Hospital of Lithuanian University of Health Sciences Kaunas Clinics

Background: Biologic therapies are widely used in patients with ulcerative colitis. Head-to-head trials of these therapies in patients with inflammatory bowel disease are lacking.
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\nMethods: In a phase 3b, double-blind, double-dummy, randomized trial conducted at 245 centers in 34 countries, we compared vedolizumab with adalimumab in adults with moderately to severely active ulcerative colitis to determine whether vedolizumab was superior. Previous exposure to a tumor necrosis factor inhibitor other than adalimumab was allowed in up to 25% of patients. The patients were assigned to receive infusions of 300 mg of vedolizumab on day 1 and at weeks 2, 6, 14, 22, 30, 38, and 46 (plus injections of placebo) or subcutaneous injections of 40 mg of adalimumab, with a total dose of 160 mg at week 1, 80 mg at week 2, and 40 mg every 2 weeks thereafter until week 50 (plus infusions of placebo). Dose escalation was not permitted in either group. The primary outcome was clinical remission at week 52 (defined as a total score of ≤2 on the Mayo scale [range, 0 to 12, with higher scores indicating more severe disease] and no subscore >1 [range, 0 to 3] on any of the four Mayo scale components). To control for type I error, efficacy outcomes were analyzed with a hierarchical testing procedure, with the variables in the following order: clinical remission, endoscopic improvement (subscore of 0 to 1 on the Mayo endoscopic component), and corticosteroid-free remission at week 52.
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\nResults: A total of 769 patients underwent randomization and received at least one dose of vedolizumab (383 patients) or adalimumab (386 patients). At week 52, clinical remission was observed in a higher percentage of patients in the vedolizumab group than in the adalimumab group (31.3% vs. 22.5%; difference, 8.8 percentage points; 95% confidence interval [CI], 2.5 to 15.0; P = 0.006), as was endoscopic improvement (39.7% vs. 27.7%; difference, 11.9 percentage points; 95% CI, 5.3 to 18.5; P<0.001). Corticosteroid-free clinical remission occurred in 12.6% of the patients in the vedolizumab group and in 21.8% in the adalimumab group (difference, -9.3 percentage points; 95% CI, -18.9 to 0.4). Exposure-adjusted incidence rates of infection were 23.4 and 34.6 events per 100 patient-years with vedolizumab and adalimumab, respectively, and the corresponding rates for serious infection were 1.6 and 2.2 events per 100 patient-years.
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\nConclusions: In this trial involving patients with moderately to severely active ulcerative colitis, vedolizumab was superior to adalimumab with respect to achievement of clinical remission and endoscopic improvement, but not corticosteroid-free clinical remission. (Funded by Takeda; VARSITY ClinicalTrials.gov number, NCT02497469; EudraCT number, 2015-000939-33.).

A 2-day workshop of ORCA and the IADR Cariology Research Group was organized to discuss and reach consensus on definitions of the most commonly used terms in cariology. The aims were to identify and to select the most commonly used terms of dental caries and dental caries management and to define them based on current concepts. Terms related to definition, diagnosis, risk assessment, and monitoring of dental caries were included. The Delphi process was used to establish terms to be considered using the nominal group method favored by consensus. Of 222 terms originally suggested by six cariologists from different countries, a total of 59 terms were reviewed after removing duplicates and unnecessary words. Sixteen experts in cariology took part in the process of reaching consensus about the definitions of the selected caries terms. Decisions were made following thorough "round table" discussions of each term and confirmed by secret electronic voting. Full agreement (100%) was reached on 17 terms, while the definitions of 6 terms were below the agreed 80% threshold of consensus. The suggested terminology is recommended for use in research, in public health, as well as in clinical practice.

