Longevity of immediate rehabilitation with direct metal-wire reinforced composite fixed partial dentures.

OBJECTIVES: This study aimed to analyze the longevity of direct metal-wire reinforced composite fixed partial dentures (MRC-FPD) and factors influencing their survival and success. METHODS: Within one private practice 513 MRC-FPD were directly applied. The preparation of a proximal cavity in abutment teeth was not limited. MRC-FPD were reinforced by one to three metal-wires. At the last follow-up MRC-FPD were considered successful, if they were still in function without any need of therapy. MRC-FPD were considered as survived, if they were repaired or replaced. Multi-level Cox proportional hazard models were used to evaluate the association between clinical factors and time. RESULTS: Mean follow-up period (range) was 59(2-249) months. Seventy-three bridges did not survive (cumulative survival rate(CSR):86%) and further 129 bridges had received a restorative follow-up treatment (CSR:61%). AFR was 2.2% for survival and 8.6% for success. In multivariate analysis MRC-FPD with> 1 wire showed a up to 2.3x higher failure rate than MRC-FPD with one wire(p ≤ 0.023). Dentist's experience in designing MRC-FDP (p ≤ 0.017), patient's caries risk (p ≤ 0.040) and bruxism (p = 0.033) significantly influenced the failure rate: the more experience, the lower caries risk and bruxism, the lower the failure rate. SIGNIFICANCE: For directly prepared metal-wire reinforced composite bridges high survival and moderate success rates were observed. MRC-FPD might, thus, be an immediate, short- and medium-term solution for replacing missing teeth. However, several factors on the levels of practice (dentist's experience in designing MRC-FDP), patient (bruxism, caries risk) and restoration (number of wires) were identified as significant predictors for the failure rate. The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00021576).

Depression and dietary intake in a cohort of HIV-positive clients in Sydney.

This cross-sectional study aimed to compare dietary intake in people living with HIV (PLHIV) experiencing symptoms of depression with those not reporting depression. The Centre for Epidemiologic Studies Depression Scale (CES-D10) was used to classify the risk of depression. Dietary nutrient intake was determined using the diet history and food frequency questionnaire. Depressed (n = 21) compared with non-depressed (n = 37) subjects had significantly lower mean intake of fibre (16.1 versus 25.4 g/day), vitamin A (801.5 versus 1524.8 mg/day), magnesium (299.8 versus 380.0 mg/day) and folate (264.8 versus 402.9 µg/day). The proportion of subjects achieving the recommended intake of these nutrients, with the exception of folate was also found to be lower in the depressed group compared with non-depressed group. The study found that depressive symptomatology in PLHIV was associated with poorer dietary nutrient intake. A multidisciplinary model of care that includes a nutrition assessment is recommended for the management of PLHIV with depression to reduce the risk of associated nutritional problems.

Improved serological response to H1N1 monovalent vaccine associated with viral suppression among HIV-1-infected patients during the 2009 influenza (H1N1) pandemic in the Southern Hemisphere.

OBJECTIVES: Patients infected with HIV-1 were targeted for vaccination against H1N1 influenza because of their anticipated increased risk of mortality associated with H1N1 infection. Reports regarding the efficacy of vaccination in HIV-1-infected patients have suggested a reduced immunogenic response compared with the general population. Hence, the study aimed to determine the serological response to pandemic H1N1 influenza vaccine in HIV-1-infected patients in a clinical setting. METHODS: A retrospective review of all HIV-1-infected patients who attended mass H1N1 vaccination between October 2009 and March 2010 at an Australian HIV clinic was carried out. Pre- and post-vaccination H1N1 antibody titres were measured. The main outcome measure was response to the vaccination, which was defined as an H1N1 antibody titre of ≥ 1:40 using a haemagglutination inhibition (HI) assay. RESULTS: Baseline blood samples were collected from 199 patients, of whom 154 agreed to receive vaccination; of these, 126 had pre- and post-vaccination HI titres measured. Seventy-seven of 199 patients (38.7%) showed a baseline antibody titre of ≥ 1:40. Eighty-five (67.4%) showed a fourfold or greater increase in titre and 109 of 126 (86.5%) achieved an antibody titre of ≥ 1:40 after vaccination. The serum HI H1N1 antibody geometric mean titre (GMT) for the 126 paired samples was 39.32 ± 3.46 pre-vaccination and increased to 237.36 ± 3.94 [standard deviation (SD)] post-vaccination (P<0.001). In a binary logistic regression analysis, HIV viral load and baseline HI antibody titre were significantly associated with post-vaccination increase in HI H1N1 antibody titre. CONCLUSIONS: A high prevalence of HI H1N1 antibodies was found before vaccination in the cohort, consistent with previous exposure to H1N1 influenza virus. The response to vaccination was considered adequate, as more than two-thirds of patients achieved a fourfold or more increase in antibody titre after vaccination. The response to vaccination was significantly greater in those patients who were aviraemic for HIV, suggesting that antiretroviral therapy improves the humoral response, which is important in optimizing vaccine effectiveness.

