Perceptions of professional social media interaction with patients and faculty members - a comparative survey among dental students from Malaysia and Finland.

BACKGROUND: Professional and personal boundaries are blurred with the wide application of social media (SM) in the health professions line of work. Little is known about practice of extending friend requests to patients and faculty members among dental students, which encompass a part of E-professionalism. The aim of this study is to assess the factors associated with the perceptions and practices of interactions with patients and faculty on SM among dental students from Malaysia and Finland. METHODS: Dental students from 4 institutions in Malaysia and Finland completed self-administered questionnaires on the practices and perceptions of SM use. The main variables assessed were the perceptions and practices of student-patient and student-faculty communication on SM, between the two countries. Students' country, age, gender, time spent on SM and perceived importance of communicating dental related aspects over SM were analysed as potential explanatory variables. Crosstabulation was used to estimate the distributions of the response variables by the background characteristics. Multivariate analyses were performed using a dichotomous logistic regression model to investigate relevant associations between the responses and the explanatory variables independent from other factors. RESULTS: A total of 643 students completed the survey in March-April 2021. More Malaysian students agreed with "guiding patients online is a new responsibility for dentists in the digital age" compared to Finnish students (86.4% vs. 73.4%). Similarly, significantly more Malaysian students befriended patients (14.1% vs. 1%) and invited faculty to be friends on SM (73.6% vs. 11.8%). Expectedly, clinical year students befriended patients more than pre-clinical (13.8% vs. 6.8%). Significantly more students who felt 'communication of dental related issues over SM' were likely to extend friend requests to faculty rather than accept patient friend requests. CONCLUSIONS: Social media regulations and socio-cultural practices contribute to dental students' attitudes and behaviour when befriending patients and faculty members on social media. Future dental curriculum should incorporate guidelines for professional communication on social media based on local and cultural needs. Students' should be encouraged to interact with their patients using professional identities on social media.

Tertiary lymphoid structures associate with improved survival in early oral tongue cancer.

BACKGROUND: The clinical significance of tertiary lymphoid structures (TLSs) is not well-documented in early oral tongue squamous cell carcinoma (OTSCC). METHODS: A total of 310 cases of early (cT1-2N0) OTSCC were included in this multicenter study. Assessment of TLSs was conducted on hematoxylin and eosin-stained sections. TLSs were assessed both in the central part of the tumor and at the invasive front area. RESULTS: The presence of TLSs associated with improved survival of early OTSCC as presented by Kaplan-Meier survival analyses for disease-specific survival (P = 0.01) and overall survival (P = 0.006). In multivariable analyses, which included conventional prognostic factors, the absence of TLSs associated with worse disease-specific survival with a hazard ratio (HR) of 1.96 (95% CI 1.09-3.54; P = 0.025) and poor overall survival (HR 1.66, 95% CI 1.11-2.48; P = 0.014). CONCLUSION: Histological evaluation of TLSs predicts survival in early OTSCC. TLSs showed superior prognostic power independent of routine WHO grading and TNM staging system.

BRCA1 mislocalization leads to aberrant DNA damage response in heterozygous ABRAXAS1 mutation carrier cells.

Whilst heterozygous germline mutations in the ABRAXAS1 gene have been associated with a hereditary predisposition to breast cancer, their effect on promoting tumourigenesis at the cellular level has not been explored. Here, we demonstrate in patient-derived cells that the Finnish ABRAXAS1 founder mutation (c.1082G > A, Arg361Gln), even in the heterozygous state leads to decreased BRCA1 protein levels as well as reduced nuclear localization and foci formation of BRCA1 and CtIP. This causes disturbances in basal BRCA1-A complex localization, which is reflected by a restraint in error-prone DNA double-strand break repair pathway usage, attenuated DNA damage response and deregulated G2-M checkpoint control. The current study clearly demonstrates how the Finnish ABRAXAS1 founder mutation acts in a dominant-negative manner on BRCA1 to promote genome destabilization in heterozygous carrier cells.

Long-term prognosis of new adult-onset asthma in obese patients.

