Prediabetes and diabetes prevalence in the Workers’ Oral Health Study

Abstract

Objective

To examine the association between periodontitis, diabetes, and prediabetes, assessed by fasting plasma glucose (FPG).

Materials and methods

Workers' Oral Health Study is a cross-sectional survey conducted on a representative sample of the Spanish employed population including 5154 participants (59.5% men, aged 16–65). Examination of periodontal status assessed Community Periodontal Index (CPI) and clinical attachment levels (CAL). Biochemical determinations included fasting plasma glucose (FPG), triglycerides, and total cholesterol. Logistic regression analysis with adjustment for potential confounders was used to evaluate the association between periodontitis and abnormal glucose regulation.

Results

Ninety-five participants (2.2%) of the study population had diabetes, while 373 (8.8%) presented prediabetes. Prediabetes was not associated with CPI or CAL in fully adjusted multivariate logistic regressions models. Diabetes was significantly associated with subjects having a CPI 4 after adjustment for potential confounders (odds ratio OR = 1.9, 95% confidence interval (CI) 1.1–3.1). This association was stronger in subjects < 45 years (OR = 4.0, 95% CI 1.2–12.7).

Conclusion

Periodontitis was associated with diabetes mellitus, but not with prediabetes, in a representative sample of the Spanish employed population. The association was stronger for younger subjects, which emphasizes the need for early detection of diabetes in younger patients affected by periodontitis, particularly because periodontal therapy may help to improve glycemic control.

Clinical relevance

Periodontitis is associated with diabetes mellitus, having at the same time a negative effect on glycemic control. It is important to develop proper early diagnosis strategies for both conditions, particularly in young male adults.

https://ift.tt/2NB02Nh

Prediabetes and diabetes prevalence in the Workers’ Oral Health Study

Abstract

Objective

To examine the association between periodontitis, diabetes, and prediabetes, assessed by fasting plasma glucose (FPG).

Materials and methods

Workers' Oral Health Study is a cross-sectional survey conducted on a representative sample of the Spanish employed population including 5154 participants (59.5% men, aged 16–65). Examination of periodontal status assessed Community Periodontal Index (CPI) and clinical attachment levels (CAL). Biochemical determinations included fasting plasma glucose (FPG), triglycerides, and total cholesterol. Logistic regression analysis with adjustment for potential confounders was used to evaluate the association between periodontitis and abnormal glucose regulation.

Results

Ninety-five participants (2.2%) of the study population had diabetes, while 373 (8.8%) presented prediabetes. Prediabetes was not associated with CPI or CAL in fully adjusted multivariate logistic regressions models. Diabetes was significantly associated with subjects having a CPI 4 after adjustment for potential confounders (odds ratio OR = 1.9, 95% confidence interval (CI) 1.1–3.1). This association was stronger in subjects < 45 years (OR = 4.0, 95% CI 1.2–12.7).

Conclusion

Periodontitis was associated with diabetes mellitus, but not with prediabetes, in a representative sample of the Spanish employed population. The association was stronger for younger subjects, which emphasizes the need for early detection of diabetes in younger patients affected by periodontitis, particularly because periodontal therapy may help to improve glycemic control.

Clinical relevance

Periodontitis is associated with diabetes mellitus, having at the same time a negative effect on glycemic control. It is important to develop proper early diagnosis strategies for both conditions, particularly in young male adults.

https://ift.tt/2NB02Nh

Transcatheter mitral valve therapies

Abstract

Dr.O.P. Yadava, Editor-in-Chief, IJTC and Dr. V Bapat, Assistant Professor at Columbia University, New York, discuss issues related to slow development and uptake of transcatheter mitral valve replacement. Dr. Bapat stresses on the basic difference between transcatheter aortic and mitral valve interventions. He laments that issues related to mitral valve repair versus replacement and role of percutaneous MitraClip are still being hotly debated. He, however, is hopeful that technology shall evolve to make percutaneous options for secondary mitral regurgitation a viable proposition.

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Opportunities and challenges for thoracic organ transplantation in government institutions

Abstract

The first successful heart transplant in India was performed by Panangipalli Venugopal on 3 August 1994 at the All India Institute of Medical Sciences, New Delhi. Twenty-five years later, only seven government institutions are performing heart transplants and only one government hospital has an established heart transplant program in India. Only one lung transplant has been performed in a government institution all over the country. This article reviews the history and current status of thoracic organ transplant in India. The authors discuss the factors responsible for the dismal progress of thoracic organ transplant in government hospitals, opportunities available in government institutions for widening the scope of transplant program, and the steps taken by the Government of India to improve healthcare in the country.

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Transcatheter mitral valve therapies

Abstract

Dr.O.P. Yadava, Editor-in-Chief, IJTC and Dr. V Bapat, Assistant Professor at Columbia University, New York, discuss issues related to slow development and uptake of transcatheter mitral valve replacement. Dr. Bapat stresses on the basic difference between transcatheter aortic and mitral valve interventions. He laments that issues related to mitral valve repair versus replacement and role of percutaneous MitraClip are still being hotly debated. He, however, is hopeful that technology shall evolve to make percutaneous options for secondary mitral regurgitation a viable proposition.

https://ift.tt/2H9nLmo

Opportunities and challenges for thoracic organ transplantation in government institutions

Abstract

The first successful heart transplant in India was performed by Panangipalli Venugopal on 3 August 1994 at the All India Institute of Medical Sciences, New Delhi. Twenty-five years later, only seven government institutions are performing heart transplants and only one government hospital has an established heart transplant program in India. Only one lung transplant has been performed in a government institution all over the country. This article reviews the history and current status of thoracic organ transplant in India. The authors discuss the factors responsible for the dismal progress of thoracic organ transplant in government hospitals, opportunities available in government institutions for widening the scope of transplant program, and the steps taken by the Government of India to improve healthcare in the country.

https://ift.tt/2tKARyx

Prediabetes and diabetes prevalence in the Workers’ Oral Health Study

Abstract

Objective

To examine the association between periodontitis, diabetes, and prediabetes, assessed by fasting plasma glucose (FPG).

Materials and methods

Workers' Oral Health Study is a cross-sectional survey conducted on a representative sample of the Spanish employed population including 5154 participants (59.5% men, aged 16–65). Examination of periodontal status assessed Community Periodontal Index (CPI) and clinical attachment levels (CAL). Biochemical determinations included fasting plasma glucose (FPG), triglycerides, and total cholesterol. Logistic regression analysis with adjustment for potential confounders was used to evaluate the association between periodontitis and abnormal glucose regulation.

Results

Ninety-five participants (2.2%) of the study population had diabetes, while 373 (8.8%) presented prediabetes. Prediabetes was not associated with CPI or CAL in fully adjusted multivariate logistic regressions models. Diabetes was significantly associated with subjects having a CPI 4 after adjustment for potential confounders (odds ratio OR = 1.9, 95% confidence interval (CI) 1.1–3.1). This association was stronger in subjects < 45 years (OR = 4.0, 95% CI 1.2–12.7).

Conclusion

Periodontitis was associated with diabetes mellitus, but not with prediabetes, in a representative sample of the Spanish employed population. The association was stronger for younger subjects, which emphasizes the need for early detection of diabetes in younger patients affected by periodontitis, particularly because periodontal therapy may help to improve glycemic control.

Clinical relevance

Periodontitis is associated with diabetes mellitus, having at the same time a negative effect on glycemic control. It is important to develop proper early diagnosis strategies for both conditions, particularly in young male adults.

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Effect of temperature on thermal, mechanical and morphological properties of polypropylene foams prepared by single step and two step batch foaming process

Abstract

This study reports the influence of foaming temperature on morphological and thermo-mechanical characteristics of polypropylene (PP) foams prepared using two different methods of batch foaming at low saturation pressures. In the first method, involving single-step pressure-induced-foaming (PIF), the solid specimen was heated to different temperatures in a high-pressure vessel, and then saturated CO₂ under pressure. Depressurization then led to foaming. In the second method, involving a two-step temperature-induced-foaming (TIF), the solid specimen was saturated with pressurized CO₂ at room temperature for a specific period of time and then the CO₂ laden specimen was immersed in hot glycerol bath at different temperatures for foaming. SEM micrographs of the fractured foamed specimens were employed for measurement of cell-size distribution. The average cell sizes ranged between 3 and 310 μm in specimens obtained using PIF, while in case of foams prepared by TIF, the cell sizes ranged between 30 and 70 μm. The cell sizes achieved in TIF are significantly smaller and more uniform as compared to those in PIF foams. The density (0.393–0.186 g cm⁻³) of PIF foams was seen to decrease with increasing foaming temperature; in contrast, in case of TIF the density remained more or less unchanged around 0.43–0.47 g cm⁻³ with changes in foaming temperature. The foamed specimens were characterized in uniaxial compression; the stiffness (elastic and collapse moduli) and compressive strengths of both the PIF and TIF foams were seen to decrease with increase in cell-size. The magnitude of plateau-regime stresses within the compressive stress-strain response showed strong correlation with the foam cell-wall thickness. The crystallinity of the foamed specimens was observed to decrease with increase in foaming temperatures. The thermal stability of both PIF and TIF foams in general showed improvement compared with the PP matrix.

https://ift.tt/2GQU3n5

Natural woodlands hold more diverse, abundant, and unique biota than novel anthropogenic forests: a multi-group assessment

