Exploring decision-making performance in young adults with mental health disorders: a comparative study using the Cambridge gambling task.

Decision-making deficits, assessed cognitively, are often associated with mental health symptoms, however, this relationship is not fully understood. This paper explores the relationship between mental health disorders and decision-making, using the Cambridge Gambling Task (CGT). Our study investigated how decision-making varied across 20 different mental health conditions compared to controls in a sample of 572 young adults from the Minneapolis and Chicago metropolitan areas, using a computerized laboratory-based task. Almost all mental health conditions were associated with at least mild (i.e. at least small effect size) impairment in all three studied parameters of the CGT (risk adjustment, quality of decision-making and overall proportion of bet). Notably, binge eating disorder had the largest cognitive impairment and gambling disorder had moderate impairment. Post-traumatic stress disorder (PTSD) was associated with impaired decision-making while obsessive-compulsive disorder (OCD) and depression showed moderate impairment. Additionally, half of the disorders assessed had moderate to large impairment in risk adjustment.These findings suggest that mental health conditions may have a more complex cognitive profile than previously thought, and a better understanding of these impairments may aid in risk assessment and targeted clinical interventions. This study underscores the need for further research to determine the causal pathways between mental health conditions and cognition, as well as to better understand the day-to-day impact of such deficits.

A laboratory study to assess the formation of effluent volatile compounds and disinfection by-products during chemomechanical preparation of infected root canals and application of activated carbon for their removal.

AIM: To assess in a laboratory setting using extracted teeth the formation of volatile compounds (VOCs) and disinfection by-products (DBPs) in effluent aliquots, during chemomechanical preparation of artificially infected root canal specimens, and determine the role of silver-impregnated activated carbon (Ag-AC) in their removal. METHODOLOGY: Single-rooted human teeth were decoronated to obtain 15 mm-long root specimens and a nutrient-stressed multispecies biofilm was grown in the root canals. Specimens were randomly assigned into three groups [Group 1; instrumentation with rotary files and irrigation with sterile saline, Groups 2 and 3; instrumentation with rotary files and irrigation with 2.5% NaOCl and 17% EDTA]. A portable medical suction device was used to collect the effluent aliquots during root canal irrigation. In Groups 1 and 2, the reaction products of the collected effluents were analysed by selected ion flow tube mass spectrometry (SIFT-MS). The effluents from Group 3 were treated with Ag-AC prior to SIFT-MS analysis, to assess the removal capacity of Ag-AC against the reaction products. The synthesis of Ag-AC was characterized with scanning electron microscopy/energy-dispersive X-ray spectroscopy (SEM/EDS). Two-way analysis of variance (anova) with post hoc Tukey tests was used for data analysis and determination of a significant difference (P < 0.05). RESULTS: In Group 1, effluent VOCs and DBPs were detectable at very low levels. In Group 2, the collected effluent aliquots released high concentrations of methanol, propanol, ammonia, chloroform and formaldehyde, which were significantly greater compared to Group 1 (P < 0.001). SEM/EDS analysis confirmed impregnation of Ag within the AC matrix. The treatment of effluent aliquots with Ag-AC (Group 3) resulted in a significant reduction in concentrations of acetone, acetic acid, propanol, acetaldehyde, acetonitrile and chloroform, compared to Group 2 (P < 0.001). The concentration levels of ethanol, methanol, ammonia and formaldehyde remained unaffected (P > 0.05). CONCLUSIONS: In this laboratory setting using extracted human teeth, the chemomechanical preparation of artificially infected root canals resulted in the formation of toxic VOCs and DBPs as effluent suspensions. Their release during aspiration with dental suction indicates that potential environmental hazards should be investigated. The use of silver-impregnated activated carbon had potential for the point-of-use treatment of post-irrigation effluent aliquots.

Ex vivo detection and quantification of apically extruded volatile compounds and disinfection by-products by SIFT-MS, during chemomechanical preparation of infected root canals.