BACKGROUND: Obesity has been associated with poor outcomes of asthma in cross-sectional studies, but long-term effect of obesity on asthma remains unknown. AIMS: To study the effects of obesity, found at the time of diagnosis of adult-onset asthma, on 12-year prognosis by focusing on oral corticosteroid (OCS) use and respiratory-related hospital admissions. METHODS: Patients diagnosed with adult-onset asthma (n=203) were divided into three categories based on diagnostic body mass index (BMI) (<25 kg·m-2, 25-29.9 kg·m-2, ≥30 kg·m-2) and followed for 12 years as part of the Seinäjoki Adult Asthma Study. Self-reported and dispensed OCS were assessed for the 12-year period. Data on hospital admissions were analysed based on medical records. RESULTS: 12 years after diagnosis, 86% of the patients who were obese (BMI ≥30 kg·m-2) at diagnosis remained obese. During the follow-up, no difference was found in weight gain between the BMI categories. During the 12-year follow-up, patients obese at diagnosis reported more frequent use of OCS courses (46.9% versus 23.1%, p=0.028), were dispensed OCS more often (81.6% versus 56.9%, p=0.014) and at higher doses (median 1350 (interquartile range 280-3180) mg versus 600 (0-1650) mg prednisolone, p=0.010) compared to normal-weight patients. Furthermore, patients who were obese had more often one or more respiratory-related hospitalisations compared to normal-weight patients (38.8% versus 16.9%, p=0.033). In multivariate logistic regression analyses, obesity predicted OCS use and hospital admissions. CONCLUSIONS: In adult-onset asthma, patients obese at diagnosis mostly remained obese at long-term and had more exacerbations and respiratory-related hospital admissions compared to normal-weight patients during 12-year follow-up. Weight loss should be a priority in their treatment to prevent this outcome.

FAK, paxillin, and PI3K in ameloblastoma and adenomatoid odontogenic tumor.

OBJECTIVE: Integrins function to bind cells to extracellular matrix in tissues, which triggers downstream signaling cascades that are important in cell survival, proliferation, cytokine activation, and cytoskeleton reorganization. These processes also play significant roles in neoplasms. This work aimed to investigate the pattern of expression of FAK, paxillin, and PI3K in ameloblastoma and adenomatoid odontogenic tumor (AOT). MATERIALS AND METHODS: Immunohistochemistry was used to study FAK, paxillin, and PI3K in 45 ameloblastomas (32 conventional, 12 unicystic, and 1 peripheral types), 7 AOTs, and two developing human teeth. RESULTS: Weak expression of FAK was seen in all AOT cases, while ameloblastoma had varying expression patterns, mostly strong to weak. The pattern of expression of paxillin and PI3K was relatively similar in both tumor types. In the dental germ, FAK and paxillin stained all the enamel organ components, while PI3K stained strongly the inner enamel epithelium. Stromal expression of FAK was not found to be useful in differentiating between tumors or tumor classes. CONCLUSION: The expression of the proteins in the enamel organ suggests that their signaling may be important in odontogenesis. While some ameloblastomas strongly expressed FAK, all cases of AOT had weak signals suggesting low presence and phosphorylating activity of FAK in the latter. CLINICAL RELEVANCE: A subset of FAK-positive ameloblastoma (as well as their malignant or metastasizing counterparts) which may have relatively aggressive behavior may be candidates for drug targeting of FAK as an additional management option.

The Quality of Statistical Reporting and Data Presentation in Predatory Dental Journals Was Lower Than in Non-Predatory Journals.

Proper peer review and quality of published articles are often regarded as signs of reliable scientific journals. The aim of this study was to compare whether the quality of statistical reporting and data presentation differs among articles published in 'predatory dental journals' and in other dental journals. We evaluated 50 articles published in 'predatory open access (OA) journals' and 100 clinical trials published in legitimate dental journals between 2019 and 2020. The quality of statistical reporting and data presentation of each paper was assessed on a scale from 0 (poor) to 10 (high). The mean (SD) quality score of the statistical reporting and data presentation was 2.5 (1.4) for the predatory OA journals, 4.8 (1.8) for the legitimate OA journals, and 5.6 (1.8) for the more visible dental journals. The mean values differed significantly (p < 0.001). The quality of statistical reporting of clinical studies published in predatory journals was found to be lower than in open access and highly cited journals. This difference in quality is a wake-up call to consume study results critically. Poor statistical reporting indicates wider general lower quality in publications where the authors and journals are less likely to be critiqued by peer review.