Abstract

Biodiversity sustained by natural ecosystems, particularly forests, provides ecosystem services essential to human well-being. However, many forests have been severely transformed, notably via monospecific plantations and the spread of invasive species. Given the extension of these novel anthropogenic forests (plantations and invasive copses), it is critical to know how they can support forest biodiversity, particularly in highly humanized biodiversity hotspots as the southwest Mediterranean Europe. Because the effects likely vary across taxonomic groups, such assessments require an integrative multi-group approach. Here, we evaluated the abundance, richness, and composition of shrubs, herbs, macrofungi, ground and flying arthropods, birds, small mammals, carnivores, and bats across the four most common forest types in Central Portugal, namely: natural oak woodlands (dominated by Quercus faginea Lam.) and anthropogenic forests, invasive Acacia dealbata Link copses, Pinus pinaster Aiton plantations (native), and Eucalyptus globulus Labill. plantations (exotic). Oak woodlands sustained higher abundance, diversity, and a unique species composition compared to the other forests, especially those dominated by exotic species. The greatest changes in biodiversity occurred in herbs and birds. Contrary to our expectations, species richness and composition of macrofungi and carnivores in acacia copses were similar to those of oak woodlands, revealing that groups respond differently to forest changes. The large-scale replacement of natural forests by novel anthropogenic forests has significant negative impacts in most, but not all groups, which should be actively considered for integrative conservation strategies.

https://ift.tt/2EoaR0N

Carnosic Acid Inhibits CXCR3 Ligands Production in IL-27-Stimulated Human Oral Epithelial Cells

Abstract

Carnosic acid, which is a bioactive compound isolated from rosemary, has various pharmacological effects. However, the anti-inflammatory effect of carnosic acid on periodontitis is still unknown. The aim of this study was to investigate the effect of carnosic acid on CXC chemokine receptor 3 (CXCR3) ligands, which are involved in Th1 cells migration and accumulation, production in interleukin (IL)-27-stimulated human oral epithelial cells (TR146 cells). Carnosic acid decreased CXC chemokine ligand (CXCL)9, CXCL10, and CXCL11 production in IL-27-stimulated TR146 cells in a dose-dependent fashion. Moreover, we disclosed that carnosic acid could suppress signal transducer and activator of transcription (STAT)1, STAT3, and protein kinase B (Akt) phosphorylation in IL-27-stimulated TR146 cells. Furthermore, STAT1, STAT3, and Akt inhibitors could suppress CXCR3 ligands production in IL-27-treated TR146 cells. In summary, carnosic acid could reduce CXCR3 ligands production in human oral epithelial cell by inhibiting STAT1, STAT3, and Akt activation.

https://ift.tt/2VryKeQ

Diagnosis and Treatment Patterns in Celiac Disease

Abstract

Celiac disease (CD) is an immune-mediated gastrointestinal (GI) disorder driven by innate and adaptive immune responses to gluten. Presentation of CD has changed over time, with non-GI symptoms, such as anemia and osteoporosis, presenting more commonly. With improved screening and diagnostic methods, the reported prevalence of CD has increased globally, and there is considerable global variation in diagnostic and treatment practices. The objective of this study was to describe the current state of CD diagnosis and treatment patterns. A targeted review of literature from MEDLINE, Embase, the Cochrane Library, and screening of relevant conference abstracts was performed. The generally recommended diagnostic approach is GI endoscopy with small bowel biopsy; however, in selected patients, biopsy may be avoided and diagnosis based on positive serology and clinical symptoms. Diagnosis often is delayed; the average diagnostic delay after symptom onset is highly variable and can last up to 12 years. Barriers to accurate and timely diagnosis include atypical presentation, lack of physician awareness about current diagnostic criteria, misdiagnosis, and limited access to specialists. Currently, strict adherence to a gluten-free diet (GFD) is the only recommended treatment, which is not successful in all patients. Only one-third of patients are monitored regularly following diagnosis. Unmet needs for CD include improvements in the accuracy and timeliness of diagnosis, and the development of treatments for both refractory CD and GFD nonresponsive CD. Further research should investigate the impact of education about gluten-free eating and the availability of gluten-free foods support adherence and improve outcomes in patients with CD.

https://ift.tt/2Sv4UV3

The effect of severe and moderate hypoxia on exercise at a fixed level of perceived exertion

Abstract

Purpose

The purpose of this study was to determine the primary cues regulating perceived effort and exercise performance using a fixed-RPE protocol in severe and moderate hypoxia.

Methods

Eight male participants (26 ± 6 years, 76.3 ± 8.6 kg, 178.5 ± 3.6 cm, 51.4 ± 8.0 mL kg^− 1 min^− 1 \(\dot {V}\) O_2max) completed three exercise trials in environmental conditions of severe hypoxia (F_IO₂ 0.114), moderate hypoxia (F_IO₂ 0.152), and normoxia (F_IO₂ 0.202). They were instructed to continually adjust their power output to maintain a perceived effort (RPE) of 16, exercising until power output declined to 80% of the peak 30-s power output achieved.

Results

Exercise time was reduced (severe hypoxia 428 ± 210 s; moderate hypoxia 1044 ± 384 s; normoxia 1550 ± 590 s) according to a reduction in F_IO₂ (P < 0.05). The rate of oxygen desaturation during the first 3 min of exercise was accelerated in severe hypoxia (− 5.3 ± 2.8% min^− 1) relative to moderate hypoxia (− 2.5 ± 1.0% min^− 1) and normoxia (− 0.7 ± 0.3% min^− 1). Muscle tissue oxygenation did not differ between conditions (P > 0.05). Minute ventilation increased at a faster rate according to a decrease in F_IO₂ (severe hypoxia 27.6 ± 6.6; moderate hypoxia 21.8 ± 3.9; normoxia 17.3 ± 3.9 L min^− 1). Moderate-to-strong correlations were identified between breathing frequency (r = − 0.718, P < 0.001), blood oxygen saturation (r = 0.611, P = 0.002), and exercise performance.

Conclusions

The primary cues for determining perceived effort relate to progressive arterial hypoxemia and increases in ventilation.

https://ift.tt/2XsKpfi

Bioaugmentation and Biostimulation of Total Petroleum Hydrocarbon Degradation in a Petroleum-contaminated Soil with Fungi Isolated from Olive Oil Effluent

Abstract

In degradation of total petroleum hydrocarbon, 35 isolates belonging to 11 genera were sanitized and 3 isolates as well as their consortium were initiated to be able to raise in association with petroleum hydrocarbon as sole source of carbon under in vitro circumstances. The isolated strains were grounded on internal transcribed spacer (ITS) rDNA sequence analysis. The fungal strains with the utmost potentiality to reduce petroleum hydrocarbon without emerging antagonistic activities were Aspergillus niger, Penicillium ochrochloron, and Trichodema viride. For fungal growth on petroleum hydrocarbon, P. ochrocholon gained weight of 44%, A. niger 49%, and T. viride 39% within the first 30–40 days. As compared to the controls, these fungi accumulated significantly higher biomass, produced extracellular enzymes, and degraded total petroleum hydrocarbon and A. niger strongly degraded total petroleum hydrocarbon with a degradation of about 71.19%. These observations with GC-MS data confirm that these isolates displayed rapid total petroleum hydrocarbon biodegradation within a period of 60 days and the half-life showed that A. niger was the shortest with t1/2 = 21.280 day⁻¹ corresponding to the highest percent degradation of 71.19% and first-order kinetic fitted into the present study. By multivariate analysis, five main factors were identified by factor analysis (FA). The first factor (F1) of the fungi species accounts for 20.0% which signifies that fungi species controls the degradation of petroleum variability and hierarchical cluster analysis (HCA) as a dendrogram with five observations and three variables shows two predominant clusters order cluster 1 > 2.

https://ift.tt/2GP5JXv

Medio-lateral functional dissociation of the rostral prefrontal cortex with focal/non-focal cues during a prospective memory task

Abstract

The rostral prefrontal cortex (rPFC) is crucial in prospective memory (PM) behavior. Several functional magnetic resonance imaging studies showed that its medial (mrPFC) and lateral (lrPFC) portions dissociate during PM tasks. In light of the Multiprocess theory (McDaniel and Einstein 2000), here we tested whether the two portions of the rPFC are dissociable by modulating strategic vs. spontaneous processes during a PM task. We investigated these two processes by means of a 2 × 2 experimental design in which focal vs. non-focal conditions were modulated by varying the conjoint nature of the ongoing task (i.e., lexical decision vs. syllable matching) and the PM cue (words vs. syllables). Using the two portions of the rPFC as regions of interest, we found an effect of the non-focal condition in the lrPFC and, conversely, an effect of the focal condition in the mrPFC. In the whole-brain analysis we found an effect of the non-focal condition in the bilateral intraparietal sulcus, the bilateral middle frontal gyrus, the supplementary motor areas and the vermis of the cerebellum, whereas we found an effect of the focal condition in the ventromedial PFC. Overall, our results show that different brain regions are involved when multiple processes underlying PM behavior are modulated.

