bluuebunny/crossref_metadata_2025 huggingface dataset:
Contemporary undergraduate implant dentistry education: a systematic review
Authors: Koole S. , De Bruyn H.
Published: February 2014

Introduction

Consensus reports recommend that students upon graduation should possess a significant level of knowledge and competence in implant dentistry, including basic competences in diagnostics, treatment planning, restorative, straightforward surgical and maintenance procedures. In response, undergraduate curricula need to integrate implant dentistry. This narrative review explores educational programmes in terms of competences, related research and barriers or reflections, regarding implementation in undergraduate curricula.

Materials and methods

Publications (2008–2013) were searched systematically in WoS, PubMed and ERIC and screened independently by two authors in four stages: removal of duplicates, title screening, abstract screening and full‐text reading. Inclusion criteria encompassed implant dentistry in undergraduate education.

Results

Finally, 37 of 420 papers were included. Detailed information regarding programme content, number of participants, staff input, logistics/funding issues is scattered. Theoretical education is predominant, and pre‐clinical/clinical training is offered minimally, often carried out in elective programmes. However, selected straightforward cases treated by undergraduates yield positive outcomes with low failure rates, few complications, high patient satisfaction and student appreciation. Barriers to implementing implant dentistry in the undergraduate curriculum include funding issues, limitations in time or staff availability/competence and lack of suitable patients. Overcoming these barriers is worthwhile as experience‐based implant education affects future practice as well‐informed students propose more restorative alternatives to their patients.

Conclusion

Although implant dentistry is increasingly integrated in undergraduate curricula, challenges remain in developing strategies to implement existing competence profiles and the extent of experience‐based education. To support further advancement, universities should report comprehensively on their implant programmes to allow comparison and reproduction in other environments.
Dental implants placed by undergraduate students: clinical outcomes and patients’/students’ perceptions
Authors: Vandeweghe S. , Koole S. , Younes F. , De Coster P. , De Bruyn H.
Published: February 2014

Introduction

Implant dentistry in undergraduate education is predominantly theoretical or prosthetics oriented. Clinical experience with implant surgery could provide students a better understanding of alternatives for tooth replacements. This study describes an implant dentistry programme for undergraduate students, which included surgical placement of implants. The study presents the clinical outcomes of the programme, patients’ satisfaction and students’ attitudes/perceptions. It reflects on barriers and problems encountered during implementation and provides suggestions for other institutions.

Materials and methods

Thirty‐six students placed one implant each for a single tooth replacement after careful radiographic assessment and pre‐surgical planning. One‐stage surgery was performed under one‐to‐one supervision. Crowns were cemented on individual abutments 3–6 months later. Crestal bone loss was assessed radiographically immediately after surgery, at crown placement and after 1 year of loading. Questionnaires were used to investigate patients’ perspectives and students’ opinions towards the programme, as well as their perceived level of competence.

Results

Thirty‐six implants were placed in 27 patients; two (5.6%) failed prior to loading; mean bone loss from time of surgery to crown placement was 1.41 mm and remained unchanged thereafter, reflecting implant success. Overall, patients were satisfied and the majority would repeat the treatment by a student. The students thought it was a valuable experience, although they realised that additional education is necessary to perform implant surgery without supervision.

Conclusion

Implant placement by undergraduate students resulted in acceptable clinical outcome parameters, patient satisfaction and positive student perceptions. These findings support the further development of clinical implant education in undergraduate dental curricula.
Current trends and status of continuing professional development in implant dentistry in Europe
Authors: Ucer T. C. , Botticelli D. , Stavropoulos A. , Mattheos N.
Published: February 2014

Introduction

Previous surveys have shown that newly graduated dentists, in most European countries, do not obtain adequate theoretical knowledge and, especially, clinical skills in implant dentistry (ID) through their undergraduate education and must therefore acquire knowledge and develop competencies through further postgraduate study. Moreover, clinicians, in general, need to continue to maintain the currency of their competence by undertaking ongoing continuing professional development (CPD). This seems particularly important in ID as techniques, and materials develop rapidly due to advances in biomedical technology. Despite recent developments, CPD in ID remains poorly organised with little standardisation or harmonisation across Europe. The objective of this survey was to explore the current status and trends within CPD education in ID in Europe.

Materials and methods

Stakeholders and opinion leaders associated with ID education were invited by email to fill an online questionnaire (closing date: 30th April 2013). Two hundred and forty‐seven questionnaires were distributed, and two separate reminders were sent to participants in 38 European countries. The survey contained 14 multiple‐choice questions, and the data were collected using SurveyMonkey© software, exported in SPSS (Inc, Chicago, IL, USA) format and analysed using descriptive statistics.

Results

Two hundred respondents working in 24 countries replied to the survey (response rate of 81% of invitees and 63% of countries surveyed). The results demonstrated a wide divergence in the content and structure of CPD in ID in Europe.

Conclusions

Dentists need CPD to develop their skills and to maintain their competence in ID. There is an urgent need for structured and accredited CPD, which should be readily available to all dentists practising ID. It should have pre‐determined learning objectives, delivered by accredited CPD providers and educators, and have assessable outcome measures to ensure the best possible impact on clinical practice and patient safety.
Implant dentistry education in Europe: 5 years after the Association for Dental Education in Europe consensus report
Authors: Koole S. , Vandeweghe S. , Mattheos N. , De Bruyn H.
Published: February 2014

Introduction

To promote consensus on implant dentistry university education in Europe, a workshop amongst university teachers and opinion leaders was organised in 2008. As a result, guidelines on both under‐ and postgraduate education were issued. This study aims to investigate the current status of university teaching of implant dentistry and the impact of the recommendations for teaching and assessment, 5 years after the first consensus. Finally, this report attempts to identify future directions in education within the discipline.