Cell-in-cell phenomenon associates with aggressive characteristics and cancer-related mortality in early oral tongue cancer.

BACKGROUND: Cell-in-cell structures (caused by cell cannibalistic activity) have been related to prognosis of many cancers. This is the first multi-institutional study to assess the prognostic impact of cell-in-cell structures in a large cohort of early oral tongue squamous cell carcinomas (OTSCC). METHODS: A total of 308 cases from five Finnish University Hospitals and from the A.C. Camargo Cancer Center, São Paulo, Brazil, were included in this study. Cell-in-cell structures were evaluated on surgical postoperative sections that stained with hematoxylin and eosin staining. RESULTS: We found that cell-in-cell structures associated with cancer-related mortality in univariable analysis with a hazard ratio (HR) of 2.99 (95%CI 1.52-5.88; P = 0.001). This association was confirmed in multivariable analysis (HR 2.22, 95%CI 1.12-4.44; P = 0.024). In addition, statistically significant associations were observed between the cell-in-cell structures and other adverse histopathologic characteristics including deep invasion (P <  0.001), high index of tumor budding (P = 0.007), worst pattern of invasion (P <  0.001), perineural invasion (P = 0.01), and stroma-rich pattern (P = 0.001). CONCLUSIONS: Our findings demonstrate a significant relationship between cell-in-cell formation and aggressive characteristics of early OTSCC. Cell-in-cell structures have a distinct impact as a novel prognostic indicator in early OTSCC and they can be easily assessed during routine pathology practice.

Histological characteristics of early-stage oral tongue cancer in young versus older patients: A multicenter matched-pair analysis.

Little is known about the histopathological characteristics that may differentiate early oral tongue cancer (OTSCC) between young and older patients. From a total of 311 cases diagnosed with clinically early-stage OTSCC at 6 institutions, only 42 patients were young patients were aged ≤45 years. For comparison, 42 patients >60 years old were matched for center of management, clinical stage and gender. We compared epithelial and stromal histopathologic parameters between the two groups. Most of the parameters were similar between the two groups, although the young patients appeared to have marginally higher intensity of tumor budding, histologic risk score, infiltrative pattern of invasion and tumor-stroma ratio. However, none of the factors showed significant difference when comparing the two groups. The histological parameters reflect mechanisms of invasive growth and tissue response to invasive growth, but not the etiological difference in OTSCC between young and older patients. Further investigations are necessary to compare the genetic background of early OTSCC in the two groups.

Genetic modifications of Mecr reveal a role for mitochondrial 2-enoyl-CoA/ACP reductase in placental development in mice.

Mitochondrial fatty acid synthesis (mtFAS) is an underappreciated but highly conserved metabolic process, indispensable for mitochondrial respiration. It was recently reported that dysfunction of mtFAS causes childhood onset of dystonia and optic atrophy in humans (MEPAN). To study the role of mtFAS in mammals, we generated three different mouse lines with modifications of the Mecr gene, encoding mitochondrial enoyl-CoA/ACP reductase (Mecr). A knock-out-first type mutation, relying on insertion of a strong transcriptional terminator between the first two exons of Mecr, displayed embryonic lethality over a broad window of time and due to a variety of causes. Complete removal of exon 2 or replacing endogenous Mecr by its functional prokaryotic analogue fabI (Mecrtm(fabI)) led to more consistent lethality phenotypes and revealed a hypoplastic placenta. Analyses of several mitochondrial parameters indicate that mitochondrial capacity for aerobic metabolism is reduced upon disrupting mtFAS function. Further analysis of the synthetic Mecrtm(fabI) models disclosed defects in development of placental trophoblasts consistent with disturbed peroxisome proliferator-activated receptor signalling. We conclude that disrupted mtFAS leads to deficiency in mitochondrial respiration, which lies at the root of the observed pantropic effects on embryonic and placental development in these mouse models.

Validity of self-reported number of teeth in middle-aged Finnish adults: the Northern Finland Birth Cohort Study 1966.

