Symptomatic apical periodontitis (SAP) is indicative of inflammation of the periodontal ligament. It may or may not be accompanied by radiographic changes and may occur with vital or necrotic pulpal diagnosis. Purpose of this study was to analyze clinical and radiographic presentations of SAP in a retrospective electronic dental chart and digital radiograph review utilizing the endodontic diagnostic template note of predoctoral dental school patients presenting with SAP. The aim was to determine prevalence of periapical radiolucencies (PARLs) in SAP, association of SAP to pulpal diagnosis, and define associated radiographic changes. Most prevalent pulpal diagnosis with SAP was symptomatic irreversible pulpitis (44%). A tooth presenting with SAP was more likely to have an intact lamina dura, but presented with a PARL 38% of the time. When a PARL was present the most common pulpal diagnosis was pulp necrosis however, 24.5% of teeth presented with a vital pulp diagnosis and lesions <2mm.

Background A perforation in the nasal septum can cause symptoms such as bleeding, obstruction, crusts and pain, and can be a challenge to treat. Surgery is the treatment of choice, but disease, size of the perforation, or the patient’s wish may contradict surgery. A custom-made silicone obturator is a successful treatment option, but little is known how this treatment affects the microbial flora. The purposes of this thesis were (i) to investigate the microbial flora around symptomatic nasal septal perforations before treatment, (ii) during and after a 12-month treatment period with a custom-made obturator, (iii) to compare the microbial flora around symptomatic perforations with the flora from the same area of the septum in healthy individuals, (iv) to investigate the microbial colonization of the silicone obturator, and (v) also to investigate the water sorption, solubility and if the wettability of silicones are affected by water. The hypotheses were (i) that the bacterial flora around symptomatic perforations would not differ from that found in healthy individuals, apart from a possible presence of Helicobacter pylori; (ii) the bacterial flora would change in composition during the course of treatment and that microorganisms and proteins could be seen on the surface of the silicone obturators; (iii) a material that has adsorbed water would also show an increase in wettability and the surface free energy of the material.  Methods Twenty-seven patients and 101 healthy individuals volunteered. Swabs were made around the rim of the perforation, or on the septum in the locus Kisselbachi area in the healthy individuals. Bacteria and fungi were isolated and identified with standard laboratory techniques. A biopsy of the granulated tissue at the perforation was taken and cultivated for Helicobacter pylori. Swabs were also taken three, six and twelve months after inserting the obturator. The obturator was analysed after being used twelve months in the nose.  Seven silicones were tested for water sorption and solubility according to ISO standards 1567:1999 and ISO 10477:2004. The change in wettability was examined by measuring the contact angle with a contact goniometer at various stages of the sorption/solubility test. Results Staphylococcus aureus was present in 88% of the untreated patients. With treatment a significant reduction of S. aureus occurred to 54.5% (p&lt;0.05). In the healthy group S. aureus was present in 13% of the subjects. No Helicobacter pylori could be cultivated from the biopsies taken of the granulated tissue at the perforation. The flora round the untreated perforation was dominated by S. aureus with few other bacterial species detected. In the healthy group there was a diversified flora with both aerobic and anaerobic bacteria. SEM revealed a rough surface on the silicone obturator and crazing of the silicone surrounding the pigment granules. Both bacteria and proteins could be seen on the obturators in SEM. Candida albicans was detected in one obturator, but not in the mucosal swab at the corresponding time. That patient had, however, been treated for Candida in the nose six months prior to the last visit in the study. Wettability was affected but did not increase with amount of adsorbed water. Some materials showed an increase and some a decrease in the surface-free energy. The tested addition silicones showed little sorption and solubility. Conclusions The patients with symptomatic perforations of the nasal septum had a bacterial flora totally dominated by S. aureus. The massive presence of S. aureus around symptomatic perforations may have an impact on the persistence of the granulated and inflamed tissue present in symptomatic perforations, thus forming a vicious circle with bleeding and crustation. S. aureus dominance in the mucosa surrounding symptomatic perforations was diminished by using a custom-made obturator. The microbial flora became more diversified with the treatment, although not resembling the flora in healthy individuals. The microbial flora of the obturators was similar, but not the same as the corresponding mucosal flora. The discovery of Candida in the obturator of a patient who had been treated for Candida in the nose six months earlier suggests that obturators need to be exchanged when fungal infections are being treated to prevent the fungus from re-infecting the patient at a later stage. The silicone had a rough surface and a poor wettability, both aspects favours colonization of microorganisms. The silicone was negatively affected by the colouring pigments, this should be considered when colouring is not necessary. The slight, but existing solubility of silicones emphasises the importance of using medical grade silicones that are more purified than industrial silicones.

