Influence of dietary supplementation of short-chain fatty acid sodium propionate in people living with HIV (PLHIV).

BACKGROUND: Non-AIDS-associated chronic diseases in HIV+ patients have been on the rise since the advent of antiretroviral therapy. Especially cardiovascular diseases and disruption in the gastrointestinal tract have limited health-related quality of life (QoL). Several of those complications have been associated with chronic systemic inflammation. Short-chain fatty acids (SCFA), with propionate as one of the major compounds, have been described as an important link between gut microbiota and the immune system, defining the pro- and the anti-inflammatory milieu through direct and indirect regulation of T-cell homeostasis. The effects of dietary supplementation of sodium propionate (SP) in people living with HIV (PLHIV) have not yet been investigated prior to this study. OBJECTIVES: To investigate the impact of SP uptake among PLHIV and its relevance to improve QoL, the study aimed to investigate metabolic, immunological, microbiome and patient-reported QoL-related changes post-SP supplementation with follow-up. METHODS: A prospective, non-randomized, controlled, monocentric interventional study was conducted in WIR, Center for Sexual Health and Medicine, in Bochum, Germany. 32 HIV+ patients with unaltered ART-regimen in the last three months were included. Participants were given SP for a duration of 12 weeks in the form of daily oral supplementation and were additionally followed-up for another 12 weeks. RESULTS: The supplementation of SP was well tolerated. We found an improvement in lipid profiles and long-term blood glucose levels. A decrease in pro-inflammatory cytokines and a depletion of effector T cells was observed. Regulatory T cells and IL-10 decreased. Furthermore, changes in taxonomic composition of the microbiome during follow-up were observed and improvement of items of self-reported life-quality assessment. CONCLUSION: Taken together, the beneficial impact of SP in PLHIV reflects its potential in improving metabolic parameters and modulating pro-inflammatory immune responses. Thus, possibly reducing the risk of cardiovascular disorders and facilitating long-term improvement of the gut flora.

Sexual behaviour, STI knowledge and Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) prevalence in an asymptomatic cohort in Ruhr-area, Germany: PreYoungGo study.

BACKGROUND AND OBJECTIVES: STIs present a significant threat to individual and public health, disproportionately affecting youth. The study aimed to evaluate (a) the prevalence of asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among youth using a rapid assay platform, (b) the participants' sexual behaviour and STI knowledge, (c) the utility of the rapid assay in reducing diagnosis-to-treatment time. METHODS: In this study, 272 subjects (14-31 years) were included between 12/2016 and 7/2018. A questionnaire was used to collect sociodemographic data, sexual behaviour and STI knowledge. Prevalence of CT and NG infections were tested from oral, vaginal and anal swabs for women and oral, anal swabs and urine for men, using the Cepheid Xpert® CT/NG assay. Time intervals between (i) test to the time the patient were informed of the result (turn around time - TAT) and (ii) test to therapy initiation was documented. RESULTS: Of the 272 subjects (48.9% female, 48.9% male, undisclosed 2.2%), 56.6 % reported university education. 46.6% were men who have sex with men (MSM), and 47.4% of women and 63.1% of men had anal intercourse. 59.9% had previously been tested for HIV, while only 39.7% had for CT, 20.6% for NG. Among these asymptomatic youth 7.7% were positive for CT and 5.5% for NG. The localization of CT were 3.7% genital, 5.5% anal and 2.2% oral, while the corresponding localization of NG were 0.4%, 2.9%, 4.4% respectively. 91.8% of the participants were informed of a positive result within 24 h with a median TAT of 03:09 h. 73.3% initiated therapy within 24 h, with a median time from testing to therapy initiation being 06:50 h. CONCLUSION: Asypmtomatic CT and NG infections are common and often not tested in persons at risk. The Cepheid Xpert® CT/NG assay is an effective strategy as it reduces STI diagnosis-to-treatment time to less than a day.

HIV pre-exposure prophylaxis during the SARS-CoV-2 pandemic: Results from a prospective observational study in Germany.