BACKGROUND: We examined the validity of self-reported number of teeth in middle-aged adults by using representative cohort data to compare corresponding self-reported and clinical values. METHODS: This validity study is part of the representative 46-year-old follow-up of the Northern Finland Birth Cohort 1966 (NFBC1966) Study. Mailed questionnaires (n = 5950) requested information on self-reported number of teeth and background variables (education, tooth brushing and smoking), while clinical oral health examinations (n = 1891) assessed the number of teeth (the 'gold standard'). The main analyses compared the self-reported and clinical values for the number of teeth in 1669 participants. Scatterplot and Bland-Altman plot served for visual analyses, and alternative correlation coefficients (Pearson, Spearman, intraclass) for numerical comparisons separately for men and women, with stratification according to background variables. RESULTS: The clinical assessment revealed that the mean value for the number of teeth was 27.46 (SD = 2.38), while the corresponding value based on self-reported information was 27.48 (SD = 2.78). According to the Bland-Altman plot, the mean difference between the clinical and self-reported values was - 0.02 (95% limits of agreement, LoA: - 3.37 to 3.32). The observed ranges of intraclass correlation coefficients (ICC) among men and women were 0.72 to 0.95 and 0.72 to 0.85, respectively, depending on the background variables. CONCLUSIONS: Self-reported number of teeth in middle-aged Finnish adults agreed closely with the corresponding clinical measure.

Evaluation of an educational intervention in oral health for primary care physicians: a cluster randomized controlled study.

BACKGROUND: Family physicians are in frequent contact with patients, and their contribution to oral health promotion programs could be utilized more effectively. We implemented an oral health care (OHC) educational seminar for physicians and evaluated its impact on their knowledge retention in OHC. METHODS: We conducted an educational trial for primary care physicians (n = 106) working in Public Health Centers in Tehran city. We launched a self-administered questionnaire about pediatric dentistry, general dental, and dentistry-related medical knowledge and backgrounds. Physicians in intervention group A (n = 38) received an educational intervention (Booklet, Continuous Medical Education (CME), and Pamphlet), and those in group B (n = 32) received only an OHC pamphlet. Group C (n = 36) served as the control. A post-intervention survey followed four months later to measure the difference in the physicians' knowledge; the Chi-square test, ANOVA and linear regression analysis served for statistical analysis. RESULTS: The intervention significantly increased the physicians' oral health knowledge scores in all three domains and their total knowledge score (p <  0.001). Those physicians who had lower knowledge scores at the baseline showed a higher increase in their post-intervention knowledge. The models showed no associations between the background variables and the knowledge change. CONCLUSION: The primary care physicians' OHC knowledge improved considerably after an educational seminar with a reminder. These findings suggest that OHC topics should be included in physicians' CME programs or in their curriculum to promote oral health, especially among non-privileged populations.

Lung tissue proteomics identifies elevated transglutaminase 2 levels in stable chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease characterized by irreversible airflow limitation. Cigarette smoking represents the main risk factor, but the specific mechanisms of COPD are not completely understood. Our aim was to identify COPD-specific proteomic changes involved in disease onset and severity. A comparative proteomic analysis of 51 lung tissues from nonsmokers, smokers, smokers with mild to moderate (stage I-II) COPD, severe to very severe COPD (stage III-IV), and patients with α-1-antitrypsin deficiency (AATD) and idiopathic pulmonary fibrosis (IPF) was performed by cysteine-specific two-dimensional difference gel electrophoresis (2D-DIGE) coupled with mass spectrometry. Selected COPD-specific changes were validated by immunoblotting and further by ELISA in 120 induced sputum and plasma samples from nonsmokers, smokers, and patients with COPD (stage I-III). Altogether 82 altered proteins were identified comprising COPD-, AATD-, and IPF-specific, overlapping, and unspecific changes. Cathepsin D (CTSD), dihydropyrimidinase-related protein 2 (DPYSL2), transglutaminase 2 (TGM2), and tripeptidyl-peptidase 1 (TPP1) were validated as COPD-specific. TGM2 was not associated with smoking and correlated with COPD severity in lung tissue. TGM2 levels in sputum and plasma were elevated in patients with COPD (stage II-III) and correlated with lung function. In conclusion, new proteins related to COPD onset and severity could be identified with TGM2 being a novel potential diagnostic and therapeutic target for COPD. Further studies in carefully characterized cohorts are required to validate the identified changes.