Materials and methods

An online survey was distributed amongst 105 academic leaders in implant education in Europe, and 52 questionnaires were returned (response rate 50%).

Results

The average amount of implant dentistry in undergraduate curricula has increased to 74 h, compared to 36 h in 2008, and the inclusion of pre‐clinical and clinical education has increased. No change occurred with regard to the aimed competence levels. It was suggested that certain implant procedures including surgery should be provided by dentists after attending additional courses, whilst complex treatments will still require specialist training. The 2008 workshop guidelines have been implemented to a varying extent (25–100%) in under‐ and postgraduate education. Main reported implementation barriers included limited time availability in the curriculum and limited financial/material resources. Future discussions about implant dentistry in Europe should be focused towards integration in current dental curricula, approaches to overcome barriers and the relations with and role of industrial partners.

Conclusion

Implant dentistry is increasingly integrating in undergraduate dental education. Development of the consensus guidelines in 2008 may have facilitated this process. Nevertheless, further progress is needed on all educational levels to align training of professionals to the growing treatment needs of the population.
Continuing professional development in implant dentistry in Europe
Authors: Ucer T. C. , Botticelli D. , Stavropoulos A. , Cowpe J. G.
Published: February 2014

Introduction

Training for dental practitioners in implant dentistry ranges from 1‐ or 2‐day short Continuing Professional Development (CPD) courses to certificate/diploma programmes run by universities. In general, the teaching of implant dentistry in Europe lacks structure and standardisation. This paper aims to: (i) identify the current trends in CPD in implant dentistry in Europe; (ii) identify potential and limitations with regards to the design and implementation of CPD activities in implant dentistry; (iii) provide recommendations on the future structure and development of CPD activities in implant dentistry.

Methods

A search of the literature was undertaken in PubMed for manuscripts published in English after 2000 reporting on CPD in dentistry and in implant dentistry in particular. In addition, an electronic survey was conducted, investigating the attitudes towards CPD among a wide group of stakeholders in implant dentistry education.

Conclusions

There is a wide diversity of educational pathways towards achieving competences in implant dentistry through CPD. At present, there is a need for improving the CPD structures in implant dentistry, strengthening the quality assurance and encouraging standardisation and transparency of the learning outcomes. Development of a structured CPD system with clearly defined educational objectives mapped against specific levels of competence is recommended.
A new unstable variant of the fetal hemoglobin HBG2 gene: Hb F‐Turritana [Gγ64(E8)Gly→Asp, HBG2:c.194G>A] found in cis to the Hb F‐Sardinia gene [Aγ(E19)Ile→Thr, HBG1:c.227T>C]
Authors: Pirastru Monica , Mereu Paolo , Trova Sandro , Manca Laura , Masala Bruno
Published: February 2014

A new variant of the fetal hemoglobin (Hb) was observed in a newborn baby subjected to phototherapy due to jaundice, by means of electrophoretic and chromatographic techniques. The variant Hb resulted unstable by the isopropanol stability test. After HBG2 gene sequencing, the G to A transversion at codon 64, position eight of the E helix, was found, which corresponds to the Asp for Gly amino acid substitution. The new variant was called Hb F‐Turritana [Gγ64(E8)Gly→Asp, HBG2:c.194G>A]. Incoming aspartic acid residue, bulky and negatively charged, may be responsible for alteration of the heme pocket steric configuration and for instability. The new abnormal HBG2 gene was found to be associated in cis with the mutated HBG1 gene, which characterizes the Hb F‐Sardinia [Aγ (E19)Ile→Thr, HBG1:c.227T>C] variant.
Aetiology, incidence and morphology of the C‐shaped root canal system and its impact on clinical endodontics
Authors: Kato A. , Ziegler A. , Higuchi N. , Nakata K. , Nakamura H. , Ohno N.
Published: February 2014

The C‐shaped root canal constitutes an unusual root morphology that can be found primarily in mandibular second permanent molars. Due to the complexity of their structure, C‐shaped root canal systems may complicate endodontic interventions. A thorough understanding of root canal morphology is therefore imperative for proper diagnosis and successful treatment. This review aims to summarize current knowledge regarding C‐shaped roots and root canals, from basic morphology to advanced endodontic procedures. To this end, a systematic search was conducted using the MEDLINE, BIOSIS, Cochrane Library, EMBASE, Google Scholar, Web of Science, PLoS and BioMed Central databases, and many rarely cited articles were included. Furthermore, four interactive 3D models of extracted teeth are introduced that will allow for a better understanding of the complex C‐shaped root canal morphology. In addition, the present publication includes an embedded best‐practice video showing an exemplary root canal procedure on a tooth with a pronounced C‐shaped root canal. The survey of this unusual structure concludes with a number of suggestions concerning future research efforts.
The bond strength of endodontic sealers to root dentine exposed to different gutta‐percha solvents
Authors: Topçuoğlu H. S. , Demirbuga S. , Tuncay Ö. , Arslan H. , Kesim B. , Yaşa B.
Published: February 2014

Aim

To evaluate the effects of various gutta‐percha solvents on the push‐out bond strength of several root canal sealers on root dentine.

