das limitações de equipe de cada ortodontista.

Cytomorphometric Characteristics of Buccal Mucosal Cells in Behçet's Disease Patients.

BACKGROUND: The aim of this study was to compare the cytomorphometric characteristics of the buccal cells of Behçet's disease patients with those of healthy controls. METHODS: This case-control study compared a group of 30 patients with Behçet's disease with an age- and gender-matched control group of 30 healthy individuals. The buccal mucosal smears were stained using the Papanicolaou technique for cytomorphometric analyses. The nuclear and cytoplasmic areas were evaluated using digital image analysis; the ratio of nuclear to cytoplasmic areas and nuclear roundness are presented. RESULTS: The nuclear and cytoplasmic areas of the BD patients' cells were significantly smaller than those of the healthy controls' cells, while the nucleus-to-cytoplasm ratio and neutrophil infiltration rate did not differ significantly between the groups. However, the nuclear area, cytoplasmic area, nucleus-to-cytoplasm ratio, and nuclear roundness factor were significantly higher in patients without aphthae. The neutrophil infiltration rate did not differ significantly in patients with or without aphthae. CONCLUSION: Behçet's disease can produce cytomorphometric changes in buccal cells that are detectable by exfoliative cytology and cytomorphometric analysis techniques.

Reduction of Acute Lung Injury by Administration of Spironolactone After Intestinal Ischemia and Reperfusion in Rats.

PURPOSE: Multiple organ failure, including acute lung injury, is a common complication of intestinal ischemia and reperfusion (I/R) injury and contributes to its high mortality rate. Activated polymorphonuclear neutrophils and reactive oxygen species contribute to the lung injury caused by intestinal I/R. Mineralocorticoid receptor antagonist spironolactone has a protective effect against I/R injury in animal models of retina, kidney, heart, and brain. The aim of the present study is to investigate the effect of aldosterone receptor blocker spironolactone on lung injury induced by intestinal I/R. METHODS: Wistar albino rats were divided into four groups: (1) sham control; (2) intestinal I/R (30 min of ischemia by superior mesenteric artery occlusion followed by 3 h of reperfusion); (3) spironolactone pretreatment (20 mg/kg) + I/R; and, (4) spironolactone pretreatment without I/R. Spironolactone was given orally 3 days prior to intestinal I/R. A marker for lipid peroxidation (malondialdehyde; MDA), an indicator or oxidation state (reduced glutathione; GSH), an index of polymorphonuclear neutrophil sequestration (myeloperoxidase; MPO), inducible nitric oxide synthase (iNOS) immunoreactivity, and the histopathology of the lung tissue were analyzed. RESULTS: Spironolactone pretreatment markedly reduced intestinal I/R-induced lung injury as indicated by histology and MDA and MPO levels. Moreover, the pretreatment decreased the iNOS immunoreactivity. CONCLUSION: The present study strongly suggests that spironolactone pretreatment decreased neutrophil infiltration, iNOS induction, oxidative stress, and histopathological injury in an experimental model of intestinal I/R induced-lung injury of rats.

Decompressive craniectomy for acute subdural haematoma: an overview of current prognostic factors and a discussion about some novel prognostic parametres.

OBJECTIVE: To identify specific factors that can be used to predict functional outcome and to assess the value of decompressive craniectomy in patients with acute subdural haematoma. METHODS: The retrospective study was done at the Zonguldak Karaelwas University Practice and Research Hospital, Turkey, and included 34 trauma patients who had undergone decompressive craniectomy for acute subdural haematoma from 2001 to 2009. At the 30th day of the operation, the patients were grouped as survivors and non-survivors. Besides, based on their Glasgow Outcome Scale, which was calculated 6 months postoperatively, the patients were divided into two functional groups: favourable outcomes (4-5 on the scale), and unfavourable outcomes (1-3 on the scale). The characteristics of the groups were compared using SPSS 15 for statistical analysis. RESULTS: One-month mortality was 38.2% (n = 13) and 6-month total mortality reached 47% (n = 16). Patients with higher pre-operative revised trauma score, Glasgow coma scale, partial anterial pressure of carbon dioxide, arterial oxygen pressure, Charlson co-morbidity index score, blood glucose level, blood urea nitrogen, and lower age had a higher rate of survival and consequently a favourable outcome. Higher platelet values were only found to be a determinant of higher survival at the end of the first month without having any significant effect on the favourable outcome. CONCLUSION: In patients of traumatic acute subdural haematoma whose Glasgow coma scale on arrival was < or = 8, a massive craniectomy along with the evacuation of the haematoma, may be considered as a treatment option for intra-operative and post-operative brain swelling. But in patients with a score of 3 on arrival and bilaterally fixed and dilated pupils, decompressive craniectomy is unnecessary.