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Inflammatory markers and imaging patterns of advanced brain aging in the general population

Abstract

Inflammaging describes the complexity between low-grade chronic inflammation with the pathogenesis of brain aging and Alzheimer´s disease (AD). We aimed to find associations of inflammatory markers: i) white blood cell count (WBC), ii) high-sensitivity C-reactive protein (hs-CRP), and iii) fibrinogen with brain structures, sensitive neuroimaging markers of advanced brain aging and AD-like atrophy, and cognitive aging scores. We analyzed magnetic resonance imaging (MRI) scans of 2204 participants from the Study of Health in Pomerania-2 (SHIP-2) and SHIP-Trend (55.6% women, mean age 52.4±13.7 years). Associations of the inflammatory markers with specific brain signatures of brain aging (SPARE-BA), AD-like brain atrophy (SPARE-AD) and white matter disease (white matter hyperintensities volume (WMHV)) were investigated. Furthermore we explored their association with general brain structures including total brain volume (TBV), gray matter volume (GMV), and white matter volume (WMV), as well as cognitive scores (Nurnberger Age Inventory (NAI); Verbal Learning and Memory Test (VLMT). We adjusted for multiple vascular risk factors (VRF; e.g. smoking and blood pressure) and corresponding medication use to take their brain aging effects into account and corrected for false-discovery rate (FDR). Results:WBC was inversely associated with SPARE-BA (FDR-adjusted p=0.003), TBV (FDR-adjusted p=0.019) and GMV (FDR-adjusted p= 0.017). GMV was also inversely associated with hs-CRP (FDR-adjusted p=0.039) and fibrinogen (FDR-adjusted p=0.039). None of the inflammatory markers was associated with WMHV. Regression analysis also revealed a trend-level interaction between intake of antiinflammatory medication and hs-CRP with brain aging (SPARE-BA; FDR-adjusted p=0.062). Inflammatatory markers are associated with neuroimaging markers, with elevated WBC leading to significant acceleration in brain aging patterns but not with AD-like imaging structural changes. Given the overlap between accelerated brain aging and AD-like atrophy, increased WBC might be associated with global dementia symptoms due to this overlap in atrophy patterns. Elevated WBC may be not causal to preclinical AD dementia, but an accessory symptom of inflammaging. At population level, our results support the relevant roles of inflammatory markers on brain aging related atrophy.

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Schizophrenia-related abnormalities in the triple network: a meta-analysis of working memory studies

Abstract

Previous meta-analyses found abnormal brain activations in schizophrenia patients compared with normal controls when performing working memory tasks. Although most studies focused on dysfunction of the working memory activation network in schizophrenia patients, deactivation abnormalities of the working memory in the default mode network have also been reported in schizophrenia but have received less attention. Our goal was to discover whether deactivation abnormalities can also be consistently found in schizophrenia during working memory tasks and, further, to consider both activation and deactivation abnormalities. Fifty-two English language peer-reviewed studies were included in this meta-analysis. Compared with normal controls, the schizophrenia patients showed activation dysfunction of the bilateral dorsolateral prefrontal cortex and posterior parietal cortex as well as the anterior insula, anterior cingulate cortex, and supplementary motor area, which are core nodes of the central executive and salience network. In addition to dysfunction of the activation networks, the patients showed deactivation abnormalities in the ventral medial prefrontal cortex and posterior cingulate cortex, which are core nodes of the default mode network. These results suggest that both activation and deactivation abnormalities exist in schizophrenia patients and that these abnormalities should both be considered when investigating the pathophysiological mechanism of schizophrenia.

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Media multitasking is associated with higher risk for obesity and increased responsiveness to rewarding food stimuli

Abstract

Obesity among children and adolescents has dramatically increased over the past two to three decades and is now a major public health issue. During this same period, youth exposure to media devices also became increasingly prevalent. Here, we present the novel hypothesis that media multitasking (MMT)—the simultaneous use of and switching between unrelated forms of digital media—is associated with an imbalance between regulatory processes and reward-related responses to appetitive food stimuli, resulting in a greater sensitivity to external food cues among high media multitaskers. This, in turn, may contribute to overeating and weight gain over time. To test this hypothesis, we conducted two studies examining research participants who grew up during the recent period of escalating multitasking and obesity—and among whom 37% are overweight or obese. In Study 1, participants' propensity to engage in MMT behaviors was associated with a higher risk for obesity (as indicated by higher body mass index and body fat percentage). Next, in Study 2, a subset of participants from Study 1 were exposed to appetitive food cues while undergoing functional neuroimaging and then, using passive mobile sensing, the time participants spent in various food points-of-sale over an academic term was inferred from GPS coordinates of their mobile device. Study 2 revealed that MMT was associated with an altered pattern of brain activity in response to appetizing food cues, specifically an imbalance favoring reward-related activity in ventral striatum and orbitofrontal cortex—relative to recruitment of the frontoparietal control network. This relationship was further tested in a mediation model, whereby increased MMT, via a brain imbalance favoring reward over control, was associated with greater time spent in campus eateries. Taken together, findings from both studies suggest the possibility that media multitasking may be implicated in the recent obesity epidemic.

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Severe asthma ‐ A population study perspective

Abstract

Background

Severe asthma is a considerable challenge for patients, health care professionals and society. Few studies have estimated the prevalence of severe asthma according to modern definitions of which none based on a population study.

Objective

To describe characteristics and estimate the prevalence of severe asthma in a large adult population‐based asthma cohort followed for 10‐28 years.

Methods

N=1006 subjects with asthma participated in a follow‐up during 2012‐14, when 830 (mean age 59y, 56% women) still had current asthma. Severe asthma was defined according to three internationally well‐known criteria: the ATS workshop definition from 2000 used in the US Severe Asthma Research Program (SARP), the 2014 ATS/ERS Task force definition and the GINA 2017. All subjects with severe asthma according to any of these criteria were undergoing respiratory specialist care, and were also contacted by telephone to verify treatment adherence.

Results

The prevalence of severe asthma according to the three definitions was 3.6% (US SARP), 4.8% (ERS/ATS Taskforce), and 6.1% (GINA) among subjects with current asthma. Although all were using high ICS doses and other maintenance treatment, >40% had uncontrolled asthma according to the asthma control test. Severe asthma was related to age >50 years, nasal polyposis, impaired lung function, sensitization to aspergillus, and tended to be more common in women. Further, neutrophils in blood significantly discriminated severe asthma from other asthma.

Conclusions and clinical relevance

Severe asthma differed significantly from other asthma in terms of demographic, clinical and inflammatory characteristics, results suggesting possibilities for improved treatment regimens of severe asthma. The prevalence of severe asthma in this asthma cohort was 4‐6%, corresponding to approximately 0.5% of the general population.

This article is protected by copyright. All rights reserved.

https://ift.tt/2EkcBbA

Rational design and in vitro characterization of novel dental implant and abutment surfaces for balancing clinical and biological needs

Abstract

Background

Long‐term success and patient satisfaction of dental implant systems can only be achieved by fulfilling clinical as well as biological needs related to maintenance, aesthetics, soft tissue sealing, and osseointegration, among others. Surface properties largely contribute to the biological and clinical performance of implants and abutments.

Purpose

To decipher the clinical and biological needs in implant dentistry. To address identified needs, next‐generation dental implant and abutment surfaces are designed and characterized in vitro.

Materials and Methods

Novel implant and abutment surface designs were produced and characterized using surface chemical analysis, surface topography analysis, scanning electron microscopy, contact‐angle measurements, and cell‐culture experiments.

Results

The novel anodized implant surface was gradually anodized, increasing the surface roughness, surface enlargement, and oxide‐layer thickness from platform to apex. The surface was phosphorus enriched, nonporous, and nanostructured at the collar, and showed micropores elsewhere. The novel anodized abutment surface was smooth, nanostructured, nonporous, and yellow. Pristine surfaces with high density of hydroxyl‐groups were protected during storage using a removable cell‐friendly layer that allowed dry packaging.

Conclusions

A novel anodized implant system was developed with surface chemistry, topography, nanostructure, color, and surface energy designed to balance the clinical and biological needs at every tissue level.

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Quantitative in vitro comparison of the thrombogenicity of commercial dental implants

Abstract

Background

Dental implants often have surface modifications that alter surface topography and chemistry to improve osseointegration and thereby increase treatment predictability. Surface contact‐induced blood coagulation is associated with the onset of osseointegration.

Purpose

To quantitatively evaluate the thrombogenicity of two commercially available dental implants that have similar surface roughness but different surface chemistry.

Material and Methods

Two commercially available dental implants with anodized or sandblasted acid‐etched surfaces were evaluated for thrombogenic properties. Thrombogenicity was assessed by incubating implants for 1 hour in fresh, partially heparinized blood followed by hemocyte quantification, microscopic evaluation, and quantification of thrombogenic biomarkers.

Results

Fibrin coverage was significantly higher on the anodized surface compared with the sandblasted acid‐etched surface (P < 0.0001). Platelet and white blood cell attachment followed a similar pattern. The increased thrombogenicity was confirmed based on a significant increase in the levels of the coagulation cascade biomarkers, thrombin antithrombin complex, and β‐thromboglobulin (all P < 0.05).

Conclusion

Dental implants with comparable roughness but differing surface chemistry had differing extents of blood contact activation. These data suggest that surface chemistry from anodization augments implant thrombogenicity compared with that from sandblasting and acid‐etching, which could have implications for osseointegration.

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On osseointegration in relation to implant surfaces

Abstract

Background

The understanding of mechanisms of osseointegration as well as applied knowledge about oral implant surfaces are of paramount importance for successful clinical results.

Purpose

The aim of the present article is to present an overview of osseointegration mechanisms and an introduction to surface innovations with relevance for osseointegration that will be published in the same supplement of Clinical Implant Dentistry and Related Research.

Materials and Methods

The present article is a narrative review of some osseointegration and implant surface‐related details.