Flatfoot is often asymptomatic but sometimes presents with symptoms, even in children. This thesis aimed to discover if there was a difference between children with and without symptoms, in the hope that this might aid treatment decisions. Firstly, an audit was performed to discover the prevalence and type of symptoms, as well as current treatment protocols. Secondly, 107 volunteers from the general population and 20 patients were assessed in more detail. The participants were divided into groups and ANOVA tests were used to find the significant differences. Pain and parental concern were frequently reported in the audit population. The majority of this population had moderate bilateral flexible flatfoot with an active Windlass mechanism and static heel valgus. Treatment was dependent on department. The symptomatic group displayed reduced passive ankle dorsiflexion indicating tightness of the tendo-Achilles, as well as increased frequency of severe knee hyperextension and knee valgus upon clinical examination. During static stance, three differences were found between symptomatic and asymptomatic groups, two differences between flat feet and neutral feet. During dynamic trials, the symptomatic group showed reduced stride length and percentage time spent in swing. The ground reaction profiles showed differences in early and late stance. Further investigation supported the idea that decreased late stance vertical ground reaction force peak was evidence of instability in the symptomatic group. Four kinematic parameters demonstrated significant differences at foot strike, five at midstance, and seven at foot off. In terms of kinetics, after controlling for relative stride length, four differences were found, but none between the asymptomatic and symptomatic flat feet. Plantar pressure was successfully used to estimate truncated foot length. The flat feet did not display increased peak midfoot pressure; it was actually lower in flat footed groups. Arch Index and Modified Arch Index were successfully used for instantaneous and continuous assessment of foot posture over stance. The differences found between symptomatic and asymptomatic flat feet (particularly at foot off) shed some light upon the potential causes of symptoms.

Objective: This study aims to derive a clinically-applicable decision rule to predict the risk of symptomatic vasospasm, a neurological deficit primarily due to abnormal narrowing of cerebral arteries supplying an attributable territory, in aneurysmal subarachnoid hemorrhage (SAH). Methods: SAH patients presenting from 2002 to 2011 were analyzed using logistic regression and recursive partitioning to identify clinical, radiological, and laboratory features that predict the occurrence of symptomatic vasospasm. Results: The incidence of symptomatic vasospasm was 21.0%. On multivariate logistic regression analysis, significant predictors of symptomatic vasospasm included age 40-59 years, high Modified Fisher Grade (Grades 3 and 4), and anterior circulation aneurysms. Conclusion: Development of symptomatic vasospasm can be reliably predicted using a clinical decision rule created by logistic regression. It exhibits increased accuracy over the Modified Fisher Grade alone and may serve as a useful clinical tool to individualize vasospasm risk once prospectively validated in other neurosurgical centres.

The yearly losses incurred by bacterial blackspot disease are high. Often trees are asymptomatic, with the pathogen either in the resident phase or latent stage of infection. Detection of the pathogen in these asymptomatic trees is one of the most important means of controlling the disease. Isolates which consistently differed in virulence were isolated from symptomatic mango plants. These isolates could be categorised into four groups based upon differences in virulence. Monoclonal antibodies (mAbs) were successfully raised using separate and pooled isolates for immunisation. MAbsraised were of the lgG class and reacted with a proteinaceous epitope. These monoclonal antibodies could distinguish between different virulence groups of Xanthomonas campestris pv. mangiferaeindicae by means of Western Blot analysis. These antibodies were used along with a selective medium, BVGA for detection of epiphytic populations as well as latent infections in mango. An enrichment step prior to the enzyme- linked immunosorbent assay (ELISA) is important, since bacterial counts on trees with latent infections are too low to result in a positive signal. These techniques in combination are thus useful for detection and monitoring of the pathogen, which may play an important role in controlling the spread of the disease. / Dissertation (MSc Agric)--University of Pretoria, 1993. / gm2014 / Microbiology and Plant Pathology / Unrestricted