Aims: Since 2017, HIV pre-exposure prophylaxis (PrEP) care has been provided through an intersectoral collaboration at WIR (Walk-in-Ruhr, Center for Sexual Health and Medicine, Bochum, Germany). The aim of this study was to establish possible impact of COVID-restrictions on the sexual behavior of PrEP users in North Rhine-Westphalia. Methods: The current PrEP study collected data of individuals using PrEP, their sexual behavior and sexually transmitted infections (STIs) before (each quarter of year 2018) and during the COVID-19 pandemic (each quarter of year 2020). Results: During the first lockdown in Germany from mid-March until May 2020, PrEP-care appointments at WIR were postponed or canceled. Almost a third of PrEP users had discontinued their PrEP intake in the 2nd quarter of 2020 due to alteration of their sexual behavior. The number of sexual partners decreased from a median of 14 partners in the previous 6 months in 1st quarter of 2020, to 7 partners in 4th quarter of 2020. Despite such a significant reduction in partner number during the pandemic in comparison to the pre-pandemic period, a steady rate of STIs was observed among PrEP users in 2020. Conclusion: The SARS-CoV-2-pandemic has impacted PrEP-using MSM in North Rhine-Westphalia with respect to their PrEP intake regimen and sexual behavior in 2020. Our study revealed a steady rate of STI among PrEP users even during the pandemic, thus highlighting the importance of ensuring appropriate HIV/STI prevention services in times of crisis.

Age specific evaluation of sexual behavior, STI knowledge and infection among asymptomatic adolescents and young adults.

OBJECTIVES: Adolescents and young adults account for 50% of new infections with sexually transmitted infection (STI), while representing only 25% of the sexually active population. An evaluation of sexual behavior, STI knowledge and infection among youth of different age groups is relevant to formulate effective sexual health strategies. METHODS: In this monocentric, open, prospective cross-sectional study, 268 asymptomatic subjects (14-30 years) were partitioned into three cohorts I: 14-19 (n=42), II: 20-25 (n=147) and III: 25-30 (n=79) years. A comparative analysis of their sexual behavior and STI knowledge was performed using a 21-item questionnaire at the WIR-Center for Sexual Health and Medicine. Prevalence of chlamydia and gonococcal infections were tested, using the Cepheid Xpert® CT/NG assay. RESULTS: The three age-specific cohorts showed statistically significant differences in their relationship status, their sexual contacts and the number of life-time sexual partners. Independent of age, men who have sex with men had greater number of sexual partners across all age groups. Although >95% of participants were aware of HIV in all age groups, the corresponding awareness of non-HIV STI was consistently lower in cohort I. The awareness of trichomonas, mycoplasma and candida in particular was <50% across all agedemographies. Chlamydia screening remains poor despite current chlamydia infection among cohort I, II & III being 7.1%, 5.4%, & 11.4% respectively. CONCLUSION: Our study demonstrates a demographic divide in the knowledge on most frequent STI apart from HIV. Current education, screening and vaccination programs for STI among the younger demographic should be improved.

Pregnancy outcomes after maternal varenicline use; analysis of surveillance data collected by the European Network of Teratology Information Services.

Varenicline is a smoking cessation aid for which limited data exist concerning safety during human pregnancy. This multicentre prospective observational comparative cohort study was undertaken using surveillance data collected by the European Network of Teratology Information Services. The study sample consisted of 89 varenicline exposed pregnancies and two matched comparator groups; 267 non-teratogen exposed (NTE) controls and 78 exposed to nicotine replacement therapy or bupropion (NRT/B) for smoking cessation. For all exposed pregnancies, varenicline use only occurred in the first trimester, with a considerable proportion discontinuing use in the very early stages of pregnancy. The major congenital malformation rate (n=2/89, 2.25%) was in keeping with the expected background rate (2-4%), and was not significantly increased for first trimester varenicline-exposed infants in comparison with non-exposed controls (vs. NTE: OR 2.02, 95%CI 0.166 to 17.9, vs. NRT/B: OR 0.874, 95%CI 0.0620 to 12.3). However, the small sample size produced very imprecise risk estimates.

Response to phenelzine among depressed patients with features of hysteroid dysphoria.

A 21-item questionnaire eliciting features of hysteroid dysphoria was administered to 51 depressed outpatients. Of the 47 patients who completed a 6-week double-blind study comparing the efficacy of amitriptyline and phenelzine, 14 had questionnaire scores greater than or equal to 13 (high score) and 33 had scores less than 13 (low score). Nine of nine high-score patients responded to phenelzine; only three of five high-score patients responded to amitriptyline. Low-score patients responded equally well to either drug (79% improved). These findings suggest that some depressed patients have features of hysteroid dysphoria and that these patients respond preferentially to phenelzine.