OBJECTIVES: To assess the release and apical extrusion of toxic volatile compounds and disinfection by-products during instrumentation and irrigation of artificially infected root canal specimens, with sodium hypochlorite and ethylene diamine tetra acetic acid. METHODS: Forty-two single-rooted human teeth were decoronated to obtain 15mm-long root specimens and working length was determined 1mm short of root apex. All specimens were initially preflared, to create sufficient conical space for the development of a nutrient-stressed multispecies biofilm. The specimens were randomly assigned into three groups [Group 1; no endodontic intervention, Group 2; instrumentation with rotary files and irrigation with sterile saline, Group 3; instrumentation with rotary files and irrigation with 2.5% sodium hypochlorite (NaOCl) and 17% ethylene diamine tetra acetic acid (EDTA)]. A customised experimental model apparatus was fabricated for each specimen. The apical root third was inserted in a glass vial filled with sterile ultrapure water, to simulate high-compliance periradicular space. The reaction products of the aliquots obtained from the glass vials were analysed in real time, by selected ion flow tube mass spectrometry (SIFT-MS) in triplicates. Two-way analysis of variance (ANOVA) with post hoc Tukey tests were used for data analysis. The level of statistical significance was set at P<0.05. RESULTS: The group of teeth that were not subjected to endodontic intervention did not show any volatile compounds (VOCs) or disinfection by products (DBPs) whilst instrumentation and irrigation of root canals (Groups 2 and 3) resulted in the apical extrusion of VOCs and DBPs. In Group 3, the aliquots obtained from periradicular space released high concentrations of methanol, propanol, ammonia, chloroform, together with unexpected higher levels of formaldehyde, which were statistically significant compared to Group 2 (P<0.05). SIGNIFICANCE: The mechanical preparation and irrigation of artificially infected root canals with rotary files, 2.5% NaOCl and 17% EDTA resulted in the formation of toxic VOCs and DBPs in a water-closed periradicular space. The chemical interaction of NaOCl and EDTA resulted in the generation of high concentrations of formaldehyde. The formation of chloroform and formaldehyde indicate that risk assessment of the potential hazards to health should be carried out.

Manifesto for a European research network into Problematic Usage of the Internet.

The Internet is now all-pervasive across much of the globe. While it has positive uses (e.g. prompt access to information, rapid news dissemination), many individuals develop Problematic Use of the Internet (PUI), an umbrella term incorporating a range of repetitive impairing behaviours. The Internet can act as a conduit for, and may contribute to, functionally impairing behaviours including excessive and compulsive video gaming, compulsive sexual behaviour, buying, gambling, streaming or social networks use. There is growing public and National health authority concern about the health and societal costs of PUI across the lifespan. Gaming Disorder is being considered for inclusion as a mental disorder in diagnostic classification systems, and was listed in the ICD-11 version released for consideration by Member States (http://www.who.int/classifications/icd/revision/timeline/en/). More research is needed into disorder definitions, validation of clinical tools, prevalence, clinical parameters, brain-based biology, socio-health-economic impact, and empirically validated intervention and policy approaches. Potential cultural differences in the magnitudes and natures of types and patterns of PUI need to be better understood, to inform optimal health policy and service development. To this end, the EU under Horizon 2020 has launched a new four-year European Cooperation in Science and Technology (COST) Action Programme (CA 16207), bringing together scientists and clinicians from across the fields of impulsive, compulsive, and addictive disorders, to advance networked interdisciplinary research into PUI across Europe and beyond, ultimately seeking to inform regulatory policies and clinical practice. This paper describes nine critical and achievable research priorities identified by the Network, needed in order to advance understanding of PUI, with a view towards identifying vulnerable individuals for early intervention. The network shall enable collaborative research networks, shared multinational databases, multicentre studies and joint publications.

Adolescent friendships predict later resilient functioning across psychosocial domains in a healthy community cohort.

BACKGROUND: Adolescence is a key time period for the emergence of psychosocial and mental health difficulties. To promote adolescent adaptive ('resilient') psychosocial functioning (PSF), appropriate conceptualisation and quantification of such functioning and its predictors is a crucial first step. Here, we quantify resilient functioning as the degree to which an individual functions better or worse than expected given their self-reported childhood family experiences, and relate this to adolescent family and friendship support. METHOD: We used Principal Component and regression analyses to investigate the relationship between childhood family experiences and PSF (psychiatric symptomatology, personality traits and mental wellbeing) in healthy adolescents (the Neuroscience in Psychiatry Network; N = 2389; ages 14-24). Residuals from the relation between childhood family experiences and PSF reflect resilient functioning; the degree to which an individual is functioning better, or worse, than expected given their childhood family experiences. Next, we relate family and friendship support with resilient functioning both cross-sectionally and 1 year later. RESULTS: Friendship and family support were positive predictors of immediate resilient PSF, with friendship support being the strongest predictor. However, whereas friendship support was a significant positive predictor of later resilient functioning, family support had a negative relationship with later resilient PSF. CONCLUSIONS: We show that friendship support, but not family support, is an important positive predictor of both immediate and later resilient PSF in adolescence and early adulthood. Interventions that promote the skills needed to acquire and sustain adolescent friendships may be crucial in increasing adolescent resilient PSF.

