Histopathologic evaluation of the effects of four calcium hydroxide liners on monkey pulps

Pulpal response of four calcium hydroxide liners, MPC 10®, MPC 12®, Dycal® and Pulpdent® were tested on primary and permanent teeth with zinc oxide and eugenol (ZOE) and silicate as controls. Responses of the pulps were evaluated in Rhesus monkeys, utilizing Class V cavity preparations at 3 days, 5 and 8 weeks. An equivalent number of anterior and posterior teeth were studied for all compounds. The Ca(OH) 2 liners, zinc oxide and eugenol (ZOE) and silicate controls were placed in 80 primary and 80 permanent teeth. Following perfusions the teeth were prepared utilizing routine histological procedures. The 3 day response of the calcium hydroxides was moderate with some disruption in the odontoblasts, vacuolization and mild inflammation underlying the cavity except Pulpdent which was more severe. At 5 weeks a decrease in inflammatory response and the formation of reparative dentin was similar for all calcium hydroxides tested at this time period. At 8 weeks more reparative dentin was noted with slight to moderate pulpal responses. At all time periods ZOE produced the least pulpal response while silicate produced the most severe response at 5 and 8 weeks. This study reports the biological responses of four calcium hydroxide compounds used as cavity liners in non-exposures in a series of primary and permanent teeth of monkeys using ZOE and silicate as controls. Responses to the four Ca(OH) 2 compounds were moderate for all the experimental compounds except Pulpdent which was more severe at the early time period tested. ZOE produced a milder and silicate a severe response at all periods. All of these compounds were placed by random selection in anterior and posterior teeth of both arches and five teeth were evaluated in both primary and permanent teeth at 3 days, 5 and 8 weeks.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74743/1/j.1600-0714.1976.tb01759.x.pd

Histopathologic Evaluation of three Ultraviolet-Activated Composite Resins on Monkey pulps

The pulpal responses of three ultraviolet-activated composite resins, Nuva-Fil®, Experimental UV #1® and Experimental UV #2®, were tested on adult monkey teeth using silicate and zinc oxide eugenol (ZOE) as positive and negative controls. All materials were placed in Class V cavity preparations in Rhesus monkey teeth using approximately 48 anterior and 63 posterior teeth of both the maxillary and mandibular arches. A total of 111 teeth were utilized and all materials were evaluated at 3 days, 5 and 8 weeks. Following left ventricular perfusion, the teeth were prepared for microscopic evaluation using routine histological procedures. The 3-day pulpal response of all the ultraviolet-activated composites was slight with some disruption and vacuolization in the odontoblastic layer and a slight inflammatory response. At 5 weeks there was a reduction of the inflammatory response and the formation of reparative dentin was noted for all ultraviolet composites. The 8-week pulp response was slight, characterized by a minimal inflammatory response adjacent to the zone of reparative dentin. Generally, ZOE produced the mildest response while silicate produced the most severe response at the three time intervals.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74732/1/j.1600-0714.1977.tb01797.x.pd

Insulin-induced gene expression changes in breast cancer cells and normal breast epithelial cells.

Obesity increases breast cancer incidence rates in postmenopausal women. Chronic high levels of insulin, present in the majority of obese and insulin resistant patients, may provide the growth promoting stimulus to explain this connection. In this work, the cancer progression and cancer initiating properties of high insulin levels were examined in breast cancer cells (MDA-MB-231) and breast epithelial cells (MCF-10a), respectively. High insulin levels (100 nM) induced differential changes in cell proliferation in the two cell lines used. Human Cancer PathwayFinder DNA Microarrays (SABiosciences) were used to examine gene expression changes after insulin treatment. High insulin levels increased expression of genes involved in cell cycle control (e.g. cyclin D1) and DNA damage repair (e.g. ATM) in MDA-MB 231 cells and in MCF-10a cells (e.g. cyclin E1, CDC25a). Expression of genes responsible for mediating apoptosis and cell senescence (e.g. APAF, BAD, bcl-X) was decreased after insulin treatment in MDA-MB 231 cells but the expression of the same group of genes did not change in MCF-10a cells. High insulin levels increased expression of genes encoding for signal transduction molecules (e.g. AKT1) and transcription factors (e.g. FOS, JUN, MYC), and of genes responsible for invasion and metastasis (e.g. MMP2) in MCF-10a cells whereas gene expression of the same groups of genes did not change or was decreased in MDA-MB 231 cells. These results suggest a role for insulin resistance in breast cancer initiation and progression, aggravating the potential of breast cancer to evade apoptosis, to metastasise and may promote carcinogenesis of healthy epithelial cells

