How valid are current diagnostic criteria for dental erosion?

In principle, there is agreement about the clinical diagnostic criteria for dental erosion, basically defined as cupping and grooving of the occlusal/incisal surfaces, shallow defects on smooth surfaces located coronal from the enamel–cementum junction with an intact cervical enamel rim and restorations rising above the adjacent tooth surface. This lesion characteristic was established from clinical experience and from observations in a small group of subjects with known exposure to acids rather than from systematic research. Their prevalence is higher in risk groups for dental erosion compared to subjects not particularly exposed to acids, but analytical epidemiological studies on random or cluster samples often fail to find a relation between occurrence or severity of lesions and any aetiological factor. Besides other aspects, this finding might be due to lack of validity with respect to diagnostic criteria. In particular, cupping and grooving might be an effect of abrasion as well as of erosion and their value for the specific diagnosis of erosion must be doubted. Knowledge about the validity of current diagnostic criteria of different forms of tooth wear is incomplete, therefore further research is needed

Soluble Fas might serve as a diagnostic tool for gastric adenocarcinoma

<p>Abstract</p> <p>Background</p> <p>Fas (Apo-1/CD95) and its specific ligand (FasL) are key elements in apoptosis. They have been studied in different malignancies but there are few published studies about the soluble forms of these markers (i.e. sFas/sFasL) in gastric cancer. We have compared the serum levels of sFas/sFasL in gastric adenocarcinoma patients and cases with pre-neoplastic lesions as potential markers for early diagnosis, and investigated their relation with clinicopathological characteristics.</p> <p>Methods</p> <p>Fifty-nine newly-diagnosed cases of gastric adenocarcinoma who had undergone gastrectomy, along with 62 endoscopically- and histologically-confirmed non-cancer individuals were enrolled in this study. sFas/sFasL serum levels were detected by Enzyme Linked Immunosurbent Assay.</p> <p>Results</p> <p>Mean serum sFas level was significantly higher in gastric cancer patients than in control group (305.97 ± 63.71 (pg/ml) vs. 92.98 ± 4.95 (pg/ml), P < 0.001); while the mean serum level of sFasL was lower in patients with gastric adenocarcinoma (0.138 ± 0.04 (pg/ml) vs. 0.150 ± 0.02 (pg/ml), P < 0.001). Mean serum levels of sFas/sFasL were significantly different in both intestinal/diffuse and cardiac/non-cardiac subtypes when compared to the control group (P < 0.001). There was an increase in the serum level of sFas from the first steps of pre-neoplastic lesions to gastric adenocarcinoma (P < 0.001). Patients who had no lymph node involvement (<it>N₀</it>) showed significantly higher serum levels of sFas compared to others (P = 0.044).</p> <p>Conclusions</p> <p>Production of sFas may play a critical role in the carcinogenesis of intestinal-type gastric cancer. sFas serum level may serve as a non-invasive tool for early diagnosis of gastric cancer.</p

Epidemiologie der Verona-Integron-Metallo-ß-Laktamasen (VIM) in Hessen, 2012 – 2016

Carbapeneme sind wichtige Antibiotika für die Behandlung multiresistenter gramnegativer Erreger. Die weltweite Ausbreitung Carbapenemase-produzierender Erreger wird als Bedrohung für die Gesundheitsversorgung angesehen. In Hessen bestand seit Ende 2011 eine Meldepflicht für den Nachweis Carbapenem-resistenter gramnegativer Erreger. Aufgrund der bundesweiten Einführung einer Meldepflicht für Carbapenem-nichtempfindliche Erreger zum 1. Mai 2016 wurde die auf einen Fünfjahreszeitraum befristete hessische Verordnung nicht verlängert. Damit endete die Meldepflicht für Carbapenem-resistente P. aeruginosa zum 31. Dezember 2016. Carbapenemasen werden auf Basis ihrer Aminosäurensequenz in unterschiedliche Gruppen eingeteilt. Verona-Integron-Metallo-ß-Laktamasen (VIM) gehören, wie die New-Delhi-Metallo-ß-Laktamasen (NDM), zur Familie der Metallo-ß-Laktamasen. Im Epidemiologischen Bulletin 49/2017 werden die hessischen Meldedaten zu Carbapenem-resistenten gramnegativen Erregern mit molekularbiologischem Nachweis einer VIM ausgewertet. Das Fazit der Autoren lautet: Verschiedene VIM-Varianten sind in Hessen endemisch. Die Meldepflicht für Carbapenemase-produzierende P. aeruginosa und die Ergebnisse der Ganzgenomsequenzierung waren hilfreich für die Bestätigung bzw. den Ausschluss von Erregerübertragungen. Nur für wenige Patienten mit Nachweis VIM-produzierender Erreger konnte ein wahrscheinlicher Übertragungsweg ermittelt werden