Results and Conclusions

Osseointegration has a changed definition since it is realized today that oral implants are but foreign bodies and that this fact explains osseointegration as a protection mechanism of the tissues. Given adequate stability, bone tissue is formed around titanium implants to shield them from the tissues. Oral implant surfaces may be characterized by microroughness and nanoroughness, by surface chemical composition and by physical and mechanical parameters. An isotropic, moderately rough implant surface such as seen on the TiUnite device has displayed improved clinical results compared to previously used minimally rough or rough surfaces. However, there is a lack of clinical evidence supporting any particular type of nanoroughness pattern that, at best, is documented with results from animal studies. It is possible, but as yet unproven, that clinical results may be supported by a certain chemical composition of the implant surface. The same can be said with respect to hydrophilicity of implant surfaces; positive animal data may suggest some promise, but there is a lack of clinical evidence that hydrophilic implants result in improved clinical outcome of more hydrophobic surfaces. With respect to mechanical properties, it seems obvious that those must be encompassing the loading of oral implants, but we need more research on the mechanically ideal implant surface from a clinical aspect.

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TGF‐β activity in acid bone lysate adsorbs to titanium surface

Abstract

Objectives

Osteoblasts lay down new bone on implant surfaces. The underlying cellular mechanism and the spatio‐temporal mode of action, however, remain unclear. It can be proposed that growth factors released upon acidification by osteoclasts adsorb to the implant surface and control the early stages of osseointegration.

Methods

To simulate bone lysis by osteoclasts, titanium discs were exposed to acid bone lysate (ABL) followed by vigorous washing and seeding of oral fibroblasts. The expression of TGF‐β target genes interleukin 11 (IL11) and NADPH oxidase 4 (NOX4) was evaluated by reverse transcriptase polymerase chain reaction and IL11 ELISA. TGF‐β signaling activation was assessed via Smad2/3 immunofluorescence. The impact of ABL on osteogenic differentiation was determined with murine ST2 mesenchymal stromal cells.

Results

We report here that ABL‐conditioned titanium discs, independent of turned or rough surface, increased the expression of IL11 and NOX4. This increase was blocked by the TGF‐β receptor 1 antagonist SB431542. Further support for the TGF‐β signaling activation came from the translocation of Smad2/3 into the nucleus of oral fibroblasts. Moreover, titanium discs exposed to ABL decreased alkaline phosphatase and osteopontin in ST2 cells.

Conclusions

These in vitro findings suggest that titanium can adsorb TGF‐β from ABLs. The data provide a strong impetus for studies on the protein adsorption on implant surfaces in vitro and in vivo, specifically for growth factors including bone‐derived TGF‐β during successful and failed osseointegration.

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On osseointegration in relation to implant surfaces

Abstract

Background

The understanding of mechanisms of osseointegration as well as applied knowledge about oral implant surfaces are of paramount importance for successful clinical results.

Purpose

The aim of the present article is to present an overview of osseointegration mechanisms and an introduction to surface innovations with relevance for osseointegration that will be published in the same supplement of Clinical Implant Dentistry and Related Research.

Materials and Methods

The present article is a narrative review of some osseointegration and implant surface‐related details.

Results and Conclusions

Osseointegration has a changed definition since it is realized today that oral implants are but foreign bodies and that this fact explains osseointegration as a protection mechanism of the tissues. Given adequate stability, bone tissue is formed around titanium implants to shield them from the tissues. Oral implant surfaces may be characterized by microroughness and nanoroughness, by surface chemical composition and by physical and mechanical parameters. An isotropic, moderately rough implant surface such as seen on the TiUnite device has displayed improved clinical results compared to previously used minimally rough or rough surfaces. However, there is a lack of clinical evidence supporting any particular type of nanoroughness pattern that, at best, is documented with results from animal studies. It is possible, but as yet unproven, that clinical results may be supported by a certain chemical composition of the implant surface. The same can be said with respect to hydrophilicity of implant surfaces; positive animal data may suggest some promise, but there is a lack of clinical evidence that hydrophilic implants result in improved clinical outcome of more hydrophobic surfaces. With respect to mechanical properties, it seems obvious that those must be encompassing the loading of oral implants, but we need more research on the mechanically ideal implant surface from a clinical aspect.

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A novel approach to modelling transcriptional heterogeneity identifies the oncogene candidate CBX2 in invasive breast carcinoma

A novel approach to modelling transcriptional heterogeneity identifies the oncogene candidate CBX2 in invasive breast carcinoma

A novel approach to modelling transcriptional heterogeneity identifies the oncogene candidate <i>CBX2</i> in invasive breast carcinoma, Published online: 01 March 2019; doi:10.1038/s41416-019-0387-8

A novel approach to modelling transcriptional heterogeneity identifies the oncogene candidate CBX2 in invasive breast carcinoma

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Roxadustat promotes angiogenesis through HIF‐1α/VEGF/VEGFR2 signaling and accelerates cutaneous wound healing in diabetic rats

Abstract

Diabetic foot ulcers are a major health‐care burden worldwide. One primary cause of the delayed wound healing in diabetic patients is impaired function of the hypoxia‐inducible factor‐1α/vascular endothelial growth factor (HIF‐1α/VEGF) axis, which results in compromised neovascularization in response to hypoxia. In the present study, we aimed to investigate the effect of roxadustat, a novel HIF prolyl‐4‐hydroxylase inhibitor, on angiogenesis and its therapeutic effect on cutaneous wound healing in diabetic rats. In vitro, we found that roxadustat could promote the angiogenic activity of human umbilical vein endothelial cells, accompanied by up‐regulation of HIF‐1α/VEGF/VEGFR2 signaling. Next, we demonstrated that Ki8751, a VEGFR2‐specific inhibitor, could inhibit the increased angiogenic activity of human umbilical vein endothelial cells induced by roxadustat. In vivo, we performed a Matrigel plug assay and demonstrated that roxadustat induced vascularization of the Matrigel plugs, and this effect could be partially inhibited by Ki8751. Finally, we utilized a streptozotocin‐induced diabetic rat model and found that roxadustat could accelerate cutaneous wound healing and promote angiogenesis in the wound sites. In conclusion, roxadustat promotes angiogenesis via activation of the HIF‐1α/VEGF/VEGFR2 pathway and exhibits therapeutic effects on diabetic wound healing by increasing angiogenesis. Our findings suggest that roxadustat can be a promising strategy to promote diabetic cutaneous wound healing.

https://ift.tt/2BYkyCW

Contributions of innate lymphocytes to allergic responses

Purpose of review Allergic diseases represent a growing global health concern, especially among pediatric populations. Current strategies for the treatment of allergies and asthma focus on limiting the severity of the symptoms; however, additional research investigating the mechanisms promoting inflammation in the context of allergic reactions may lead to the development of more effective therapeutic strategies. Recent findings Novel studies have highlighted the contributions of innate lymphocytes to the induction of inflammatory responses to allergens. Remarkably, neuron-derived signals, hormones, and even vitamins have been suggested to modulate the activity of innate lymphocytes, opening new windows of opportunity for the treatment of allergic inflammation. Summary These studies highlight the complex interactions of the nervous, endocrine, and immune system that promote pathology in the context of allergic inflammation. Further studies are required to understand these interactions in order to aid in the development of novel and much-needed therapies to treat allergic conditions.

from ! ORL Sfakianakis via paythelady.61 on Inoreader https://ift.tt/2NCheSl
via IFTTT

Neutrophil activation in occupational asthma

Purpose of review The aim of this review is to emphasize the role of neutrophils in patients with occupational asthma. This review facilitates a better understanding, accurate diagnosis, and proper management of asthmatic reactions provoked at the workplace. Recent findings Increased recruitment and infiltration of neutrophils are found in patients with occupational asthma. Activated neutrophils release several mediators including pro-inflammatory cytokines and extracellular traps, leading to stimulation of airway epithelium and other inflammatory cells. Summary New insights into neutrophils in the pathogenesis of occupational asthma may provide a novel approach to the individual patient with occupational asthma.

from ! ORL Sfakianakis via paythelady.61 on Inoreader https://ift.tt/2GS7vqu
via IFTTT

Phenotypes of wheezing and asthma in preschool children

Purpose of review The purpose of this review is to provide an overview of the identified phenotypes of preschool wheezing. Recent findings Early life wheezing patterns have been described in multiple populations, with several commonalities found between cohorts. Early life environmental exposures have been found to be differentially associated with preschool wheezing phenotypes and their future trajectories. These include allergen and microbe exposure, environmental tobacco smoke exposure, and maternal stress and depression. Elevated IgE in early life may also influence future asthma risk. Summary Preschool wheezing phenotypes are heterogeneous and complex, with trajectories that are related to factors including environmental exposures. More research is needed to characterize these relationships, hopefully leading to targeted prevention strategies.