PURPOSE: The purpose of this study was to compare the outcomes of mosaic-type osteochondral autologous transplantation (OAT) and microfracture (MF) procedures for the treatment of the articular cartilage defects of the knee joint in young active athletes. TYPE OF STUDY: Prospective randomized clinical study. METHODS: Between 1998 and 2002, a total of 60 athletes with a mean age of 24.3 years (range, 15 to 40 years) and with a symptomatic lesion of the articular cartilage in the knee were randomized to undergo either an OAT or an MF procedure. Only those athletes playing in competitive sports at regional or national levels were included in the study. Fifty-seven athletes (95%) were available for a follow-up. There were 28 athletes in the OAT group and 29 athletes in the MF group. The mean duration of symptoms was 21.32 +/- 5.57 months and the mean follow-up was 37.1 months (range, 36 to 38 months), and none of the athletes had prior surgical interventions to the affected knee. Patients were evaluated using modified Hospital for Special Surgery (HSS) and International Cartilage Repair Society (ICRS) scores, radiograph, magnetic resonance imaging (MRI), and clinical assessment. An independent observer performed a follow-up examination after 6, 12, 24, and 36 months. At 12.4 months postoperatively, arthroscopy with biopsy for histologic evaluation was carried out. A radiologist and a pathologist, both of whom were blinded to each patient's treatment, did the radiologic and histologic evaluations. RESULTS: After 37.1 months, both groups had significant clinical improvement (P < .05). According to the modified HSS and ICRS scores, functional and objective assessment showed that 96% had excellent or good results after OAT compared with 52% for the MF procedure (P < .001). At 12, 24, and 36 months after surgery, the HSS and ICRS showed statistically significantly better results in the OAT group (P = .03; P = .006; P = .006). Younger athletes did better in both groups. No serious complications were reported. There was 1 failure in the OAT group and 9 in the MF group. The ICRS Cartilage Repair Assessment for macroscopic evaluation during arthroscopy at 12.4 months showed excellent or good repairs in 84% after OAT and in 57% after MF. Biopsy specimens were obtained from 58% of the patients and histologic evaluation of repair showed better scores (according to ICRS) for the OAT group (P < .05). MRI evaluation showed excellent or good repairs in 94% after OAT compared with 49% after MF. Twenty-six (93%) OAT patients and 15 (52%) MF patients returned to sports activities at the preinjury level at an average of 6.5 months (range, 4 to 8 months). Others showed a decline in sports activity level. CONCLUSIONS: At an average of 37.1 months (range, 36 to 38 months) follow-up, our prospective, randomized, clinical study in young active athletes under the age of 40 has shown significant superiority of OAT over MF for the repair of articular cartilage defects in the knee. We found that only 52% of MF athletes could return to sports at the preinjury level. Limitations of our study included a small number of athletes and a relatively short (3-year) follow-up. A long-term follow-up is needed to assess the durability of articular cartilage repair using these methods in young active athletes. LEVEL OF EVIDENCE: Level I, Therapeutic study, randomized controlled trial, significant difference (a).

BACKGROUND: Dalbavancin, a novel lipoglycopeptide with a pharmacokinetic profile that allows weekly dosing, is active against gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). The efficacy of dalbavancin for treatment of skin and skin structure infections (SSSIs) was demonstrated in a phase 2 study. METHODS: In a phase 3 noninferiority study, patients with complicated SSSIs, including infections known or suspected to involve MRSA, were randomized (ratio, 2 : 1) in a double-blind manner to receive dalbavancin (1000 mg given intravenously on day 1 and 500 mg given intravenously on day 8) or linezolid (600 mg given intravenously or intravenously/orally every 12 h for 14 days). Efficacy was assessed by determining clinical and microbiological responses at the end of therapy and at the test-of-cure visit. Relapses were identified by additional follow-up approximately 1 month later. RESULTS: MRSA was identified in 51% of patients from whom a pathogen was isolated at baseline. Dalbavancin and linezolid demonstrated comparable clinical efficacy in the clinically evaluable population at the test-of-cure visit (88.9% and 91.2% success, respectively). The rate of clinical success at the end of therapy was >90% in both arms. Less than 1.0% of patients in either treatment arm experienced relapse after the test-of-cure visit. Both treatments yielded successful microbiological response in excess of 85% among microbiologically evaluable patients at end of therapy and at the test-of-cure visit for all pathogens combined, for all S. aureus strains, and for MRSA. Gastrointestinal symptoms were among the most common adverse events in both arms. A higher proportion of patients in the linezolid arm reported adverse events that were judged by the investigator to be probably/possibly related to treatment (dalbavancin arm, 25.4% of subjects; linezolid arm, 32.2% of subjects). CONCLUSIONS: Two doses of dalbavancin (1000 mg given on day 1 followed by 500 mg given on day 8) were as well tolerated and as effective as linezolid given twice daily for 14 days for the treatment of patients with complicated SSSI, including those infected with MRSA.

