Cytokine responses of CD4+ T cells and NKT cells to periodontitis-associated bacteria in individuals with or without periodontitis.

AIM: Periodontitis is an inflammatory disease driven by opportunistic bacteria including Porphyromonas gingivalis and Fusobacterium nucleatum, where T-cell and NKT-cell responses to these bacteria in patients with periodontitis grade B or C are not fully elucidated. The objective is to determine if exaggerated proinflammatory Th-cell responses to periodontitis-associated bacteria, but not commensal bacteria, is a characteristic of increased periodontitis grade. METHODS: Mononuclear cells from patients with periodontitis grade C (n = 26) or grade B (n = 33) and healthy controls (HCs; n = 26) were stimulated with P. gingivalis, F. nucleatum or the commensal bacteria, Staphylococcus epidermidis and Cutibacterium acnes. Cytokine production by different T-cell populations and FOXP3-expression by regulatory T cells were assessed by flow cytometry. RESULTS: Compared to HCs, grade C patients had decreased frequencies of interleukin (IL)-10-producing CD4+ T cells before stimulation (p = .02) and increased frequencies of IFN-y-producing CD4+ T cells after stimulation with P. gingivalis (p = .0019). Grade B patients had decreased frequencies of FOXP3+ CD4+ T cells before (p = .030) before and after stimulation with anti-CD2/anti-CD3/anti-CD28-loaded beads (p = .047), P. gingivalis (p = .013) and S. epidermidis (p = .018). Clinical attachment loss correlated with the frequencies of IFN-y-producing Th1 cells in P. gingivalis- and F. nucleatum-stimulated cultures in grade B patients (p = .023 and p = .048, respectively) and with the frequencies of Th17 cells in P. gingivalis-stimulated cultures (p = .0062) in grade C patients. Patients with periodontitis grade C or grade B showed lower frequencies of IL-10-producing NKT cells than HCs in unstimulated cultures (p = .0043 and p = .027 respectively). CONCLUSIONS: Both periodontitis groups showed decreased frequencies of immunoregulatory T-cell and NKT cell subsets at baseline. Clinical attachment loss correlated with P. gingivalis-induced Th17-responses in grade C patients and with Th1-responses in grade B patients when cells were stimulated with P. gingivalis, supporting that dysregulated pro-inflammatory T-cell responses to periodontitis-associated bacteria contribute to the pathogenesis of periodontitis.

Evaluation of circulating IgG antibodies against Porphyromonas gingivalis or its gingipains as serological markers of periodontitis and carriage of the bacterium.

BACKGROUND: Increasing evidence indicates that periodontitis contributes to systemic low-grade inflammation. Porphyromonas gingivalis is strongly associated with periodontitis, and antibodies against the bacterium may be used as a serological proxy to account for periodontal status, when studying diseases associated with periodontitis. The aim of the present study is to identify an easily accessible and reliable serological biomarker for determination of periodontal status and oral carriage of the bacterium. METHODS: Saliva and serum samples were collected from periodontally healthy controls (n = 27), and patients with periodontitis stage II (n = 12) or stages III or IV (n = 44). Serum levels of immunoglobulin G (IgG) antibodies against intact and fragmented P. gingivalis, recombinant gingipains (RgpA and RgpB), and the bacteria Escherichia coli and Capnocytophaga ochracea as controls were quantified with a multiplex bead-based assay. P. gingivalis was identified in saliva using quantitative polymerase chain reaction (qPCR). RESULTS: Serum IgG antibodies against P. gingivalis whole bacteria were good indicators of periodontitis (area under the curve [AUC]: 0.75, 95% confidence interval [CI]: 0.64-0.85). The same was observed for levels of antibodies against P. gingivalis fragments (AUC: 0.78, 95% CI: 0.68-0.88). Likewise, levels of antibodies against P. gingivalis whole bacteria or P. gingivalis fragments were good indicators of oral carriage of P. gingivalis (AUC: 0.92, 95% CI: 0.86-0.98 and AUC: 0.96, 95% CI: 0.92-1, respectively). Conversely, antibodies against recombinant RgpA and RgpB were not good indicators of periodontitis or oral carriage of the bacterium. None of the antibody levels differed significantly between stage II and stage III or IV periodontitis. CONCLUSION: Serum IgG antibody levels against heat-inactivated whole P. gingivalis proved to be the preferable biomarker for periodontitis and oral carriage of the bacterium.