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21680号 / 医博第4486号 / 新制||医||1036(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊佐 正, 教授 村井 俊哉, 教授 松原 和夫 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Objectives. To identify treatment indications for symptomatic and asymptomatic Florid Cemento- Osseous Dysplasia in adult patients. To explore the relationship between clinical variables, demographics, and radiographic findings. Methods. A systematic review was conducted by an independent investigator using the electronic databases, PubMed, ProQuest, Embase, Web of Science, Dentistry and Oral Sciences Database (DOSS) and TRIP databases to identify cohort, retrospective, and cross-sectional studies on Florid Cemento-Osseous dysplasia treatment options in adults from 2001-2022. Inclusion criteria for this systematic review included: studies must be in English; open-access; published between 2001-2021. The PRISMA guidelines and Joanna Briggs Institute (JBI) Critical Appraisal checklist were used for reporting and quality assessment of each study. Results. From initial 122 studies, 11 fit the criteria and were analyzed for this systematic review. Black females were reported to have significant presentation for FCOD. Mean age of patients was 40 years old. Eight studies reported symptoms as clinical presentation of FCOD, making it the most common. Six studies reported swelling and three studies reported infection. Five studies recommended surgical treatment in symptomatic patients with disturbances around the lesions such as, presence of necrotic bone, secondary infection, or neoplasia. Treatment of asymptomatic FCOD or biopsies were contraindicated in all studies but one, while dental prophylaxis was recommended. Conclusion. For cases of Asymptomatic FCOD, dental prophylaxis and monitoring were the most common treatment options provided. According to existing literature, symptomatic FCOD may be treated through curettage, blood stimulation, or pulp vitality testing of specific areas with periapical inflammation. Continued dental prophylaxis and monitoring were the most common treatment options suggested. More research should be done using experimental and clinical trials to explore proper treatment options for symptomatic and asymptomatic FCOD to draw clear consensus. / Oral Biology

No description available.

This thesis explored the mechanism of action of MPTP and its toxic metabolite, MPP⁺, and compared it to the mechanism of action of haloperidol metabolites, some of which are found in schizophrenic patients. Experiments assessed the effects of these compounds on several aspects of amine uptake in mouse brain synaptosomes. Both MPTP and MPP⁺ were inhibitors of labeled neurotransmitter (serotonin and dopamine) uptake consistent with previous studies. MPP⁺ had a higher inhibitory potency in the dopaminergic system, while MPTP had a higher inhibitory potency in the serotonergic system. Haloperidol metabolites (HPP⁺, R-HPP⁺, and HPTP) also inhibited both amine transport systems with a greater affinity for the serotonergic system. Additional studies demonstrated that all of the above compounds showed reversible inhibition of serotonin uptake following drug removal by centrifugation and resuspension. In the dopaminergic system, both MPTP and MPP⁺ were reversible; however, HPP⁺ was not. This finding suggests that HPP⁺ treatment may result in irreversible poisoning of the nerve terminal or it may demonstrate a slow off-rate for its interaction with the dopamine transporter. Furthermore, HPP+ showed non-competitive inhibition of both serotonin and dopamine uptake. Amine uptake in the presence and absence of HPP* had a decreased maximal inhibitory effect and no potency change. The reversible inhibition of serotonin uptake by HPP⁺ might suggest competitive inhibition, but apparently, the comparative rates of binding and unbinding of HPP⁺ and serotonin resulted in a non-competitive interaction. These experiments support the use of MPTP as a model system for analyzing the neurotoxic potential of toxins, drug metabolites, and pesticides. The similar in vitro potencies suggest that the haloperidol derivatives could have effects similar to those of MPP⁺ in vivo. / Master of Science

