Contact allergies to dental materials in patients.

BACKGROUND: Concerns regarding contact allergies and intolerance reactions to dental materials are widespread among patients. Development of novel dental materials and less frequent amalgam use may alter sensitization profiles in patients with possible contact allergy. OBJECTIVES: To analyse current sensitization patterns to dental materials in patients with suspected contact allergy. METHODS: This retrospective, multicentre analysis from the Information Network of Departments of Dermatology (IVDK) selected participants from 169 834 people tested in 2005-2019 and registered with (i) an affected area of 'mouth' (and 'lips'/'perioral'), (ii) with the dental material in question belonging to one of three groups (dental filling materials, oral implants or dentures or equivalents) and (iii) with patch-testing done in parallel with the German baseline series, (dental) metal series and dental technician series. RESULTS: A total of 2730 of 169 834 tested patients met the inclusion criteria. The patients were predominantly women (81.2%) aged ≥ 40 years (92.8%). The sensitization rates with confirmed allergic contact stomatitis in women (n = 444) were highest for metals (nickel 28.6%, palladium 21.4%, amalgam 10.9%), (meth)acrylates [2-hydroxyethyl methacrylate (HEMA) 4.8%] and the substances propolis (6.8%) and 'balsam of Peru' (11.4%). The most relevant acrylates were HEMA, 2-hydroxypropyl methacrylate, methyl methacrylate, ethylene glycol dimethacrylate and pentaerythritol triacrylate. Few men were diagnosed with allergic contact stomatitis (n = 68); sensitization rates in men were highest for propolis (14.9%) and amalgam (13.6%). CONCLUSIONS: Allergic contact stomatitis to dental materials is rare. Patch testing should not only focus on metals such as nickel, palladium, amalgam and gold, but also (meth)acrylates and the natural substances propolis and 'balsam of Peru'.

2-Hydroxyethyl methacrylate (HEMA): A clinical review of contact allergy and allergic contact dermatitis. Part 2. Cross- and co-sensitization, other skin reactions to HEMA, position of HEMA among (meth)acrylates, sensitivity as screening agent, presence of HEMA in commercial products and practical information on patch test procedures.

This is the second part of a literature review of the clinical aspects of contact allergy to and allergic contact dermatitis from 2-hydroxyethyl methacrylate (HEMA). Topics include cross- and co-sensitization, atypical manifestations of contact allergy, frequency of positive patch tests to HEMA compared with other (meth)acrylates, sensitivity of HEMA as a screening agent, the presence of HEMA in commercial products, and practical information on patch testing procedures. Primary sensitization to methacrylates including HEMA may result in methacrylate and acrylate cross-sensitization. There is a strong cross-allergy between HEMA, ethylene glycol dimethacrylate (EGDMA), and hydroxypropyl methacrylate; many reactions to EGDMA are cross-reactions to primary HEMA sensitization. Rare atypical manifestations of HEMA-allergy include lichen planus, lymphomatoid papulosis, systemic contact dermatitis, leukoderma after positive patch tests, and systemic side effects such as nausea, diarrhoea, malaise, and palpitations. The occurrence of respiratory disease caused by methacrylates such as asthma is not infrequent. HEMA is the most frequently patch test-positive methacrylate. It is a good screening agent for allergy to other (meth)acrylates. Patch test sensitization to HEMA 2% pet. is extremely rare. There are (some) indications that HEMA is frequently used in dental products and nail cosmetics.

Increased Rates of Gold and Acrylate Allergy in Individuals with Fibromyalgia Tested with an Extended Dental Patch Test Series.