Exposure to teflubenzuron reduces drought tolerance of collembolans.

Chitin synthesis inhibitors (CSIs) are commonly used insecticides compromising cuticle formation and structure in arthropods. Arthropods rely on intact cuticles to maintain water balance and cellular homeostasis to survive in different weather conditions. We hypothesized that physiological impacts of CSIs may make arthropods more vulnerable to harsh environmental conditions, such as extreme heat, cold or drought. The aim of this study was to investigate if pre-exposure to teflubenzuron (a common CSI) would influence Folsomia candida's (Collembola: Isotomidae) sensitivity to natural stressors. Here, we exposed adult collembolans to teflubenzuron through food for two weeks, then survivors were immediately divided into three groups for subsequent acute heat, cold, and drought exposure. After acute exposure to these natural stressors, the collembolans were moved to optimal conditions for a one-week recovery period during which their survival, time to regain reproduction, and egg production were examined. We analyzed the interaction between effects of teflubenzuron and natural stressors using a multiplicative model. No interaction between effects of teflubenzuron and heat was observed in any test endpoints. A synergistic interaction between effects of teflubenzuron and cold was observed in the time to regain reproduction. Both survival and egg production, on the other hand, showed synergistic interaction between effects of teflubenzuron and drought, as well as a tendency for longer reproduction recovery times. Our results suggest that pre-exposure to teflubenzuron reduces drought tolerance in F. candida, while its impact on heat or cold tolerance is minor or absent. This study is among the first to explore the combined effects of CSI and natural stressors on soil arthropods, providing more insight on potential risks posed by such chemicals in the environment.

The prevention of adverse pregnancy outcomes by periodontal treatment during pregnancy (PROBE) intervention study-A controlled intervention study: Protocol paper.

INTRODUCTION: Pregnancy increases the risk of periodontitis due to the increase in progesterone and estrogen. Moreover, periodontitis during pregnancy is associated with development of pregnancy and birth related complications. The aim of this study is to determine, whether periodontal treatment during pregnancy can reduce systemic inflammation and lower the risk of adverse pregnancy and birth related outcomes. METHODS AND ANALYSIS: The PROBE study is a non-randomized controlled intervention study conducted among 600 pregnant women with periodontitis. The women will be recruited among all pregnant women at two Danish hospitals in Region Zealand during their nuchal translucency scan and will subsequently be screened for periodontitis. The intervention group includes 300 pregnant women, who will be offered state-of-the-art periodontal treatment during pregnancy. The control group includes additional 300 pregnant women, who will be offered periodontal treatment after giving birth. Outcome measures include periodontal measures, inflammatory, hormonal and glycaemic markers as well as the prevalence of preterm birth risk, low birth weight and risk markers of gestational diabetes mellitus (GDM) and preeclampsia that will be collected from all screened women and further during pregnancy week 20 and pregnancy week 35 for women enrolled in the intervention. ETHICS AND DISSEMINATION: The study's findings will be published in peer reviewed journals and disseminated at national and international conferences and through social media. The PROBE study is designed to provide important new knowledge as to whether periodontal treatment during pregnancy can reduce the prevalence of complications related to pregnancy and birth. CLINICAL TRIALS REGISTRATION: The study was registered on clinicaltrials.gov (NCT06110143).

circHIPK3 nucleates IGF2BP2 and functions as a competing endogenous RNA.

