Analyses of Gingival Adhesion Molecules in Periodontitis: Theoretical In Silico,Comparative In Vivo,and Explanatory In Vitro Models

Background: A deeper understanding of periodontitis pathophysiology is central to future development of novel biomarkers and therapeutics. The following is reported here: 1) an in silico network model of interactions among cell adhesion molecules and a network‐focused microarray analysis of the corresponding genes in periodontitis; 2) analysis of secretions of adhesion molecules in gingival tissue samples from patients with periodontitis and healthy controls; and 3) effect of the human neutrophilic peptide‐1 (HNP‐1) on epithelial adhesion molecules. Methods: The network model identified 85 nodes in relation to the interactions of adhesion molecules. Subsequently, the relative gene expression was overlaid on the network model. Differential gene expression was analyzed, and false discovery rate control was performed for statistical assessment of the microarray data. Both tissue and cell culture samples were immunostained for desmocollin (DSC)2, occludin (OCLN), desmoglein (DSG)1, tight junction protein 2, and gap junction protein α. Results: The differential gene expression analysis revealed that the epithelial adhesion molecules were significantly lower in abundance in individuals with periodontitis than controls. In contrast, the genes for leukocyte adhesion molecules showed a significant upregulation. Immunostainings revealed elevated secretions of both DSG1 and OCLN in periodontitis. An in vitro model suggested reduced DSC2 and OCLN secretions in the presence of HNP‐1. Conclusions: Gene expression of gingival adhesion molecules in periodontitis is regulated by leukocyte transmigration, whereas the neutrophilic antimicrobial peptide HNP‐1 is noted as a putative regulator of epithelial adhesion molecules. These observations contribute to the key mechanisms by which future biomarkers might be developed for periodontitis.     

Tension‐free vaginal tape procedure without preoperative urodynamic examination: Long‐term outcome

Objectives: To evaluate the long‐term outcome of the tension‐free vaginal tape procedure. Methods: A total of 191 patients were operated on with tension‐free vaginal tape between January 1998 and May 2000. Of these, 127 (66%) had stress urinary incontinence, 64 (34%) had mixed urinary incontinence and 39 (20%) had recurrent incontinence. A total of 34 (18%) patients had had concomitant surgery. The diagnosis of incontinence was based on a history of leakage during stress and physical examination with a supine stress test in all patients. Tension‐free vaginal tape was carried out under local (82%) or spinal (18%) anesthesia. After a mean of 10.5 years follow up, the assessment included a gynecological examination and a supine stress test. Subjective outcome was evaluated with Urinary Incontinence Severity Score, Detrusor Instability Score, visual analog scale, European quality of life‐five dimensions, European quality of life – visual analog scale and short versions of Incontinence Impact Questionnaire‐7 and Urogenital Distress Inventory‐6. Objective cure was defined as a negative stress test and an absence of reoperation for incontinence during the follow up. Results: A total of 138 (72%) of 191 patients were evaluated. Patients with minimally invasive surgery before operation had significantly higher scores in Urinary Incontinence Severity Score, Detrusor Instability Score, Incontinence Impact Questionnaire‐7 and Urogenital Distress Inventory‐6 at follow up than the patients with stress urinary incontinence (P < 0.01). Recurrent incontinence and concomitant surgery did not affect the long‐term outcome. Three patients (2.3%) had late‐onset adverse events. The objective and subjective cure rates were 90% and 78%, respectively. Conclusions: The tension‐free vaginal tape procedure is effective and safe even after 10 years. The objective cure rate is high, but the subjective outcome is significantly lower in mixed urinary incontinence patients compared with patients with pure stress urinary incontinence. Recurrent stress urinary incontinence does not affect the outcome, and tape‐related problems are rare.     