Background: Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments. Methods: This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study. Results: A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%. Conclusions: The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.

Of 250 consecutively admitted patients with central nervous system (CNS) infections who were treated during a 1-year period, all 133 patients with tickborne encephalitis (TBE) were included in a prospective follow-up study. TBE presented as mild (meningeal) in 43.6% of patients and as moderate or severe (encephalitic) in 43.6% and 12.8% of patients, respectively. Paralytic disease was observed in 3.8% of the subjects, and cranial nerve injury was observed in 5.3%. One patient died of TBE. Permanent CNS dysfunction after 1 year was found in 30.8% of patients; in 8.5% of all TBE cases, severe disabilities required adjustment of daily activities. Corticosteroid treatment did not seem to improve outcome. A progressive course of TBE was noted in 2 patients. The risk of incomplete recovery was significantly higher among patients with the encephalitic form of TBE (odds ratio, 4.066; 95% confidence interval, 1.848-8.947). In conclusion, TBE is an important pathogen in CNS infection in the Kaunas region of Lithuania, and it causes long-lasting morbidity in one-third of cases.

Tickborne encephalitis (TBE) virus infections can be asymptomatic or cause moderate to severe injuries of the central nervous system. Why some individuals develop severe disease is unknown, but a role for host genetic factors has been suggested. To investigate whether chemokine receptor CCR5 is associated with TBE, CCR5Delta32 genotyping was performed among Lithuanian patients with TBE (n=129) or with aseptic meningoencephalitis (n=76) as well as among control subjects (n=134). We found individuals homozygous for CCR5Delta32 (P= .026) only among patients with TBE and a higher allele prevalence among patients with TBE compared with the other groups studied. CCR5Delta32 allele prevalence also increased with the clinical severity of disease.

The purpose of this prospective randomized clinical study was to compare the outcomes of mosaic type autologous osteochondral transplantation (OAT) and microfracture (MF) procedures for the treatment of the articular cartilage defects of the knee joint in athletes. Between 1998 and 2002, a total of 57 athletes with a mean age of 24.3 years and with a symptomatic lesion of the articular cartilage in the knee were randomized to undergo either OAT or MF procedure. There were 28 athletes in OAT group and 29 in MF group. Patients were evaluated using a modified Hospital for Special Surgery (HSS) and International Cartilage Repair Society (ICRS) scores, MRI and clinical assessment after 6, 12, 24 and 36 months after the surgery. According to the modified HSS and ICRS scores, functional and objective assessment showed that 96% had excellent or good results after OAT compared with 52% after MF procedure (P<0.001). In 12, 24 and 36 months after the operations, the HSS and ICRS showed statistically significantly better results in the OAT group (P=0.03; P=0.006; P=0.006). Twenty-six (93%) athletes following OAT and fifteen (52%) athletes following MF returned to sports activities at the preinjury level at an average of 6.5 months (range, 4-8 months) after the operations. At an average of 37.1 months follow-up, our prospective, randomized, clinical study in athletes has shown significant superiority of the OAT over MF for the repair of articular cartilage defects in the knee.

Although the downregulation of creatine kinase activity has been associated with heart failure, creatine kinase-deficient transgenic hearts have a preserved contractile function. This suggests the existence of alternative phosphotransfer pathways in the myocardium, the identity of which is still unknown. In this study, we examined the contribution of adenylate kinase-catalyzed phosphotransfer to myocardial energetics. In the isolated mitochondria/actomyosin system, which possesses endogenous adenylate kinase activity in both compartments, substrates for adenylate kinase promoted the rate and amplitude of actomyosin contraction that was further enhanced by purified adenylate kinase. Inhibition of adenylate kinase activity diminished both actomyosin contraction and mitochondrial respiration, which indicated reduced energy flow between mitochondria and myofibrils. In intact myocardium, the net adenylate kinase-catalyzed phosphotransfer rate was 10% of the total ATP turnover rate as measured by 18O-phosphoryl labeling in conjunction with gas chromatography and mass spectrometry. In pacing-induced failing heart, adenylate kinase-catalyzed phosphotransfer increased by 134% and contributed 21% to the total ATP turnover. Concomitantly, the contribution by creatine kinase dropped from 89% in normal hearts to 40% in failing hearts. These phosphotransfer changes were associated with reduced levels of metabolically active ATP but maintained overall ATP turnover rate. Thus, this study provides evidence that adenylate kinase facilitates the transfer of high-energy phosphoryls and signal communication between mitochondria and actomyosin in cardiac muscle, with an increased contribution to cellular phosphotransfer in heart failure. This phosphotransfer function renders adenylate kinase an important component for optimal myocardial bioenergetics and a compensatory mechanism in response to impaired intracellular energy flux in the failing heart.