Clinical experience with nevirapine combined with tenofovir plus emtricitabine or lamivudine-containing regimens in HIV-infected subjects.

We retrospectively evaluated the durability and reasons for discontinuation of nevirapine (NVP) in combination with a tenofovir (TDF) and emtricitabine (FTC) or lamivudine (3TC)-containing antiretroviral therapy (ART) regimen in an Australian outpatient setting. Between January 2003 and June 2009, 64 patients (29 naïve and 35 treatment-experienced) received NVP/TDF-based regimens. The median exposure was 13.0 months (interquartile range [IQR] 6.0-20.0 months). The two- and three-year probability of continuing a NVP/TDF with FTC or 3TC regimen was 76% and 70%, respectively. Thirteen (20.3%) patients discontinued their regimen during the observation period. Reasons for discontinuation included virological failure in four (6.3%), rash in three (4.7%), lost to follow-up in three (4.7%), liver toxicity in two (3.1%) and HIV-1-related encephalopathy in one (1.6%). Long-term follow-up with a NVP/TDF-based regimen showed a low rate of discontinuation and enabled physicians to extend the use of ART over a long period, often with simplified (once-daily) regimens.

Factors associated with unprotected anal intercourse between HIV-positive men and regular male partners in a Sydney cohort.

Blood plasma HIV-RNA load (BPVL) is the strongest predictor of HIV-1 transmission during sex. Unprotected anal intercourse (UAI) is the highest risk activity for transmission among men who have sex with men (MSM). Awareness of BPVL may influence rates of UAI. We assessed whether optimism towards antiretroviral therapy (ART) and/or biomedical factors influenced sexual activities with regular partners. Questionnaires were administered to 109 HIV-positive MSM participating in a cross-sectional study of BPVL and seminal viral load. The survey assessed HIV transmission beliefs and sexual practices with regular male partners in the past three months. Sixty-nine of 109 (63.3%) had been in a regular relationship and 42 reported having had anal sex. Unprotected receptive anal intercourse without ejaculation (URAI - e) was associated with awareness that their most recent BPVL was detectable (>50 RNA copies/mL) and not taking ART. Receptive UAI with ejaculation (URAI + e) was associated with not taking ART, having a sexually transmissible infection and having an HIV-positive partner; the latter was also associated with insertive UAI with ejaculation (UIAI + e). Treatment optimism was not associated with UAI. In this cohort, sexual practices were based more upon knowledge of biomedical factors rather than attitudes regarding transmission risks.

Resuturing following penetrating keratoplasty: a retrospective analysis.

AIM: To examine the clinical profile of cases requiring resuturing following penetrating keratoplasty (PKP) at a tertiary care eye hospital. METHODS: The medical records of 947 consecutive patients who had undergone PKP between 1998 and 2006 were reviewed retrospectively and cases that were resutured during this period were analysed. The main parameters studied were indications for PKP, suturing techniques, causes of resuturing, visual acuity outcome and post-resuturing complications. RESULTS: The incidence of resuturing was 5.4% (51 eyes). The number of cases requiring resuturing was higher in corneal grafts performed for microbial keratitis (12%) than those for keratoconus (10%) and corneal endothelial decompensation (2.5%; p = 0.08). Wound dehiscence was the leading cause for resuturing (43%), followed by loose or broken sutures (37.3%). The most common complications after resuturing were occurrence of microbial keratitis (7.8%) and graft failure (5.9%). DISCUSSION: Resuturing may have to be performed more commonly for corneal transplantation surgery done for microbial keratitis and keratoconus. The major indications for resuturing are wound dehiscence and loose/broken sutures.

Comparison of different methodologies for CD4 estimation in a clinical setting.