Circular RNAs (circRNAs) represent a class of widespread endogenous RNAs that regulate gene expression and thereby influence cell biological decisions with implications for the pathogenesis of several diseases. Here, we disclose a novel gene-regulatory role of circHIPK3 by combining analyses of large genomics datasets and mechanistic cell biological follow-up experiments. Specifically, we use temporal depletion of circHIPK3 or specific RNA binding proteins (RBPs) and identify several perturbed genes by RNA sequencing analyses. Using expression-coupled motif analyses of mRNA expression data from various knockdown experiments, we identify an 11-mer motif within circHIPK3, which is also enriched in genes that become downregulated upon circHIPK3 depletion. By mining eCLIP datasets, we find that the 11-mer motif constitutes a strong binding site for IGF2BP2 and validate this circHIPK3-IGF2BP2 interaction experimentally using RNA-immunoprecipitation and competition assays in bladder cancer cell lines. Our results suggest that circHIPK3 and IGF2BP2 mRNA targets compete for binding. Since the identified 11-mer motif found in circHIPK3 is enriched in upregulated genes following IGF2BP2 knockdown, and since IGF2BP2 depletion conversely globally antagonizes the effect of circHIPK3 knockdown on target genes, our results suggest that circHIPK3 can sequester IGF2BP2 as a competing endogenous RNA (ceRNA), leading to target mRNA stabilization. As an example of a circHIPK3-regulated gene, we focus on the STAT3 mRNA as a specific substrate of IGF2BP2 and validate that manipulation of circHIPK3 regulates IGF2BP2-STAT3 mRNA binding and thereby STAT3 mRNA levels. However, absolute copy number quantifications demonstrate that IGF2BP2 outnumbers circHIPK3 by orders of magnitude, which is inconsistent with a simple 1:1 ceRNA hypothesis. Instead, we show that circHIPK3 can nucleate multiple copies of IGF2BP2, potentially via phase separation, to produce IGF2BP2 condensates. Finally, we show that circHIPK3 expression correlates with overall survival of patients with bladder cancer. Our results are consistent with a model where relatively few cellular circHIPK3 molecules function as inducers of IGF2BP2 condensation thereby regulating STAT3 and other key factors for cell proliferation and potentially cancer progression.

Probiotics Support Resilience of the Oral Microbiota during Resolution after Experimental Gingivitis-A Randomized, Double-Blinded, Placebo-Controlled Trial.

The present study aims to test whether probiotics protect against experimental gingivitis incited by 14 days of oral hygiene neglect and/or subsequently support the restoration of oral homeostasis. Eighty systemically and orally healthy participants refrained from oral hygiene procedures for 14 days, followed by 14 days with regular oral hygiene procedures. Additionally, participants consumed either probiotics (n = 40) or placebo (n = 40) throughout the trial. At baseline, day 14, and day 28, supragingival plaque score and bleeding-on-probing percentage (BOP %) were registered, and supragingival plaque and saliva samples were collected. The supragingival microbiota was characterized using 16S sequencing, and saliva samples were analyzed for levels of pro-inflammatory cytokines and proteases. At day 28, the relative abundance of Lautropia (p = 0.014), Prevotella (p = 0.046), Fusobacterium (p = 0.033), and Selenomonas (p = 0.0078) genera were significantly higher in the placebo group compared to the probiotics group, while the relative abundance of Rothia (p = 0.047) species was associated with the probiotics group. Streptococcus sanguinis was associated with the probiotics group, while Campylobacter gracilis was associated with the placebo group. No difference was observed in salivary cytokines, albumin, or any enzyme activity. The present study suggests that probiotics support the resilience of the oral microbiota in the resolution period after gingivitis.

Probiotics Partly Suppress the Impact of Sugar Stress on the Oral Microbiota-A Randomized, Double-Blinded, Placebo-Controlled Trial.

The aim was to test if probiotics counteract oral dysbiosis during 14 days of sugar stress and subsequently help restore oral homeostasis. Eighty healthy individuals received either probiotics (n = 40) or placebo lozenges (n = 40) for 28 days and rinsed with a 10% sucrose solution 6-8 times during the initial 14 days of the trial. Saliva and supragingival samples were collected at baseline, day 14, and day 28. Saliva samples were analyzed for levels of pro-inflammatory cytokines, albumin, and salivary enzyme activity. The supragingival microbiota was characterized according to the Human Oral Microbiome Database. After 14 days of sugar stress, the relative abundance of Porphyromonas species was significantly higher (p = 0.03) and remained significantly elevated at day 28 in the probiotic group compared to the placebo group (p = 0.004). At day 28, the relative abundance of Kingella species was significantly higher in the probiotic group (p = 0.03). Streptococcus gordinii and Neisseria elongata were associated with the probiotic group on day 28, while Streptococcus sobrinus was associated with the placebo group on day 14 and day 28. On day 28, the salivary albumin level was significantly lower in the probiotic group. The present study demonstrates a potential stabilizing effect on the supragingival microbiota mediated by consumption of probiotics during short-term sugar stress.

Treated periodontitis and recurrent events after first-time myocardial infarction: A Danish nationwide cohort study.