Results on the mandatory notification of carbapenem-resistant Gram-negative bacteria, Hesse, Germany, January 2012 - April 2013

Carbapenems are important therapeutic agents for treating infections caused by multidrug-resistant Gram-negative bacteria. Mandatory reporting of carbapenem-resistant Gram-negative bacteria (CR-GN) can allow for a better understanding of the changing CR-GN burden and can help facilitate intervention. In November 2011, identification of CR-GN with acquired carbapenem resistance became notifiable in Hesse, Germany. Hesse is one of the 16 German federal states, with a population of 6.1 million. We report on CR-GN notified between 1 January and 8 April 2013, when reporting requirements were changed. During this period, 549 CR-GN were isolated from 525 patients. Of these, 67.0% (368/549) were Pseudomonas aeruginosa . The remaining 181 CR-GN comprised 59 (32.6%) K. pneumoniae , 53 (29.3%) Acinetobacter baumannii , 28 (15.5%) Enterobacter spp., 20 (11.5%) E. coli , and 21 (11.6%) other CR-GN. Seventy-three (13.3%) CR-GN were reported to harbour a carbapenemase. Fourteen different carbapenemase types were reported, with the most frequent being OXA-23 (n=18), OXA-48 (n= 16), VIM-2 (n=12), VIM-1 (n=11), and NDM (n=5). Our results suggest the widespread presence of CR-GN, a high diversity of identified carbapenemases, autochthonous transmissions, and regional differences in incidence for the different species and carbapenemases, even in the absence of major outbreaks of infection

Impact of single-room contact precautions on hospital-acquisition and transmission of multidrug-resistant Escherichia coli: a prospective multicentre cohort study in haematological and oncological wards

Objectives: Colonization and infection with third-generation cephalosporin-resistant Escherichia coli (3GCR-EC) are frequent in haematological and oncological patients. In this high-risk setting, German guidelines recommend single-room contact precautions (SCP) for patients with 3GCR-EC that are non-susceptible to fluoroquinolones (F3GCR-EC). However, this recommendation is controversial, as evidence is limited. Methods: We performed a prospective, multicentre cohort study at four haematology and oncology departments assessing the impact of SCP on hospital-acquired colonization or bloodstream infection (BSI) with F3GCR-EC. Two sites performed SCP for F3GCR-EC patients including single rooms, gloves and gowns (SCP sites), and two did not (NCP sites). Active screening for 3GCR-EC was performed and isolates were characterized with molecular typing methods including whole genome sequencing and core genome multiple locus sequence typing to assess patient-to-patient transmission. Potential confounders were assessed by competing-risk regression analysis. Results: Within 12 months, 1386 patients at NCP sites and 1582 patients at SCP sites were included. Hospital-acquisition of F3GCR-EC was observed in 22/1386 (1.59%) and 16/1582 (1.01%) patients, respectively (p 0.191). There were 3/1386 (0.22%) patients with BSI caused by F3GCR-EC at NCP sites and 4/1582 (0.25%) at SCP sites (p 1.000). Patient-to-patient transmission occurred in three cases at NCP and SCP sites each (p 1.000). The number of patients needed to screen in order to prevent one patient-to-patient transmission of F3GCR-EC was determined to be 3729. Conclusions: Use of SCP had no significant impact on hospital-acquisition or patient-to-patient transmission of F3GCR-EC in this high-risk setting. (C) 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved