A regret theory approach to decision curve analysis: A novel method for eliciting decision makers' preferences and decision-making

Background  

Decision curve analysis (DCA) has been proposed as an alternative method for evaluation of diagnostic tests, prediction models, and molecular markers. However, DCA is based on expected utility theory, which has been routinely violated by decision makers. Decision-making is governed by intuition (system 1), and analytical, deliberative process (system 2), thus, rational decision-making should reflect both formal principles of rationality and intuition about good decisions. We use the cognitive emotion of regret to serve as a link between systems 1 and 2 and to reformulate DCA.     

The role of genital pathogens in morbidity following diathermy loop excision of the transformation zone of the uterine cervix

ObjectiveTo evaluate the role of genital pathogens in postoperative morbidity following diathermy loop excision of the transformation zone (LETZ) of the uterine cervix.MethodsPatients with cervical intraepithelial neoplasia (CIN) who underwent diathermy LETZ were included in a prospective study. Cervical swabs for genital pathogens were collected before the diathermy procedure. After surgery, women were followed-up regarding the occurrence and severity of postoperative pain, bleeding, and discharge.ResultsGenital pathogens were present in 463 of 788 (58.8%) cases. The most frequently isolated groups of microorganisms were group B β-hemolytic Streptococcus, α-hemolytic Streptococcus, Enterococcus species, and coliforms. In patients with genital pathogens, postoperative pain was present in 298 (37.8%), discharge in 262 (33.2%), and bleeding in 236 (29.9%) cases. In patients without genital pathogens, 199 (25.3%) experienced pain, 181 (23.0%) discharge, and 143 (18.1%) bleeding. The differences between the 2 groups were not statistically significant (χ² for pain = 0.675; χ² for discharge = 0.031; χ² for bleeding = 3.444; P > 0.05).ConclusionGenital pathogens are very common among patients with CIN and do not affect the occurrence or severity of pain, discharge, or postoperative bleeding after diathermy LETZ.     

Endodontic Management of the Three-Rooted Mandibular First Permanent Molar: a Case Report

The distal root of the mandibular first permanent molar (MFPM) contains one or two canals. More rarely, the second/third distal canal is found in a separate root in a distolingual (DL) position – a radix entomolaris (RE). In Caucasians, this occurs in less than 4% of cases, but it is equally important to be aware of this possibility. Careful examination of the preoperative periapical radiographs (orthoradial and mesially angled) and inspection of the pulp chamber floor during endodontic management may indicate that this radicular variant is present. RE’s lingual inclination and buccolingual curvature must be taken into account during cleaning and shaping of the canal within this root to avoid procedural errors, such as straightening and ledging of the root canal, perforation or instrument fracture. The aim of the present paper was to discuss a case report of a young patient, referred to an endodontic office after a ledge was created by inappropriate instrumentation of a buccolingually curved RE canal.Key words: mandibular first permanent molar, root canal therapy, radix entomolaris, supernumerary root, anatomical variants     

Knee anterior laxity: a risk factor for traumatic knee injury among sportswomen?

The purpose of this study was to investigate if knee anterior laxity, measured with an arthrometer, is a risk factor for traumatic knee injury in sportswomen. To allow a more complete analysis, other, easily measured variables such as anthropometry, lower leg characteristics, sport exposure and menstrual cycle characteristics were also evaluated as possible risk factors. Subjects were Slovenian sportswomen aged between 11 and 41 years participating in basketball, team handball and volleyball (N = 540). Sportswomen were tested in the pre-season and followed for one season. The data collection included: written informed consent, background questionnaire, anthropometric tests, leg dominance assessment, navicular drop test (measurement of foot pronation), passive knee extension assessment and measurement of knee anterior laxity with a KT arthrometer. Several sets of data analysis were performed including logistic regression analysis in order to build a model for predicting traumatic knee injury among sportswomen. Height and average hours of training per week were found to differ significantly (P < 0.05) between injured and uninjured sportswomen. More sportswomen injured their non-dominant leg. Traumatic knee injuries among Slovenian sportswomen participating in basketball, team handball and volleyball are associated with higher amounts of training, greater body height and greater knee anterior laxity. Only 1% of the variability in traumatic knee injuries among sportswomen were explained with those variables suggesting that there are many other variables associated with traumatic knee injuries among sportswomen than were tested in this study.     

Interactions of metal ions with DNA, its constituents and derivatives, which may be relevant for anticancer research

In this review several types of interactions between metal ions and DNA are given, starting from basic binding to the use of metal complexes in cancer treatment and diagnostics. Metal cations help to neutralize the negative charge of DNA and thus enable the normal functions of DNA but many other interactions are also possible and are discussed in this paper. Various consequences of such interactions can be reversible (e. g. conformational changes) or irreversible (e. g. cleavage). It is known that some metal ions can also damage DNA which can provoke mutations and in some cases leads to cancer. It is clear that we know a lot about metal-DNA interactions but much more information is needed to understand the role of metal ions completely and to use this knowledge successfully.     

Correlates of knee anterior laxity in sportswomen

The purpose of this study was to evaluate whether any of the following factors are related to knee anterior laxity in healthy sportswomen: anthropometric characteristics, lower limb alignment characteristics, hormone-related factors and sport history. Six hundred and sixteen sportswomen were tested in the pre-season. The data have been analysed using linear regression for possible association of knee anterior laxity with other variables. Univariate linear regression indicated a positive association of knee anterior laxity with knee extension and navicular drop and a negative association with body height. Multivariate linear regression analysis showed statistically significant associations between knee anterior laxity and the combination of passive knee extension and the chosen sport (R² = 0.089; p < 0.05). The combination of passive knee extension and sport type was found to be related to the amount of knee anterior laxity, although the association was weak with this combination of factors able to explain only about 9% of the variability in laxity. Knowing which factors influence the amount of knee anterior laxity will help us to better interpret the results of knee anterior laxity testing and help us to understand the possible role of knee anterior laxity as a risk factor for knee injury.     

Infective endocarditis due to Abiotrophia defectiva: a report of two cases

BACKGROUND AND AIM OF THE STUDY: Endocarditis due to Abiotrophia sp. is rare and often associated with negative blood cultures. The rates of treatment failure, infection relapse and mortality are higher than in endocarditis caused by other viridans streptococci. METHODS: A retrospective review of A. defectiva endocarditis in a patient with prosthetic aortic valve and in a patient with Marfan syndrome was performed. RESULTS: A. defectiva, susceptible to penicillin (MIC 0.064 mg/l and 0.016 mg/l, respectively) was isolated from blood cultures of both patients. Treatment with penicillin and gentamicin was started in both patients. Since the first patient developed a macular rash and leukopenia, penicillin was substituted with ceftriaxone. Both patients responded well to antibiotic treatment, did not need prosthetic valve insertion or reinsertion, and were without any sequelae at one year follow up. CONCLUSION: Standard treatment of bacterial endocarditis with penicillin and gentamicin was effective in both patients. In contrast to previous reports, the present patients had a favorable outcome on completion of treatment and at one-year follow up.