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Severe asthma in children: therapeutic considerations

Purpose of review Children with poor asthma control despite maximal maintenance therapy have problematic severe asthma (PSA). A step-wise approach including objective adherence monitoring and a detailed multidisciplinary team assessment to identify modifiable factors contributing to poor control is needed prior to considering therapy escalation. Pathophysiological phenotyping in those with true severe therapy-resistant asthma (STRA) and the current array of add-on therapies will be discussed. Recent findings Adherence monitoring using electronic devices has shown that only 20–30% of children with PSA have STRA and need additional therapies. Omalizumab and mepolizumab are licensed for children with STRA aged 6 years and older. Although robust safety and efficacy data, with reduced exacerbations, are available for omalizumab, biomarkers predicting response to treatment are lacking. Paediatric safety data are available for mepolizumab, but efficacy data are unknown for those aged 6–11 years and minimal for those 12 years and older. A sub-group of children with STRA have neutrophilia, but the clinical significance and contribution to disease severity remains uncertain. Summary Most children with PSA have steroid sensitive disease which improves with adherence to maintenance inhaled corticosteroids. Add-on therapies are only needed for the minority with STRA. Paediatric efficacy data of novel biologics and biomarkers that identify the optimal add-on for each child are lacking. If we are to progress toward individualized therapy for STRA, pragmatic clinical trials of biologics in accurately phenotyped children are needed.

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via IFTTT

Basophil activation testing in occupational respiratory allergy to low molecular weight compounds

Purpose of review There is an unmet need for better immunological tests in cases of suspected occupational asthma to many workplace chemicals; here we consider the basophil activation test (BAT), a potential alternative to the detection of specific IgE antibodies. Recent findings BAT is fairly widely used in general allergy services; and there is increasing experience of its use in the diagnosis of occupational allergy to low molecular weight agents and chemicals including wood dusts, persulphates, antibiotics and latex. Summary There is potential for BAT to become a useful tool in the clinical consideration of occupational asthma and of its mechanisms, and even to take a place in a Bayesian-based diagnostic algorithm. Further development will only occur if specialist centres with appropriate facilities, and preferably in collaboration, contemplate its use.

from ! ORL Sfakianakis via paythelady.61 on Inoreader https://ift.tt/2GSnGnJ
via IFTTT

Preventing the development of asthma: stopping the allergic march

Purpose of review To describe important precipitants of asthma and allergic disease, to highlight the links between these triggers and modifications within the immune system, and to examine innovative research regarding asthma prevention with focus on attenuating the atopic march. Recent findings Allergen avoidance, allergen immunotherapy, IgE antagonists, prevention and treatment of respiratory infections, as well as management of gastrointestinal and respiratory dysbiosis have been considered as strategies in asthma prevention. Antenatal vitamin D supplementation in expectant mothers and aggressive control of atopic dermatitis to prevent the development of other allergic conditions were carefully studied as well. Summary Asthma is a major cause of morbidity and lost productivity. Despite the tremendous burden of this disease, the scientific community is still struggling to find an effective means of prevention. The contribution of genetics to the development of atopy cannot be altered, but environmental changes as well as pharmacotherapy have been studied as modifiable risk factors. Many trials to date have been effective only for subjects with certain characteristics. This is likely because asthma is a heterogenous condition, with a variety of triggers and clinical phenotypes. Thus far, a universally effective prevention strategy has eluded us. However, if an intervention can be found to prevent asthma and the allergic march, it will greatly improve quality of life for millions of sufferers and decrease healthcare expenditures.

from ! ORL Sfakianakis via paythelady.61 on Inoreader https://ift.tt/2NzNQMN
via IFTTT

Use of population data for assessing trends in work-related asthma mortality

Purpose of review Work-related asthma has been associated with poorer asthma control and frequent unscheduled healthcare visits, and can be fatal. Case reports of work-related asthma deaths are rare, but can initiate efforts to prevent additional cases. We reviewed relevant literature and data sources to evaluate whether analyzing mortality data at the population level can help identify potential sources of exposures that contribute to work-related asthma. Recent findings A limited number of population-based studies have addressed work-related asthma mortality. Data on asthma mortality are derived from death certificates using the International Classification of Diseases (ICD) as a standard for coding cause. However, no discrete code for work-related asthma is available. Analysis of asthma mortality relative to industries and occupations appears to identify high-risk jobs that were not identified by analyzing asthma morbidity data. Summary Beyond recognized work-related asthma deaths, it is possible that occupational exposures have contributed to other asthma deaths that have gone unnoticed and could potentially be identified by the analysis of mortality data at the population level. Such analyses in the United States appear to assist in recognizing high-risk occupations and industries. Additional analyses would be possible if a work-related asthma ICD code were available.

from ! ORL Sfakianakis via paythelady.61 on Inoreader https://ift.tt/2NCh0KZ
via IFTTT

Editorial introductions

No abstract available

from ! ORL Sfakianakis via paythelady.61 on Inoreader https://ift.tt/2GS8tmT
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Precision medicine in childhood asthma

Purpose of review Childhood asthma is a heterogeneous disease and many children have uncontrolled disease. Therefore an individualized approach is needed to improve asthma outcomes in children. Precision medicine using clinical characteristics, biomarkers, and the rapidly involving field of genomics and pharmacogenomics aims to achieve asthma control and reduce future risks with less side-effects in individual children with asthma. Recent findings It is not yet possible to select treatment options on clinical characteristics. Novel monoclonal antibodies are efficacious in patients with severe, eosinophilic asthma. Reduced lung function growth and early decline is a prevalent finding in children with persistent asthma. Pharmacogenetic studies have identified children at risk for cortisol suppression when using inhaled corticosteroids. Summary Clinical characteristics and simple biomarkers like eosinophils, IgE, and the fraction of exhaled nitric oxide may be used in clinical practice for a basic precision medicine approach, deciding which children will have the best chance to respond to inhaled corticosteroids and to the biologicals omalizumab and mepolizumab. Further application of pharmacogenomics and breathomics needs additional studies before they can be applied as tools for precision medicine in individual children with asthma.

from ! ORL Sfakianakis via paythelady.61 on Inoreader https://ift.tt/2GQTY2A
via IFTTT

Management of acute loss of asthma control: yellow zone strategies

Purpose of review Asthma exacerbations are associated with a significant burden to both the individual patient and to the healthcare system. Patients often step-up home therapies in response to increased asthma symptoms, and the asthma action plan was created to empower patients to self-manage their asthma care. The yellow (intermediate) zone of the asthma action plan is frequently poorly defined, and current Expert Panel Report 3 guideline recommendations are not effective for all patients. This article reviews the evidence behind various recommended yellow zone intervention strategies. Recent findings There are many potential methods of delivering yellow zone therapy, and recent studies have assessed preventive efficacy of a scheduled increase in controller medication(s), reliever medication(s), or a symptom-driven combination of both. The literature suggests that, in certain asthma subpopulations, some methods may be more efficacious than others. Summary Multiple yellow zone approaches may be beneficial, and the yellow zone is not a 'one size fits all' narrative.

from ! ORL Sfakianakis via paythelady.61 on Inoreader https://ift.tt/2GS7fYy
via IFTTT

The impact of exercise on asthma

Purpose of review Asthma is one of the most common chronic diseases in children and adults in developed countries around the world. Despite international treatment guidelines, poor asthma control remains a frequent problem leading to missed school and work, and emergency room visits and hospitalizations. Many patients with asthma report exercise as a trigger for their asthma, which likely leads to exercise avoidance as a means to control symptoms. Evolving research has suggested that routine exercise may actually help improve some aspects of asthma control. This review discusses the recent research addressing how routine exercise affects important asthma-related outcomes including symptoms, lung function and quality of life. Recent findings Several systematic reviews and meta-analyses have been conducted in recent years, which strongly support the safety of routine exercise in children and adults with asthma. Exercise appears to favor improvements in aerobic fitness, asthma symptoms and quality of life, but results so far are less consistent in demonstrating improvements to lung function and airway hyperresponsiveness. Summary In addition to routine management guidelines, clinicians should recommend for their patients with asthma routine exercise for its general health benefits and likely improvement in asthma symptoms and quality of life.

from ! ORL Sfakianakis via paythelady.61 on Inoreader https://ift.tt/2NBvOJV
via IFTTT

Symptom-based patient-reported outcomes in adults with eosinophilic esophagitis: value for treatment monitoring and randomized controlled trial design

Purpose of review In adults with eosinophilic esophagitis (EoE), a chronic, inflammatory immune-mediated condition of the esophagus, both inflammation and fibrosis are likely associated with symptom generation. Therefore, assessing symptom-based patient-reported outcomes (PROs), defined by US Food and Drug Administration as 'any report of the status of a patient's health condition that comes directly from the patients, without interpretation of the patient's response by a clinician or anyone else', is important in the context of trials and observational studies of emerging therapies. Recent findings For purposes of treatment monitoring, lack of symptoms does not predict the absence of biologic inflammation; hence, endoscopy with esophageal biopsies should be performed to check for residual inflammation. Lack of inflammation does not predict lack of symptoms, and the presence of subepithelial fibrosis cannot be excluded. No published instrument currently measures the frequency of dysphagia described all possible ways, strategies of living with this symptom and various pain types. In randomized controlled trials, in which symptom response was detected using validated PRO measures, only modest decreases in symptom scores were observed. Summary Accessing full EoE symptom spectrum and optimizing PRO measures remains a challenge that should be tackled to reliably assess response to existing and emerging therapies.

