Proceedings of a workshop, held in Constanta, Romania on 22 May 2014, on Oral Health of Children in the Central and Eastern European Countries in the context of the current economic crisis

This report presents the proceedings of a workshop held in Constanta, Romania on 22 May 2014. During the workshop, representatives from 18 Central and Eastern European countries gave oral presentations on the current oral health of children and young adults aged 16 years and younger. The aim of the workshop was to collect and present data relating to the oral health of children from Central and Eastern European countries and to discuss them in the context of the political changes that have taken place over the last two decades and the recent economic crisis. The presenters had previously completed a series of questions on oral epidemiological studies, prevention of oral disease, treatment and payment, dental personnel, uptake of oral health care and other considerations and structured their presentations on these topics plus the influence of the economic crisis on oral health. It should be remembered that this paper is a report of the proceedings of a workshop and not a study. Ethics approval is not required for workshops. After the 18 oral presentations a 90 min discussion took place during which further points were raised. The presentations, the discussion and the conclusions which were reached are reported in this manuscript

Simplified open repair for anterior chest wall deformities. Analysis of results in 205 patients

SummaryIntroductionPectus deformities are the most frequently seen congenital thoracic wall anomalies. The cause of these conditions is thought to be abnormal elongation of the rib cartilages. We here report our clinical experience and the results of a sternochondroplasty procedure based on the subperichondrial resection of the elongated cartilages.HypothesisThis technique is a valuable surgical strategy to treat the wide variety of pectus deformities.Patients and methodsDuring the period from October 2001 through September 2009, 205 adult patients (171 men and 34 women) underwent pectus excavatum (181), carinatum (19) or arcuatum (5) repair. The patients’ pre and postoperative data were collected using a computerized database, and the results were assessed with a minimum 2-year follow-up.ResultsThe postoperative morbidity rate was minimal and the mortality was nil. The surgeon graded cosmetic results as excellent (72.5%), good (25%) or fair (2.5%), while patients reported better results. Patients with pectus excavatum were found to have much more patent foramen ovale (PFO) than the normal adult population, which occluded after the procedure in 61% of patients, and significant improvement was found in exercise cardiopulmonary function and exercise tolerance at the 1-year follow-up.DiscussionOur sternochondroplasty technique based on the subperichondrial resection of the elongated cartilages allows satisfactory repair of both pectus excavatum and sternal prominence. It is a safe procedure that might improve the effectiveness of surgical therapy in patients with pectus deformities.Level of evidenceLevel IV. Retrospective study

Effectiveness of Two Different Fluoride-Based Agents in the Treatment of Dentin Hypersensitivity: A Prospective Clinical Trial

Hyperesthesia is related to increased sensitivity of dental tissues to mechanical, chemical and thermal stimuli. The aim of this prospective clinical trial was to compare the effectiveness of a calcium-fluoride-forming agent (Tiefenfluorid®, Humanchemie GmbH, Alfeld, Germany) with that of a fluoride varnish (Enamelast™, Ultradent Inc., Cologne, Germany) in the treatment of dental hyperesthesia in adult patients. In total, 176 individuals (106 females and 70 males, aged 18–59 years old) diagnosed with dental hyperesthesia (DH) were enrolled. The main clinical symptoms were hyperesthesia from coldness and sweetness during chewing; the types of clinical lesions were also determined and recorded. The patients were selected randomly and divided into two groups: (i) the first group of 96 patients was treated with Tiefenfluorid® applied in three appointments at 7-day intervals; (ii) the second group of 80 patients was treated with Enamelast™, applied seven times at 7-day intervals. All the patients were recalled 7 days, 14 days, 1 month, 3 months, and 6 months from the last application. At the baseline and during every follow-up visit, the DH was measured with a pulp tester. A random intercept/random slope model was used to evaluate the effect of the treatment, at various times with respect to the initial diagnosis. Within the limits of the present study, Tiefenfluorid® was more effective than Enamelast™ against DH in that it provided long-lasting results, with a significant improvement still detected at the latest 6-month follow-up

Genetic and Dietary Factors Influencing the Progression of Nuclear Cataract.

