Agreement between an isolated rater and a group of raters

The agreement between two raters judging items on a categorical scale is traditionally assessed by Cohen’s kappa coefficient. We introduce a new coefficient for quantifying the degree of agreement between an isolated rater and a group of raters on a nominal or ordinal scale. The group of raters is regarded as a whole, a reference or gold-standard group with its own heterogeneity. The coefficient, defined on a population-based model, requires a specific definition of the concept of perfect agreement. It has the same properties as Cohen’s kappa coefficient and reduces to the latter when there is only one rater in the group. The new approach overcomes the problem of consensus within the group of raters and generalizes Schouten’s index. The method is illustrated on published syphilis data and on data collected from a study assessing the ability of medical students in diagnostic reasoning when compared with expert knowledge

A new curcuma extract (flexofytol(R)) in osteoarthritis: results from a belgian real-life experience.

This retrospective observational study summarizes the experiences of 820 patients treated with a new Curcuma extract (Flexofytol(R), 4-6 capsules per day), for more than 6 months for various forms of painful osteoarthritis. These experiences were reported by 110 Belgian general practitioners via a questionnaire that included quality-of-life parameters for assessing patient experience. Data were submitted to an independent statistician for analysis. Within the first 6 weeks, Flexofytol(R) improved patient pain, articular mobility, and quality of life. Excellent tolerance was reported, and more than half of these patients were able to discontinue analgaesic and anti-inflammatory drugs. Patient satisfaction was confirmed by their decision to maintain Flexofytol(R) therapy for more than 6 months. These data must be confirmed with randomized controlled studies. We currently conclude that Flexofytol(R) which is based on a new preparation of curcumin, is as a potential neutraceutical for the care of patients complaining of joint problems, with excellent tolerance and rapid benefits for articular mobility, pain, and quality of life.Peer reviewe

Biostatistics: Facing the Interpretation of 2 × 2 Tables

There are multiple ways in which 2 x 2 tables arise in clinical research. Different facets of 2 x 2 tables can be identified which require appropriate statistical analysis and interpretation. This paper presents a brief overview of such tables

Understanding limitations in at-work productivity in patients with active ankylosing spondylitis : the role of work-related contextual factors

Objective: To explore the effect of health-related and contextual factors on presenteeism, absenteeism, and overall work productivity loss in patients with active ankylosing spondylitis (AS). Methods: Consecutive patients with AS starting their first tumor necrosis factor inhibitor and in paid employment were eligible. Patients completed the Work Productivity and Activity Impairment (WPAI) questionnaire for AS to assess presenteeism, absenteeism, and overall work productivity loss in the previous 7 days. In addition, they answered questions about work characteristics (type, characteristics of workplace, satisfaction of contacts with colleagues, and importance of work in life) and health status [Bath AS Functional Index (BASFI), AS Disease Activity Score-C-reactive protein (ASDAS-CRP)]. Physicians assessed the Bath Ankylosing Spondylitis Metrology Index, presence of articular and extraarticular manifestations, comorbidities, and laboratory indicators of inflammation. Stepwise regression models were computed to determine which work-related and health-related factors contributed to WPAI outcomes. Results: The study included 80 patients. The WPAI presenteeism, absenteeism, and overall work productivity loss scores were 49.1%, 30.2%, and 53.1%, respectively. Presenteeism was associated with higher BASFI, female sex, and poor quality of contact with colleagues. Absenteeism was associated with increasing age, current smoking status, higher ASDAS-CRP, and low importance of work for life. Overall work productivity loss was associated with female sex, higher BASFI, past adaptation of job because of illness, number of working hours, and manual profession. Conclusion: Both health-related and contextual factors contribute to work limitations in patients with AS and suggest additional opportunities for improvement by addressing the working environment

The weather-beaten dorsal hand. Clinical rating, shadow casting optical profilometry and skin capacitance mapping.