Guidelines, guidelines and more guidelines: And we still do not know how to follow-up patients with breast cancer

BACKGROUND: A major challenge facing us is the provision of health care and appropriate allocation of available resources for the treatment of patients with breast cancer. This is of particular concern in the provision of follow-up care. With the increasing incidence of breast cancer and the improvements in survival which have resulted in up to 75% of patients surviving for more than five years, an increasing resource is required. However, there is controversy as to the most appropriate schedule for follow-up of these patients. This brief review has focused on the evidence-base and guidelines that currently exist in the United Kingdom for the follow-up of patients who have been treated for breast cancer. METHODS: A review of the current guidelines published in the United Kingdom for the follow-up of patients with breast cancer (National Institute for Clinical Excellence, Scottish Intercollegiate Guidelines Network, British Association of Surgical Oncology) and the randomised controlled trials evaluating the follow-up of patients with breast cancer was undertaken. RESULTS: The results have demonstrated the different follow-up protocols currently indicated in these guidelines within the same country. Furthermore, the lack of well designed, randomised controlled trials on which to base a follow-up protocol for patients with breast cancer is apparent. CONCLUSION: The evidence-base on which these guidelines have been developed is lacking. It is apparent that well designed randomised controlled trials are needed urgently if we are to understand the most appropriate and effective ways of following up patients with breast cancer

Linking pre- and post-adoption records for research in anonymised form in a data safe haven:

Introduction: The long-term health and wellbeing of adoptees is under-researched. One reason for this has been limited data accessibility regarding the adoption process, and another is a practice common in some UK jurisdictions of changing the NHS number (or equivalent) at adoption, as part of creating the new identity. The SAIL Databank holds data from the Wales Children and Family Court Advisory and Support Service (Cafcass Cymru), together with children’s social care data, and can link these with routine health and administrative data in anonymised form. However, because the linkage key at SAIL is based on an encryption of the NHS number, working with pre- and post-adoption records for longitudinal research remains a major challenge. We set out to explore the legal implications of, and social support for, linking these records for use in anonymised form for longitudinal research. Methods: We reviewed the main legislation and regulations governing the use of data about adoptees in England and Wales. We gauged support for a social licence in Wales by carrying out interviews with individuals who had been involved in the adoptions process, and by engaging with general public groups for their views. We drew out the main emerging themes and, in combination with the review, propose a way forward. Results: The legal review indicated that there are provisions in the Family Procedure Rules (England and Wales) and the General Data Protection Regulation that can be relied upon for the lawful processing of adoption data into anonymised form for research. The main points of concern about linking pre- and post-adoption records were privacy, data security, the need to limit the number of organisations involved in data sharing, and re-identification risk. The over-riding message was favourable with longitudinal research seen as strongly beneficial. Conclusion: This study has indicated that in Wales, there is no legal impediment, nor major objection from individuals involved in the adoptions process, as well as the general public for the use of adoption data in anonymised form, in a data safe haven. This includes the linkage of pre- and post‑adoption records to enable novel longitudinal research to take place. The provisos were that robust safeguards must be in place, and that the research should aim to benefit adoptees and to improve policy and practice. We conclude that it is reasonable to proceed with caution to develop practical ways to link pre- and post‑adoption records in a data safe haven

Admissions to a low resource neonatal unit in Malawi using The NeoTree application: A digital perinatal outcome audit