Methodology

The root canals of 210 single‐rooted human teeth were prepared with the ProTaper System (Dentsply Maillefer, Ballaigues, Switzerland) up to a master apical file size of F4, and the following variables evaluated for bond strength: solvent type (chloroform, eucalyptol and orange oil), time (2 and 5 min), sealer type (AH Plus, MTA Fillapex and Sealapex) and root thirds (coronal, middle and apical). After canal filling, three 1‐mm‐thick slices were obtained from each root sample, and the bond strength of the test materials was measured using a push‐out test set‐up at a cross‐head speed of 1 mm min−1. The data were analysed using four‐way factorial anova (P = 0.05).

Results

Bond strength was significantly affected by solvent type and time (P < 0.001). The use of chloroform for 5 min in the root canal decreased bond strength of all sealers (P < 0.001). Eucalyptol and orange oil did not affect the bond strength of the sealers (P > 0.05). In all conditions, the push‐out bond strength was highest for AH Plus and lowest for MTA Fillapex (P < 0.001). Bond strength values decreased in a corono‐apical direction in all groups (P < 0.001).

Conclusions

Chloroform used for 5 min during retreatment decreased the bond strength of AH Plus, Sealapex and MTA Fillapex to root dentine.
Microwave Dielectric Properties of Ultralow‐Temperature Cofirable Ba3V4O13 Ceramics
Authors: Kalathil Suresh E. , Neelakantan Unnimaya A. , Ratheesh Raveendran
Published: February 2014

Ultralow‐temperature sinterable Ba3V4O13 ceramics have been prepared through solid‐state ceramic route. Structural properties of the ceramic material are studied using powder X‐ray diffraction. Ba3V4O13 ceramic has monoclinic structure and the existence of [V4O13]6− polyhedra is confirmed through Laser Raman studies. The sample sintered at 600°C for 1 h shows dense microstructure with microwave dielectric properties of εr = 9.6, Q × f = 56 100 GHz, and τf = −42 ppm/°C. The ceramics under study show good chemical compatibility with aluminum during cofiring.
Mortality in captive baboons (Papio spp.): a‐23‐year study
Authors: Dick Edward J. , Owston Michael A. , David John M. , Sharp R. Mark , Rouse Scott , Hubbard Gene B.
Published: February 2014

Background

We report the causes of mortality for 4350 captive baboons that died or were euthanized due to natural causes during a 23 year period at the Southwest National Primate Research Center.

Methods

Necropsy records were retrieved and reviewed to determine a primary cause of death or indication for euthanasia. Data was evaluated for morphological diagnosis, organ system, and etiology.

Results

The 20 most common morphologic diagnoses accounted for 76% of the cases, including stillborn (10.8%); colitis (8.6%); hemorrhage (8.4%); ulcer (5.2%); seizures (4.7%); pneumonia (4.2%); inanition (4.1%); dermatitis (3.8%); spondylosis (3.3%); and amyloidosis (3.0%). The digestive system was most frequently involved (21.3%), followed by the urogenital (20.3%), cardiovascular (12.2%), and multisystem disease (10.3%). An etiology was not identified in approximately one‐third of cases. The most common etiologies were trauma (14.8%), degenerative (9.5%), viral (8.7%), and neoplastic/proliferative (7.0%).

Conclusion

This information should be useful for individuals working with baboons.
Characterization of a novel acetamidobenzoxazolone‐based PET ligand for translocator protein (18 kDa) imaging of neuroinflammation in the brain
Authors: Tiwari Anjani K. , Yui Joji , Fujinaga Masayuki , Kumata Katsushi , Shimoda Yoko , Yamasaki Tomoteru , Xie Lin , Hatori Akiko , Maeda Jun , Nengaki Nobuki , Zhang Ming‐Rong
Published: February 2014

We developed the novel positron emission tomography (PET) ligand 2‐[5‐(4‐[11C]methoxyphenyl)‐2‐oxo‐1,3‐benzoxazol‐3(2H)‐yl]‐N‐methyl‐N‐phenylacetamide ([11C]MBMP) for translocator protein (18 kDa, TSPO) imaging and evaluated its efficacy in ischemic rat brains. [11C]MBMP was synthesized by reacting desmethyl precursor (1) with [11C]CH3I in radiochemical purity of ≥ 98% and specific activity of 85 ± 30 GBq/μmol (n = 18) at the end of synthesis. Biodistribution study on mice showed high accumulation of radioactivity in the TSPO‐rich organs, e.g., the lungs, heart, kidneys, and adrenal glands. The metabolite analysis in mice brain homogenate showed 80.1 ± 2.7% intact [11C]MBMP at 60 min after injection. To determine the specific binding of [11C]MBMP with TSPO in the brain, in vitro autoradiography and PET studies were performed in an ischemic rat model. In vitro autoradiography indicated significantly increased binding on the ipsilateral side compared with that on the contralateral side of ischemic rat brains. This result was supported firmly by the contrast of radioactivity between the ipsilateral and contralateral sides in PET images. Displacement experiments with unlabelled MBMP or PK11195 minimized the difference in uptake between the two sides. In summary, [11C]MBMP is a potential PET imaging agent for TSPO and, consequently, for the up‐regulation of microglia during neuroinflammation.

image

We developed 2‐[5‐(4‐[11C]methoxyphenyl)‐2‐oxo‐1,3‐benzoxazol‐3(2H)‐yl]‐N‐methyl‐N‐phenylacetamide ([11C]MBMP) as a novel positron emission tomography ligand for imaging of translocator protein (18 kDa, TSPO) in the brain. [11C]MBMP exhibited high in vitro and in vivo specific binding with TSPO in the ischemic rat brain.
Factors associated with pain induced by orthodontic separators
Authors: Beck V. J. , Farella M. , Chandler N. P. , Kieser J. A. , Thomson W. M.
Published: February 2014

Pain resulting from the application of orthodontic forces varies markedly across individuals. The reasons of this variability are still largely unknown. To investigate factors that may be associated with orthodontic pain following the application of orthodontic separators. One hundred and seven participants were screened for pain response over 48 h following placement of orthodontic elastomeric separators. The highest (n = 10) and lowest (n = 10) pain responders were identified, and data collected on tooth pain sensitivity to electrical stimulation in conjunction with using the Pain Catastrophising Scale (PCS), Dental Anxiety Scale (DAS) and cold pressor test (CPT). There were statistically significant differences between high‐ and low‐pain responders in catastrophising score (P ≤ 0·023). For every PCS magnification score of 1 unit higher, the relative risk of being a high‐pain responder was 1·6 (P = 0·002); those scoring higher on helplessness had a lower risk of being so. DAS scores of high‐pain responders were twice as high as those of low‐pain responder (P = 0·043). During the first 2 min of CPT, the high‐pain responders experienced more pain than the low‐pain responders (P ≤ 0·029). Tooth pain thresholds did not differ between the two different pain responder groups. Pain catastrophising, dental anxiety and cold sensitivity appear to modify the pain experienced following placement of orthodontic separators. Further research is needed to determine the validity of screening questions to identify at‐risk patients prior to commencing orthodontic treatment.
Calcifying Cystic Odontogenic Tumour: immunohistochemical expression of matrix metalloproteinases, their inhibitors (TIMPs and RECK) and inducer (EMMPRIN)
Authors: Prosdócimi Fábio C. , Rodini Camila O. , Sogayar Mari C. , Sousa Suzana C. O. M. , Xavier Flávia C. A. , Paiva Katiúcia B. S.
Published: February 2014

Background

Calcifying cyst odontogenic tumour (CCOT) is a rare benign cystic neoplasm of odontogenic origin. MMPs are responsible for extracellular matrix remodelling and, together their inhibitors and inducer, determinate the level of its turnover in pathological processes, leading to an auspicious microenvironment for tumour development. Thus, our goal was to evaluate matrix metalloproteinases (MMPs‐2, ‐7, ‐9 and ‐14), their inhibitors (TIMPs‐2, ‐3, ‐4 and RECK) and its inductor (EMMPRIN) expression in CCOT.

Materials and Methods

We used 18 cases of CCOT submitted to immunolocalization of the target proteins and analysed in both neoplastic odontogenic epithelial and stromal compartments.

Results

All molecules evaluated were expressed in both compartments in CCOT. In epithelial layer, immunostaining for MMPs, TIMPs, RECK and EMMPRIN was found in basal, suprabasal spindle and stellate cells surrounding ghost cells and ghost cells themselves, except for MMP‐9 and TIMP‐2 which were only expressed by ghost cells. In stromal compartment, extracellular matrix, mesenchymal (MC) and endothelial cells (EC) were positive for MMP‐2, ‐7, TIMP‐3 and ‐4, while MMP‐9, TIMP‐2 and RECK were positive only in MC and MMP‐14 only in EC. Statistical significance difference was found between both compartments for MMP‐9 (P < 0.001), RECK (P = 0.004) and EMMPRIN (P < 0.001), being more expressed in epithelium than in stroma. Positive correlation between both stromal EMMPRIN and RECK expression was found (R = 0.661, P = 0.003).

Conclusions

We concluded that these proteins/enzymes are differentially expressed in both epithelium and stroma of CCOT, suggesting an imbalance between MMPs and their inducer/inhibitors may contribute on the tumour behaviour.
Panax notoginseng saponins inhibit areca nut extract‐induced oral submucous fibrosis in vitro
Authors: Dai Jian‐Ping , Chen Xiao‐Xuan , Zhu Dan‐Xia , Wan Qian‐Ying , Chen Cheng , Wang Ge‐Fei , Li Wei‐Zhong , Li Kang‐Sheng
Published: February 2014

Background

Oral submucous fibrosis (OSF) is a premalignant and fibrosing disease, which is closely associated with the habit of chewing areca nut. Panax notoginseng Buck F. H. Chen is an often used antifibrotic and antitumor agent. To treat areca nut‐induced OSF, we have developed a chewable tablet, in which one of the major medicines is total Panax notoginseng saponins (PNS). In this study, we have investigated the antifibrotic effect and mechanism of PNS on areca nut‐induced OSF in vitro.

Methods

Through human procollagen gene promoter luciferase reporter plasmid, hydroxyproline assay, gelatin zymography, qRT‐PCR, ELISA, and Western blot, the influences of PNS on areca nut extract (ANE)‐induced cell growth, collagen accumulation, procollagen gene transcription, MMP‐2/‐9 activity, MMP‐1/‐13 and TIMP‐1/‐2 expression, cytokine secretion, and the activation of PI3K/AKT, ERK/JNK/p38 MAPK, and TGFβ/Smads pathways were detected.

Results

Panax notoginseng saponins could inhibit the ANE‐induced abnormal growth and collagen accumulation of oral mucosal fibroblasts in a concentration‐dependent manner. PNS (25 μg/ml) could significantly inhibit the ANE‐induced expression of Col1A1 and Col3A1, augment the ANE‐induced decrease of MMP‐2/‐9 activity, inhibit the ANE‐induced increase of TIMP‐1/‐2 expression, and decrease the ANE‐induced transcription and release of CTGF, TGFβ1, IL‐6, and TNFα. PNS (25 μg/ml) also significantly inhibited the ANE‐induced activation of AKT and ERK/JNK/p38 MAPK pathways in oral mucosal fibroblasts and the ANE‐induced activation of TGFβ/smad pathway in HaCaT cells.

Conclusion

Panax notoginseng saponins possess excellent anti‐OSF activity, and its mechanism may be related to its ability to inhibit the ANE‐induced activation of PI3K/AKT, ERK/JNK/p38 MAPK, and TGFβ/smad pathways.
The axis inhibition protein 2 polymorphisms and non‐syndromic orofacial clefts susceptibility in a Chinese Han population
Authors: Han Yue , Zhou Lian , Ma Lan , Li Dandan , Xu Min , Yuan Hua , Ma Junqing , Zhang Weibing , Jiang Hongbing , Wu Yunong , Wang Lin , Pan Yongchu
Published: February 2014

Background

The axis inhibition protein 2 (AXIN2) is an important regulator of β‐catenin degradation in the Wnt pathway, which plays a key role in craniofacial morphogenesis. The goal of this study was to investigate the potential relationship between AXIN2 polymorphisms and the risks of non‐syndromic orofacial clefts (NSOC) in a Chinese Han population.

Methods

Four polymorphisms of AXIN2 (rs2240307, rs11867417, rs2240308, and rs7591) were selected to perform a case–control study with 599 NSOC cases and 602 healthy individuals from a Chinese Han population. The single nucleotide polymorphisms (SNPs) were genotyped on basis of double ligation and multiplex fluorescence PCR.

Results

Weak associations were found between these four SNPs and the risk of NSOC. Further stratified analysis showed that the overall genotype frequencies of rs2240307 were different between the cleft palate only (CPO) group and the control group (P = 0.048), and GG genotype markedly contributed to the susceptibility to CPO (OR = 3.22, 95% CI = 1.13–9.18). The similar effect was also observed on GA/AA genotype compared with GG homozygote (OR = 0.30, 95% CI = 0.11–0.84). The results of LD analysis between each pair of SNPs revealed that two SNPs (rs11867417 and rs7591) were in a LD block (r2 > 0.8). But no statistically significant was found between cases and controls from haplotype analysis in these two loci.

Conclusions

The borderline results gave us a hint that rs2240307 contributed to the susceptibility to CPO in a Chinese Han population, which was conductive to improving our awareness of the causes of NSOC.
16S rDNA‐based metagenomic analysis of dental plaque and lung bacteria in patients with severe acute exacerbations of chronic obstructive pulmonary disease
Authors: Tan L. , Wang H. , Li C. , Pan Y.
Published: February 2014

Background and Objective

Acute exacerbations of chronic obstructive pulmonary disease (AE‐COPD) are leading causes of mortality in hospital intensive care units. We sought to determine whether dental plaque biofilms might harbor pathogenic bacteria that can eventually cause lung infections in patients with severe AE‐COPD.

Material and Methods

Paired samples of subgingival plaque biofilm and tracheal aspirate were collected from 53 patients with severe AE‐COPD. Total bacterial DNA was extracted from each sample individually for polymerase chain reaction amplification and/or generation of bacterial 16S rDNA sequences and cDNA libraries. We used a metagenomic approach, based on bacterial 16S rDNA sequences, to compare the distribution of species present in dental plaque and lung.

Results

Analysis of 1060 sequences (20 clones per patient) revealed a wide range of aerobic, anaerobic, pathogenic, opportunistic, novel and uncultivable bacterial species. Species indistinguishable between the paired subgingival plaque and tracheal aspirate samples (97–100% similarity in 16S rDNA sequence) were dental plaque pathogens (Aggregatibacter actinomycetemcomitans, Capnocytophaga sputigena, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola) and lung pathogens (Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Streptococcus pneumoniae). Real‐time polymerase chain reaction of 16S rDNA indicated lower levels of Pseudomonas aeruginosa and Porphyromonas gingivalis colonizing the dental plaques compared with the paired tracheal aspirate samples.

Conclusion

These results support the hypothesis that dental bacteria may contribute to the pathology of severe AE‐COPD.
Birth Volume and the Quality of Obstetric Care in Rural Hospitals
Authors: Kozhimannil Katy B. , Hung Peiyin , Prasad Shailendra , Casey Michelle , McClellan Maeve , Moscovice Ira S.
Published: February 2014

Background

Childbirth is the most common reason for hospitalization in the United States. Assessing obstetric care quality is critically important for patients, clinicians, and hospitals in rural areas.

Methods

The study used hospital discharge data from the Statewide Inpatient Databases, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, for 9 states (Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington, and Wisconsin) to identify all births in rural hospitals with 10 or more births/year in 2002 (N = 94,356) and 2010 (N = 103,880). Multivariate logistic regression was used to assess the relationship between hospital annual birth volume, measured as low (10‐110), medium (111‐240), medium‐high (241‐460) or high (>460), and 3 measures of obstetric care quality (low‐risk cesarean rates for term, vertex, and singleton pregnancies with no prior cesarean; nonindicated cesarean; and nonindicated induction) and 2 patient safety measures (episiotomy and perineal laceration).