A preliminary study about the effects of warm priming solution on oxidative stress and postoperative atrial fibrillation in open heart surgery.

BACKGROUND: An important reason for production of ischemia and reperfusion injury and oxidative stress is the sudden and rapid changes in body temperature during the institution of cardiopulmonary bypass. The aim of this study was to investigate the effects of warm priming solution on oxidative stress and atrial fibrillation. METHODS: This is a preliminary prospective study on a group of 40 patients who underwent elective coronary artery bypass grafting operation using cardiopulmonary bypass. Patients were randomized into two groups, each consisting of 20 patients; one group was primed with a solution at 20 °C and the other at 36 °C initially for cardiopulmonary bypass. Blood samples from both of the groups were drawn preoperatively and at the 15th and 60th min of aortic cross clamping and 24th h following the surgery. Serum malondialdehyde levels, protein carbonyl content and total antioxidant status were detected. Patients were followed for postoperative atrial fibrillation. RESULTS: Malondialdehyde and protein carbonyl content were found to be significantly higher and total antioxidant status was concordantly lower in the cold priming group at the 15th and 60th min, recovering to the normal range postoperatively at the 24th h. Patients in the cold priming group had developed a significantly higher rate of atrial fibrillation when compared with the patients in the warm priming group during the postoperative period. CONCLUSION: In conclusion, although this study has its limitation about the sample size it may provide an insight about the probable preventive effects of 36 °C warm priming solution in oxidative stress and postoperative atrial fibrillation.

Placental chorangiosis: the association with oxidative stress and angiogenesis.

BACKGROUND/AIMS: Chorangiosis is considered to be strongly associated with fetal, maternal, and placental disorders, and has been found to be correlated with increased fetal morbidity and mortality. In this study, it is aimed to investigate the association of angiogenesis and oxidative stress with the pathogenesis of chorangiosis. METHODS: Expressions of heat shock protein 70 (HSP70), vascular endothelial growth factor-A (VEGF-A) and basic fibroblast growth factor (b-FGF), which are investigated with avidin-biotin-peroxidase method in formalin-fixed, paraffin-embedded sections from placental tissues diagnosed as no chorangiosis (n = 18) and chorangiosis (n = 18), have been evaluated in a semiquantitative manner. RESULTS: There were significant differences between chorangiosis and no chorangiosis cases with respect to birth weight, birth length, and Apgar scores (p < 0.001). Statistically significant (p < 0.001), diffuse and strong expressions with HSP70, VEGF-A and b-FGF were observed in the villous tissue of placental chorangiosis cases when compared with no chorangiosis cases. CONCLUSION: The majority of the chorangiosis cases had an accompanying poor perinatal outcome, and also those with accompanying angiogenesis and increased oxidative stress demonstrated diffuse and strong expressions of HSP70, VEGF-A and b-FGF. The interaction of maternal, placental, and fetal factors with increased oxidative stress and angiogenesis may possibly contribute to this arising pathologic change.

The effect of atorvastatin and its role on systemic cytokine network in treatment of acute experimental colitis.