AIM: To investigate the association between previous periodontal treatment and recurrent events after first-time myocardial infarction (MI). MATERIALS AND METHODS: From the Danish nationwide registries, patients with first-time MI between 2000 and 2015 were divided into three groups according to oral health care within 1 year prior to first-time MI. A multiple logistic regression model provided adjusted odds ratios (ORs) with 95% confidence intervals (CIs) to assess the 3-year risk of major adverse cardiovascular events (MACE). RESULTS: A total of 103,949 patients were included. Patients with treated periodontitis (PD) prior to first-time MI had an adjusted 3-year risk of MACE similar to patients presumed periodontally healthy (OR 0.97 [95% CI 0.92-1.03]). Patients with no prior dental visits were significantly older, had more comorbidities and showed significantly increased adjusted 3-year risks of MACE (OR 1.47 [95% CI 1.42-1.52]), cardiovascular death (OR 1.71 [95% CI 1.64-1.78]) and heart failure (OR 1.13 [95% CI 1.07-1.20]) compared with patients presumed periodontally healthy. CONCLUSIONS: Patients with treated PD 1 year prior to first-time MI had a similar risk of recurrent cardiovascular events as patients presumed periodontally healthy. No dental visit prior to first-time MI was an independent risk factor for recurrent events.

Short-term sugar stress induces compositional changes and loss of diversity of the supragingival microbiota.

Frequent intake of free sugars is a major risk factor for dental caries, but the immediate influence of sugar intake on the supragingival microbiota remains unknown. We aim to characterize the effect of 14 days of sugar rinsing on the supragingival microbiota. Forty orally and systemically healthy participants rinsed their mouth with a 10% sucrose solution, 6-8 times a day, for 14 days, followed by 14 days without sugar stress. Supragingival plaque samples were collected at baseline, and after 14, and 28 days. The supragingival microbiota was analyzed using 16S rDNA sequencing. Taxonomic classification was performed using the Human Oral Microbiome Database. After 14 days of sugar stress induced by the daily sugar rinses, a significant loss of α-diversity (p = 0.02) and a significant increase in the relative abundance of Actinomyces (6.5% to 9.6%, p = 0.006) and Corynebacterium (6.2% to 9.1%, p = 0.03) species were recorded. In addition, a significant decrease in Streptococcus (10.3% to 6.1%, p = 0.001) species was observed. Sugar-mediated changes returned to baseline conditions 14 days after the last sugar rinse. The present study shows that temporary sugar stress induces loss of diversity and compositional changes to the supragingival microbiota, which are reversible if oral care is maintained.

Implementing wood ants in biocontrol: Suppression of apple scab and reduced aphid tending.

BACKGROUND: Ants can become efficient biocontrol agents in plantation crops as they prey on pest insects and may inhibit plant pathogens by excreting broad-spectrum antibiotics. However, ants also provide a disservice by augmenting attended honeydew producing homopterans. This disservice may be avoided by offering ants artificial sugar as an alternative to honeydew. Here we tested the effect of artificial sugar feeding on aphid abundance in an apple plot with wood ants (Formica polyctena, Förster), and tested the effect of ant presence on apple scab (Venturia inaequalis, Cooke) disease incidence. RESULTS: Over a 2-year period, sugar feeding eliminated ant-attended aphid populations on the apple trees. Furthermore, scab symptoms on both leaves and apples were reduced considerably on ant trees compared to control trees without ants. The presence of ants on the trees reduced leaf scab infections by 34%, whereas spot numbers on fruits were reduced by between 53 and 81%, depending on apple variety. In addition, the spots were 56% smaller. CONCLUSION: This shows that problems with wood ant-attended homopterans can be solved and that ants can control both insect pests and plant pathogens. We therefore propose wood ants as a new effective biocontrol agent suitable for implementation in apple orchards and possibly other plantation crops. © 2023 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Influence of Soil Moisture on Bioaccumulation, Growth, and Recruitment of Folsomia candida Exposed to Phenanthrene-Polluted Soil.

