Implantoplasty Improves Clinical Parameters over a 2-Year Follow-Up: A Case Series

Background and Objectives: Peri-implantitis treatment is still undefined. Regenerative treatment is expensive and technically demanding due to the need to handle biomaterials, membranes and different methodologies of decontamination. Resective treatment and implantoplasty might be a viable solution. This case series presents a 24 month retrospective observational study of 10 peri-implantitis patients treated with implantoplasty. Materials and Methods: In the present case series, 10 peri-implantitis patients (20 implants) were treated with a resective approach and implantoplasty. Previous to implantoplasty, all patients underwent non-surgical treatment. This surgery consisted in a full-thickness flap and implant surface exposure. The exposed non-osseointegrated implant body was submitted to implantoplasty. The flap was apically repositioned and sutured. Patients were accompanied for 24 months. Results: The mean initial probing depth (PD) (PD = 5.37 ± 0.86 mm), bleeding on probing (BoP = 0.12 ± 0.06%) and suppuration (Sup = 0.01 ± 0.01%) decreased significantly at the 12 month evaluation (PD = 2.90 ± 0.39 mm; BoP = 0.01 ± 0.01% and Sup = 0.00 ± 0.00%). Between the 12 and 24 month evaluations, there were no significant clinical changes (PD = 2.85 ± 0.45 mm; BoP = 0.01 ± 0.01% and Sup = 0.00 ± 0.00%). Mucosal recession (MR) had a significant increase between the baseline and the first 12 months (0.69 ± 0.99 mm vs. 1.96 ± 1.33 mm), but there were no significant changes between the 12th and 24th month (1.94 ± 1.48 mm). The success rate was 100% without implant fracture or loss. Conclusions: Resective surgery and implantoplasty might be a valid option in some specific peri-implantitis cases. Properly designed clinical trials are needed to confirm this possibility.

The Individual Ictal Fingerprint: Combining Movement Measures With Ultra Long-Term Subcutaneous EEG in People With Epilepsy

Background: Epileptic seizures are caused by abnormal brain wave hypersynchronization leading to a range of signs and symptoms. Tools for detecting seizures in everyday life typically focus on cardiac rhythm, electrodermal activity, or movement (EMG, accelerometry); however, these modalities are not very effective for non-motor seizures. Ultra long-term subcutaneous EEG-devices can detect the electrographic changes that do not depend on clinical changes. Nonetheless, this also means that it is not possible to assess whether a seizure is clinical or subclinical based on an EEG signal alone. Therefore, we combine EEG and movement-related modalities in this work. We focus on whether it is possible to define an individual “multimodal ictal fingerprint” which can be exploited in different epilepsy management purposes.Methods: This study used ultra long-term data from an outpatient monitoring trial of persons with temporal lobe epilepsy obtained with a subcutaneous EEG recording system. Subcutaneous EEG, an EMG estimate and chest-mounted accelerometry were extracted from four persons showing more than 10 well-defined electrographic seizures each. Numerous features were computed from all three modalities. Based on these, the Gini impurity measure of a Random Forest classifier was used to select the most discriminative features for the ictal fingerprint. A total of 74 electrographic seizures were analyzed.Results: The optimal individual ictal fingerprints included features extracted from all three tested modalities: an acceleration component; the power of the estimated EMG activity; and the relative power in the delta (0.5–4 Hz), low theta (4–6 Hz), and high theta (6–8 Hz) bands of the subcutaneous EEG. Multimodal ictal fingerprints were established for all persons, clustering seizures within persons, while separating seizures across persons.Conclusion: The existence of multimodal ictal fingerprints illustrates the benefits of combining multiple modalities such as EEG, EMG, and accelerometry in future epilepsy management. Multimodal ictal fingerprints could be used by doctors to get a better understanding of the individual seizure semiology of people with epilepsy. Furthermore, the multimodal ictal fingerprint gives a better understanding of how seizures manifest simultaneously in different modalities. A knowledge that could be used to improve seizure acknowledgment when reviewing EEG without video.

Functional changes in neural networks of the brain in patients with spastic diplegia after translingual neurostimulation

Introduction. Rehabilitation of children with cerebral palsy is one of the most difficult tasks in modern neurology. One of the promising areas is the combination of physiotherapy with methods of stimulation of various parts of the nervous system, among which functional electrical stimulation of muscles and nerves (FES) is distinguished.Purpose of research. Assessment of changes in the functional connectivity of neural networks in the brain in patients with cerebral palsy before and after translingual neurostimulation using functional MRI at rest.Materials and methods. Analyzed the results of changes in the functional connectivity of neural networks in the brain in 25 patients with cerebral palsy before and after translingual neurostimulation. A clinical examination was carried out with an assessment of complaints, anamnesis and an assessment on neurological scales, followed by standard and functional MRI of the brain at rest.Summary. In children with spastic diplegia, functional changes in neural networks with a predominance of processes of strengthening intra- and interhemispheric connections (p<0,05) were revealed, which correlates with clinical changes in the form of a decrease in spasticity and an improvement in motor skills.