Fibromyalgia is a common chronic pain condition. Rates of contact allergy in individuals with fibromyalgia have not been widely studied. Systemic contact allergy can present with muscle and joint pain and general malaise. The aim of this study is to investigate contact allergy rates in individuals with fibromyalgia to the sensitizers in an extended dental series and compare with control groups. Contact allergy to gold was significantly more common in the fibromyalgia group than the dermatitis control group. When corrected for patch test system, contact allergy to gold was significantly more common in the fibromyalgia group than the dental control group. Contact allergy to hydroxyethyl methacrylate and grouped acrylates and methacrylates was significantly more common in the fibromyalgia group than the dental control group. In conclusion, individuals with fibromyalgia may have a propensity to sensitization to gold, either via an increased exposure or an alteration in the oral environment. Gold is also implicated in systemic contact dermatitis and may be a factor in elicitation of symptoms in individuals with fibromyalgia. Acrylate allergy is also common in the fibromyalgia population and may be a consequence of occupational exposure or dental treatment.

The COlorectal NEoplasia Endoscopic Classification to Choose the Treatment classification for identification of large laterally spreading lesions lacking submucosal carcinomas: A prospective study of 663 lesions.

INTRODUCTION: Optical diagnosis is necessary when selecting the resection modality for large superficial colorectal lesions. The COlorectal NEoplasia Endoscopic Classification to Choose the Treatment (CONECCT) encompasses overt (irregular pit or vascular pattern) and covert (macroscopic features) signs of carcinoma in an all-in-one classification using validated criteria. The CONECCT IIC subtype corresponds to adenomas with a high risk of superficial carcinoma that should be resected en bloc with free margins. METHODS: This prospective multicentre study investigated the diagnostic accuracy of the CONECCT classification for predicting submucosal invasion in colorectal lesions >20 mm. Optical diagnosis before en bloc resection by endoscopic submucosal dissection (ESD) was compared with the final histological diagnosis. Diagnostic accuracy for the CONECCT IIC subtype was compared with literature-validated features of concern considered to be risk factors for submucosal invasion (non-granular large spreading tumour [NG LST], macronodule >1 cm, SANO IIIA area, and Paris 0-IIC area). RESULTS: Six hundred 63 lesions removed by ESD were assessed. The en bloc, R0, and curative resection rates were respectively 96%, 85%, and 81%. The CONECCT classification had a sensitivity (Se) of 100%, specificity (Sp) of 26.2%, positive predictive value of 11.6%, and negative predictive value (NPV) of 100% for predicting at least submucosal adenocarcinoma. The sensitivity of CONECCT IIC (100%) to predict submucosal cancer was superior to all other criteria evaluated. COlorectal NEoplasia Endoscopic Classification to Choose the Treatment IIC lesions constituted 11.5% of all submucosal carcinomas. CONCLUSION: The CONECCT classification, which combines covert and overt signs of carcinoma, identifies with very perfect sensitivity (Se 100%, NPV 100%) the 30% of low-risk adenomas in large laterally spreading lesions treatable by piecemeal endoscopic mucosal resection or ESD according to expertise without undertreatment. However, the low specificity of CONECCT leads to a large number of potentially not indicated ESDs for suspected high-risk lesions.

High-resolution melting effectively pre-screens for TP53 mutations before direct sequencing in patients with diffuse glioma.

TP53 mutations are important molecular markers in diffuse astrocytic tumors and medulloblastomas. We examined the efficacy of a pre-screening method for high-resolution melting (HRM) analysis of TP53 mutation before direct sequencing using samples from patients with diffuse glioma. Surgical samples from 64 diffuse gliomas were classified based on the 2016 World Health Organization (WHO) histopathological grading system and the cIMPACT-NOW (consortium to inform molecular and practical approaches to CNS tumor taxonomy-not official WHO) update. TP53 mutations from exon 5 to exon 8 were assessed by direct sequencing. The results of HRM and p53 immunohistochemistry (IHC) analysis were compared by recording the sensitivity, specificity, and false negative and false positive rates. Direct sequencing detected TP53 mutations in 18 of 64 samples (28.1%): diffuse astrocytoma, IDH-mutant (n = 3); diffuse astrocytoma, IDH-wild type (n = 1); anaplastic astrocytoma, IDH-mutant (n = 3); anaplastic astrocytoma, IDH-wild type (n = 4); and glioblastoma, IDH-wild type (n = 7). A total of 22 mutations was detected in the 18 samples; 4 samples exhibited duplicate missense mutations. Sensitivity and specificity were 0.96 and 0.96, respectively, for HRM analysis; they were 0.89 and 0.52, respectively, for p53 IHC. Overall accuracy was 0.98 for HRM and 0.63 for IHC. HRM analysis is a good pre-screening method for the detection of TP53 mutation before direct sequencing.