OBJECTIVES: To determine the therapeutic equivalence and safety of once daily (OD) versus three times daily (TID) dosing of a total daily dose of 3 g Salofalk (mesalazine) granules in patients with active ulcerative colitis. DESIGN: A randomised, double-blind, double-dummy, parallel group, multicentre, international, phase III non-inferiority study. SETTING: 54 centres in 13 countries. PATIENTS: 380 patients with confirmed diagnosis of established or first attack of ulcerative colitis (clinical activity index (CAI)>4 and endoscopic index > or =4 at baseline) were randomised and treated. INTERVENTIONS: 8-week treatment with either 3 g OD or 1 g TID mesalazine granules. MAIN OUTCOME MEASURES: Clinical remission (CAI< or =4) at study end. RESULTS: 380 patients were evaluable for efficacy and safety by intention-to-treat (ITT); 345 for per protocol (PP) analysis. In the ITT population, 79.1% in the OD group (n = 191) and 75.7% in the TID group (n = 189) achieved clinical remission (p<0.0001 for non-inferiority). Significantly more patients with proctosigmoiditis achieved clinical remission in the OD group (86%; n = 97) versus the TID group (73%; n = 100; p = 0.0298). About 70% of patients in both treatment groups achieved endoscopic remission, and 35% in the OD group and 41% in the TID group achieved histological remission. About 80% of all patients preferred OD dosing. Similar numbers of adverse events occurred in 55 patients (28.8%) in the OD group and in 61 patients (32.3%) in the TID group, indicating that the two dosing regimens were equally safe and well tolerated. CONCLUSIONS: OD 3 g mesalazine granules are as effective and safe as a TID 1 g schedule. With respect to the best possible adherence of patients to the treatment, OD dosing of mesalazine should be the preferred application mode in active ulcerative colitis.

OBJECTIVE: Insufficient angiogenesis with tissue ischemia and accumulation of extracellular matrix are hallmarks of systemic sclerosis (SSc). Based on the severely decreased oxygen levels in the skin of patients with SSc, we aimed to investigate the role of hypoxia in the pathogenesis of SSc. METHODS: Subtractive hybridization was used to compare gene expression in dermal fibroblasts under hypoxic and normoxic conditions. Dermal fibroblasts were further characterized by exposure to different concentrations of oxygen and for different time periods as well as by interference with hypoxia-inducible factor 1alpha (HIF-1alpha). The systemic normobaric hypoxia model in mice was used for in vivo analyses. RESULTS: Several extracellular matrix proteins and genes involved in extracellular matrix turnover, such as thrombospondin 1, proalpha2(I) collagen, fibronectin 1, insulin-like growth factor binding protein 3, and transforming growth factor beta-induced protein, were induced by hypoxia in SSc and healthy dermal fibroblasts. The induction of these genes was time- and dose-dependent. Experiments with HIF-1alpha-knockout mouse embryonic fibroblasts, deferoxamine/cobalt ions as chemical stabilizers of HIF-1alpha, and HIF-1alpha small interfering RNA consistently showed that extracellular matrix genes are induced in dermal fibroblasts by HIF-1alpha-dependent, as well as HIF-1alpha-independent, mechanisms. Using the systemic normobaric hypoxia mouse model, we demonstrated that dermal hypoxia leads to the induction of the identified extracellular matrix genes in vivo after both short exposure and prolonged exposure to hypoxia. CONCLUSION: These data show that hypoxia contributes directly to the progression of fibrosis in patients with SSc by increasing the release of major extracellular matrix proteins. Targeting of hypoxia pathways might therefore be of therapeutic value in patients with SSc.