OBJECTIVE: To compare flow cytometry assays, using traditional dual platform (DP) or newer single platform (SP) for CD4 enumeration. METHOD: Records of subjects enrolled in four separate clinical trials using the same central laboratory [SP methodology (Trucount)] were reviewed retrospectively. Eighteen subjects had 60 matching contemporaneous samples at multiple timepoints. RESULTS: DP flow cytometry yielded higher CD4 counts in 50/60 assays (83%). CD4 count and percentage by the two methods showed strong correlation for the counts (r=0.965, P<0.0001) and percentages (r=0.959, P<0.0001). Bland-Altman plot analysis showed that the limits of variation were within agreeable limits of +/-2SD in 56/60 (93.3%) samples tested. Twenty-five (42%) samples had a difference of >50 cells/microL. Of these six (24%) exceeded 100 cells. CONCLUSION: This study is in agreement with previous reports of strong correlation between DP and SP flow cytometry. This review found differences in CD4 counts in a high proportion of samples tested highlighting the importance for clinicians to be aware of such differences when interpreting results from the two methods.

eEF1A2 activates Akt and stimulates Akt-dependent actin remodeling, invasion and migration.

eEF1A2 (eukaryotic protein elongation factor 1 alpha 2) is a protein translation factor that is likely a human oncogene by virtue of its capacity to transform mammalian cells and its high expression in tumors of the ovary, breast and lung. Here, we show that expression of eEF1A2 is sufficient to stimulate the formation of filopodia in BT549 human breast cancer cells and non-transformed Rat2 cells. Filopodia formation in eEF1A2-expressing cells is dependent on the activity of phosphatidylinositol-3 kinase (PI3K), and the ROCK and Akt kinases. Furthermore, eEF1A2 expression is sufficient to activate Akt in a PI3K-dependent fashion and inactivation of eEF1A2 by short interfering RNA reduces Akt activity. Using breast cancer cell line BT 549, we show that eEF1A2 expression stimulates cell migration and invasion in a largely PI3K- and Akt-dependent manner. These results suggest that eEF1A2 regulates oncogenesis through Akt and PI3K-dependent cytoskeletal remodeling.

Spectroscopic approaches to the conformation of tau protein in solution and in paired helical filaments.

The abnormal aggregation of the microtubule-associated protein tau into paired helical filaments is one the hallmarks of Alzheimer's disease. This aggregation is based in the partial formation of beta-structure. In contrast, the soluble protein shows a mostly random coil structure, as judged by circular dichroism, Fourier transform infrared, X-ray scattering and biochemical assays. Here, we review the basis of the natively unstructured character of tau, as well as recent studies of residual structure and long-range interactions between different domains of the protein. Analysis of the primary structure reveals a very low content of hydrophobic amino acids and a high content of charged residues, both of which tend to counteract a well-folded globular state of proteins. In the case of tau, the low overall hydrophobicity is sufficient to explain the lack of folding. This is in contrast to other proteins which also carry an excess charge at physiological pH. By tryptophan scanning mutagenesis and fluorimetry we found that most of the sequence is solvent exposed. Analysis of the hydrodynamic radii confirms a mostly random coil structure of various tau isoforms and tau domains. The proteins can be further expanded by denaturation with GdHCl which indicates some global folding. This was substantiated by a FRET-based approach where the distances between different domains of tau were determined. The combined data show that tau is mostly disordered and flexible but tends to assume a hairpin-like overall fold which may be important in the transition to a pathological aggregate.

Conformationally restricted mimics of vitamin D rotamers.

Drug developments in the vitamin D field have continued to focus on structure-function studies of analogs produced by chemically modifying the structure of 1alpha,25-dihydroxyvitamin D(3) (1,25-D3) and its metabolites. Direct structural information gleaned from X-ray crystallographic or NMR studies regarding the ligand-receptor complex and other guest-host systems, which are likely involved in initiating biologic responses, also offers potential insight into drug design. Evidence has accrued suggesting that topologically different conformers of 1,25-D3 may bind to proteins in different ways, including the induction of different conformations of protein. This paper concerns our progress on the chemical synthesis of analogs (e.g. ansa-steroids, suprasterols, vinylallenes and other analogs) conformationally locked or at least rotationally restricted to mimic higher energy conformers of 1,25-D3.

Denture stomatitis in an elderly edentulous Asian population.

Denture stomatitis is a common oral disease in denture wearers. Multiple aetiological and predisposing factors are believed to be responsible for its initiation and progression. The aim of this study was to assess the relationship between denture age, denture hygiene habits, denture wearing and denture cleanliness in an elderly edentulous Asian population. Seventy-five edentulous patients, all wearing maxillary complete dentures were divided into two groups. The test group comprised 36 patients (14 male and 22 female) with Type II denture stomatitis. The control group comprised 39 subjects (14 male and 25 female) with clinically healthy palatal mucosa. A standardized interview and clinical appraisal were carried out. The dye disclosing method was used to assess denture cleanliness and the resultant staining pattern scored. Statistical appraisal between the two groups revealed significant differences in denture hygiene habits (P < 0.05), denture wearing behaviour (P < 0.01) and denture cleanliness (P < 0.01). No significant difference was observed in the age of dentures between the test group and controls (P > 0.05). In the studied Asian edentulous population, a relationship between denture hygiene habits, denture wearing behaviour and denture cleanliness to the presence of denture stomatitis was observed.