Background: Mobile-health has increasing potential to address health outcomes in under-resourced settings as smart-phone coverage increases. The NeoTree is a mobile-health application co-developed in Malawi to improve the quality of newborn care at the point of admission to neonatal units. While collecting vital demographic and clinical data this interactive platform provides clinical decision-support, and training for the end-users (health care workers (HCW)), according to evidence based national and international guidelines. Objective: Our aims were to examine one month of data collected using the NeoTree in an outcome audit of babies admitted to a district-level neonatal nursery in Malawi and to demonstrate proof of concept of digital audit data in this setting. Methods: Using a phased approach over one month (21 Nov – 19 Dec, 2016), frontline HCWs were trained and supported to use the NeoTree to admit newborns. Discharge data were collected by the research team using a discharge form within the NeoTree ‘NeoDischarge’. Descriptive analysis was conducted on the exported pseudonomysed data and presented to the newborn care department as a digital audit. Results: Of 191 total admissions, 134 (70%) admissions were completed using the NeoTree and 129 (67%) were exported and analysed. Of these 129, 102 (79%) were discharged alive. Overall case fatality rate was 93 per 1000 admitted babies. Prematurity with respiratory distress syndrome, Birth Asphyxia, and Neonatal sepsis contributed to 41.6%, 58.3% and 16.6% of deaths respectively. Deaths may have been under-reported due to phased implementation and some families of babies with imminent deaths self-discharging home. Detailed characterisation of the data enabled departmental discussion of modifiable factors for quality improvement, for example improved thermoregulation of infants. Conclusions: This digital outcome audit demonstrates that data can be captured digitally at the bedside by HCWs in under-resourced newborn facilities and these data can contribute to meaningful review of quality of care/outcomes and potential modifiable factors. Coverage may be improved during future implementation by streamlining the admission process to be solely via digital format. Our results present a new methodology for newborn audit in low-resource settings and are a proof of concept for a novel newborn data system in these settings

Prenatal and perinatal risk factors for disability in a rural Nepali birth cohort

Background: Improving newborn health remains a global health priority. Little however is known about the neurodevelopmental consequences for survivors of complications in pregnancy, labour and the neonatal period in in low-income countries outside of small selective and typically urban facility studies. We ask which antenatal, birth and neonatal factors are associated with disability in childhood in a large community birth cohort from rural Nepal. Methods: 6436 infants were recruited during a cluster randomised control trial (RCT) of participatory women's groups (ISRCTN31137309), of whom 6075 survived beyond 28 days. At mean age of 11∙5 years (range 9.5–13.1), 4219 children (27% lost to follow-up) were available for disability screening which was conducted by face-to-face interview using the Module on Child Functioning and Disability produced by the Washington Group/UNICEF. Hypothesised risk factors for disability underwent multivariable regression modelling. Findings: Overall prevalence of disability was 7.4%. Maternal underweight (OR 1.44 (95% CI 1.01–2.08)), maternal cohabitation under 16 years of age (OR 1.50 (1.13–2.00)), standardised infant weight at 1 month (OR 0.82 (0.71–0.95)) and reported infant diarrhoea and vomiting in the first month (OR 2.48 (1.58–3.89)) were significantly associated with disability adjusted for trial allocation. The majority of hypothesised risk factors, including prematurity, were not significant. Interpretation: Proxies for early marriage and low birth weight and a measure of maternal undernutrition were associated with increased odds of disability. The lack of association of most other recognised risk factors for adverse outcome and disability may be due to survival bias

The Effect of Various Restorative Materials on the Microhardness of Reparative Dentin

This study showed a statistically significant difference between the microhardness of reparative and primary dentin at both five- and eight-week intervals. Reparative dentin from occlusal trauma is harder than reparative dentin underlying a cavity preparation at the 99% level. No statistical difference was noted in the hardness of reparative dentin underlying different materials, but trends were observed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66484/2/10.1177_00220345800590020101.pd