Climate change has resulted in an increased occurrence of summer droughts in large parts of the world. Low soil moisture has marked impacts on the physiology of soil invertebrates and lowers degradation rates of organic contaminants in soil. Polycyclic aromatic hydrocarbons (PAHs) are hydrophobic contaminants that readily accumulate in the lipids of soil organisms. Here, we exposed springtails (Collembola, small soil living arthropods) to phenanthrene (a common PAH) in combination with a range of soil water contents to investigate the combined effects of these factors on the bioaccumulation, survival, recruitment, and body growth in a full factorial experiment. The results showed that phenanthrene up to 60 mg/kg dry soil had moderate effects on survival (<20%), whereas dry soil (4% soil water content) caused approximately 60% mortality. The bioaccumulation of phenanthrene increased almost 3-fold when soil water content decreased from 22 to 4%. We observed a joint effect of low soil water content and phenanthrene on recruitment, suggesting a synergistic interaction. The recruitment EC50 values of phenanthrene decreased from approximately 40 mg/kg dry soil at 22% soil water content to approximately 10 mg/kg dry soil at 12% soil water content. Our results show that the effects of phenanthrene are more pronounced in dry soil partly because bioaccumulation is enhanced when soils become dry.

Increased daily temperature fluctuations exacerbate the toxicity of phenanthrene in Enchytraeus albidus (Enchytraeidae).

Temperature variability in soils is expected to increase due to the more frequent occurrence of heat waves, putting species under thermal stress. In addition, organic pollutants such as polycyclic aromatic hydrocarbons (PAHs) are released into the environment due to anthropogenic activities. Both stressors negatively impact terrestrial organisms and may interact with each other. Here, we subjected the soil living enchytraeid, Enchytraeus albidus, to combined exposure to phenanthrene (PHE; 0, 10, 20, 40, and 80 mg kg-1 dry soil) and a range of temperature treatments (constant temperature (CT): 10, 15 and 20 °C; different mean temperature with the same daily temperature fluctuation (DTF-5): 10 ± 5, 15 ± 5 and 20 ± 5 °C; daily temperature fluctuation with the same mean, but different amplitudes (DTF-A): 20, 20 ± 2, 20 ± 5 and 20 ± 7 °C). We measured internal PHE concentration in adults and found that an increase in mean temperature significantly increased the internal PHE concentration. The production of juveniles was measured using a standardized test. We found a synergistic interaction between the temperature amplitude (DTF-A treatments) and PHE on the reproduction of E. albidus. The EC50 of reproduction decreased with increasing amplitude. These results show that the negative effects of PHE on E. albidus can be magnified if stressful temperatures are reached (although briefly) during diurnal fluctuations of soil temperature. Our results highlight the importance and inclusion of extreme thermal events in the risk assessment of pollutants.

B-cell cytokine responses to Porphyromonas gingivalis in patients with periodontitis and healthy controls.

BACKGROUND: Cytokine-producing B cells play a well-established role in modifying immune responses in chronic inflammatory diseases. We characterized B-cell cytokine responses against periodontitis-associated bacteria in patients with periodontitis. METHODS: Blood and saliva samples were collected from patients with periodontitis grade B (N = 31) or grade C (N = 25), and 25 healthy controls (HCs). Mononuclear cells were stimulated with Porphyromonas gingivalis, Fusobacterium nucleatum, Staphylococcus epidermidis, or Cutibacterium acnes, and B-cell production of tumor necrosis factor (TNF)-α, interleukin (IL)-6, interferon (IFN)-γ, IL-10 and transforming growth factor (TGF)-ß by B cells was assessed by flow cytometry. RESULTS: HCs had higher baseline frequencies of B cells producing IFN-γ or TNF-α than grade B patients, but only B cells from grade B patients showed significant differentiation into IFN-γ-, TNF-α-, TGF-ß-, or IL-10-producing cells after challenge with P. gingivalis and into IFN-γ-, TGF-ß-, or IL-10-producing cells after challenge F. nucleatum. Notably, the baseline frequency of IL-10-producing B cells from grade C patients correlated inversely with clinical attachment loss (AL). The major proportion of the IFN-γ- and TGF-ß-producing B cells were CD27+ memory cells, while the IL-10-producing B cells were mainly CD27- CD5- . CONCLUSIONS: B cells from grade B patients, particularly those harboring P. gingivalis, showed proinflammatory B-cell responses to P. gingivalis. Moreover, the baseline frequency of IL-10-producing B cells in the grade C group correlated inversely with AL, suggesting a diminished immunoregulatory capacity of IL-10-producing B cells in these patients.

Heat stress delays detoxification of phenanthrene in the springtail Folsomia candida.