ABSTRACT Abelson kinase (c‐abl) and platelet‐derived growth factor (PDGF) are key players in the pathogenesis of systemic sclerosis (SSc). The aim of the present study was to evaluate the antifibrotic potential of dasatinib and nilotinib, 2 novel inhibitors of c‐abl and PDGF, which are well tolerated and have recently been approved. Dasatinib and nilotinib dose‐dependently reduced the mRNA and protein levels of extracellular matrix proteins in human stimulated dermal fibroblasts from SSc patients (IC 50 of 0.5–2.0 nM for dasatinib and 0.8–2.5 nM for nilotinib). In a mouse model of bleomycin‐induced dermal fibrosis, dasatinib and nilotinib potently reduced the dermal thickness, the number of myofibroblasts, and the collagen content of the skin in a dose‐dependent manner at well‐tolerated doses. These data indicate that dasatinib and nilotinib potently inhibit the synthesis of extracellular matrix in vitro and in vivo at biologically relevant concentrations. Thus, we provide the first evidence that dasatinib and nilotinib might be promising drugs for the treatment of patients with SSc.—Akhmetshina, A., Dees, C., Pileckyte, M., Maurer, B., Axmann, R., Jüngel, A., Zwerina, J., Gay, S., Schett, G., Distler, O., Distler, J. H. W. Dual inhibition of c‐abl and PDGF receptor signaling by dasatinib and nilotinib for the treatment of dermal fibrosis. FASEB J. 22, 2214–2222 (2008)

Background and objectives: Oral mucositis is one of the main adverse events of cancer treatment with chemotherapy or radiation therapy. It presents as erythema, atrophy or/and ulceration of oral mucosa. It occurs in almost all patients, who receive radiation therapy of the head and neck area and from 20% to 80% of patients who receive chemotherapy. There are few clinical trials in the literature proving any kind of treatment or prevention methods to be effective. Therefore, the aim of this study is to perform systematic review of literature and examine the most effective treatment and prevention methods for chemotherapy or/and radiotherapy induced oral mucositis. Materials and methods: Clinical human trials, published from 1 January 2007 to 31 December 2017 in English, were included in this systematic review of literature. Preferred reporting items for systematic reviews and meta-analysis (PRISMA) protocol was followed while planning, providing objectives, selecting studies and analyzing data for this systematic review. “MEDLINE” and “PubMed Central” databases were used to search eligible clinical trials. Clinical trials researching medication, oral hygiene, cryotherapy or laser therapy efficiency in treatment or/and prevention of oral mucositis were included in this systematic review. Results: Results of the studies used in this systematic review of literature showed that laser therapy, cryotherapy, professional oral hygiene, antimicrobial agents, Royal jelly, L. brevis lozenges, Zync supplementation and Benzydamine are the best treatment or/and prevention methods for oral mucositis. Conclusions: Palifermin, Chlorhexidine, Smecta, Actovegin, Kangfuxin, L. brevis lozenges, Royal jelly, Zync supplement, Benzydamine, cryotherapy, laser therapy and professional oral hygiene may be used in oral mucositis treatment and prevention.

In recent years, ophthalmology has experienced significant developments with respect to imaging modalities. Optical coherence tomography angiography is one such technology that seeks to improve diagnostics for retinal diseases. Using standard structural ocular coherence tomography hardware, optical coherence tomography angiography demonstrates the ability to non-invasively visualise the vasculature in the retina and the choroid with high resolution, allowing greater insight into retinal vascular pathologies. In addition, retinal and choroidal vessel density and blood flow can be quantified, offering potential to assist in the diagnosis of a variety of retinal diseases. To date, numerous retinal diseases, such as open-angle glaucoma, have been found to possess a vascular component. Specifically, ischaemia of the optic nerve head and lamina cribrosa has been theorised as a causative factor in ganglion cell death; however, confirmation of this mechanism has been prohibited by the limitations of currently existing imaging modalities. Optical coherence tomography angiography provides clear imaging of these regions and the possibility to elucidate further understanding of vascular factors that contribute to glaucoma development and progression. Furthermore, this imaging modality may provide insight to neural pathologies with vascular components such as Alzheimer's disease. Herein, the authors discuss the theory of operation for optical coherence tomography angiography and the current findings from pilot studies with a focus on open-angle glaucoma. In addition, speculation is offered for future applications of the technology to study other diseases with microvascular contributions.

