Factors determining phage stability/activity: challenges in practical phage application

Introduction: Phages consist of nucleic acids and proteins that may lose their activity under different physico-chemical conditions. The production process of phage formulations may decrease phage infectivity. Ingredients present in the preparation may influence phage particles, although preparation and storage conditions may also cause variations in phage titer. Significant factors are the manner of phage application, the patient’s immune system status, the type of medication being taken, and diet.

Areas covered: We discuss factors determining phage activity and stability, which is relevant for the preparation and application of phage formulations with the highest therapeutic efficacy. Our article should be helpful for more insightful implementation of clinical trials, which could pave the way for successful phage therapy.

Expert opinion: The number of naturally occurring phages is practically unlimited and phages vary in their susceptibility to external factors. Modern methods offer engineering techniques which should lead to enhanced precision in phage delivery and anti-bacterial activity. Recent data suggesting that phages may also be used in treating nonbacterial infections as well as anti-inflammatory and immunomodulatory agents add further weight to such studies. It may be anticipated that different phage activities could have varying susceptibility to factors determining their actions.     

Adolescent “Saxophone Penis” Secondary to Crohn's Disease: Misdiagnosed as Being Posttraumatic

We describe a patient with a “saxophone penis” mistakenly diagnosed as having posttraumatic changes. A careful history and attention to blood tests at presentation may have alerted clinicians that there was a nontraumatic cause for our patient's disease. It is essential that clinicians consider “metastatic” anogenital Crohn's disease as a possible cause of “saxophone penis”.     

Baseline characteristics as 3-year predictors of tooth fracture and crack progression: Findings from The National Dental Practice-Based Research Network

BackgroundThe authors of this practice-based study estimated the risk of experiencing tooth fractures and crack progression over 3 years and correlated baseline patient-, tooth-, and crack-level characteristics with these outcomes.MethodsTwo-hundred-and-nine National Dental Practice-Based Research Network dentists enrolled a convenience sample of 2,601 participants with a cracked vital posterior tooth that had been examined for at least 1 recall visit over 3 years. Data were collected at the patient, tooth, and crack levels at baseline, annual follow-up visits, and any interim visits. Associations between these characteristics and the subsequent same-tooth fractures and crack progression were quantified.ResultsOf the 2,601 teeth with a crack or cracks at baseline, 78 (3.0%; 95% confidence interval, 2.4% to 3.7%) subsequently developed a fracture. Of the 1,889 patients untreated before year 1, 232 (12.3%; 95% confidence interval, 10.9% to 13.8%) had some type of crack progression. Baseline tooth-level characteristics associated with tooth fracture were the tooth was maxillary and had a wear facet through enamel and a crack was detectable with an explorer, on the facial surface, and in a horizontal direction. Crack progression was associated with males and teeth with multiple cracks at baseline; teeth with a baseline facial crack were less likely to show crack progression. There was no commonality between characteristics associated with tooth fracture and those associated with crack progression.ConclusionsDevelopment of tooth fractures and crack progression over 3 years were rare occurrences. Specific characteristics were associated with the development of tooth fracture and crack progression, although none were common to both.Practical ImplicationsThis information can aid dentists in assessing factors that place posterior cracked teeth at risk of experiencing adverse outcomes.     

Fracture strength of ceramic bracket tie wings subjected to tension

One of the most common areas of ceramic bracket fracture is within the tie-wing complex. When an archwire is ligated into position, tensile forces are placed under the tie wing. However, no study, to date, has focused specifically on the fracture resistance of the tie-wing complex. The aim of this study is to compare the tensile fracture strength of seven currently available ceramic brackets (Inspire, Fascination, Mystique, InVu, Clarity, Virage, and Luxi) as a function of bracket brand and bracket configuration, semitwin vs true-twin. Based on a power analysis of pilot data, 10 maxillary central incisor brackets per group were tested to failure with a tensile load placed directly under the distoincisal tie wing. The results ranged from a maximum mean fracture strength of 147.71 (5.87) MPa with Fascination brackets to a minimum mean fracture strength of 84.28 (7.01) MPa with Luxi brackets. The statistical analysis indicated a significant effect on fracture strength as a function of bracket brand (P < .05) and that semitwin brackets, Fascination, Mystique, and Virage, had significantly higher fracture strength than true-twin brackets, Clarity, lnVu, and Luxi (P < .05). Interestingly, the only monocrystalline bracket in the study, Inspire, could not be fractured using the investigation protocol. In fact, the steel ligature fixture wire would break before tie-wing fracture at a mean fixture failure of 198.65 MPa.