Inflammatory bowel diseases are characterized by disabilities in gastrointestinal system and defects in mucosal immune system. Statins are 3-hydroxy-3-methyl glutaryl coenzyme A reductase inhibitor and are used to treat hypercholesterolemia in patients with coronary artery and atherosclerotic diseases. Recent studies have demonstrated that statins have immunomodulatory role by effecting different pathways in immune system. In this study, we investigated the effect of atorvastatin and its mechanism on systemic immune response in treatment of trinitrobenzene sulfonic acid (TNBS)-induced colitis mice. We observed that atorvastatin significantly suppressed the severity of TNBS-induced colitis in BALB/c mice. This was manifested in reduced rectal bleeding, decrease in colon length, reduction of histological damage, and improved survival. Concurrently, we investigated the immunomodulatory role of atorvastatin on systemic immune system. We investigated the proinflammatory (IL-1α, IL-6, TNF-α), Th1 (IFN-γ, IL-2), Th2 (IL-4, IL-5, IL-10), and Th17 (IL-17, IL-23) cytokine levels in serum samples of colitis and atorvastatin-administered mice. We discovered that administration of atorvastatin significantly down-regulates systemic TNF-α level and Th17 cytokine levels. Furthermore, atorvastatin treatment switches Th1 type T-cell response toward/to Th2 (IL-4, IL-10) type response.

Demonstration of the histopathological and immunohistochemical effects of a novel hemostatic agent, Ankaferd Blood Stopper, on vascular tissue in a rat aortic bleeding model.

BACKGROUND: Ankaferd Blood Stopper® (ABS) is a folkloric medicinal plant extract used as a hemostatic agent in traditional Turkish medicine. This experimental study investigated the histopathological and immunohistochemical effects of ABS on vascular tissue in a rat model of aortic bleeding. METHODS: Four groups of 11 Wistar albino rats were used. The abdominal aortas of the rats were wounded; an ABS-soaked tampon was applied to rats in Groups 1 and 3, and a plain gauze tampon was applied to rats in Groups 2 and 4 until the bleeding stopped. The bleeding time was recorded. Immediately following sacrificing, the arteriotomy sites from Groups 1 and 2 were removed. The abdominal incisions in Groups 3 and 4 were closed following hemostasis. On Day 7 of the study, Group 3 and 4 rats were sacrificed and the abdominal aorta arteriotomy sites were removed for histopathological and immunohistochemical evaluation. RESULTS: The mean bleeding time in 15 animals in Groups 2 and 4 was 4.9 ± 0.6 s, and in 22 animals in Groups 1 and 3 was 3.1 ± 0.6 s. Distal aortic occlusion was not observed on either Day 1 or 7 in any group. Significantly more widespread and dense endothelial nitric oxide synthase (eNOS) staining was observed in Group 1 animals than Group 2. On Days 1 and 7 after application of ABS, histopathological changes, consisting of necrosis, inflammation, and endothelial cell loss, in the rat abdominal aortas did not differ between Groups 1 and 2. The basophilic discoloration in the ABS group on the operation day was a result of a foreign body reaction and hemosiderin-loaded histiocyte accumulation, which occurred on Day 7. CONCLUSIONS: In this study, hemostasis was successfully achieved with ABS in rat abdominal aortas. No histopathological change was found in the rat abdominal aortas between the ABS and control groups on Days 1 and 7. Further studies on the long-term effects of foreign body reactions and hemosiderin-loaded histiocyte accumulation are required.

Expression of heat shock protein 70 and endothelial nitric oxide synthase in placental tissue of preeclamptic and intrauterine growth-restricted pregnancies.

Ischemia, hypoxia, and elevated vascular resistance disturb placental functions by increasing oxidative stress. Heat shock protein 70 (HSP70) is an oxidative stress marker. Endothelial nitric oxide synthase (eNOS) is a nitric oxide enzyme with a key role in pathologic and physiologic angiogenesis and vasculogenesis. This study was performed to investigate the role of oxidative stress in the pathogenesis of preeclampsia and intrauterine growth-restricted (IUGR) pregnancies by comparing the levels of HSP70 and eNOS in placentas from women with these diseases and those with healthy pregnancies. HSP70 and eNOS were examined using the streptavidin-biotin-peroxidase complex technique on formalin-fixed, paraffin-embedded sections from 135 placental villous tissues obtained from normal pregnancies (n=45) and pregnancies complicated with preeclampsia (n=45) and IUGR (n=45). The intensity of labeling in placental tissues with antibodies to HSP70 and eNOS was scored between 0 and 3, using a semiquantitative scale. HSP70 and eNOS levels were increased in the syncytiotrophoblasts, cytotrophoblasts, and extravillous trophoblast cells of preeclamptic and IUGR placentas (P<0.001), compared with normal pregnancies. However, their levels were increased only in the villous endothelial cells of IUGR placentas (P<0.001). Oxidative stress is thought to play an important role in the pathogenesis of preeclampsia and IUGR pregnancies.