OBJECTIVE: To assess the prevalence of antenatal depressive disorder in different trimesters and to evaluate the relation of psychosocial risk factors to antenatal depressive disorder. DESIGN: Cohort follow-up. SETTING: University Hospital, Kaunas, Lithuania. SAMPLE: Two hundred and thirty pregnant women consecutively admitted. METHODS: At 12-16 weeks, 22-26 weeks, and 32-36 weeks of pregnancy, participants were screened for depression using the World Health Organization's Composite International Diagnostic Interview Short Form (CIDI-SF). Women who gave at least one positive answer to the CIDI-SF depression-screening question were evaluated for depressive disorder using the non-patient version of the Structured Clinical Interview for DSM-III-R (SCID-NP). Psychosocial stressors and two Big Five Personality dimensions, neuroticism and extraversion, were also evaluated. MAIN OUTCOME MEASURES: Prevalence of depressive disorder. RESULTS: The prevalence of the antenatal depressive disorder at 12-16 weeks' gestation was 6.1%, at 22-26 weeks 3.5%, and at 32-36 weeks 4.4%. In the first trimester, a greater prevalence of current depressive disorder was independently associated with unplanned and unwanted pregnancy, high neuroticism, low education, and a previous history of depression; in the second trimester with unplanned and unwanted pregnancy and high neuroticism; in the third trimester with unplanned and unwanted pregnancy, high neuroticism, and the occurrence of psychosocial stressors during the last year. CONCLUSIONS: The highest prevalence of depressive disorders was found in the first trimester, the lowest in mid-pregnancy. Several determinants (unwanted and unplanned pregnancy, high neuroticism) were independent predictors of antenatal depressive disorders throughout whole pregnancy, while other determinants (low education, previous history of depression, the occurrence of psychosocial stressors at the end of pregnancy) were trimester specific.

BACKGROUND: Although there is preliminary evidence that alexithymia may influence the course of coronary heart disease (CHD), there are no studies exploring attempts to modify alexithymic characteristics in cardiac patients. METHOD: Twenty post-myocardial infarction (MI) patients (19 men and 1 woman) were placed in a treatment group, which received weekly group psychotherapy for 4 months. Seventeen post-MI patients (16 men and 1 woman) were placed in a comparison group which received two educational sessions over a period of 1 month. All subjects completed the Toronto Alexithymia Scale (TAS) before the start of group therapy, at the end of the 4-month period, and in follow-up assessment after 6-month, 1-year, and 2-year intervals. RESULTS: In the psychotherapy treatment group, there was a significant reduction in the mean TAS score following group therapy, which was maintained over the 2-year follow-up period. In the educational group, there were no significant changes in mean TAS scores between the initial testing and any of the follow-up intervals. On an individual basis, a decrease to a lower level of TAS scores occurred in a higher percentage of patients in the treatment group than in the educational group. Over the 2-year follow-up period, patients with decreased alexithymia following group therapy experienced fewer cardiac events (reinfarction, sudden cardiac death, or rehospitalization for rhythm disorder or severe angina) than patients whose alexithymia remained unchanged. CONCLUSIONS: The results indicate that group psychotherapy is able to decrease alexithymia and that for many patients this change can be maintained for at least 2 years. A reduction in the degree of alexithymia seems to influence favorably the clinical course of CHD.