A clinically viable index for quantifying denture plaque.

A denture plaque index using the dye disclosing method was evaluated in 24 patients with Type II denture stomatitis and 17 control subjects with healthy palatal mucosa. Patients with denture stomatitis had statistically significantly higher plaque scores than did controls, indicating a quantitative increase in denture plaque in patients with denture stomatitis. When this plaque index was tested by two examiners for intraexaminer and interexaminer reproducibility, it yielded a 92% to 96% reproducibility. The plaque index used in this study seems to satisfy the criteria for an ideal clinical index: It is simple, reliable, reproducible, and economical and can be carried out in the shortest possible time in a clinical setting.

The use of removable partial dentures amongst private dental practitioners in Singapore.

A questionnaire survey was carried out in 1995 amongst university trained general dental practitioners in the city state of Singapore to assess the use of removable partial dentures (RPD). 37% of the original sample of 469 completed and returned the questionnaire. The results of this survey indicate that RPDs are a common treatment modality in Singapore. Acrylic partial dentures appear to be the preferred choice for RPD treatment. The work profile of those who had a postgraduate qualification in removable prosthodontics did not differ from that of the general dental practitioner.

Copper electroplating of non-aqueous elastomeric impression materials: a subjective appraisal of their platability.

Electroplating of non-aqueous elastomeric impression materials is a well-documented technique. Electroplated silver or copper plated dies have many clinical advantages compared to other die systems. Silver electroplating appears to be used more frequently than copper electroplating. Utilization of silver for electroplating requires an appreciation of financial and biohazard considerations. Research on compatibility of copper electroplating with current non aqueous elastomeric impression materials is lacking. Samples of currently used non aqueous elastomeric impression materials were used to register impressions of conventional crown preparations on a typodont. These impressions were electroplated to form copper plated dies. The surface qualities of the dies were evaluated. Not all impression materials produced visually acceptable or workable copper plated dies.

Common faults in complete dentures: a review.

Complete-denture therapy involves a complex interplay between biologic demands and technical limitations. Success with complete-denture therapy is reportedly high. Dissatisfied denture patients, although few, do exist. This paper reviews some of the common faults reported with complete dentures.

Immunodiagnosis in oral candidiasis. A review.

Detection of anti-Candida antibodies in sera and saliva of patients with oral candidiasis has been regarded as a valuable laboratory technique in the diagnosis of the lesion. However, despite considerable research, the value of candidal immunodiagnosis remains controversial. Conflicting conclusions about the sensitivities and specificities of these techniques as applied to human sera and saliva have appeared. These controversies have arisen because of the use of different antigen preparations and immunologic techniques. For the present, the use of purified cytoplasmic protein antigen of Candida albicans and the ELISA technique seems to be the most reliable laboratory method.

Denture stomatitis--a review of the aetiology, diagnosis and management.

Denture stomatitis is a common recurring problem of the denture wearers. The aetiology of the disease includes infection, trauma and probably a defect in the host defence mechanism. Current thinking suggests an interplay of most of these factors in the pathogenesis of the disease. The extent of interplay of these factors is still a controversy. Candida albicans has been implicated as the causative organism. However, in the light of recent research it is debatable if it is the only causative organism. Recently, cases resistant to antifungal therapy have been reported. In such cases other micro-organisms have been isolated. At the moment, comprehensive management includes meticulous denture hygiene together with anti-fungal or antibacterial therapy and correction of denture faults.

Immunoglobulin A1 and A2 subclass of salivary antibodies to Candida albicans in patients with oral candidosis.

Immunoglobulin A antibody titres to a cytoplasmic protein extract of Candida albicans were determined by ELISA in saliva from 20 patients with oral candidosis and 21 controls. Patients had significantly increased levels of salivary IgA anti-Candida antibodies when compared with controls (P less than 0.001). Antibody levels were associated with IgA1 subclass in 90% of the patients; in contrast, IgA2 subclass was predominant in 67% of the controls. Antifungal therapy resulted in significantly decreased IgA1 titres (P less than 0.05) whilst the mean IgA2 antibody titre remained unchanged. The results indicate that Candida infection may change the subclass pattern of salivary IgA antibodies.