Intrauterine growth restriction and placental angiogenesis.

BACKGROUND: Vascular endothelial growth factor (VEGF), basic-fibroblast growth factor (b-FGF), and endothelial nitric oxide synthase (eNOS) are factors that take part in placental angiogenesis. They are highly expressed during embryonic and fetal development, especially in the first trimester. In this study, we aimed to investigate the role of placental angiogenesis in the development of intrauterine growth restriction (IUGR) by comparing the levels of expression of VEGF-A, b-FGF, and eNOS in normal-term pregnancy and IUGR placentas. METHODS: The expression of VEGF-A, b-FGF, and eNOS was studied using the avidin-biotin-peroxidase method in placental tissues diagnosed as normal (n = 55) and IUGR (n = 55). Results were evaluated in a semi-quantitative manner. RESULTS: The expression of all the markers was significantly higher (p < 0.001) in cytotrophoblasts, syncytiotrophoblasts, extravillous trophoblasts, vascular smooth muscle cells, chorionic villous stromal cells, and villous vascular endothelial cells of the IUGR placentas when compared with those collected from normal-term pregnancies. CONCLUSION: Increased expression of VEGF-A, b-FGF, and eNOS may be the result of inadequate uteroplacental perfusion, supporting the proposal that abnormal angiogenesis plays a role in the pathophysiology of IUGR.

The evaluation of serum cystatin C, malondialdehyde, and total antioxidant status in patients with metabolic syndrome.

BACKGROUND: This study was designed to determine if serum cystatin C (Cys C) levels are affected by metabolic syndome and whether they correlate with lipid peroxidation and total antioxidant status (TAS) in this disorder. MATERIAL/METHODS: Cases with metabolic syndrome diagnosed according to the ATP III criteria (18 females, 12 males) were compared with healthy control subjects (20 females, 17 males) matched by age and gender. Plasma Cys C, malondialdehyde (MDA), and TAS levels were studied. RESULTS: Compared with the controls, Cys C and MDA levels were significantly higher (p<0.001 and p<0.001, respectively), whereas TAS was lower (p<0.001) in metabolic syndrome patients. A significant positive correlation between MDA and Cys C (r=0.308, p<0.05) and a significant negative correlation between TAS and Cys C levels (r=-0.358, p<0.01) were found. CONCLUSIONS: As Cys C and MDA levels increased but TAS decreased, Cys C may be an important indicator in the pathogenesis of metabolic syndrome.

Immunohistochemical comparison of traditional and modified harvesting of the left internal mammary artery.

The left internal mammary artery is the conduit of choice for coronary artery bypass grafting. In the traditional ("clipped-artery") harvesting technique, this artery is prepared as a pedicle; the distal part is clipped, cut, and covered with a papaverine-soaked cloth until anastomosis is performed. In modified ("nonclipped-artery") harvesting, the prepared artery is kept in situ and left connected to the systemic circulation until anastomosis. Better outcomes from use of the nonclip technique have been reported. In order to determine comparative endothelial integrity and endothelial nitric oxide synthase activity, we performed an immunohistochemical study of arterial graft segments that were procured by each technique. This cross-sectional study involved 40 patients who underwent elective coronary artery bypass grafting. The patients were randomized into 2 groups of 20. One group underwent traditional clipped-artery harvesting; the other group, modified nonclipped-artery harvesting. By immunohistochemical methods, we examined redundant segments taken from bifurcation levels of the arteries. The tunica media was thinner in the clipped arterial segments, a phenomenon that we attribute to high luminal pressure. Endothelial nitric oxide synthase immunostaining was absent in regions of denudation in the luminal endothelia of the clipped arteries; in contrast, pronounced immunostaining occurred in the endothelia of the nonclipped segments. We found that traditional harvesting disrupted the integrity of the luminal endothelia of the clipped arteries. In addition, the traditional procedure decreased nitric oxide production, as was revealed by immunostaining.