A major CYP2D6 autoepitope in autoimmune hepatitis type 2 and chronic hepatitis C is a three-dimensional structure homologous to other cytochrome P450 autoantigens.

Liver-kidney microsomal antibodies type 1 (LKM) are a diagnostic marker for autoimmune hepatitis type 2 (AIH-2), however, LKM autoantibodies are also detected in a small percentage of patients with chronic hepatitis C. The major target of LKM antibodies as evidenced by indirect immunofluorescence is cytochrome P4502D6 (CYP2D6). Anti-CYP2D6 titers of 62 LKM positive sera, 196 sera of patients with hepatic and rheumatic diseases and 33 sera of healthy blood donors (BD) were determined by an in vitro transcription/in vitro translation assay (ITT). Twenty five out of 26 AIH-2 sera and 33/36 LKM positive hepatitis C virus (HCV) sera were anti-CYP2D6 positive by ITT and antibody titers were similar in both patient groups. Epitope mapping experiments were performed by a series of truncated CYP2D6 proteins and by single epitopes of 257-269, 321-351, 373-389 and 410-419 amino acid (aa) expressed as DHFR-fusion proteins in Escherichia coli. The major linear epitope consists of 257-269 aa. This epitope is recognized with a significantly higher prevalence (64%) in AIH-2 than in LKM sera from patients with chronic hepatitis C (24%) (p < 0.001). None of the other autoepitopes showed significant differences in the prevalence of recognition by sera from both patient groups. Minor binding sites consisted of 321-351 aa, which was recognized by less than 20% of LKM sera and in the C-terminal region of 350-494 aa, which was recognized by less than 5% of LKM sera Our study revealed an epitope of 321-379 an on CYP2D6, which was shown to be conformation dependent. It was recognized by the vast majority of LKM sera, specifically by 76% of sera from HCV positive LKM patients and also by 76% of sera from patients with AIH-2. This epitope is homologous to three-dimensional epitopes detected by autoantibodies directed against hepatic cytochromes P450s in drug induced hepatitis and to an autoepitope on CYP21B associated with adrenal failure.

A seven-and-a-half-year survival study of resin-bonded bridges.

A clinical trial, concerning 203 resin-bonded bridges (RBBs), was performed for investigation of the influence of retainer-type and cementation materials on the survival of these restorations. The survival rates after a 7.5-year follow-up were 75% for anterior RBBs and 44% for posterior bridges. Etched metal RBBs (E-bridges) were significantly more retentive than perforated RBBs (P-bridges); the survival rates were 78% and 63%, respectively. With respect to the cementation materials, Clearfil F, in combination with E-bridges, had the best overall survival (89%, anterior and posterior). Maxillary anterior RBBs were more susceptible to failure than mandibular anterior RBBs.

Prevalence in the Dutch adult population and a meta-analysis of signs and symptoms of temporomandibular disorder.

A nationwide survey of oral conditions, treatment needs, and attitudes toward dental health care in Dutch adults was carried out in 1986. One of the aims of the study was to assess the prevalence of signs and symptoms of temporomandibular disorder (TMD). A sample of 6577 persons (from 15 to 74 yr of age), stratified for gender, age, region, and socio-economic status, was contacted. Of this sample, 4496 persons participated in the behavioral part of the study, of whom 3526 were examined clinically. The TMD prevalence was based on (1) perceived signs and symptoms of TMD and (2) clinical examination of joint sounds, deviation, and pain on mandibular movements. A total of 21.5% of the Dutch adult population perceived some dysfunction, and 44.4% showed clinically assessed signs and symptoms of TMD. In nearly all age groups, the signs and symptoms of TMD appeared more in women than in men. Agreement between the results of the clinical examination and the anamnestic dysfunction index was significant (p < 0.0001); however, the Pearson's correlation coefficient was low (r = 0.29). The odds-value (risk-ratio) that subjects who perceived signs and symptoms of TMD would present with clinically assessed signs and symptoms of TMD was 2.3. The results of the survey were compared with results of a meta-analysis performed on 51 TMD prevalence studies. The analysis revealed (1) a perceived dysfunction rate of 30% and (2) a clinically assessed dysfunction of 44%, both based on compound samples of, respectively, over 15,000 (23 studies) and over 16,000 (22 studies) randomly selected subjects.

Demand and need for treatment of craniomandibular dysfunction in the Dutch adult population.