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via IFTTT

Vitamin D and childhood asthma: causation and contribution to disease activity

Purpose of review To review the literature of the past 18 months (April 2017 through September, 2018) relating to vitamin D and childhood asthma. Recent findings A combined analysis of two clinical trials of maternal vitamin D supplementation trials showed a significant protective effect of vitamin D supplementation trials in the primary prevention of asthma and recurrent wheeze up to age 3 years. Secondary analyses from these trials have also suggested that initial maternal vitamin D status could affect the response to supplementation during pregnancy, with the biggest protective effect in children born to mothers with initial 25hydroxyvitamin D (25OHD) levels of at least 30 ng/ml. A postnatal, 6-month vitamin D supplementation trial in black, premature babies showed a 34% decreased risk of recurrent wheezing at 1 year among the infants who received supplementation. An individual patient data meta-analysis of published clinical trials concluded that vitamin D supplementation decreased the risk of asthma exacerbations in those with 25OHD levels less than 10 ng/ml. Results of observational analyses on primary prevention of asthma and in prevention of exacerbations remain mixed, with the bulk of the evidence suggesting that there is a protective effect of higher vitamin D levels. Summary Evidence continues to accumulate that vitamin D supplementation helps to prevent the development of asthma and recurrent wheeze in early life, and may also help in the management of asthma. The level(s) of circulating vitamin D that maximizes these effects remains to be identified.

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How guideline can shape clinical practice globally: the diagnosis and rationale for action against cow's milk allergy experience

Purpose of review Allergic diseases are increasing worldwide and are considered an important public health problem causing severe and even life-threatening reactions. The creation of guidelines aims to help clinicians improving the quality of diagnosis and management of such diseases. Clinical practice guidelines alone are not sufficient and there is a need for implementation strategies for their introduction into daily practice. We report here the main international allergy guidelines with a more focused look on the Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines and their effect on clinical practice. Recent findings DRACMA guidelines have clearly modified the approach to cow's milk allergy (CMA) from its diagnosis to treatment tailoring the choices for each patient. Although they strongly recommend oral food challenge for diagnosing CMA, they also indicate that it may not be necessary in many cases with the introduction of the pretest probability of CMA. Studies on the implementation of DRACMA guidelines show how they influenced the formula market, making appropriate treatments more affordable. Summary DRACMA reconciled international differences in the diagnosis and management of CMA. They introduced the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology in the field of food allergy and highlighted the importance for meta-analyses to be able to adapt recommendations to the local context.

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Comparative study on long-term stability in mandibular sagittal split ramus osteotomy: hydroxyapatite/poly- l -lactide mesh versus titanium miniplate

Abstract

Background

Resorbable devices have recently been adopted in the field of orthognathic surgery with controversies about their postoperative skeletal stability. Hence, we determined the long-term skeletal stability of unsintered hydroxyapatite/poly-l-lactic acid (HA/PLLA) mesh for osteofixation of mandibular sagittal split ramus osteotomy (SSRO), and compared it with that of titanium miniplate.

Methods

Patients were divided into resorbable mesh and titanium miniplate fixation groups. A comparative study of the change in the mandibular position was performed with preoperative, 1-day, 6-month, and 2-year postoperative lateral cephalograms.

Results

At postoperative 6 months—compared with postoperative 1 day, point B (supra-mentale) was significantly displaced anteriorly in the titanium-fixation group. Moreover, at postoperative 2 years—compared with postoperative 6 months, point B was significantly displaced inferiorly in the titanium-fixation. However, the HA/PLLA mesh-fixation group did not show any significant change with respect to point B postoperatively.

Conclusions

The HA/PLLA mesh-fixation group demonstrated superior long-term skeletal stability with respect to the position of mandible, when compared with the titanium-fixation group.

https://ift.tt/2EjKQzP

Comparative study on long-term stability in mandibular sagittal split ramus osteotomy: hydroxyapatite/poly- l -lactide mesh versus titanium miniplate

Abstract

Background

Resorbable devices have recently been adopted in the field of orthognathic surgery with controversies about their postoperative skeletal stability. Hence, we determined the long-term skeletal stability of unsintered hydroxyapatite/poly-l-lactic acid (HA/PLLA) mesh for osteofixation of mandibular sagittal split ramus osteotomy (SSRO), and compared it with that of titanium miniplate.

Methods

Patients were divided into resorbable mesh and titanium miniplate fixation groups. A comparative study of the change in the mandibular position was performed with preoperative, 1-day, 6-month, and 2-year postoperative lateral cephalograms.

Results

At postoperative 6 months—compared with postoperative 1 day, point B (supra-mentale) was significantly displaced anteriorly in the titanium-fixation group. Moreover, at postoperative 2 years—compared with postoperative 6 months, point B was significantly displaced inferiorly in the titanium-fixation. However, the HA/PLLA mesh-fixation group did not show any significant change with respect to point B postoperatively.

Conclusions

The HA/PLLA mesh-fixation group demonstrated superior long-term skeletal stability with respect to the position of mandible, when compared with the titanium-fixation group.

https://ift.tt/2EjKQzP

Contributions of innate lymphocytes to allergic responses

Purpose of review Allergic diseases represent a growing global health concern, especially among pediatric populations. Current strategies for the treatment of allergies and asthma focus on limiting the severity of the symptoms; however, additional research investigating the mechanisms promoting inflammation in the context of allergic reactions may lead to the development of more effective therapeutic strategies. Recent findings Novel studies have highlighted the contributions of innate lymphocytes to the induction of inflammatory responses to allergens. Remarkably, neuron-derived signals, hormones, and even vitamins have been suggested to modulate the activity of innate lymphocytes, opening new windows of opportunity for the treatment of allergic inflammation. Summary These studies highlight the complex interactions of the nervous, endocrine, and immune system that promote pathology in the context of allergic inflammation. Further studies are required to understand these interactions in order to aid in the development of novel and much-needed therapies to treat allergic conditions.

https://ift.tt/2NCheSl

Neutrophil activation in occupational asthma

Purpose of review The aim of this review is to emphasize the role of neutrophils in patients with occupational asthma. This review facilitates a better understanding, accurate diagnosis, and proper management of asthmatic reactions provoked at the workplace. Recent findings Increased recruitment and infiltration of neutrophils are found in patients with occupational asthma. Activated neutrophils release several mediators including pro-inflammatory cytokines and extracellular traps, leading to stimulation of airway epithelium and other inflammatory cells. Summary New insights into neutrophils in the pathogenesis of occupational asthma may provide a novel approach to the individual patient with occupational asthma.

https://ift.tt/2GS7vqu

Phenotypes of wheezing and asthma in preschool children

Purpose of review The purpose of this review is to provide an overview of the identified phenotypes of preschool wheezing. Recent findings Early life wheezing patterns have been described in multiple populations, with several commonalities found between cohorts. Early life environmental exposures have been found to be differentially associated with preschool wheezing phenotypes and their future trajectories. These include allergen and microbe exposure, environmental tobacco smoke exposure, and maternal stress and depression. Elevated IgE in early life may also influence future asthma risk. Summary Preschool wheezing phenotypes are heterogeneous and complex, with trajectories that are related to factors including environmental exposures. More research is needed to characterize these relationships, hopefully leading to targeted prevention strategies.

https://ift.tt/2NzlJNM

Impact of occupational exposure on human microbiota

Purpose of review Recent evidence suggests that environmental exposures change the adult human microbiome. Here, we review recent evidence on the impact of the work microbiome and work-related chemical, metal and particulate exposures on the human microbiome. Recent findings Prior literature on occupational microbial exposures has focused mainly on the respiratory effects of endotoxin, but a recent study suggests that not all endotoxin is the same; endotoxin from some species is proinflammatory, whereas endotoxin from other species is anti-inflammatory. Work with animals can change the adult human microbiome, likely through colonization. Early studies in military personnel and animal models of gulf war illness show that military exposures change the gut microbiome and increase gut permeability. Heavy metal and particulate matter exposure, which are often elevated in occupational settings, also change the gut microbiome. Summary An emerging body of literature shows that work-related exposures can change the human microbiome. The health effects of these changes are currently not well studied. If work exposures lead to disease through alterations in the human microbiome, exposure cessation without addressing changes to the human microbiome may be ineffective for disease prevention and treatment.

https://ift.tt/2GO9MmE

Basophil activation testing in occupational respiratory allergy to low molecular weight compounds

Purpose of review There is an unmet need for better immunological tests in cases of suspected occupational asthma to many workplace chemicals; here we consider the basophil activation test (BAT), a potential alternative to the detection of specific IgE antibodies. Recent findings BAT is fairly widely used in general allergy services; and there is increasing experience of its use in the diagnosis of occupational allergy to low molecular weight agents and chemicals including wood dusts, persulphates, antibiotics and latex. Summary There is potential for BAT to become a useful tool in the clinical consideration of occupational asthma and of its mechanisms, and even to take a place in a Bayesian-based diagnostic algorithm. Further development will only occur if specialist centres with appropriate facilities, and preferably in collaboration, contemplate its use.

https://ift.tt/2GSnGnJ

Preventing the development of asthma: stopping the allergic march

Purpose of review To describe important precipitants of asthma and allergic disease, to highlight the links between these triggers and modifications within the immune system, and to examine innovative research regarding asthma prevention with focus on attenuating the atopic march. Recent findings Allergen avoidance, allergen immunotherapy, IgE antagonists, prevention and treatment of respiratory infections, as well as management of gastrointestinal and respiratory dysbiosis have been considered as strategies in asthma prevention. Antenatal vitamin D supplementation in expectant mothers and aggressive control of atopic dermatitis to prevent the development of other allergic conditions were carefully studied as well. Summary Asthma is a major cause of morbidity and lost productivity. Despite the tremendous burden of this disease, the scientific community is still struggling to find an effective means of prevention. The contribution of genetics to the development of atopy cannot be altered, but environmental changes as well as pharmacotherapy have been studied as modifiable risk factors. Many trials to date have been effective only for subjects with certain characteristics. This is likely because asthma is a heterogenous condition, with a variety of triggers and clinical phenotypes. Thus far, a universally effective prevention strategy has eluded us. However, if an intervention can be found to prevent asthma and the allergic march, it will greatly improve quality of life for millions of sufferers and decrease healthcare expenditures.