Nail cosmetics: a dermatological perspective.

Nail cosmetics are used by millions worldwide and the variety of products available is expanding. They are relatively safe, but complications can occur, and patients experiencing complications may present to dermatologists. The physical processes can cause nail thinning and onycholysis, poor technique can promote infection, and consumers may develop allergic contact dermatitis. Ultraviolet nail lamps are widely used for curing gel nails, but their use is unregulated and they are readily accessible in salons or for home use. There is concern about potential carcinogenesis; however, the risk is negligible and can be further reduced with the use of sunscreen. Despite the potential complications, nail cosmetics may be a useful adjunct in treating nail disorders. Familiarity with the procedures will enable the dermatologist to recognize problems and advise on safe use.

Development and Validation of the Pediatric Medical Complexity Algorithm (PMCA) Version 3.0.

OBJECTIVE: To modify the Pediatric Medical Complexity Algorithm (PMCA) to include both International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification (ICD-9/10-CM) codes for classifying children with chronic disease (CD) by level of medical complexity and to assess the sensitivity and specificity of the new PMCA version 3.0 for correctly identifying level of medical complexity. METHODS: To create version 3.0, PMCA version 2.0 was modified to include ICD-10-CM codes. We applied PMCA version 3.0 to Seattle Children's Hospital data for children with ≥1 emergency department (ED), day surgery, and/or inpatient encounter from January 1, 2016, to June 30, 2017. Starting with the encounter date, up to 3 years of retrospective discharge data were used to classify children as having complex chronic disease (C-CD), noncomplex chronic disease (NC-CD), and no CD. We then selected a random sample of 300 children (100 per CD group). Blinded medical record review was conducted to ascertain the levels of medical complexity for these 300 children. The sensitivity and specificity of PMCA version 3.0 was assessed. RESULTS: PMCA version 3.0 identified children with C-CD with 86% sensitivity and 86% specificity, children with NC-CD with 65% sensitivity and 84% specificity, and children without CD with 77% sensitivity and 93% specificity. CONCLUSIONS: PMCA version 3.0 is an updated publicly available algorithm that identifies children with C-CD, who have accessed tertiary hospital emergency department, day surgery, or inpatient care, with very good sensitivity and specificity when applied to hospital discharge data and with performance to earlier versions of PMCA.

Effect of Molecular Architecture on Cell Interactions and Stealth Properties of PEG.

PEGylation, covalent attachment of PEG to therapeutic biomolecules, in which suboptimal pharmacokinetic profiles limiting their therapeutic utility are of concern, is a widely applied technology. However, this technology has been challenged by reduced bioactivity of biomolecules upon PEGylation and immunogenicity of PEG triggering immune response and abrogating clinical efficacy, which collectively necessitate development of stealth polymer alternatives. Here we demonstrate that comb-shape poly[oligo(ethylene glycol) methyl ether methacrylate] (POEGMA), a stealth polymer alternative, has a more compact structure than PEG and self-organize into nanoparticles in a molecular weight dependent manner. Most notably, we show that comb-shape POEGMA promotes significantly higher cellular uptake and exhibits less steric hindrance imposed on the conjugated biomolecule than PEG. Collectively, comb-shape POEGMA offers a versatile alternative to PEG for stealth polymer-biomolecule conjugation applications.

(Meth)Acrylate Occupational Contact Dermatitis in Nail Salon Workers: A Case Series.