Effects of angiotensin-converting enzyme gene polymorphism and serum vitamin D levels on ambulatory blood pressure measurement and left ventricular mass in Turkish hypertensive population.

INTRODUCTION: Regulation of angiotensin converting enzyme (ACE) and angiotensin II (ang-II) levels is under genetic control. 1,25(OH)2 vitamin D3 treatment has been shown to reduce the ang-II level, reduce myocardial hypertrophy and to decrease blood pressure. This study was designed to examine the effect of ACE gene polymorphisms on 24-h ambulatory blood pressure measurement (24 h) values, vitamin D levels and target organ damage in hypertensive patients. METHODS: This study was carried on 118 patients with essential hypertension (female/male: 70/48, mean age: 49.1+/-7.6 years, hypertension duration: 56+/-40.5 months). All patients were assessed for target organ damage; the eye by retinal examination, the heart with echocardiography and the kidney with blood and 24-h urine analysis. 24-h ambulatory blood pressure measurement was performed in all patients. PCR amplification was employed to detect ACE genotypes. RESULTS: ACE genotypes were as follows: DD (n=49) 41.5%; ID (n=37) 31.4% and II (n=32) 27.1%. No difference was present between groups of ACE polymorphism when 24-h ambulatory blood pressure measurement values, retinal vascular changes and microalbuminuria were taken into account. Statistically significant left ventricular mass index levels were obtained in the DD group when compared with the non-DD (ID+II) group (P : 0.009). Positive correlations have been noted between left ventricular mass index and day/night and early morning systolic pressures. A negative correlation exists between serum 25 (OH) vitamin D levels and 24-h ambulatory blood pressure measurement values (P<0.05). CONCLUSIONS: The presence of the D allele is linked with a higher risk for left ventricular mass index in the Turkish hypertensive population.

Celiac disease in patients having recurrent aphthous stomatitis.

BACKGROUND/AIMS: Celiac disease is a condition related to the small intestine's intolerance to gluten. In epidemiologic studies the prevalence is highly variable. The diagnosis can be difficult due to the wide spectrum of signs and symptoms. As the risk for intestinal lymphoma is higher in these patients, early diagnosis has its privileges. The higher prevalence of recurrent aphthous stomatitis in celiac disease led us to investigate the celiac disease prevalence in patients with recurrent aphthous stomatitis, which might assist in diagnosis of asymptomatic celiac disease patients. The aim of this study was to determine the prevalence of celiac disease in patients presenting with recurrent aphthous stomatitis. METHODS: The study group consisted of patients having a history of recurrent aphthous stomatitis. The control group included patients not having aphthous stomatitis. Antibodies to gliadin IgG and IgA and antibodies to endomysium were determined from the serum samples of all patients. Biopsies were obtained from the distal part of the duodenum. RESULTS: Biopsies of two patients (4.8%) out of 41 belonging to the study group were diagnosed as celiac disease. In serum samples of both, antibodies to gliadin IgA and antibodies to endomysium were found to be positive. Antibodies to gliadin IgG antibody were positive in only one of these two patients. None of the 49 patients in the control group was diagnosed as celiac disease. CONCLUSION: Further evaluation of recurrent aphthous stomatitis patients for celiac disease must be performed. As the endoscopic procedures are invasive and costly, evaluation of recurrent aphthous stomatitis patients for celiac disease must include serologic markers at the beginning. If any positivity is determined in markers, then endoscopic procedures including biopsies of the duodenum must be considered as the second-step intervention.

Benign fibrous histiocytoma of the eyelid with an unusual clinical presentation.

Benign fibrous histiocytoma is a common soft tissue tumor that can be deep or superficially located. Although the deep type of fibrous histiocytoma has a predilection for the orbit, the eyelids are an unusual location for the cutaneous type. A 42-year-old woman had bilateral yellowish nodular masses of the eyelids for two years. Pathological examination after excision revealed benign fibrous histiocytoma. Our case is an unusual clinical presentation of cutaneous fibrous histiocytoma as well as a rare location such as the eyelids.