https://ift.tt/2NzNQMN

Use of population data for assessing trends in work-related asthma mortality

Purpose of review Work-related asthma has been associated with poorer asthma control and frequent unscheduled healthcare visits, and can be fatal. Case reports of work-related asthma deaths are rare, but can initiate efforts to prevent additional cases. We reviewed relevant literature and data sources to evaluate whether analyzing mortality data at the population level can help identify potential sources of exposures that contribute to work-related asthma. Recent findings A limited number of population-based studies have addressed work-related asthma mortality. Data on asthma mortality are derived from death certificates using the International Classification of Diseases (ICD) as a standard for coding cause. However, no discrete code for work-related asthma is available. Analysis of asthma mortality relative to industries and occupations appears to identify high-risk jobs that were not identified by analyzing asthma morbidity data. Summary Beyond recognized work-related asthma deaths, it is possible that occupational exposures have contributed to other asthma deaths that have gone unnoticed and could potentially be identified by the analysis of mortality data at the population level. Such analyses in the United States appear to assist in recognizing high-risk occupations and industries. Additional analyses would be possible if a work-related asthma ICD code were available.

https://ift.tt/2NCh0KZ

Editorial introductions

No abstract available

https://ift.tt/2GS8tmT

Diagnosis of occupational hypersensitivity pneumonitis

Purpose of review To discuss the diagnostic methods currently used in the study of patients with hypersensitivity pneumonitis, with special emphasis on the most recent contributions published in the medical literature regarding the diagnosis of occupational hypersensitivity pneumonitis (OHP). This review presents an update of the use of these diagnostic tests, a controversial issue among experts. Recent findings In spite of the multiple attempts at systematization and the publication of expert consensus statements, standardizing and diagnostic methods and criteria remain particularly difficult. As a result, centers tend to rely on their own experience and establish diagnosis by consensus among their multidisciplinary teams. Though recommendable in many ways, this method presents significant limitations. Summary Diagnosis of OHP should be made with a thorough clinical history of the symptoms and clinical signs as well as a meticulous review, if possible by an expert, of possible exposures in the working environment; a meticulous physical examination; high-resolution computed tomography of the thorax; serum determination of specific immunoglobuline Gs; bronchoalveolar lavage and possibly cryobiopsy; fungal culture; and, when appropriate, a specific inhalation challenge test with the suspected antigen.

https://ift.tt/2NBwgrB

Precision medicine in childhood asthma

Purpose of review Childhood asthma is a heterogeneous disease and many children have uncontrolled disease. Therefore an individualized approach is needed to improve asthma outcomes in children. Precision medicine using clinical characteristics, biomarkers, and the rapidly involving field of genomics and pharmacogenomics aims to achieve asthma control and reduce future risks with less side-effects in individual children with asthma. Recent findings It is not yet possible to select treatment options on clinical characteristics. Novel monoclonal antibodies are efficacious in patients with severe, eosinophilic asthma. Reduced lung function growth and early decline is a prevalent finding in children with persistent asthma. Pharmacogenetic studies have identified children at risk for cortisol suppression when using inhaled corticosteroids. Summary Clinical characteristics and simple biomarkers like eosinophils, IgE, and the fraction of exhaled nitric oxide may be used in clinical practice for a basic precision medicine approach, deciding which children will have the best chance to respond to inhaled corticosteroids and to the biologicals omalizumab and mepolizumab. Further application of pharmacogenomics and breathomics needs additional studies before they can be applied as tools for precision medicine in individual children with asthma.

https://ift.tt/2GQTY2A

Single inhaler maintenance and reliever therapy in pediatric asthma

Purpose of review Asthma affects more than 25 million people worldwide and continues to grow in prevalence. According to a center for disease control and prevention (CDC) report, the total annual cost of asthma in the United States between 2008 and 2013, including medical care, absenteeism, and mortality, was $81.9 billion. Although the National Institute of Health guidelines recommend fixed inhaled corticosteroid (ICS) dosing, the 2008–2010 Medical Expenditure Panel Survey showed that asthma is still poorly controlled. Single inhaler maintenance and reliever therapy (SMART) offers a possible alternative management plan. This is a review of SMART vs. current treatment guidelines. Recent findings SMART addresses variable inflammation with symptom-driven dosing of ICS. It relies on a combination inhaler that has a long-acting β-agonist, which has an immediate onset of action to provide quick relief, in combination with an ICS. Recent studies show that SMART decreases the frequency and severity of asthma exacerbations when compared to fixed ICS dosing. In addition, intermittent use of ICS gave a reduced effect on growth and permitted a lower total amount of ICS to be delivered. Summary SMART appears to outperform treatment that is based on current guidelines in the United States. As inhalers capable of being used for SMART are already approved, what is needed is Food and Drug Administration approval of the SMART strategy.

https://ift.tt/2NBw6jZ

Management of acute loss of asthma control: yellow zone strategies

Purpose of review Asthma exacerbations are associated with a significant burden to both the individual patient and to the healthcare system. Patients often step-up home therapies in response to increased asthma symptoms, and the asthma action plan was created to empower patients to self-manage their asthma care. The yellow (intermediate) zone of the asthma action plan is frequently poorly defined, and current Expert Panel Report 3 guideline recommendations are not effective for all patients. This article reviews the evidence behind various recommended yellow zone intervention strategies. Recent findings There are many potential methods of delivering yellow zone therapy, and recent studies have assessed preventive efficacy of a scheduled increase in controller medication(s), reliever medication(s), or a symptom-driven combination of both. The literature suggests that, in certain asthma subpopulations, some methods may be more efficacious than others. Summary Multiple yellow zone approaches may be beneficial, and the yellow zone is not a 'one size fits all' narrative.

https://ift.tt/2GS7fYy

The impact of exercise on asthma

Purpose of review Asthma is one of the most common chronic diseases in children and adults in developed countries around the world. Despite international treatment guidelines, poor asthma control remains a frequent problem leading to missed school and work, and emergency room visits and hospitalizations. Many patients with asthma report exercise as a trigger for their asthma, which likely leads to exercise avoidance as a means to control symptoms. Evolving research has suggested that routine exercise may actually help improve some aspects of asthma control. This review discusses the recent research addressing how routine exercise affects important asthma-related outcomes including symptoms, lung function and quality of life. Recent findings Several systematic reviews and meta-analyses have been conducted in recent years, which strongly support the safety of routine exercise in children and adults with asthma. Exercise appears to favor improvements in aerobic fitness, asthma symptoms and quality of life, but results so far are less consistent in demonstrating improvements to lung function and airway hyperresponsiveness. Summary In addition to routine management guidelines, clinicians should recommend for their patients with asthma routine exercise for its general health benefits and likely improvement in asthma symptoms and quality of life.

https://ift.tt/2NBvOJV

Symptom-based patient-reported outcomes in adults with eosinophilic esophagitis: value for treatment monitoring and randomized controlled trial design

Purpose of review In adults with eosinophilic esophagitis (EoE), a chronic, inflammatory immune-mediated condition of the esophagus, both inflammation and fibrosis are likely associated with symptom generation. Therefore, assessing symptom-based patient-reported outcomes (PROs), defined by US Food and Drug Administration as 'any report of the status of a patient's health condition that comes directly from the patients, without interpretation of the patient's response by a clinician or anyone else', is important in the context of trials and observational studies of emerging therapies. Recent findings For purposes of treatment monitoring, lack of symptoms does not predict the absence of biologic inflammation; hence, endoscopy with esophageal biopsies should be performed to check for residual inflammation. Lack of inflammation does not predict lack of symptoms, and the presence of subepithelial fibrosis cannot be excluded. No published instrument currently measures the frequency of dysphagia described all possible ways, strategies of living with this symptom and various pain types. In randomized controlled trials, in which symptom response was detected using validated PRO measures, only modest decreases in symptom scores were observed. Summary Accessing full EoE symptom spectrum and optimizing PRO measures remains a challenge that should be tackled to reliably assess response to existing and emerging therapies.

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Vitamin D and childhood asthma: causation and contribution to disease activity

Purpose of review To review the literature of the past 18 months (April 2017 through September, 2018) relating to vitamin D and childhood asthma. Recent findings A combined analysis of two clinical trials of maternal vitamin D supplementation trials showed a significant protective effect of vitamin D supplementation trials in the primary prevention of asthma and recurrent wheeze up to age 3 years. Secondary analyses from these trials have also suggested that initial maternal vitamin D status could affect the response to supplementation during pregnancy, with the biggest protective effect in children born to mothers with initial 25hydroxyvitamin D (25OHD) levels of at least 30 ng/ml. A postnatal, 6-month vitamin D supplementation trial in black, premature babies showed a 34% decreased risk of recurrent wheezing at 1 year among the infants who received supplementation. An individual patient data meta-analysis of published clinical trials concluded that vitamin D supplementation decreased the risk of asthma exacerbations in those with 25OHD levels less than 10 ng/ml. Results of observational analyses on primary prevention of asthma and in prevention of exacerbations remain mixed, with the bulk of the evidence suggesting that there is a protective effect of higher vitamin D levels. Summary Evidence continues to accumulate that vitamin D supplementation helps to prevent the development of asthma and recurrent wheeze in early life, and may also help in the management of asthma. The level(s) of circulating vitamin D that maximizes these effects remains to be identified.