Results

The odds of low‐risk and nonindicated cesarean were lower in medium‐high and high‐volume rural hospitals compared with low‐volume hospitals after controlling for maternal demographic and clinical factors. In low‐volume hospitals, odds of labor induction without medical indication were higher than in medium‐volume hospitals, but not significantly different from medium‐high or high‐volume hospitals. Odds of episiotomy were greater in medium‐high or high‐volume hospitals than in low‐volume hospitals. The likelihood of perineal laceration did not differ significantly by birth volume.

Conclusions

Obstetric quality and safety outcomes vary significantly across rural hospitals by birth volume. Better performance is not consistently associated with either lower or higher volume facilities.
Access to Medical and Supportive Care for Rural and Remote Cancer Survivors in Northern British Columbia
Authors: Fuchsia Howard A. , Smillie Kirsten , Turnbull Kristin , Zirul Chelan , Munroe Dana , Ward Amanda , Tobin Pam , Kazanjian Arminee , Olson Rob
Published: February 2014

Background

Rural cancer survivors (RCS) potentially have unique medical and supportive care experiences when they return to their communities posttreatment because of the availability and accessibility of health services. However, there is a limited understanding of cancer survivorship in rural communities.

Purpose

The purpose of this study is to describe RCS experiences accessing medical and supportive care postcancer treatment.

Methods

Interviews and focus groups were conducted with 52 RCS residing in northern British Columbia, Canada. The data were analyzed using qualitative content analysis methods.

Results

General Population RCS and First Nations RCS experienced challenges accessing timely medical care close to home, resulting in unmet medical needs. Emotional support services were rarely available, and, if they did exist, were difficult to access or not tailored to cancer survivors. Travel and distance were barriers to medical and psychological support and services, not only in terms of the cost of travel, but also the toll this took on family members. Many of the RCS lacked access to trusted and useful information. Financial assistance, for follow‐up care and rehabilitation services, was rarely available, as was appropriate employment assistance.

Conclusion

Medical and supportive care can be inaccessible, unavailable, and unaffordable for cancer survivors living in rural northern communities.
Histological subclassification of cirrhosis can predict recurrence after curative resection of hepatocellular carcinoma
Authors: Kim Seung Up , Jung Kyu Sik , Lee Sarah , Park Jun Yong , Kim Do Young , Ahn Sang Hoon , Choi Gi Hong , Kim Kyung Sik , Choi Jin Sub , Han Kwang‐Hyub , Park Young Nyun
Published: February 2014

Background

Recurrence of hepatocellular carcinoma (HCC) after curative resection continues to be a major cause of death. This prospective study is designed to investigate whether histological subclassification of cirrhosis using the Laennec system could predict recurrence in patients with hepatitis B virus (HBV)‐related HCC after curative resection.

Methods

Patients with HBV‐related HCC who underwent curative resection and showed Laennec stage 3 to 4 were enrolled and the cases with stage 4 were subclassified histologically into three groups (stages 4A, 4B and 4C) according to the Laennec system. Between February 2006 and August 2009, 92 patients were recruited.

Results

Stage 3, 4A, 4B and 4C were identified in 24 (26.1%), 15 (16.3%), 43 (46.7%) and 10 (10.9%) patients respectively. The cumulative incidence rates of recurrence at 1, 2 and 3 years were 24.2%, 40.5% and 55.1% respectively. On multivariate analysis, serum albumin [hazard ratio (HR), 0.528; 95% confidence interval (CI), 0.312–0.891; P = 0.017] and Edmondson–Steiner grade III–IV (HR, 3.456; 95% CI, 1.123–10.517; P = 0.031) were significantly correlated with early recurrence (<1 year), whereas stage 4C (HR, 5.426; 95% CI, 1.030–28.598; P = 0.046) was the only independent risk factor for late recurrence (≥1 year).

Conclusions

Histological subclassification of cirrhosis using the Laennec system is a significant predictor of late recurrence in patients with HBV‐related HCC after curative resection.
Metabolomic tissue signature in human non‐alcoholic fatty liver disease identifies protective candidate metabolites
Authors: von Schönfels Witigo , Patsenker Eleonora , Fahrner René , Itzel Timo , Hinrichsen Holger , Brosch Mario , Erhart Wiebke , Gruodyte Auste , Vollnberg Bernd , Richter Klaus , Landrock Andreas , Schreiber Stefan , Brückner Stephan , Beldi Guido , Sipos Bence , Becker Thomas , Röcken Christoph , Teufel Andreas , Stickel Felix , Schafmayer Clemens , Hampe Jochen
Published: February 2014

Background

Non‐alcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder in industrialized countries, yet its pathophysiology is incompletely understood. Small‐molecule metabolite screens may offer new insights into disease mechanisms and reveal new treatment targets.

Methods

Discovery (N = 33) and replication (N = 66) of liver biopsies spanning the range from normal liver histology to non‐alcoholic steatohepatitis (NASH) were ascertained ensuring rapid freezing under 30 s in patients. 252 metabolites were assessed using GC/MS. Replicated metabolites were evaluated in a murine high‐fat diet model of NAFLD.

Results

In a two‐stage metabolic screening, hydroquinone (HQ, pcombined = 3.0 × 10−4) and nicotinic acid (NA, pcombined = 3.9 × 10−9) were inversely correlated with histological NAFLD severity. A murine high‐fat diet model of NAFLD demonstrated a protective effect of these two substances against NAFLD: Supplementation with 1% HQ reduced only liver steatosis, whereas 0.6% NA reduced both liver fat content and serum transaminase levels and induced a complex regulatory network of genes linked to NALFD pathogenesis in a global expression pathway analysis. Human nutritional intake of NA equivalent was also consistent with a protective effect of NA against NASH progression.