Peer reviewe

Analysis of anthropometrics characteristics and jumping ability in junior top level volleyball athletes

Aim. The volleyball is a situational sport classified among activities laying on alternative aerobe and anaerobe processes, with an important participation of the muscular mass and an accentuated prevalence of the alactacid anaerobe process. Within a population of young top volleyball athletes, the goal of the study was to compare several anthropometrical and functional variables according to the role of the player during the game. Methods. Data were collected by 42 volleyball players which trained with the Italian national junior team, divided into four groups: 1) side spikers (n=14; age=18.5 +/- 1.4 y.); 2) centre spikers (n=15; age 18.1 +/- 11.1 y.); (3) setters (n=7; age=18.4 +/- 1.3 y), and; 4) universal spikers (n=6; age=17.5 +/- 0.8 y.). Morphological data were height, weight, body mass index (BMI), indirect ratio of body fat determined by the method of Katch (%BF), reach with 1 (R1) or 2 (R2) hands. The explosive force was measured with the method of Bosco [1] : squat jump (SJ), counter movement jump (CMJ), CMJ with arms (CMJas) and repeated jumps during 15 seconds (RJ15). The ability to jump was measured with the Vertec test in two conditions: spike (Vertec attack, VA) and block (Vertec block, VB). Jumping performance was determined through the difference between VA and R1 (running spring, RS) and VB and R2 (standing spring, SS). Results. Significant differences were pointed out for the height (F=4,75; p < 0,006), R1 (F=3,6; p < 0,02) and R2 (F=3,66; p < 0,02). For the three anthropological variables, centre spikers (C) were significantly higher than setters (S). Comparing players' performance at the Bosco test, no significant differences appeared between groups. Results of Vertec test showed significant differences in VA (F = 7.29; p < 0.001) where group C performed better than groups S and U (universal spikers), and in VB (F = 3.95; p < 0.05) where group C achieved significantly better then setters. Analysis of the correlation matrix showed that height and weight were strongly correlated between them and with R1 and R2. Performances at Bosco test and at Vertec test were respectively correlated between them but no correlation was observed between results of Bosco and Vertec test. With Bosco test gathered information provide an assessment of the jumping ability without connection to the specific skills while Vertec test provide more specific information about the athlete's ability to use spring in specific conditions. A high correlation was identified between anthropometrics variables and the results of the Vertec test. Multiple regression analysis confirmed that, excepted %BF which is only (inversely) correlated to Vertec performances, all groups of variables were correlated between them. Conclusion. Results pointed out that in junior top level volleyball, the anthropometrical profile of the players is directly related to specific variables which must be used to select talented athletes and to plan training in connection with specific role of the player in the game. Because of the reduced duration of the game episodes and to the increasing intensity of the game rhythm, the modern volleyball involve increasingly the alactacid anaerobe component. It is for all above reasons that top level volleyball needs always more muscular powerful athletes who are also fast and able to use high jumping abilities. For that reason, assessment, training and follow up of the jumping abilities become some of the most determinant aspects of the player's effectiveness. Data underline the interest of the use of specific tests to identify the jumping ability of volleyball athletes. The protocol developed in that study can provide determinant information during the first phase of athletes' selection

Microleakage after Thermocycling of Three Self-Etch Adhesives under Resin-Modified Glass-Ionomer Cement Restorations

This study was designed to evaluate microleakage that appeared on Resin-Modified Glass-Ionomer Cement (RMGIC) restorations. Sixty class V cavities (h × w × l = 2 mm × 2 mm × 3 mm) were cut on thirty extracted third molars, which were randomly allocated to three experimental groups. All the buccal cavities were pretreated with polyacrylic acid, whereas the lingual cavities were treated with three one-step Self-Etch adhesives, respectively, Xeno III (Dentsply Detrey GmbH, Konstanz, Germany), iBond exp (Heraeus Kulzer gmbH & Co. KG, Hanau, Germany), and Adper Prompt-L-Pop (3M ESPE AG, Dental products Seefeld, Germany). All cavities were completely filled with RMGIC, teeth were thermocycled for 800 cycles, and leakage was evaluated. Results were expressed as means ± standard deviations (SDs). Microleakage scores were analysed by means of generalized linear mixed models (GLMMs) assuming an ordinal logistic link function. All results were considered to be significant at the 5% critical level (P < .05). The results showed that bonding RMGIC to dentin with a Self-Etch adhesive rather than using polyacrylic acid did not influence microleakage scores (P = .091), except for one tested Self-Etch adhesive, namely, Xeno III (P < .0001). Nevertheless, our results did not show any significant difference between the three tested Self-Etch adhesive systems. In conclusion, the pretreatment of dentin with Self-Etch adhesive system, before RMGIC filling, seems to be an alternative to the conventional Dentin Conditioner for the clinicians as suggested by our results (thermocycling) and others (microtensile tests)

A new method to evaluate the part of stress in pain: injection of dextrose 5% (neural prolotherapy) on acupuncture points corresonponding to stellate, coeliac and mesenteric ganglions. A pilot study