BACKGROUND: Recently, many cases of acrylate-associated allergic contact dermatitis have appeared among nail salon workers. Common acrylate-containing products in nail salons include traditional nail polish, ultraviolet-cured shellac nail polish, ultraviolet-cured gel nails, and press-on acrylic nails. METHODS: Nail salon technicians seen in the occupational medicine clinic in 2015 and 2016 were identified, and their patch test results and clinical features were summarized. Patch testing was done with the Chemotechnique (Meth)Acrylate nail series, and either the North American Standard series or the North American Contact Dermatitis Group screening series. RESULTS: Six patients were identified, all women, ages 38 to 58. Common presentations included erythematous dermatitis of the dorsa of the hands, palms, and forearms and fissures on the fingertips. Less common sites of eruptions included the periorbital region, cheeks, posterior ears, neck, sacral area, lateral thighs, and dorsa of the feet. All patients reacted to hydroxyethyl methacrylate, and 5 patients reacted to ethyl acrylate. Each patient also reacted to (meth)acrylates that are not found on either standard series, including ethyleneglycol dimethacrylate, 2-hydroxypropyl methacrylate, and 2-hydroxyethyl acrylate. CONCLUSIONS: The authors report 6 cases of allergic contact dermatitis to acrylates in nail technicians seen over the past year, representing a new trend in their clinic. These cases are reflective of a growing trend of nail technicians with allergic contact dermatitis associated with occupational (meth)acrylate exposure. Efforts to improve prevention are needed.

Proptosis and Anterior Dislocation as a Late Noninflammatory Complication of Failure of Tissue Integration in the Alphasphere Implant.

A 57-year-old healthy female underwent enucleation for choroidal melanoma with primary implantation of a 2-hydroxyethyl methacrylate sphere (AlphaSphere, Addition Technology, Des Plaines, IL). Her course was uneventful, with successful prosthetic fitting 6 weeks postoperatively. She returned 2 years later, with anterior displacement of the implant, poor implant movement, and poor prosthetic fit. There was no defect in the conjunctiva, Tenon's layer or evidence of inflammation. Successful orbital implant exchange was performed, replacing the AlphaSphere with an eyebank-scleral wrapped acrylic implant. Intraoperative findings revealed dissolution of the scaffolding aspect of the anterior implant, with loss of extraocular muscle attachments and no fibrovascular ingrowth. This case demonstrates late AlphaSphere failure in an otherwise unremarkable course; further review of similar cases or a larger study is warranted to examine the efficacy of this relatively new implant.

Comparison of the uptake of methacrylate-based nanoparticles in static and dynamic in vitro systems as well as in vivo.

Polymer-based nanoparticles are promising drug delivery systems allowing the development of new drug and treatment strategies with reduced side effects. However, it remains a challenge to screen for new and effective nanoparticle-based systems in vitro. Important factors influencing the behavior of nanoparticles in vivo cannot be simulated in screening assays in vitro, which still represent the main tools in academic research and pharmaceutical industry. These systems have serious drawbacks in the development of nanoparticle-based drug delivery systems, since they do not consider the highly complex processes influencing nanoparticle clearance, distribution, and uptake in vivo. In particular, the transfer of in vitro nanoparticle performance to in vivo models often fails, demonstrating the urgent need for novel in vitro tools that can imitate aspects of the in vivo situation more accurate. Dynamic cell culture, where cells are cultured and incubated in the presence of shear stress has the potential to bridge this gap by mimicking key-features of organs and vessels. Our approach implements and compares a chip-based dynamic cell culture model to the common static cell culture and mouse model to assess its capability to predict the in vivo success more accurately, by using a well-defined poly((methyl methacrylate)-co-(methacrylic acid)) and poly((methyl methacrylate)-co-(2-dimethylamino ethylmethacrylate)) based nanoparticle library. After characterization in static and dynamic in vitro cell culture we were able to show that physiological conditions such as cell-cell communication of co-cultured endothelial cells and macrophages as well as mechanotransductive signaling through shear stress significantly alter cellular nanoparticle uptake. In addition, it could be demonstrated by using dynamic cell cultures that the in vivo situation is simulated more accurately and thereby can be applied as a novel system to investigate the performance of nanoparticle systems in vivo more reliable.