Conclusion

This first small‐molecular screen of human liver tissue identified two replicated protective metabolites. Either the use of NA or targeting its regulatory pathways might be explored to treat or prevent human NAFLD.
Fetuin‐A negatively correlates with liver and vascular fibrosis in nonalcoholic fatty liver disease subjects
Authors: Sato Motoya , Kamada Yoshihiro , Takeda Yuri , Kida Sachiho , Ohara Yuka , Fujii Hironobu , Akita Maaya , Mizutani Kayo , Yoshida Yuichi , Yamada Makoto , Hougaku Hidetaka , Takehara Tetsuo , Miyoshi Eiji
Published: February 2014

Background & Aims

Fetuin‐A (α2HS‐glycoprotein), a liver secretory glycoprotein, is known as a transforming growth factor (TGF)‐β1 signalling inhibitor. Serum fetuin‐A concentration is associated with nonalcoholic fatty liver disease (NAFLD) and cardiovascular disease. However, the usefulness of serum fetuin‐A as a predictive fibrosis biomarker in NAFLD patients remains unclear. In this study, we investigated the relationship between circulating fetuin‐A levels and fibrosis‐related markers [platelet count, NAFLD fibrosis score and carotid intima media thickness (IMT)] in subjects with NAFLD.

Methods

A total of 295 subjects (male, 164; female, 131) who received medical health check‐ups were enrolled in this study. NAFLD was diagnosed using abdominal ultrasonography. Serum fetuin‐A was measured by ELISA. IMT was assessed using a high‐resolution ultrasound scanner. Using recombinant human fetuin‐A, we investigated the effects of fetuin‐A on hepatic stellate cells, which play a pivotal role in the process of hepatic fibrosis.

Results

Serum fetuin‐A concentration was significantly correlated with platelet count (R = 0.19, P < 0.01), NAFLD fibrosis score (R = −0.25, P < 0.01) and mean IMT (R = −0.22, P < 0.01). Multivariate analyses revealed that the fetuin‐A concentration is a significant and independent determinant of platelet count, NAFLD fibrosis score and mean IMT. Recombinant fetuin‐A suppressed TGF‐β1 signalling and fibrosis‐related gene expression and increased the expression of TGF‐β1 pseudoreceptor bone morphogenic protein and activin membrane‐bound inhibitor (BAMBI).

Conclusions

Serum fetuin‐A level is associated with liver/vessel fibrosis‐related markers in NAFLD patients. Circulating fetuin‐A could be a useful serum biomarker for predicting liver and vascular fibrosis progression in NAFLD patients.
Skin toxins in coral‐associated Gobiodon species (Teleostei: Gobiidae) affect predator preference and prey survival
Authors: Gratzer Barbara , Millesi Eva , Walzl Manfred , Herler Juergen
Published: February 2014

Predation risk is high for the many small coral reef fishes, requiring successful sheltering or other predator defence mechanisms. Coral‐dwelling gobies of the genus Gobiodon live in close association with scleractinian corals of the genus Acropora. Earlier studies indicated that the low movement frequency of adult fishes and the development of skin toxins (crinotoxicity) are predation avoidance mechanisms. Although past experiments showed that predators refuse food prepared with goby skin mucus, direct predator–prey interactions have not been studied. The present study compares the toxicity levels of two crinotoxic coral gobies – Gobiodon histrio, representative of a conspicuously coloured species, and Gobiodon sp.3 with cryptic coloration – using a standard bioassay method. The results show that toxin levels of both species differ significantly shortly after mucus release but become similar over time. Predator preferences were tested experimentally in an aquarium in which the two gobies and a juvenile damselfish Chromis viridis were exposed to the small grouper Epinephelus fasciatus. Video‐analysis revealed that although coral gobies are potential prey, E. fasciatus clearly preferred the non‐toxic control fish (C. viridis) over Gobiodon. When targeting a goby, the predator did not prefer one species over the other. Contrary to our expectations that toxic gobies are generally avoided, gobies were often captured, but they were expelled quickly, repeatedly and alive. This unusual post‐capture avoidance confirms that these gobies have a very good chance of surviving attacks in the field due to their skin toxins. Nonetheless, some gobies were consumed: the coral shelter may therefore also provide additional protection, with toxins protecting them mainly during movement between corals. In summary, chemical deterrence by crinotoxic fishes seems to be far more efficient in predation avoidance than in physical deterrence involving body squamation and/or strong fin spines.
Related to ABA‐Insensitive3(ABI3)/Viviparous1 and AtABI5 transcription factor coexpression in cotton enhances drought stress adaptation
Authors: Mittal Amandeep , Gampala Srinivas S. L. , Ritchie Glen L. , Payton Paxton , Burke John J. , Rock Christopher D.
Published: February 2014