PURPOSE: To compare the concomitant treatment of articular cartilage damage in the medial femoral condyle with osteochondral autologous transplantation (OAT), microfracture, or debridement procedures at the time of anterior cruciate ligament (ACL) reconstruction. METHODS: Between 2006 and 2009, 102 patients with a mean age of 34.1 years and with an ACL rupture and articular cartilage damage in the medial femoral condyle of the knee were randomized to undergo OAT, microfractures, or debridement at the time of ACL reconstruction. A matched control group was included, comprising 34 patients with intact articular cartilage at the time of ACL reconstruction. There were 34 patients in the OAT-ACL group, 34 in the microfracture (MF)-ACL group, 34 in the debridement (D)-ACL group, and 34 in the control group with intact articular cartilage (IAC-ACL group). The mean time from ACL injury to operation was 19.32 ± 3.43 months, and the mean follow-up was 36.1 months (range, 34 to 37 months). Patients were evaluated with the International Knee Documentation Committee (IKDC) score, Tegner activity score, and clinical assessment. RESULTS: Of 102 patients, 97 (95%) were available for the final follow-up. According to the subjective IKDC score, all 4 groups fared significantly better at the 3-year follow-up than preoperatively (P < .005). The OAT-ACL group's IKDC subjective knee evaluation was significantly better than that of the MF-ACL group (P = .024) and D-ACL group (P = .018). However, the IKDC subjective score of the IAC-ACL group was significantly better than the OAT-ACL group's IKDC evaluation (P = .043). There was no significant difference between the MF-ACL and D-ACL groups' IKDC subjective scores (P = .058). Evaluation of manual pivot-shift knee laxity according to the IKDC knee examination form showed similar findings for the 4 groups immediately postoperatively and at 3-year follow-up, and the findings were rated as normal or nearly normal (IKDC grade A or B) in 29 of 33 patients (88%) in the OAT-ACL group, 28 of 32 patients (88%) in the MF-ACL group, 27 of 32 patients (84%) in the D-ACL group, and 31 of 34 patients (91%) in the IAC-ACL group. CONCLUSIONS: Our study shows that intact articular cartilage during ACL reconstruction yields more favorable IKDC subjective scores compared with any other articular cartilage surgery type. However, if an articular defect is present, the subjective IKDC scores are significantly better for OAT versus microfracture or debridement after a mean period of 3 years. Anterior knee stability results were not significantly affected by the different articular cartilage treatment methods. LEVEL OF EVIDENCE: Level II, prospective comparative study.

PURPOSE: This study investigates the relationship between intraocular pressure (IOP) and retinal hemodynamics and predicts how arterial blood pressure (BP) and blood flow autoregulation (AR) influence this relationship. METHODS: A mathematical model is developed to simulate blood flow in the central retinal vessels and retinal microvasculature as current flowing through a network of resistances and capacitances. Variable resistances describe active and passive diameter changes due to AR and IOP. The model is validated by using clinically measured values of retinal blood flow and velocity. The model simulations for six theoretical patients with high, normal, and low BP (HBP-, NBP-, LBP-) and functional or absent AR (-wAR, -woAR) are compared with clinical data. RESULTS: The model predicts that NBPwAR and HBPwAR patients can regulate retinal blood flow (RBF) as IOP varies between 15 and 23 mm Hg and between 23 and 29 mm Hg, respectively, whereas LBPwAR patients do not adequately regulate blood flow if IOP is 15 mm Hg or higher. Hemodynamic alterations would be noticeable only if IOP changes occur outside of the regulating range, which, most importantly, depend on BP. The model predictions are consistent with clinical data for IOP reduction via surgery and medications and for cases of induced IOP elevation. CONCLUSIONS: The theoretical model results suggest that the ability of IOP to induce noticeable changes in retinal hemodynamics depends on the levels of BP and AR of the individual. These predictions might help to explain the inconsistencies found in the clinical literature concerning the relationship between IOP and retinal hemodynamics.

The main objective of this report is to encourage consistent quality of testing and reporting within and between centres that use colour Doppler imaging (CDI) for assessment of retrobulbar blood flow. The intention of this review is to standardize methods in CDI assessment that are used widely, but not to exclude other approaches or additional tests that individual laboratories may choose or continue to use.

The aim of this study was to investigate the relationship among type 1 diabetes mellitus, dental caries, and salivary status in children. The study comprised 68, 10-15-yr-old diabetics, and 68, age- and gender-matched non-diabetic controls. Diabetics were categorized into well-to-moderately controlled (HbA1c < 9.0%) and poorly controlled (HbA1c >or= 9.0%) groups. Caries was recorded by assessing lesion activity at non-cavitated and cavity levels. Teeth were examined visually for the presence of dental plaque. Saliva was analyzed for unstimulated and stimulated flow rates, buffer effect, mutans streptococci, lactobacilli, and yeasts. Diabetics had fewer caries and plaque, lower salivary flow rates and buffer effect, and more frequent growth of yeasts than their non-diabetic controls. Well-to-moderately controlled diabetics had fewer decayed surfaces and lower counts of mutans streptococci and yeasts than poorly controlled diabetics, but the level of metabolic control of diabetes had no influence on salivary flow rates and buffer effect. High caries levels in diabetics were significantly associated with age, plaque score, and decreased unstimulated salivary flow rate, but were not associated with the level of metabolic control of diabetes. High caries experience in this study population could be related to plaque accumulation and/or to changes in saliva induced by diabetes mellitus.