Poly-L-Lysine-Poly[HPMA] Block Copolymers Obtained by RAFT Polymerization as Polyplex-Transfection Reagents with Minimal Toxicity.

Herein we describe the synthesis of poly-L-lysine-b-poly[N-(2-hydroxypropyl)-metha-crylamide)] (poly[HPMA]) block copolymers by combination of solid phase peptide synthesis or polymerization of α-amino acid-N-carboxy-anhydrides (NCA-polymerization) with the reversible addition-fragmentation chain transfer polymerization (RAFT). In the presence of p-DNA, these polymers form polyplex micelles with a size of 100-200 nm in diameter (monitored by SDS-PAGE and FCS). Primary in vitro studies with HEK-293T cells reveal their cellular uptake (FACS studies and CLSM) and proof successful transfection with efficiencies depending on the length of polylysine. Moreover, these polyplexes display minimal toxicity (MTT-assay and FACS-measurements) featuring a p[HPMA] corona for efficient extracellular shielding and the potential ligation with antibodies.

Cement-associated signs of inflammation: retrospective analysis of the effect of excess cement on peri-implant tissue.

PURPOSE: Excess cement left in the peri-implant sulcus after the placement of prosthetic restorations risks inflammation in the peri-implant tissue. While many current studies deal with the question of how to avoid undetected excess cement, relatively little is known about the clinical consequences of this complication. This study analyzed the clinical findings associated with excess cement. Further, the influence of the sojourn time of undetected excess cement in the peri-implant pocket on clinical findings was investigated. MATERIALS AND METHODS: Within the scope of a retrospective clinical follow-up, the suprastructures that were originally cemented with a methacrylate cement were revised in 93 patients (171 implants). The patients were split into two groups according to the time between placement of the prosthetic restoration and revision. Group 1 (G1) had treatment revisions within 2 years of restoration placement (71 patients with 126 implants); in group 2 (G2), treatment revisions were conducted at a later time (22 patients with 45 implants). For the purpose of statistical analysis, both groups were further analyzed based on the presence/absence of excess cement at the time of revision. RESULTS: By definition, the average time to revision in G1 was shorter than in G2 (0.71 years versus 4.07 years). There was no significant difference in the frequency of excess cement at revision between G1 (59.5%) and G2 (62.2%). The clinical findings around the implants in G1 were significantly less severe than in G2 (bleeding on probing: G1 without excess cement--17.6%, G1 with excess cement--80%, G2 without excess cement--94.1%, G2 with excess cement--100%; suppuration: G1 without excess--0%, G1 with excess cement--21.3%, G2 without excess cement--23.3%, G2 with excess cement--89.3%). After removing the excess cement, cleaning and disinfecting the implant abutment and restoration, and using a different cement, significantly fewer signs of inflammation were found at further follow-up in both groups. CONCLUSIONS: Within the limitations of this retrospective observational study, excess cement was present in a high number of cement-retained implant restorations. Signs of inflammation were present in a large proportion of implants at short- to medium-term follow-up. At the time of restoration revisions, the clinical observation of previously undetected excess cement was associated with increased prevalence of inflammation. Removal of excess cement significantly reduced the signs of inflammation.

Does the current fungicide risk assessment provide sufficient protection for key drivers in aquatic ecosystem functioning?

The level of protection provided by the present environmental risk assessment (ERA) of fungicides in the European Union for fungi is unknown. Therefore, we assessed the structural and functional implications of five fungicides with different modes of action (azoxystrobin, carbendazim, cyprodinil, quinoxyfen, and tebuconazole) individually and in mixture on communities of aquatic hyphomycetes. This is a polyphyletic group of fungi containing key drivers in the breakdown of leaf litter, governing both microbial leaf decomposition and the palatability of leaves for leaf-shredding macroinvertebrates. All fungicides impaired leaf palatability to the leaf-shredder Gammarus fossarum and caused structural changes in fungal communities. In addition, all compounds except for quinoxyfen altered microbial leaf decomposition. Our results suggest that the European Union's first-tier ERA provides sufficient protection for the tested fungicides, with the exception of tebuconazole and the mixture, while higher-tier ERA does not provide an adequate level of protection for fungicides in general. Therefore, our results show the need to incorporate aquatic fungi as well as their functions into ERA testing schemes to safeguard the integrity of aquatic ecosystems.