Strength and mobility of the neck-shoulder region in adolescent headache

The significance of the musculoskeletal function of the neck-shoulder region in different headache types in children and adolescents is not clear. The purpose of this study was to investigate the association between different types of headache and the strength and mobility of the neck-shoulder region in 13-year-old schoolchildren. A structured questionnaire on headache was sent to all 1,409 children in the sixth grade in the city of Turku. Of the 1,135 (81%) children who completed the questionnaire, a sample from different headache groups was randomly selected for clinical examination. The study consisted of 59 children with migraine, 65 with episodic tension-type headache (TTHA), and 59 headache-free controls. Dynamic muscle strength of the upper extremities (UE endurance), mobility of both shoulders (UE mobility), and the cervical range of motion (CROM) were measured. Girls with episodic TTHA had lower UE endurance of both dominant and nondominant sides than girls in the other study groups. Girls with migraine had lower UE endurance of nondominant side than girls in the control group. In boys, no significant differences were observed. An interesting association between the function of the neck-shoulder region and headache complaints in adolescents was ascertained.     

Surface Integrity of Dimethacrylate Composite Resins with Low Shrinkage Comonomers

The goal of current research was to investigate the influence of adding low shrinkage “Phene” like comonomers hexaethylene glycol bis(carbamate-isoproply-α-methylstyrene) (HE-Phene) and triethylene glycol bis(carbamate-isoproply-α-methylstyrene) (TE-Phene) on the surface and color characteristics of composite resin. A range of weight fractions (0, 10, 20, 30, 40 wt.%) of HE/TE-Phene monomers were mixed with bisphenol A glycidyl methacrylate (GMA)/triethylene glycol dimethacrylate (TEGDMA) monomer. Experimental composite resins were made by mixing 71 wt.% of silica fillers to 29 wt.% of the resin matrix. A Vickers indenter and glossmeter were used for testing surface hardness (SH) and gloss (SG) at 60°. A chewing-simulator was used to evaluate the surface wear after 15,000 cycles. Color change (∆E) and translucency parameter (TP) were measured using a spectrophotometer. Data showed that HE/TE-Phene monomer had no negative impact (p > 0.05) on surface gloss, wear, color change and translucency of experimental composite resins. Surface hardness was in a reducing direction with the increas in HE/TE-Phene weight fraction (p < 0.05). The study results suggested that incorporating HE/TE-Phene monomers up to 30 wt.% with Bis-GMA/TEGDMA resin did not negatively influence the surface integrity of composite resins except for SH.     

Recovery after severe cervical spine luxation

Permanent neurologic damage may be avoided after severe cervical spine injury if diagnosis is rapid and therapy is initiated immediately.     

Swallowing after free-flap reconstruction in patients with oral and pharyngeal cancer

Swallowing and intraoral sensation outcome were investigated prospectively after microvascular free-flap reconstruction. Forty-one patients with a large oral or oropharyngeal carcinoma underwent free-flap surgery usually combined with radiotherapy. The patients completed modified barium swallow, self-rating of swallowing, and 2-point moving discrimination preoperatively and at four time points during the 12-month follow-up period, and a plain chest X-ray one year after operation. Swallowing was impaired with respect to an objective and subjective measure after therapy. Rates for nonsilent and silent aspiration increased during the follow-up. Intraoral sensation deteriorated. Swallowing outcome was not related to sensation. One year after surgery, 86% of the patients ate regular masticated or soft food. Microvascular transfers offer a reasonable option for oral reconstruction. This study does not support the need for sensate flaps. Swallowing problems should be routinely sought and patients rehabilitated during a sufficiently long follow-up with videofluorography regardless of the patient's perception of swallowing.     

How palliative care of cancer patients is organised between a university hospital and primary care in Finland

The aim of this study was to find out how palliative care is organised between the Helsinki University Central Hospital (University Hospital) and primary care. The study consisted of 102 patients whose oncological treatment was terminated and the responsibility of palliative care was transferred to primary care. The patients were interviewed by phone using a structured questionnaire. Another questionnaire form was sent to the primary care physicians. Half of the patients were treated in more than one primary care unit. One third of the outpatients were unaware who was responsible for the care. Most of the patients wanted to be at home but this was achieved in less than half of the cases. Most patients were symptomatic while leaving the University Hospital and no improvement was seen thereafter. Every third patient reported of poor quality of palliative care in the primary care. Also the physicians reported a need for training in palliative care.