Concentration-related mydriasis in a patient with renal dysfunction treated with phenytoin.

INTRODUCTION: There is very limited evidence concerning phenytoin-related mydriasis. CASE REPORT: A 59-year-old male was hospitalized in the intensive care unit due to a head injury. During his hospitalization, phenytoin was administrated. Some days later he presented bilateral mydriasis.  At that time he had impaired creatinine clearance 7 ml/min, albumin levels 3.4 gr/dl, and phenytoin serum concentration 19.94 µg/dl. Evaluation with brain computed tomography and magnetic resonance imaging did not reveal any potential cause of mydriasis, while none of the co-administrated drugs have been reported to cause significant mydriasis. After initiation of continuous venovenous hemodiafiltration and discontinuation of phenytoin, mydriasis was reversed. CONCLUSION: Clinicians should be aware that mydriasis due to a toxic concentration of phenytoin may be manifested. Hippokratia 2016, 20(2): 166-168.

Crown discoloration induced by endodontic sealers: spectrophotometric measurement of Commission International de I'Eclairage's L*, a*, b* chromatic parameters.

Despite the improvement of endodontic materials, crown discoloration induced by root canal sealers remains a concerning clinical issue. The aim of this study is the measurement of the alterations in CIE L*, a*, b* chromatic parameters of tooth crowns after placement of commonly used and new-generation endodontic sealers in pulp chambers. Eighty intact, fully developed third mandibular molars were randomly assigned in five groups. Crowns were cross-sectioned from the root complex 1 mm below the cement-enamel junction. The internal axial walls of the pulp chambers were debrided and coated with endodontic sealers (Roth-811, AH-26, Guttaflow, Epiphany SE). The apical access was sealed with glass-ionomer cement. The control group was only debrided. Crowns were stored in individually marked vials in standard conditions (100% humidity, 37°C). The spectral reflectance lines were recorded with a UV-Vis spectrophotometer in the visual spectrum. The CIE L*a*b* parameters were obtained by a linked computer software before sealer placement (baseline), after one week, one, three, and six months, respectively. Statistical analysis was performed with two-way mixed ANOVA models. The level of statistical significance was set at p<0.05. With the exception of the control group, experimental groups presented varying chromatic alterations. Among all experimental groups, Roth-811 sealer induced the most severe alterations in CIE L*, a*, b* chromatic parameters, during all observation periods. After root canal obturation, the clinician should be aware of the presence of remaining root canal filling materials. Thorough debridement of the pulp chamber is essential for the prevention of sealer-induced discoloration.

Connecting tube colonic erosion and gastrocolic fistula formation following late gastric band erosion.

Band erosion is a rare complication of laparoscopic adjustable gastric banding (LAGB) with a reported prevalence varying from 0.3% to 14%. Intraluminal colonic erosion of the connecting tube is very rare, as only isolated cases have been described. Consequently, simultaneous gastric band erosion and connecting tube colonic erosion is an extremely rare event. Herein, we present a case of a woman with morbid obesity, who submitted to LABG 4 years ago. The patient presented with symptoms and signs of right lower quadrant peritonitis. Computed tomography (CT) demonstrated migration of the band into the gastric lumen, inflammation around the intra-abdominal course of the connecting tube and an inflammatory mass surrounding the tube at the right lower quadrant. Laparotomy revealed the eroded band, the eroded transverse colon from the connecting tube, a gastrocolic fistula along the course of the tube and a right lower quadrant phlegmon. The connecting tube was mobilized from the surrounding adherent tissues, the gastric band removed, the stomach and colon walls closed, and the gastrocolic fistula excised. To our knowledge this is the second case of concurrent band erosion and connecting tube colonic erosion along with gastrocolic fistula formation in a patient with morbid obesity treated with LAGB.