Cathepsin K expression is increased in oral lichen planus.

BACKGROUND: Oral lichen planus (OLP) is an idiopathic T-cell-mediated mucosal inflammatory disease. Cathepsin K (Cat K) is one of the lysosomal cysteine proteases. It is involved in many pathological conditions, including osteoporosis and cancer. The expression and role of Cat K in OLP are unknown. METHODS: Twenty-five oral mucosal specimens diagnosed histopathologically as OLP and fourteen healthy controls (HC) were used to study the immunohistochemical (IHC) expression of Cat K. Colocalization of Cat K with CD1a, Melan-A, CD68, CD45, mast cell tryptase (MCT), and Toll-like receptors (TLRs) 4 and 9 were studied using double IHC and/or immunofluorescence (IF) staining. Expression of Cat K was also evaluated in OLP tissue samples before and after topical tacrolimus treatment. RESULTS: Cat K was expressed in a higher percentage of cells in the epithelial zone, and the staining intensity was stronger in the stroma in OLP compared to controls (P < 0.001). In OLP, Cat K was present mostly in melanocytes and macrophages and sporadically in basal keratinocytes, endothelial cells, and extracellularly. Cat K was found also in some fibroblasts in HC and OLP samples. Coexpression of Cat K and TLRs 4 and 9 was seen in some dendritic cells (presumably melanocytes) and macrophages. In OLP, tacrolimus treatment reduced the expression of Cat K in the epithelium but increased it in the stroma. CONCLUSIONS: These results suggest that Cat K is involved in the pathogenesis of OLP. Cat K possibly takes part in the modulation of matrix molecules and cellular receptors.

Does securin expression have significance in prognostication of oral tongue cancer? A pilot study.

The proliferation marker, securin, is involved in the progression of many carcinomas. However, its expression in oral tongue squamous cell carcinoma (OTSCC) has not been previously studied. We examined securin expression by immunohistochemistry in OTSCC. A total of 93 cases treated for OTSCC were included in this study. Expression of securin in OTSCC was studied by immunohistochemistry of tissue microarrays (52 cases) and routine tumor sections (41 cases). Securin overexpression is significantly associated with higher tumor grade (P = 0.03). Overexpression of securin was observed more frequently in advanced stages of OTSCC than in earlier stages but the difference was not statistically significant. These findings suggest that overexpression of securin in OTSCC may be important during progression of this cancer. No significant association was found between securin expression and the prognosis of OTSCC.

Altered expression of hyaluronan, HAS1-2, and HYAL1-2 in oral lichen planus.

BACKGROUND: Oral lichen planus (OLP) is an immune-mediated mucosal disease of unclear etiology and of unresolved pathogenesis. Hyaluronan (HA) is an extracellular matrix glycosaminoglycan involved in inflammation and tumor progression. However, its presence in OLP has not been reported. We therefore aimed to study the immunohistochemical expression of HA, its receptor CD44, hyaluronan synthases (HAS1-3), and hyaluronidases (HYAL1-2) in OLP. METHODS: The presence of HA, CD44, HAS1-3, and HYAL1-2 was studied by immunohistochemical methods in 55 OLP and 23 control oral mucosal specimens (CTR). The localization, intensity, and differences of the epithelial expression between OLP and CTRs were analyzed. RESULTS: HA and CD44 were found on cell membranes in the epithelial basal and intermediate layers in CTR and OLP specimens. The HA staining intensity was stronger in the basal layer of the epithelium in OLP than in CTRs (P < 0.001). HAS1 (P = 0.001) and HAS2 (P < 0.001) showed stronger staining in the basal and weaker staining in the superficial (P < 0.001) epithelial layers in OLP than in CTRs. The immunostaining of HAS3 was low in both OLP and CTRs. Positive HYAL1 and HYAL2 staining were mainly found in the basal and intermediate epithelial layers, and their intensities were significantly increased in OLP, except HYAL 2 in the intermediate epithelial layer. CONCLUSIONS: HA, HAS1-2, and HYAL1-2 have altered expression in OLP compared to CTRs and may therefore have a role in OLP pathogenesis.