A nationwide survey of oral conditions, treatment needs, and attitudes toward dental health care in Dutch adults was carried out in 1986. One of the aims of the study was to investigate the perceived need and demand for treatment of craniomandibular dysfunction (CMD). A sample of 6577 persons (15-74 yrs of age), stratified for gender, age, region, and socio-economic status, was contacted. Of this sample, 4496 persons participated in the behavioral part of the study, of which 3526 were examined clinically. The CMD-treatment demand was based on (1) CMD complaints in the past, (2) CMD complaints at present, and (3) an anticipated increase of the present complaints. CMD was both anamnestically and clinically assessed, independently by different examiners. A total of 21.5% of the Dutch adult population reported dysfunction, but 85% of these perceived no need for treatment. With most of the remaining 15% either seeking or intending to seek treatment (or having had it before), a figure of 3.1% can be used to summarize the actual level of treatment need for CMD in the Dutch adult population.

Diurnal variations of estriol and cortisol in serum and urine in late pregnancy with and without fenoterol-therapy.

The serum concentration of unconjugated estriol, total estriol, cortisol in one hour intervals and the urinary excretion of total estrogens and cortisol in three hour intervals was determined in eleven apparently healthy women between 26 and 40 weeks of gestation. They were divided into two groups, in order to study the influence of Fenoterol treatment on the daily variation of the measured parameters. Six patients were treated with Fenoterol and five patients received no medication. Between the two groups no statistical differences could be detected for the measured parameters. Regular and marked diurnal variations in cortisol have been observed, whereas total and unconjugated estriol showed small and irregular daily changes. These daily variations of "estriol" were of the same magnitude as the two-fold methodical standard deviation. For this reason it is not necessary to standardize the sampling time.

Distal extension removable partial dentures supported by implants and residual teeth: considerations and case reports.

The traditional treatment for an edentulous maxilla opposed by a partially edentulous mandible with a complete denture and a distal extension removable partial denture is fundamentally inadequate. Continuing resorption of alveolar bone under the denture base of the removable partial denture causes changes in the occlusal plane. Consequently, overloading of the anterior maxillary region occurs, usually leading to increased bone resorption in the anterior maxillary ridge. Placement of implants beneath the distal extension denture base of the removable partial denture can result in a stable and durable occlusion. Two patients in whom the use of implants combined with a cast metal removable partial denture provided occlusal stability and improved functional comfort are presented.

Management of an anterior defect with a removable partial denture supported by implants and residual teeth: a case report.

The treatment of a patient with a major defect in the anterior region of the mandible is described. A large part of the anterior dental arch and underlying mandibular bone was involved in the defect. A removable partial denture supported by implants as well as residual teeth was used to restore the defect. Compared with a traditional removable partial denture, which was used by the patient for several years as an interim prosthesis, the application of implants resulted in improved functional comfort and stability.

A method to compare cost-effectiveness of dental treatments: adhesive bridges compared to conventional bridges.

The cost-effectiveness of a dental restoration depends primarily on the durability and the cost of the restoration. In this report a method is described to compare the cost-effectiveness using the durability data of adhesive bridges and conventional bridges. The study shows that, for the situation in the Netherlands, the breakeven point for equal cost-effectiveness compared to conventional bridges is achieved when the 50% survival for adhesive bridges is approximately 6.5 yr. Clinical data indicate a higher cost-effectiveness for anterior adhesive bridges. The method described in this report is considered to be useful for comparing cost-effectiveness of dental restorations in different situations.

A meta-analysis of durability data on conventional fixed bridges.

A meta-analysis was performed on the dental literature since 1970, presenting clinical data of conventional bridges. 42 publications were found that contained durability data of conventional fixed bridges. These publications dealt with 33 different samples. According to the exclusion criteria 26 studies were excluded for the meta-analysis. The data of 4118 conventional bridges were analyzed. The calculated overall survival rate was 74.0 +/- 2.1% after 15 yr.

Relationship between wearing a removable partial denture and satisfaction in the elderly.