Spectrophotometric analysis of coronal discolouration induced by grey and white MTA.

AIM: To evaluate the specific alterations in tooth colour with white and grey MTA when used to fill pulp chambers. METHODOLOGY: Forty-five fully developed, intact, mandibular third molars were sectioned 1 mm below their cemento-enamel junction (CEJ). Their pulp chambers were chemo-mechanically debrided, and the specimens were randomly assigned into three groups: Group 1-white MTA (Angelus(™)), Group 2-grey MTA (Angelus(™)) and Group 3-negative control (unfilled). During the experimental period, specimens were immersed in vials containing distilled water up to the CEJ (37±1 °C). Spectral reflectance lines were recorded by utilizing a UV-vis spectrophotometer equipped with an integration sphere in the visual spectrum, at baseline, 1 week and 1, 2 and 3 months after placement of the materials. Data were transformed into values of the CIE L*a*b* colour system, and the corresponding ΔΕ values were calculated. The results were analysed using two-way mixed anova models, whilst pairwise comparisons were conducted with Bonferroni's method at P < 0.05 level of significance. RESULTS: Both types of MTA induced significant decreases in L*, a* and b* values. The colour change was greater with grey MTA. Grey MTA led to clinically perceptible crown discolouration after 1 month, whilst the total colour change caused by white MTA exceeded the perceptible threshold for the human eye after 3 months. CONCLUSIONS: The application of both grey and white MTA formulations induced a decrease in lightness and reduction in redness and yellowness in teeth. The present findings suggest that application of grey MTA in the aesthetic zone should be avoided, whilst white MTA should be used with caution when filling pulp chambers with the materials.

[Surgical laparoscopy in tumors of the adnexa]. / Operative Laparoskopie bei Adnextumoren.

OBJECTIVES: The laparoscopic management of adnexal masses is still controversial. The main problems are preoperative diagnosis, operative technique and the possibility of compromising the prognosis by spillage of cancer cells when operating on a hitherto unrecognized early stage ovarian cancer. We report on our experience with minimal invasive surgery of adnexal masses. METHOD: From June 1989 to July 1992, 375 patients underwent surgery for adnexal tumors at the University Hospital, Zurich. In 112 cases a laparoscopic operation was performed. The indications were unilateral or bilateral masses in the adnexal region with or without clinical symptoms. The preoperative workup included patient's history, clinical examinations, vaginal sonography and intraoperative evaluation of the tumor. RESULTS: In 72% (83) of cases the organs were preserved by the laparoscopic procedure while in 28% (32) salpingo-oophorectomy, ovariectomy or salpingectomy was performed. The histopathologic findings included cystadenomas, cystadenofibromas, benign cystic teratomas, simple and functional cysts, mesothelium cysts, tubo-ovarian abscesses, endometriomas, and torqued tubes and/or ovaries. In no patient was a malignant process found. Only one postoperative complication was noted in a patient who had to be relaparoscoped due to adhesions to the operated ovary. One recurrence occurred in a hydrosalpinx. CONCLUSIONS: Adnexal masses may safely be managed laparoscopically, with all the advantages of minimal invasive surgery, provided that strict diagnostic and therapeutic rules are observed.

[Minimally invasive surgery in the treatment of extrauterine pregnancy]. / Minimal invasive Chirurgie zur Behandlung der Extrauteringravidität.

Of 147 patients operated by endoscopy, 86 (59%) were treated conservatively by linear salpingotomy or tubal aspiration and 61 (41%) were treated by salpingectomy. One patient with a history of bilateral salpingectomy had a cornual implantation and was also successfully treated by laparoscopic technique. There were no intraoperative complications. In eight patients (4.5%) with postoperative complications, a second operation was performed because of persistent trophoblast and/or hemorrhage. Six patients were treated by laparoscopic salpingectomy. All complications were associated with conservative treatment and typically occurred with a delay of up to 23 days. In six of these instances, the surgeon was rather inexperienced in laparoscopic operation. After an average follow-up time of 22 months, the pregnancy rate was 68%, of which 73% were intrauterine pregnancies. Laparoscopic treatment of ectopic pregnancies has proven to be an effective and safe procedure even at a teaching hospital. Since all complications occurred after conservative treatment this data suggests that salpingectomy should be the treatment of choice in ectopic pregnancy, whereas linear salpingotomy should only be performed when specially indicated.