Drought tolerance is an important trait being pursued by the agbiotech industry. Abscisic acid (ABA) is a stress hormone that mediates a multitude of processes in growth and development, water use efficiency (WUE) and gene expression during seed development and in response to environmental stresses. Arabidopsis B3‐domain transcription factor Related to ABA‐Insensitive3 (ABI3)/Viviparous1 (namely AtRAV2) and basic leucine zipper (bZIPs) AtABI5 or AtABF3 transactivated ABA‐inducible promoter:GUS reporter expression in a maize mesophyll protoplast transient assay and showed synergies in reporter transactivation when coexpressed. Transgenic cotton (Gossypium hirsutum) expressing AtRAV1/2 and/or AtABI5 showed resistance to imposed drought stress under field and greenhouse conditions and exhibited improved photosynthesis and WUEs associated with absorption through larger root system and greater leaf area. We observed synergy for root biomass accumulation in the greenhouse, intrinsic WUE in the field and drought tolerance in stacked AtRAV and AtABI5 double‐transgenic cotton. We assessed AtABI5 and AtRAV1/2 involvement in drought stress adaptations through reactive oxygen species scavenging and osmotic adjustment by marker gene expression in cotton. Deficit irrigation‐grown AtRAV1/2 and AtABI5 transgenics had ‘less‐stressed’ molecular and physiological phenotypes under drought, likely due to improved photoassimilation and root and shoot sink strengths and enhanced expression of endogenous GhRAV and genes for antioxidant and osmolyte biosynthesis. Overexpression of bZIP and RAV TFs could impact sustainable cotton agriculture and potentially other crops under limited irrigation conditions.
Immunogenicity of a prophylactic quadrivalent human papillomavirus L1 virus‐like particle vaccine in male and female adolescent transplant recipients
Authors: Gomez‐Lobo V. , Whyte T. , Kaufman S. , Torres C. , Moudgil A.
Published: February 2014

Organ TX recipients are at an increased risk of developing cancers of the lower genital tract related to HPV. The quadrivalent HPV vaccine has high efficacy in preventing these diseases, but response to many vaccines is suboptimal after organ transplantation. Liver and kidney TX recipients received quadrivalent HPV vaccine. Serum samples were tested for anti‐HPV levels. Of 20 renal transplant recipients screened, 14 received vaccine. Of these, seven completed the vaccine series and seven had incomplete vaccination. Of five liver TX children, three received vaccines (two complete and one incomplete). All eight kidney and liver TX children with complete vaccination and available results were seronegative at baseline and had seroconversion at month 7 for all four HPV types. Six of 14 (42.8%) kidney TX recipients developed AR. During the same time period, eight of 28 (28.5%) non‐vaccine renal transplant recipients developed AR (p = ns). Transplant adolescents developed 100% seroconversion to all four HPV serotypes with HPV vaccine with serologic titers similar to historic controls. A non‐significant increased incidence of AR was noted among kidney transplant vaccine recipients. A much larger study would be needed to evaluate whether HPV vaccination increases AR in transplant adolescents.
Successful ABO incompatible renal transplantation following rituximab and DFPP after failed immunoadsorption
Authors: Thalgahagoda Shenal , Webb Nicholas J. A. , Roberts Denise , Birch Allison , Milford David V. , Tavakoli Afshin , Shenoy Mohan
Published: February 2014

Effective antibody removal using PE, DFPP and IA has led to increased access to live donor organs through ABOi RT for patients with chronic kidney disease. However, there have been no head‐to‐head comparator studies between these modalities, and the choice of technique is usually influenced by cost and institutional preference. We describe the clinical course of a child undergoing ABOi RT, in whom IA without preconditioning with rituximab did not achieve a satisfactory reduction in the antibody titers, who went on to have a successful living donor RT following rituximab and DFPP.
Relationship between problems related to child late effects and parent burnout after pediatric hematopoietic stem cell transplantation
Authors: Lindahl Norberg Annika , Mellgren Karin , Winiarski Jacek , Forinder Ulla
Published: February 2014

A few studies have indicated that parents' reactions to a child's serious disease may entail long‐term stress for the parents. However, further knowledge of its consequences is valuable. The aim of the study was to investigate the occurrence of burnout in a Swedish national sample of parents of children who had undergone HSCT and survived. Burnout (Shirom–Melamed Burnout Questionnaire) and estimations of the child's health status (Lansky/Karnofsky estimations and study‐specific questions) were self‐reported by 159 mothers and 123 fathers. In addition, physicians made estimations of the child's health status (Lansky/Karnofsky estimations). Nonparametric tests revealed that burnout symptoms occurred more often among fathers of children who had undergone transplantation within the last five yr compared to fathers of children with no history of serious disease (34.4% vs. 19.9%). Burnout among mothers and fathers was associated with the child's number and severity of health impairments up to five yr after the child underwent HSCT (Spearman's rho for mothers 0.26–0.36 and for fathers 0.36–0.61). In conclusion, chronic stress in parents after a child's HSCT seems to abate eventually. However, parents should be monitored and offered adequate support when needed. Moreover, the situation of fathers in the often mother‐dominated pediatric setting should receive more attention in research as well as in the clinic.
Successful outcome of allogeneic stem cell transplantation in Seckel syndrome
Authors: Darrigo Luiz Guilherme , Rodrigues Maria Carolina , Pieroni Fabiano , Stracieri Ana Beatriz Pereira Lima , Moraes Daniela Aparecida , Grecco Carlos Eduardo Setanni , Dias Juliana Bernardes Elias , Sobral Ana Carolina , Simões Belinda Pinto
Published: February 2014

Seckel syndrome is a rare autosomal recessive disease, genetically heterogeneous, characterized by short stature, prenatal microcephaly, intellectual disability, dysmorphic features, chromosomal instability, and hematological disorders. We report the case of a six‐yr‐old boy with Seckel syndrome and aplastic anemia who underwent successful allogeneic bone marrow transplantation from ten of ten HLA matched unrelated donor. Currently the patient is on D+771, in good health conditions and with no further complications. In conclusion, this case indicates that bone marrow transplantation is an acceptable therapeutic option for Seckel syndrome complicated by hematological alterations.