Introdução: Os objetivos do tratamento do Transtorno Afetivo Bipolar (TB) foram além da recuperação sintomática, incluindo também a recuperação funcional, foco das abordagens psicossociais como a psicoeducação. Objetivo: Verificar o impacto da psicoeducação na recuperação sintomática e funcional dos pacientes bipolares. Métodos: Trata-se de um estudo randomizado controlado com 51 pacientes portadores de TB tipo I ou II, de acordo com os critérios do DSM-IV TR; em remissão, com pontuação 7 na escala HDRS 17 itens e 6 na escala YMRS; em acompanhamento ambulatorial no GRUDA do IPq HC FMUSP, ou em acompanhamento psiquiátrico particular ou ainda no CAPS Del Rei MG. A distribuição dos sujeitos nos grupos foi feita por meio de randomização estratificada, em que os sujeitos, primeiramente, foram divididos em blocos estratificados de acordo com gênero, faixa etária, número de episódios anteriores da doença, escolaridade e estado civil. Posteriormente, dentro de cada bloco, os sujeitos foram distribuídos nos grupos aleatoriamente, por meio do lançamento da moeda ao ar repetidas vezes, em que GE foi cara e GC coroa. Assim, foram formados dois grupos homogêneos, evitando-se tendências e favorecimentos. O grupo experimental foi composto de 29 pacientes que receberam, além do tratamento farmacológico, a intervenção psicoeducacional. O grupo controle foi composto de 22 pacientes que receberam, além do tratamento farmacológico, encontros placebo. Entende-se placebo por intervenção em relaxamento. Ambos os grupos tiveram 16 encontros, duas vezes por semana, com 90 minutos de duração. Os instrumentos de avaliação foram aplicados no início (TA), no meio (TB) e no fim do tratamento (TC), e no seguimento de seis (TD) e 12 meses (TE). As escalas utilizadas para avaliar a recuperação sintomática foram: HDRS para a depressão, e YMRS, para a mania. As escalas para avaliar a recuperação funcional foram: WHOQOL-Bref e Escala de Adequação Social- EAS. A melhora clínica global foi avaliada pela CGI. Resultados: HDRS aumentou de forma significativa ao longo do tempo (p=0,002), não houve diferença entre os grupos (p=0,890) e como a interação não foi significativa (p=0,373), o aumento foi equivalente entre os grupos; YMRS não alterou de forma significativa ao longo do tempo (p=0,359) e também não houve diferença significativa entre os grupos (p=0,294), as médias iniciaram baixas e mantiveram-se baixas; WHOQOL-Bref no domínio 4, houve uma tendência de diminuição das médias ao longo do tempo em ambos os grupos (p=0,059), apesar de não ter havido diferença significativa entre os grupos (p=0,175), parece haver uma tendência (p=0,084) do GE diminuir mais do que o GC; e EAS aumentou de forma significativa ao longo do tempo (p=0,044), não houve diferença entre os grupos (p=0,167) e, como a interação não foi significativa (p=0,410), o aumento foi equivalente nos dois grupos. CGI após o término do tratamento: 92,5% da PE e 78,2% do GC apresentaram melhora clínica global; após um ano, foram: 87,5% da PE e 75,1% do GC. Conclusão: Os resultados mostraram que a PE tendeu a impactar positivamente no bem estar do indivíduo em seu meio ambiente; promoveu uma melhora clínica global maior em todos os tempos avaliados com relação ao controle e essa melhora foi mantida em um ano; PE e controle mantiveram a recuperação sintomática maníaca. Apesar disso, a PE não protegeu de recaídas depressivas e de piora da adequação social. Portanto, a PE mostrou-se eficaz no bem-estar do paciente em seu meio ambiente, na melhora clínica global e na proteção de recaídas maníacas. / Introduction: The goals of treatment of bipolar affective disorder (BD) expanded beyond symptomatic recovery, also including functional recovery, the focus of psychosocial approaches as psychoeducation. Objective: To investigate the impact of psychoeducation (PE) in the symptomatic and functional recovery in bipolar patients. Methods: This is a randomized controlled trial with 51 patients with BD type I or II, according to the DSM-IV TR; in remission (score 7 on the HDRS - 17 items and 6 on the YMRS); in outpatient in the GRUDA IPq HC FMUSP, or in psychiatric care in private or CAPS Del Rei - MG. The distribution of subjects in the groups was made by stratified randomization, the subjects first were divided into blocks stratified by gender, age, number of previous episodes of illness, education and marital status. Subsequently, within each block, subjects were randomly divided into two groups, through the launch of the coin again and again, in which experimental group (EG) was expensive and control group (CG) crown. Thus were formed two homogeneous groups, avoiding trends and favors. The EG consisted of 29 patients who received, in addition to pharmacological treatment, the psychoeducational intervention. The CG consisted of 22 patients who received, in addition to pharmacological treatment, meetings \"placebo\". Both groups had 16 meetings, twice a week with 90 minutes. The assessment instruments were applied at the beginning (TA), in the middle (TB) and at the end of treatment (TC), and following six (TD) and 12 months (TE). The scales used to assess symptomatic recovery were: HDRS for depression, and YMRS for mania. Scales to assess functional recovery were WHOQOL-Bref and the Social Adjustment Scale- EAS. Clinical improvement was assessed by the CGI. Results: HDRS increased significantly over time (p = 0.002), no difference between groups (p = 0.890) and the interaction was not significant (p = 0.373), the increase was equivalent between groups; YMRS not change significantly over time (p = 0.359) and there was no significant difference between groups (p = 0.294), the averages started lower and remained low; WHOQOL-Bref in 4, there was a trend decrease in mean over time in both groups (p = 0.059), although there was no significant difference between groups (p = 0.175), there seems to be a trend (p = 0.084) lower in the EG than the CG , and EAS has increased significantly over time (p = 0.044), no difference between groups (p = 0.167), and the interaction was not significant (p = 0.410), the increase was equivalent in both groups. CGI after the end of treatment: 92.5% for PE and 78.2% of the control group showed clinical improvement overall, after one year were 87.5% for PE and 75.1% of GC. Conclusion: The results showed that the PE has tended to impact positively on the welfare of individuals in their environment, promoted a greater overall clinical improvement at all times evaluated than control and this improvement was maintained at one year. EG and CG maintained recovery symptomatic manic. Nevertheless, the PE did not protect depressive relapses and worsening of social adequacy. Therefore, the PE was effective in well-being of the patient in his environment, the global clinical improvement and protection of manic relapses.