Climate change has intensified the occurrence of heat waves, resulting in organisms being exposed to thermal and chemical stress at the same time. The effects of mild heat shock combined with sublethal concentrations of phenanthrene (PHE) on defense mechanisms in springtails Folsomia candida were investigated. The transcription of Heat Shock Protein 70 (HSP70) was significantly upregulated by heat shock but tended to reach the control levels after 42 h of recovery. The transcription of cytochrome P450 3A13 (CYP3A13) was upregulated 3-13 fold by PHE but suppressed by heat shock. The suppression by heat shock might contribute to the reduced detoxification of PHE during high-temperature exposure. In line with this, we found that the internal PHE concentration was approximately 70% higher in heat-shocked springtails than in animals kept at control temperature. In general, the transcription of genes encoding enzymes of detoxification phase Ⅱ (glutathione S-transferase 3) and phase Ⅲ (ABC transporter 1) and the activity of antioxidant defense enzymes (superoxide dismutase and catalase) were less influenced than genes encoding phase I detoxification mechanisms (CYP3A13). These results indicate that heat shock delays the detoxification of PHE in springtails.

Effect of nitrogen and glyphosate on the plant community composition in a simulated field margin ecosystem: Model-based ordination of pin-point cover data.

The effect of nitrogen and glyphosate on the plant community composition was investigated in a simulated field margin ecosystem. The plant community composition was inferred from pin-point cover data using a model-based ordination method that is suited for modelling pin-point cover data. The mean structure of the ordination model is analogous to a standard linear model, which enabled us to estimate the mean effects of nitrogen and glyphosate and their interaction in the two-dimensional ordination space. There were significant effects of both nitrogen and glyphosate on the plant community composition and overall species diversity. The effects of nitrogen and glyphosate on the plant community composition differed significantly. Furthermore, the estimated combined effects of nitrogen and glyphosate indicated that nitrogen and glyphosate enforced the effect of each other on the plant community composition by synergistic interactions. Addition of nitrogen and glyphosate was found to favor a plant community that was dominated by perennial grasses, and there was a tendency for glyphosate to select for plant communities in which annual plants were more frequent. The results suggest that using the notion of plant functional types and specific knowledge of the degree of glyphosate tolerance may be effective for predicting the effect of glyphosate on the community composition.

Complement component 3 and its activation split-products in saliva associate with periodontitis.

BACKGROUND: Periodontitis (PD) is classified by Grades A through C according to the risk of further progression, PD Grade C (PD-C) being the most severe progressing form. It is a matter of controversy, whether the disease activity observed in PD-C is due to impaired immune reactivity toward bacteria embedded in biofilms or a hyper-reactive immune response causing tissue damage as a bystander phenomenon. Little is known about the role of complement in this respect. METHODS: Plasma and unstimulated saliva samples were collected from patients with PD-B (n = 34) or -C (n = 27) and healthy controls (HCs) (n = 28). Salivary and plasma levels of total C3, C3c, and C3dg were quantified using sandwich enzyme-linked immunosorbent assay (ELISA). RESULTS: Salivary levels of total C3 and C3dg were elevated in PD-B and PD-C patients compared to HCs (both P < 0.05), while the levels of C3c were elevated in PD-C compared to HCs. Plasma levels of C3c were higher in PD-B patients than in HCs (P < 0.05). CONCLUSION: PD-B and PD-C patients show increased complement activation compared to HCs, but no difference was found between the two disease grades. PD-B, but not PD-C, is associated with increased systemic complement activation as assessed by C3c in plasma.

The transcriptional landscape and biomarker potential of circular RNAs in prostate cancer.