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How guideline can shape clinical practice globally: the diagnosis and rationale for action against cow's milk allergy experience

Purpose of review Allergic diseases are increasing worldwide and are considered an important public health problem causing severe and even life-threatening reactions. The creation of guidelines aims to help clinicians improving the quality of diagnosis and management of such diseases. Clinical practice guidelines alone are not sufficient and there is a need for implementation strategies for their introduction into daily practice. We report here the main international allergy guidelines with a more focused look on the Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines and their effect on clinical practice. Recent findings DRACMA guidelines have clearly modified the approach to cow's milk allergy (CMA) from its diagnosis to treatment tailoring the choices for each patient. Although they strongly recommend oral food challenge for diagnosing CMA, they also indicate that it may not be necessary in many cases with the introduction of the pretest probability of CMA. Studies on the implementation of DRACMA guidelines show how they influenced the formula market, making appropriate treatments more affordable. Summary DRACMA reconciled international differences in the diagnosis and management of CMA. They introduced the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology in the field of food allergy and highlighted the importance for meta-analyses to be able to adapt recommendations to the local context.

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Failure on the Foam Eyes Closed Test of Standing Balance Associated With Reduced Semicircular Canal Function in Healthy Older Adults

Objectives: Standing on foam with eyes closed (FOEC) has been characterized as a measure of vestibular function; however, the relative contribution of vestibular function and proprioceptive function to the FOEC test has not been well described. In this study, the authors investigate the relationship between peripheral sensory systems (vestibular and proprioception) and performance on the FOEC test in a cohort of healthy adults. Design: A total of 563 community-dwelling healthy adults (mean age, 72.7 [SD, 12.6] years; range, 27 to 93 years) participating in the Baltimore Longitudinal Study of Aging were tested. Proprioceptive threshold (PROP) was evaluated with passive motion detection at the right ankle. Vestibulo-ocular reflex (VOR) gain was measured using video head impulses. Otolith function was measured with cervical and ocular vestibular-evoked myogenic potentials. Participants stood on FOEC for 40 sec while wearing BalanSens (BioSensics, LLC, Watertown, MA) to quantify center of mass sway area. A mixed-model multiple logistic regression was used to examine the odds of passing the FOEC test based on PROP, VOR, cervical vestibular-evoked myogenic potential, and ocular vestibular-evoked myogenic potential function in a multisensory model while controlling for age and gender. Results: The odds of passing the FOEC test decreased by 15% (p

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Telephone-Based Progressive Tinnitus Management for Persons With and Without Traumatic Brain Injury: A Randomized Controlled Trial

Objectives: This randomized controlled trial evaluated the efficacy of delivering coping skills education from Progressive Tinnitus Management (PTM) by telephone (Tele-PTM). The trial followed a previous pilot study that showed positive results for Tele-PTM. Design: Participants included individuals with bothersome tinnitus (N = 205) located anywhere within the United States. A special emphasis was given to including individuals who had experienced one or more traumatic brain injuries (TBIs). Participants were randomized to either Tele-PTM intervention or 6-month wait-list control (WLC). The Tele-PTM intervention involved five telephone appointments—two led by an audiologist (teaching how to use therapeutic sound) and three by a psychologist (teaching coping skills derived from cognitive-behavioral therapy). It was hypothesized that Tele-PTM would be more effective than WLC in reducing functional effects of tinnitus as measured with the Tinnitus Functional Index. Additional outcome measures included the Self-Efficacy for Managing Reactions to Tinnitus questionnaire and the Hospital Anxiety and Depression Scale. The effect of Tele-PTM on outcomes was estimated using linear mixed models. Results: Overall results showed convincingly that the Tele-PTM group had significantly better outcomes than the WLC group. These results were consistent across all outcome measures, indicating not only a reduction of tinnitus functional distress but also increased self-efficacy. Improvements in measures of anxiety and depression were also observed. Tele-PTM participants in all TBI categories showed significant improvement. Conclusions: Results provide strong support for use of Tele-PTM methodology for persons with bothersome tinnitus, regardless of whether the person also has TBI symptoms. The effect size for Tele-PTM was high for the primary outcome measure, the Tinnitus Functional Index, and all other outcome measures showed significant improvement. Combined with our previous pilot study, the Tele-PTM method is validated for potential nationwide provision of tinnitus services.

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Do Personality Factors Assessed Before Cochlear Implantation Predict Hearing-Related Quality Of Life After Cochlear Implantation in Postlingually Deafened Adults?

Background: Studies have shown that cochlear implants improve deaf patients' hearing-related quality of life (hrQoL), but the degree of improvement varies considerably between patients. This study investigated whether personality factors contribute to hrQoL outcome after cochlear implantation. Method: Fifty adult patients with postlingual hearing loss who received a unilateral cochlear implant were administered the Neuroticism-Extraversion-Openness Five-Factor Inventory (NEO-FFI; a personality inventory) and the Nijmegen Cochlear Implant Questionnaire (NCIQ; a hrQoL questionnaire). The NEO-FFI was administered only before implantation; the NCIQ was administered before implantation and 12 months after implant activation. A linear regression analysis was computed to detect whether NCIQ scores at 12 months were predicted by the NEO-FFI personality factors (i.e., Extraversion, Neuroticism, Openness to Experience, Agreeableness, and Conscientiousness) assessed before implantation. Results: HrQoL scores had significantly improved 12 months after cochlear implantation in all subdomains of the NCIQ. Of the five personality factors, solely Neuroticism was negatively associated to the NCIQ subdomain self-esteem (β = −0.34; p = 0.013) at 12 months after cochlear implantation. Conclusions: While significant improvement of hrQoL was seen 12 months after implant activation, this improvement was barely predicted by the Big-Five personality traits measured before implantation. Only Neuroticism was found to moderately influence postimplantation hrQoL in our patients, in the way that higher degrees of Neuroticism tend to go along with lower degrees of self-esteem (as conceptualized by the NCIQ). The failure to detect personality effects on hrQoL could partly be due to the low levels of Extraversion and Openness to Experience observed in our sample of patients with hearing loss.

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Predictors of Reading Skills in Children With Listening Concerns

Objectives: Previous research shows that children with reading disorders perform poorly on auditory processing (AP) tasks. Correlational studies have also shown significant associations between some AP tasks and word and nonword reading. There is less clear evidence for AP contributions to spelling and passage reading. The aim of this research was to extend current knowledge by investigating the association between a range of AP measures used clinically and children's reading of words, nonwords, and passages, as well as word spelling. Design: Regression analyses were conducted on data from 90 children 7 to 13 years of age (58 males) with reported listening and/or reading concerns. All children had normal hearing sensitivity and were tested on AP tasks including the frequency pattern test (FPT), dichotic digits test, random gap detection test, and the masking level difference. Reading tasks included word, nonword, and passage reading. Phonologic processing, core language skills, nonverbal intelligence, memory, and attention were also measured. Results: All multiregression analyses were fixed order with age and gender, nonverbal intelligence, core language, phoneme manipulation, and digits backward scores included in the model before AP measures. FPT was the only AP task that accounted for significant unique variance in word/nonword reading and nonword spelling, but not passage reading. Conclusions: The findings from this study failed to show an association between many clinically used AP measures and children's reading and spelling outcomes. Nevertheless, they reiterate the importance of evaluating FPT in children with word reading disorders. The findings justify further investigation into the role of this test when diagnosing children with reading or spelling disorders.

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To Ear and Hearing Reviewers: Thank You

No abstract available

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Heritability of Age-Related Hearing Loss in Middle-Aged and Elderly Chinese: A Population-Based Twin Study

Objectives: The heritability of age-related hearing loss has been studied mostly in developed countries. The authors aimed to estimate the heritability of better ear hearing level (BEHL), defined as hearing level of the better ear at a given frequency, and pure-tone averages at the middle (0.5, 1.0, and 2.0 kHz) and high (4.0, 8.0, and 12.5 kHz) frequencies among middle-aged and elderly Chinese twins, and to explore their genetic correlations. Design: This population-based twin study included 226 monozygotic and 132 dizygotic twin-pairs and 1 triplet (age range, 33 to 80 years; mean age, 51.55 years). Pure-tone air-conducted hearing thresholds in each ear were measured at the frequencies of 0.5, 1.0, 2.0, 4.0, 8.0, and 12.5 kHz with a diagnostic audiometer. Univariate and multivariate twin models were fitted to evaluate heritability and genetic correlations. Results: Our data showed a reverse J-shaped pattern of BEHLs at six frequencies by age and sex. Univariate analysis showed that the heritability of BEHLs at the frequencies between 2.0 and 12.5 kHz ranged from 47.08 to 54.20%, but the heritability at the frequencies of 0.5 and 1.0 kHz was 1.65% and 18.68%, respectively. The heritability of pure-tone average at the middle and high frequencies was 34.77% and 43.26%, respectively. Multivariate analysis showed significant genetic correlations among BEHLs at all six frequencies, with the correlation coefficients ranging from 0.48 to 0.83 at middle frequencies, and from 0.46 to 0.75 at high frequencies. Conclusions: This population-based twin study suggests that genetic factors are associated with age-related hearing loss at middle and high frequencies among middle-aged and elderly Chinese.

https://ift.tt/2U8oY10