Statistically Non-significant Papers in Environmental Health Studies included more Outcome Variables.

OBJECTIVE: The number of analyzed outcome variables is important in the statistical analysis and interpretation of research findings. This study investigated published papers in the field of environmental health studies. We aimed to examine whether differences in the number of reported outcome variables exist between papers with non-significant findings compared to those with significant findings. Articles on the maternal exposure to mercury and child development were used as examples. METHODS: Articles published between 1995 and 2013 focusing on the relationships between maternal exposure to mercury and child development were collected from Medline and Scopus. RESULTS: Of 87 extracted papers, 73 used statistical significance testing and 38 (43.7%) of these reported 'non-significant' (P>0.05) findings. The median number of child development outcome variables in papers reporting 'significant' (n=35) and 'non-significant' (n=38) results was 4 versus 7, respectively (Mann-Whitney test P-value=0.014). An elevated number of outcome variables was especially found in papers reporting non-significant associations between maternal mercury and outcomes when mercury was the only analyzed exposure variable. CONCLUSION: Authors often report analyzed health outcome variables based on their P-values rather than on stated primary research questions. Such a practice probably skews the research evidence.

The statistical reporting quality of articles published in 2010 in five dental journals.

OBJECTIVES: Statistical methods play an important role in medical and dental research. In earlier studies it has been observed that current use of methods and reporting of statistics are responsible for some of the errors in the interpretation of results. The aim of this study was to investigate the quality of statistical reporting in dental research articles. METHODS: A total of 200 articles published in 2010 were analysed covering five dental journals: Journal of Dental Research, Caries Research, Community Dentistry and Oral Epidemiology, Journal of Dentistry and Acta Odontologica Scandinavica. Each paper underwent careful scrutiny for the use of statistical methods and reporting. A paper with at least one poor reporting item has been classified as 'problems with reporting statistics' and a paper without any poor reporting item as 'acceptable'. RESULTS: The investigation showed that 18 (9%) papers were acceptable and 182 (91%) papers contained at least one poor reporting item. CONCLUSIONS: The proportion of at least one poor reporting item in this survey was high (91%). The authors of dental journals should be encouraged to improve the statistical section of their research articles and to present the results in such a way that it is in line with the policy and presentation of the leading dental journals.

Soluble receptor for advanced glycation end-products and progression of airway disease.

BACKGROUND: The receptor for advanced glycation end-products (RAGE) is highly expressed in the lung, where it is believed to have a homeostatic role. Reduced plasma levels of soluble RAGE (sRAGE) have been reported in patients with chronic obstructive pulmonary disease (COPD). The aim of the present study was to evaluate the association of plasma sRAGE levels with a longitudinal decline of lung function. We have also measured plasma levels of high mobility group box 1 (HMGB1), a RAGE ligand which has been associated with chronic inflammatory diseases including COPD. METHODS: Baseline plasma concentrations of sRAGE and HMGB1 were measured in non-smokers (n = 32), smokers without COPD (n = 212), and smokers with COPD (n = 51), and the associations of the plasma sRAGE and HMGB1 levels with longitudinal declines of lung function during a 4-year follow-up period were analysed. RESULTS: The plasma levels of sRAGE were significantly lower in smokers without COPD and in smokers with COPD, as compared to those of non-smokers. Plasma sRAGE levels positively correlated with FVC and FEV1 and inversely correlated with BMI and pack-years. Lower sRAGE levels were associated with greater declines of FEV1/FVC over 4 years in all participants. Moreover, multivariate regression analysis indicated that the baseline plasma sRAGE concentration was an independent predictor of FEV1/FVC decline in all groups. A subgroup analysis showed that decreased sRAGE levels are significantly associated with a more rapid decline of FEV1/FVC in smokers with COPD. There was no significant correlation between plasma HMGB1 levels and longitudinal decline of lung function. CONCLUSIONS: Lower plasma concentrations of sRAGE were associated with greater progression of airflow limitations over time, especially in smokers with COPD, suggesting that RAGE might have a protective role in the lung.