Natural dentitions of elderly people are often reduced, remaining teeth heavily restored and removable partial dentures (RPD's) frequently used to replace absent teeth. Lack of knowledge exists on how the elderly experience the comfort of these replacements. To get more insight 320 dentate noninstitutionalized subjects between 55 and 75 yr of age were clinically examined and interviewed by means of a questionnaire. Data showed that only 13% of the subjects had a complete dentition from the right to the left first molar; 50% had less than four occlusal units. 39% of the subjects was wearing a RPD. Analysis showed that subjects with a RPD were in general less satisfied with their dental state than subjects without a partial denture. However, when the RPD added occlusal units to the dentition, satisfaction increased significantly. No differences in satisfaction were found between subjects with a metal frame prosthesis and an acrylic denture, nor between tooth-bounded and distal extension prostheses. The conclusion can be drawn that the indication for a RPD should be limited in elderly people, unless the RPD increased the number of the occlusal units.

The shortened dental arch concept and its implications for oral health care.

The minimum number of teeth needed to satisfy functional demands has been the subject of several studies. However, since functional demands--and consequently the number of teeth needed--can vary from individual to individual, this minimum number cannot be defined exactly. In general, occlusion of a complete dental arch is preferable. However, this goal might be neither attainable, for general, dental or financial reasons, nor necessary. Many studies demonstrate that shortened dental arches comprising the anterior and premolar regions can meet the requirements of a functional dentition. Consequently, when priorities have to be set, restorative therapy should be aimed at preserving the most strategic parts of the dental arch: the anterior and premolar regions. This also implies that in cases of a shortened dental arch, the prompt replacement of absent posterior molars by free-end removable partial dentures leads to overtreatment and discomfort. The shortened dental arch concept is based on circumstantial evidence: it does not contradict current theories of occlusion and fits well with a problem-solving approach. The concept offers some important advantages and may be considered a strategy to reduce the need for complex restorative treatment in the posterior regions of the mouth.

An analysis of multiple failures of resin-bonded bridges.

A clinical trial involving 203 resin-bonded bridges (RBBs) was undertaken to investigate the influence of several variables on the survival of these prostheses. This article presents the experiences with rebonded and replacement RBBs after failure of the originally bonded RBBs. A total of 62 dislodged and rebonded RBBs was included in this study and evaluated using Kaplan-Meier estimates. Rebonded RBBs that dislodged for a second time were replaced by another type of RBB ('replacement' RBBs, n = 32). The study revealed that rebonded RBBs were more susceptible to dislodgement than originally bonded RBBs. Fifty per cent survival was reached 2.1 years after rebonding. The sooner the first dislodgement occurred, the lower the retention rate of the rebonded RBB (PH-model, beta = 0.78, P = 0.02). Also some failure characteristics were evaluated. Failure characteristics (i.e. fracture site and partial versus complete dislodgement) of first and second dislodgement were not correlated (Chi-square, P values > 0.25). The survival of 'replacement' RBBs was significantly better than the survival of multiply failure RBBs (median survivals respectively 1.6 years and 1.0 year, P = 0.03). From the results of this study it may be concluded that the survival rates of rebonded and replacement RBBs were unacceptable.

An analysis of durability data on post and core restorations.

An attempt was made to review the dental literature since 1970, presenting clinical data of posts and core restorations, by the use of a meta-analytic procedure. Fourteen publications were found that contained durability data on post and core systems. According to the exclusion criteria 11 studies were excluded for further analysis of the data. The survivals of these studies varied from 98.6% survival after a follow-up period of more than 10 years (F.S. Weine et al. 1991, J. Endodont. 17, 293-297) to 77.6% survival after a mean follow-up period of 5.2 years (D.H. Roberts, 1970, Br. Dent. J. 128, 117-124). The data of the three selected studies were reconstructed according to the method of Kaplan-Meier but could not be combined for an overall survival assessment because the study characteristics were too heterogeneous. Therefore the survivals were presented separately. The reconstructed survivals of the studies after 6 years were 81% survival (standard error 6%) for resin composite build-ups in combination with screw posts and 91% survival for two studies including cast posts and cores (standard errors respectively 3% and 2%). Although it was not meaningful to combine the data for an overall survival, the meta-analytic method of this study revealed homogenic survival data and as such the followed procedure is considered to be an appropriate method to obtain insights in clinical durability data.

Shortened dental arches and masticatory ability.

In a previous study concerning oral function with shortened dental arches, it was found that approximately 10 per cent of the patients investigated complained of impaired masticatory ability despite a substantial reduction in arch length and, as a consequence, food platform area. This finding differs from those of studies relating masticatory performance to food platform area. From a review of pertinent literature, it is concluded that impairment of masticatory ability is manifest when less than 10 occluding pairs of teeth are present. Shortened dental arches are not associated with shifts in food selection adversely affecting general health.