Framework for considering abnormal heart rate characteristics and other signs of sepsis in very low birth weight infants

Objective: A heart rate characteristics index (HeRO score), incorporating low variability and superimposed decelerations, was developed as a sepsis risk indicator for preterm infants in the NICU. A rise in the risk score should prompt consideration of other clinical changes that may be signs of sepsis to decide whether a workup and antibiotics are indicated. We aimed to develop a framework to systematically consider signs potentially indicating sepsis in very low birth weight (VLBW) infants. Study Design We developed easy-recall acronyms for ten signs of sepsis in VLBWs. Over 12 months in a level IV NICU, Neonatology Fellows completed a brief survey after each shift to document changes prompting sepsis work-ups. We analyzed associations between survey data, hourly HRC data, and the diagnosis of the work-up, grouped as culture-positive sepsis (CXSEP, positive blood or urine culture), clinical sepsis (CLINSEP, negative cultures treated with antibiotics ≥5 days), or sepsis ruled out (SRO, negative cultures, <3 days antibiotics). Results We analyzed 93 sepsis work-ups in 48 VLBW infants (35 CXSEP, 20 CLINSEP, 38 SRO). The most frequently cited changes prompting the work-ups were heart rate patterns and respiratory deterioration, which were common in all three categories. Low blood pressure and poor perfusion were uncommonly cited but were more likely to be associated with CXSEP than the other signs. A rise in the HeRO score ≥1 from 0-12h before the blood culture compared to 12-72h prior occurred in 31% of work-ups diagnosed as CXSEP, 16% CLINSEP, and 31% SRO. Conclusion The HeRO score can alert clinicians to VLBW infants at high or increasing risk for a sepsis-like illness, but HRC patterns are highly variable in individual babies. The easy-recall NeoSEP-10 framework can assist clinicians in considering other clinical changes when making decisions about sepsis work-ups and the duration of antibiotics.

Laurence-Moon-Bardet-Biedl syndrome

Lawrence-Moon-Bardet-Biedl syndrome is a rare autosomal recessive genetic disorder, which may result in a number of multiorgan abnormalities, including impaired brain function, eye diseases, kidney and limbs’ dysfunction. The main symptoms of this syndrome include retinal degeneration, polydactyly, obesity, hypogonadism, congenital kidney abnormalities and mental retardation. However, Lawrence-­Moon­-Barde­-Biedl syndrome may also present with other secondary abnormalities, including ataxia, diabetes insipidus, and dental abnormalities. Clinical changes of the eyes include retinitis pigmentosa, low visual acuity, and vision loss, often due to photoreceptor disorders in the retinal tissue with macular degeneration, leading to night blindness and then, in most cases, can cause complete blindness. In patients with an archetypal manifestation of Lawrence­-Moon­-Barde-­Biedl syndrome, abdominal obesity is common, even if the birth weight is usually normal. In addition, this group of patients has type 2 diabetes mellitus. A distinctive feature of this syndrome is postaxial polydactyly. Hypogonadism, which is a common sign of the disease, as usual can be diagnosed at early age in men in a form of micropenis and testicular hypoplasia).The paper presents clinicalcase of Lawrence­-Moon­-Barde-­Bidle syndrome in a thirteen-year-old boy who referred to endocrinologist with complaints of excessivegain of body weight, memoryloss, visual impairment, difficulties in school, delayedsexual development. Ad ditional investigations enabled to establish the diagnosis of Laurence­-Moon­-Bardet­-Biedl syndrome.

Adaptive Optics Imaging Technique in Diabetic Retinopathy

Adaptive optics ophthalmoscopy opened a new era in the medical retina field. The possibility of obtaining high-resolution retinal images of photoreceptors and retinal vessels addresses new perspectives in retinal physiology and pathophysiology. The overwhelming incidence of diabetes in the global population justifies the need to develop and refine methods of diagnosing early retinal changes, in order to preserve vision and avoid complications. The current grading of diabetic retinopathy is based on clinical changes only. Nevertheless, imaging tools such as optical coherence tomography and optical coherence tomography angiography are also used for screening of this pathology. The corroboration of the information provided by these imaging methods may lay the foundations for a new approach to the definition and diagnosis of diabetic retinopathy.