BACKGROUND: Circular RNAs (circRNAs) constitute a largely unexplored source for biomarker discovery in prostate cancer (PC). Here, we characterize the biomarker potential of circRNAs in PC, where the need for novel diagnostic and prognostic tools to facilitate more personalized management is pressing. METHODS: We profiled the transcriptomic landscape of circRNAs in PC by total RNA sequencing of 31 adjacent-normal and 143 tumor samples from localized (radical prostatectomy (RP)) and metastatic PC patients (cohort 1, training). Diagnostic and prognostic potential was evaluated in cohort 1, and 39 top circRNA candidates were selected for validation in two additional PC cohorts (cohort 2, n = 111; RP cohort 3, n = 191) by NanoString-based expression analysis. Biochemical recurrence (BCR)-free survival was assessed using Kaplan-Meier, univariate, and multivariate Cox regression analyses. The circRNA candidates were further detected in extracellular vesicle (EV)-enriched plasma samples from PC patients and controls (cohort 4, n = 54). RESULTS: Expression of circABCC4, circFAT3, circATRNL1, and circITGA7 was highly cancer-specific (area under the curve 0.71-0.86), while low circITGA7 expression was significantly (P < 0.05) associated with BCR in univariate analysis in two RP cohorts. Moreover, we successfully trained and validated a novel 5-circRNA prognostic signature (circKMD1A/circTULP4/circZNF532/circSUMF1/circMKLN1) significantly associated with BCR beyond routine clinicopathological variables (RP cohort 1: P = 0.02, hazard ratio = 2.1; RP cohort 3: P < 0.001, hazard ratio = 2.1). Lastly, we provide proof-of-principle for detection of candidate circRNAs in EV-enriched plasma samples from PC patients. CONCLUSIONS: circRNAs hold great biomarker potential in PC and display both high cancer specificity and association to disease progression.

Periodontal care attendance in Denmark in 2012-2016 - a nationwide register-based study.

OBJECTIVE: Planning and evaluation of oral healthcare systems rely on monitoring of care patterns. Monitoring periodontal care patterns provide information on the burden and occurrence of periodontitis in the population and on the direct financial cost. The aims of the study were to describe patterns in periodontal care among dental care attenders that might incite subsequent investigation and revised treatment guidelines. Secondly, to estimate the direct societal costs of periodontal care. MATERIAL AND METHODS: A retrospective register-based study utilising data from the Danish Public Health Insurance which includes all dental care attenders in 2012-2016, three years before and one year after a national risk-based recall maintenance program was rolled out in Denmark. RESULTS: The 2.7 million yearly dental care attenders corresponded to ∼60% of the eligible population and in the range of 20-24% received periodontal care. Total expenditure for periodontal care in Denmark increased by 13% from 2012 to 2016, from €78 to €88 million. The proportion of total healthcare funding spent on periodontal care was 0.61% in 2016. CONCLUSIONS: Patients with periodontitis have large out-of-pocket yearly expenses for periodontal care. Despite small changes in periodontal clinical practice that may indicate improved targeting of patients in need of periodontal care, challenges of reaching non-attenders and non-adherence to care are unsolved. More research into outcomes from periodontal therapy in daily practice, seen from both normative and patient perspectives, would help establish knowledge of the efficiency of existing periodontal care systems and help identify barriers and facilitators for attending care in Denmark.

Mapping the ecological resilience of Atlantic postglacial heathlands.

Anthropogenic heathlands are semi-natural ecosystems with a unique cultural and biodiversity value, considered worthy of preservation across most of the world. Their rate of loss, however, is alarming. Currently, we know little about the heathlands' actual span of resilience affordances and their association with abiotic and anthropogenic factors, including how much additional intervention they need to persist. Consequently, we are missing out on vital knowledge for conservation, management and the historical persistence of heathlands.This paper develops a method to assess the ecological resilience affordances of Atlantic postglacial heaths in the absence of human management. We use 12 existing cases of heathland succession to establish a four-step resilience grade for each site, which we regress onto a series of explaining factors and use it in predicting heath resilience across postglacial Atlantic Northern Europe.We find that temperature, humidity, elevation and sandiness have a positive correlation with high heathland resilience. Our predictive mapping shows an uneven distribution of ecological heath resilience across Atlantic Northern Europe within an area of 1,000 × 1,200 km of 5 × 5 km resolution.Historic heathland distributions far exceed areas that afford high heath resilience, suggesting that heath distribution and persistence depend on both abiotic and anthropogenic factors. Policy implications: The map predicting the ecological resilience of Atlantic postglacial heaths can be used by managers working towards heath preservation and restoration to prioritize conservation efforts and to plan management practices across Atlantic Northern Europe. Together with the predictive model, it provides an important initial screening tool to assess heathland resilience in the absence of management as well as the impact of atmospheric nitrogen. The results are equally relevant for scholars who are interested in humans' role in increasing and decreasing ecosystem resilience. Our predictive method can be applied in other regions across the world by adding regionally specific variables.