PURPOSE: To determine the heritability of nuclear cataract progression and to explore prospectively the effect of dietary micronutrients on the progression of nuclear cataract. DESIGN: Prospective cohort study. PARTICIPANTS: Cross-sectional nuclear cataract and dietary measurements were available for 2054 white female twins from the TwinsUK cohort. Follow-up cataract measurements were available for 324 of the twins (151 monozygotic and 173 dizygotic twins). METHODS: Nuclear cataract was measured using a quantitative measure of nuclear density obtained from digital Scheimpflug images. Dietary data were available from EPIC food frequency questionnaires. Heritability was modeled using maximum likelihood structural equation twin modeling. Association between nuclear cataract change and micronutrients was investigated using linear and multinomial regression analysis. The mean interval between baseline and follow-up examination was 9.4 years. MAIN OUTCOME MEASURES: Nuclear cataract progression. RESULTS: The best-fitting model estimated that the heritability of nuclear cataract progression was 35% (95% confidence interval [CI], 13-54), and individual environmental factors explained the remaining 65% (95% CI, 46-87) of variance. Dietary vitamin C was protective against both nuclear cataract at baseline and nuclear cataract progression (β = -0.0002, P = 0.01 and β = -0.001, P = 0.03, respectively), whereas manganese and intake of micronutrient supplements were protective against nuclear cataract at baseline only (β = -0.009, P = 0.03 and β = -0.03, P = 0.01, respectively). CONCLUSIONS: Genetic factors explained 35% of the variation in progression of nuclear cataract over a 10-year period. Environmental factors accounted for the remaining variance, and in particular, dietary vitamin C protected against cataract progression assessed approximately 10 years after baseline

Prevalence of electronegative electroretinograms in a healthy adult cohort

Objective: An electronegative electroretinogram (ERG) can indicate important ocular or systemic disease. This study explored the prevalence of electronegative responses to dark-adapted stimuli in a largely healthy cohort. Methods: and Analysis 211 participants recruited from the TwinsUK cohort underwent ERG testing incorporating international standard (International Society for Clinical Electrophysiology of Vision (ISCEV)) protocols and additional stimuli. Responses were recorded using conductive fibre electrodes, following pupil dilation and 20 min dark adaptation. Responses analysed were to the ISCEV standard and strong flashes (3.0 and 10 cd/m2 s), and to additional white flashes (0.67–67 cd/m2 s). A-wave and b-wave amplitudes were extracted; b:a ratios were calculated and proportions of eyes with ratios<1 were noted. Results: Mean (SD) age was 62.4 (11.4) years (median, 64.3; range 23–86 years). 93% were female. Mean (SD) b:a ratios for right and left eyes, respectively, were 1.86 (0.33) and 1.81 (0.29) for the standard flash, and 1.62 (0.25) and 1.58 (0.23) for the stronger flash; average b:a ratio was lower for the stronger flash (p<0.0001). No waveforms were electronegative. For additional flashes, b:a ratio decreased with increasing flash strength. No electronegative waveforms were seen except in three eyes (0.7%) for the strongest flash; in some cases, drift in the waveform may have artefactually reduced the b:a ratio. Conclusion: For standard dark-adapted stimuli, no participants had electronegative waveforms. The findings support the notion that electronegative waveforms (in response to standard flash strengths) are unusual, and should prompt further investigation

Cone-driven strong flash electroretinograms in healthy adults: Prevalence of negative waveforms

Purpose Both rod and cone-driven signals contribute to the electroretinogram (ERG) elicited by a standard strong flash in the dark. Negative ERGs usually reflect inner retinal dysfunction. However, in diseases where rod photoreceptor function is selectively lost, a negative waveform might represent the response of the dark-adapted cone system. To investigate the dark-adapted cone-driven waveform in healthy individuals, we delivered flashes on a dim blue background, designed to saturate the rods, but minimally adapt the cones. Methods ERGs were recorded, using conductive fibre electrodes, in adults from the TwinsUK cohort. Responses to 13 cd m−2 s white xenon flashes (similar to the standard DA 10 flash), delivered on a blue background, were analysed. Photopic and scotopic strengths of the background were 1.3 and 30 cd m−2, respectively; through a dilated pupil, this is expected to largely saturate the rods, but adapt the cones much less than the standard ISCEV background. Results Mean (SD) participant age was 62.5 (11.3) years (93% female). ERGs from 203 right and 204 left eyes were included, with mean (SD) b/a ratios of 1.22 (0.28) and 1.18 (0.28), respectively (medians, 1.19 and 1.17). Proportions with negative waveforms were 23 and 26%, respectively. Right and left eye b/a ratios were strongly correlated (correlation coefficient 0.74, p &lt; 0.0001). We found no significant correlation of b/a ratio with age. Conclusions Over 20% of eyes showed b/a ratios less than 1, consistent with the notion that dark-adapted cone-driven responses to standard bright flashes can have negative waveforms. The majority had ratios greater than 1. Thus, whilst selective loss of rod function can yield a negative waveform (with reduced a-wave) in some, our findings also suggest that loss of rod function can occur without necessarily yielding a negative ERG. One potential limitation is possible mild cone system adaptation by the background

Motivation to Follow a Career in Dentistry of Students in Three South-East European Countries