[Anti-oncogene of opioid binding protein/cell adhesion molecule-like methylation status in malignant transformation of human bronchial epithelial cells induced by glycidyl methacrylate].

OBJECTIVE: To analyze the opioid binding protein/cell adhesion molecule-like (OPCML) methylation status at different stages of malignant transformation of human bronchial epithelial (16HBE) cells induced by Glycidyl Methacrylate (GMA) and to explore the effect of OPCML methylation in the process of malignant transformation. METHODS: Cells were harvested at different stages (the 10th generation, the 20th generation and the 30th generation). To verify the Methylation chip result of OPCML methylation status in the process of malignant transformation, we detected it by methylation-specific-PCR (MSP); Real-time fluorescence Quantitative PCR (qPCR) were applied to measure the gene expression levels of OPCML at different transformed stage, and compared with the control groups (treated with DMSO). RESULTS: Based on the result of methylation chip, the gene of OPCML methylation occurred in all stages, which was consistent to the result of MSP; qPCR showed that the levels of gene expression decreased in the 20th generation and 30th generation. CONCLUSION: Methylation status of OPCML gene promoter could be considered as a stable and specific biomarker in the transformation process.

Concomitant contact allergy to formaldehyde and methacrylic monomers in students of dental medicine and dental patients.

OBJECTIVES: A multitude of acrylic monomers is used in dentistry. Formaldehyde is a ubiquitous chemical agent, which is an ingredient of some dental materials and may be released from methacrylate-based composites. The purpose of the study is to evaluate the incidence and the risk of cross-sensitization to some methacrylic monomers (methylmethacrylate - MMA, triethyleneglycol dimethacrylate - TEGDMA, ethyleneglycol dimethacrylate - EGDMA, 2,2-bis-[4-(2-hydroxy-3-methacrylo-xypropoxy)phenyl]-propane - Bis-GMA, 2-hydroxy-ethyl methacrylate 2-HEMA, and tetrahydrofurfuryl methacrylate) and formaldehyde in students of dentistry, dental professionals and dental patients. MATERIAL AND METHODS: A total of 139 participants were included in the study, i.e., occupationally exposed dental professionals, students of the 3rd, 4th and 6th year of dental medicine, and occupationally unexposed dental patients. They were patch-tested with methacrylic monomers and formaldehyde. The results were subjected to statistical analysis (p < 0.05). RESULTS: From the allergic to formaldehyde students of the 3rd and 4th year of dental medicine, 46.2% were also sensitized to MMA. Among the group of patients, the incidence of cross-sensitization to formaldehyde and methacrylic monomers was as follows: to TEGDMA - 20.6%, to ethyleneglycol dimethacrylate - 20.7%, to 2-HEMA - 20.7% and to tetrahydrofurfuryl methacrylate - 24.1%. Contact allergy to MMA was diagnosed among 22.7%, and to TEGDMA - among 27.1% of the students of the 3rd and 4th year of dental medicine. In the group of occupationally unexposed dental patients the prevalence of contact allergy to ethyleneglycol dimethacrylate was 20.7%, to Bis-GMA - 27.6%, to 2-HEMA - 44.9% and to tetrahydrofurfuryl methacrylate - 38.0%. CONCLUSIONS: The students of the 3rd and 4th year of dental medicine could be outlined as a group at risk of sensitization to MMA and TEGDMA and of cross-sensitization to MMA and formaldehyde. Probably, due to the ubiquitous occurrence of formaldehyde and the wide use of composite resins and bonding agents containing TEGDMA, ethyleneglycol dimethacrylate, 2-HEMA and tetrahydrofurfuryl methacrylate in dentistry, the group of dental patients could be at risk of cross-sensitization to formaldehyde and some methacrylic monomers.