In neuralgia (neuropathic pain), the skin rolling test is painful (allodynia to pinch) but when painful everywhere on the body (polyneuralgia) it often indicates that the patient is in a stress state, in a fight or flight situation. Thus, when starting a treatment, it is important to differentiate between these patients and those who have perineal pain only. The aim of this study was to evaluate the effect on pain and stress of a neural prolotherapy treatment (dextrose 5% injections) at seven acupuncture points linked with orthosympathetic ganglia. The studied population comprised 55 patients treated in two private clinical settings (authors 1 and 2). The short-term effect on pain was studied by comparing the pain induced by the arm skin rolling test before and 15 minutes after injections. To evaluate the long term effect on pain, the average level of body pain during the two weeks preceding the treatment was compared with that following treatment. The World Health Organization (WHO) Five Well-Being Index was used to evaluate the patient’s level of stress before and two weeks after injections. Fifteen minutes after dextrose injections, pain induced by the skin rolling test at the arm was decreased (-3.0 ± 1.6; p<0.0001). Two weeks after treatment, the global body pain score was significantly reduced (-2.0 ± 2.4; p<0.0001) and the total WHO score increased (+21.0 ± 20.5; p<0.0001). Treatment of polyneuralgic patients with neural prolotherapy of seven acupuncture points significantly improves well-being sensation and reduces pain

Predicting probing depth reduction after periodontal non-surgical treatment in smokers according to the nicotine dependence and the number of cigarette consumed.

peer reviewed[en] Introduction: Smoking is considered as a risk factor for the poor outcomes after periodontitis non-surgical treatment (PNST). The aim of this short communication is to predict probing depth reduction after periodontal non-surgical treatment in smokers according to the nicotine dependence (FTND) and the number of cigarette consumed (NCC). Methods: This work is a post-hoc study of a prospective controlled study on the effect of oral hygiene instructions and PNST on periodontal outcomes. This short communication focused only on the current conventional smokers (N = 34), based on specific smoking indicators, and on probing depth (PD) parameter that were recorded at baseline (time 0), after oral hygiene instruction (time 1) and 3 months after PNST (time 2). Results: The 34 smokers had a mean age 46.5 ± 11.5 years. The NCC- and FTND-based predictions allowed to show in a specific nomogram the PD values 3 months after PNST for each NCC and FTND category. Conclusion: Two nomograms are proposed for prognostic purposes and allow patients to understand the impact of smoking on periodontitis according to the number of cigarette consumed and the level of nicotine dependence. These nomograms might be also used for supporting smoking cessation. Clinical significance: In smoker patients with periodontitis, there is a need to predict, for both patient and clinicians, the impact of the number of cigarettes consumed and the level of nicotine dependence on probing depth after oral hygiene instructions and debridement. Two nomograms are proposed for prognostic purposes

Decrease of a specific biomarker of collagen degradation in osteoarthritis, Coll2-1, by treatment with highly bioavailable curcumin during an exploratory clinical trial

BACKGROUND: The management of osteoarthritis (OA) remains a challenge. There is a need not only for safe and efficient treatments but also for accurate and reliable biomarkers that would help diagnosis and monitoring both disease activity and treatment efficacy. Curcumin is basically a spice that is known for its anti-inflammatory properties. In vitro studies suggest that curcumin could be beneficial for cartilage in OA. The aim of this exploratory, non-controlled clinical trial was to evaluate the effects of bio-optimized curcumin in knee OA patients on the serum levels of specific biomarkers of OA and on the evaluation of pain. METHODS: Twenty two patients with knee OA were asked to take 2x3 caps/day of bio-optimized curcumin (Flexofytol®) for 3 months. They were monitored after 7, 14, 28 and 84 days of treatment. Pain over the last 24 hours and global assessment of disease activity by the patient were evaluated using a visual analog scale (100 mm). The serum levels of Coll-2-1, Coll-2-1NO(2), Fib3-1, Fib3-2, CRP, CTX-II and MPO were determined before and after 14 and 84 days of treatment. RESULTS: The treatment with curcumin was globally well tolerated. It significantly reduced the serum level of Coll2-1 (p < 0.002) and tended to decrease CRP. No other significant difference was observed with the other biomarkers. In addition, curcumin significantly reduced the global assessment of disease activity by the patient. CONCLUSION: This study highlighted the potential effect of curcumin in knee OA patient. This effect was reflected by the variation of a cartilage specific biomarker, Coll2-1 that was rapidly affected by the treatment. These results are encouraging for the qualification of Coll2-1 as a biomarker for the evaluation of curcumin in OA treatment. TRIAL REGISTRATION: NCT01909037 at clinicaltrials.go