Uvod: Željelo se istražiti i usporediti čimbenike koji su potaknuli studente na studij stomatologije uzemljama sličnog okružja (Albanija, Hrvatska i Republika Sjeverna Makedonija) i procijeniti je li se njihova motivacija tijekom godina promijenila ili ne.Materijal i metode: U 2014./2015. Godini provedenasu poprečno-presječna istraživanja (cross-sectional) na državnim stomatološkim fakultetima u Tirani(Albanija), Zagrebu (Hrvatska) i Skoplju (Makedonija) kako bi se procijenilo stajalište studenata o njihovoj motivaciji za karijeru. Dobrovoljno i anonimno sudjelovali su studenti stomatologije s prve, trećei završne godine. Upitnik s pet stavki preveden je na jezike zemalja sudionica. Etičko odobrenje daloje Etičko povjerenstvo Sveučilišta sveti Ćiril i Metod iz Skoplja. Chi kvadrat testom ispitano je postojeli statistički značajne razlike u odgovorima između studenata u trima državama i između godina studija.Rezultati: Ukupno je bilo uključeno 739 ispitanika (319 u Tirani, 211 u Zagrebu i 208 u Skoplju).Razlike u odgovorima studenata prve godine u svim trima zemljama bile su statistički značajne (χ2 = 82,65; p < 0,01). Najintrigantnije je bilo pitanje o pritisku roditelja da studiraju stomatologiju nakoje je najviše pozitivnih odgovora bilo u Tirani (čak 27,7 %). Pozitivna slika bio je najčešći odgovorzagrebačkih studenata (do 79,7 %), ali se smanjuje od prve do posljednje godine u Skoplju. Takođersu postojale značajne razlike između fakulteta unutar trećih i posljednjih godina studija.Zaključci: Pozitivna slika stomatološke profesije bila je glavni razlog za upis na svim trima fakultetima – tako jeodgovorilo čak 97 % studenata na završnoj godini u Hrvatskoj, članici Europske unije (EU). U dvjemadržavama koje nisu članice EU-a (Albanija, Sjeverna Makedonija) činilo se da stomatološka profesi-ja nema tako dobar status, a očekivanja studenata se ne ispunjavaju, posebno u Skoplju (čak 33,9 %spremno je promijeniti zvanje i njih do 64,5 % izgubilo je motivaciju za studij). Jedna od strategija zapoboljšanje stanja mogla bi biti uključivanje više kliničke prakse i bolja organizacija pojedinih studijaObjective: To investigate and compare the factors that motivated students to study dentistry in countries with similar background (Albania, Croatia and the Republic of Northern Macedonia) and to as-sess whether or not their motivation changed during time. Material and methods: In 2014/2015,cross-sectional studies were conducted in state funded dental schools in Tirana (Albania), Zagreb(Croatia) and Skopje (North Macedonia) to assess student views on their career motivation. All den-tal students from the first, third and final years of study were invited to participate. The participationwas voluntary and anonymous. A five-item questionnaire was translated into languages of the par-ticipating countries. Ethics approval was granted by the Ethics Committee of the University of SaintsCyril and Methodius, Skopje. The Chi square test was used to test if there were statistically significantdifferences in answers between students in 3 countries, furthermore between years of the study.Re-sults: The total number of respondents was 739 (319 in Tirana, 211 in Zagreb and 208 in Skopje) Thedifferences in the answers between the first-year students from all three countries were statistical-ly significant (χ2=82.65; p<.01). The most striking answer was to the question on parents’ pressureto study dentistry, which was far more frequent in Tirana (up to 27.7%). A “positive image” was themost frequent response from students from Zagreb (up to 79.7%), but it declined from the first to thefinal year in Skopje. There were also significant differences the schools within the 3rdand final years of study. Conclusions: A positive image of dental profession was the main reason for students studying dentistry at all three schools; as many as 97% of the students of the final year in Croa-tia, a member of the European Union (EU). In the two non-EU countries (Albania, North Macedonia) itseemed that dental profession does not have such good status and student expectations are not be-ing fulfilled, especially in Skopje (up to 33.9% willing to change their vocation and up to 64.5% losttheir motivation to study) One of the strategies to improve the situation could be to include more clinical practice and to better organize the study

Plasma metabolite profile for primary open-angle glaucoma in three US cohorts and the UK Biobank

Glaucoma is a progressive optic neuropathy and a leading cause of irreversible blindness worldwide. Primary open-angle glaucoma is the most common form, and yet the etiology of this multifactorial disease is poorly understood. We aimed to identify plasma metabolites associated with the risk of developing POAG in a case-control study (599 cases and 599 matched controls) nested within the Nurses' Health Studies, and Health Professionals' Follow-Up Study. Plasma metabolites were measured with LC-MS/MS at the Broad Institute (Cambridge, MA, USA); 369 metabolites from 18 metabolite classes passed quality control analyses. For comparison, in a cross-sectional study in the UK Biobank, 168 metabolites were measured in plasma samples from 2,238 prevalent glaucoma cases and 44,723 controls using NMR spectroscopy (Nightingale, Finland; version 2020). Here we show higher levels of diglycerides and triglycerides are adversely associated with glaucoma in all four cohorts, suggesting that they play an important role in glaucoma pathogenesis