Application of FACT in the academic context to improve the health in high school students

There is growing evidence showing the efficacy of contextual or third-generation therapies in various contexts and clinical conditions. In large groups of first- and second-year high school students (n= 112), the present study compares the efficacy of applying a program based on Acceptance and Commitment Therapy (ACT) versus a combined program using strategies from Functional-Analytical Psychotherapy (FAP), resulting in a so-called FACT approach. The purpose of this intervention was to extract the most relevant processes underpinning clinical changes to design training programs based on contextual behavioral science to improve students' health. The results indicated that both interventions produced statistically significant improvement in the health of the students. The program combined with FACT was superior in the self-concept variable. The implications of both brief programs to improve students' health in short periods are discussed on the basis of a behavioral methodology adapted to the academic context.

Long-Term Evaluation of Poly(lactic acid) (PLA) Implants in a Horse: An Experimental Pilot Study

In horses, there is an increasing interest in developing long-lasting drug formulations, with biopolymers as viable carrier alternatives in addition to their use as scaffolds, suture threads, screws, pins, and plates for orthopedic surgeries. This communication focuses on the prolonged biocompatibility and biodegradation of PLA, prepared by hot pressing at 180 °C. Six samples were implanted subcutaneously on the lateral surface of the neck of one horse. The polymers remained implanted for 24 to 57 weeks. Physical examination, plasma fibrinogen, and the mechanical nociceptive threshold (MNT) were performed. After 24, 28, 34, 38, and 57 weeks, the materials were removed for histochemical analysis using hematoxylin-eosin and scanning electron microscopy (SEM). There were no essential clinical changes. MNT decreased after the implantation procedure, returning to normal after 48 h. A foreign body response was observed by histopathologic evaluation up to 38 weeks. At 57 weeks, no polymer or fibrotic capsules were identified. SEM showed surface roughness suggesting a biodegradation process, with an increase in the median pore diameter. As in the histopathological evaluation, it was not possible to detect the polymer 57 weeks after implantation. PLA showed biocompatible degradation and these findings may contribute to future research in the biomedical area.

Effects of Histobulin (Immunoglobulin/Histamine Complex) on Depression and Anxiety in Chronic Urticaria: Psychiatric Manifestations or Psychiatric Comorbidities of Chronic Urticaria?: A Case Report

Background: Psychiatric comorbidities of chronic urticaria (CU) have been reported and examined recently. The prevalence of mental disorders and emotional distress is high in patients with CU. This is a case report in which Histobulin was found to be effective for psychiatric manifestations in chronic spontaneous urticaria (CSU). Case Presentation: Three cases of CSU accompanying psychiatric manifestations (PMs) were treated with Histobulin. One patient with CSU with severe depression showed clinical changes in depressive symptoms in parallel to changes in allergic symptoms during treatment. Histobulin clearly improved not only CSU but also the accompanying PMs in one patient and slightly improved them in another patient. The PMs were not improved by an antihistamine (H1 blocker) in any case. Histobulin is effective not only for allergic manifestations (AMs) but also for PMs of CSU. Conclusions: PMs as well as AMs of CSU were improved by Histobulin therapy. PMs were suspected to be a part of the clinical manifestations in CSU, possibly through histamine-mediated mechanisms. These conditions were suggested to be ‘allergic psychiatric manifestations (APMs)’ or ‘histamine-mediated psychiatric manifestations (HPMs)’. Further study of PMs based on histamine-mediated mechanisms, including allergies, may be necessary. Accordingly, it should be clarified whether the PMs of CSU are a part of the clinical manifestations of CSU or are psychiatric comorbidities of CSU.

Effects of a Non-Energy-Restricted Ketogenic Diet on Clinical Oral Parameters. An Exploratory Pilot Trial

Ketogenic diets (KDs) may be a helpful complement in the prevention of and therapy for several diseases. Apart from their non-cariogenic properties, it is still unclear how KDs affect oral parameters. The aim of this study was to investigate the influence of a KD on clinical periodontal parameters. Twenty generally healthy volunteers with an average age of 36.6 years underwent a KD for 6 weeks. Their compliance was monitored by measuring their urinary ketones daily and by keeping 7-day food records. Clinical oral parameters included plaque (PI), gingival inflammation (GI), a complete periodontal status (probing depths, bleeding on probing), and general physical and serologic parameters at baseline and after 6 weeks. The results showed a trend towards lower plaque values, but with no significant changes from baseline to the end of the study with regard to the clinical periodontal parameters. However, their body weight and BMI measurements showed a significant decrease. The regression analyses showed that the fat mass and the BMI were significantly positively correlated to periodontal inflammation, while HDL, fiber, and protein intake were negatively correlated to periodontal inflammation. The KD change did not lead to clinical changes in periodontal parameters in healthy participants under continued oral hygiene, but it did lead to a significant weight loss.