Higher Habitual Dietary Intakes of Flavanols and Anthocyanins Differentially Associate with Lower Incidence of Ischemic Stroke Subtypes-A Follow-Up Analysis.

BACKGROUND: We previously reported that habitual consumption of dietary flavanol oligomers + polymers and anthocyanins is associated with a lower risk of ischemic stroke. However, no studies have investigated their relationship with ischemic stroke subtypes. OBJECTIVES: In this follow-up analysis, we aimed to examine the association of flavanol oligomers + polymers and anthocyanin intake with ischemic stroke subtypes, including the following: 1) large-artery atherosclerosis, 2) cardioembolism, 3) small-vessel occlusion, 4) other determined etiology, and 5) undetermined etiology. METHODS: Participants (n = 55,094) from the Danish Diet, Cancer, and Health Study were followed up for <16 y for first-time ischemic stroke events, which were classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Intakes of flavanol oligomers + polymers and anthocyanins were calculated from food frequency questionnaires using the Phenol-Explorer database, and their relationships with ischemic stroke subtypes were investigated using restricted cubic splines within Cox proportional hazards models. After multivariable adjustment, higher habitual intakes (quintile 5 compared with quintile 1) of flavanol oligomers + polymers and anthocyanins were associated with a lower risk of specific ischemic stroke subtypes, including large-artery atherosclerosis [flavanol oligomers + polymers, hazard ratio {HR} (95% confidence interval {CI}): 0.64 (0.47, 0.87)], cardioembolism [anthocyanins, HR (95% CI): 0.45 (0.25, 0.82)], and small-vessel occlusion [flavanol oligomers + polymers, HR (95% CI): 0.65 (0.54, 0.80); anthocyanins, HR (95% CI): 0.79 (0.64, 0.97)], but not stroke of other determined or undetermined etiology. CONCLUSIONS: Higher habitual intakes of flavanols and anthocyanins are differentially associated with a lower risk of ischemic stroke from atherosclerosis and/or cardioembolism but not with other subtypes.

Carbohydrate Mouth Rinse Improves Cycling Time-Trial Performance without Altering Plasma Insulin Concentration.

Rinsing the mouth with a carbohydrate solution has been shown to improve exercise performance in a manner similar to carbohydrate ingestion. However, the underlying mechanisms behind these ergogenic benefits remain unclear. This study evaluated whether rinsing the mouth with a carbohydrate solution alters plasma insulin and glucose concentration during the initial stages of a 40 km cycling time-trial. Eight trained, competitive cyclists [age (mean ± SEM) = 24 ± 2 y; V̇O2max = 64.5 ± 2.2 ml·kg-1·min-1] completed three simulated 40 km time-trials comprised of a familiarization trial, a carbohydrate condition (CHO) and a placebo mouth rinse condition (PLA). In the two mouth rinse conditions, rinsing was administered prior to onset of exercise and every 5 km throughout exercise. Plasma insulin was collected at 5 km intervals throughout the first 25 km, and glucose samples were collected at 5 km intervals throughout the exercise bout. No change in plasma insulin was detected between conditions (p = 0.638, ES < 0.03) for the first 25 km of the time-trial. Likewise, plasma glucose concentration did not differ between CHO and PLA (p = 0.801, ES < 0.01) and remained relatively stable throughout exercise. Time to complete the 40 km time-trial was significantly faster for CHO (67.1 ± 1.1 min) compared to PLA [67.9 ± 1.0 min; (P = 0.028, ES 0.27)]. Performance time was faster by an average of 1.1% (95% confidence interval range 0.2-2.0%) in the CHO condition. Exercise intensity (% V̇O2max) throughout the trial was similar between conditions (p = 0.846). Respiratory exchange ratio was not significantly different between conditions (0.88 ± 0.01 for PLA, and 0.91 ± 0.01 for GLC; p = 0.081). Performance gains elicited by a carbohydrate mouth rinse occurred independently of changes in plasma insulin concentration.

Flexible and accessible workflows for improved proteogenomic analysis using the Galaxy framework.

Proteogenomics combines large-scale genomic and transcriptomic data with mass-spectrometry-based proteomic data to discover novel protein sequence variants and improve genome annotation. In contrast with conventional proteomic applications, proteogenomic analysis requires a number of additional data processing steps. Ideally, these required steps would be integrated and automated via a single software platform offering accessibility for wet-bench researchers as well as flexibility for user-specific customization and integration of new software tools as they emerge. Toward this end, we have extended the Galaxy bioinformatics framework to facilitate proteogenomic analysis. Using analysis of whole human saliva as an example, we demonstrate Galaxy's flexibility through the creation of a modular workflow incorporating both established and customized software tools that improve depth and quality of proteogenomic results. Our customized Galaxy-based software includes automated, batch-mode BLASTP searching and a Peptide Sequence Match Evaluator tool, both useful for evaluating the veracity of putative novel peptide identifications. Our complex workflow (approximately 140 steps) can be easily shared using built-in Galaxy functions, enabling their use and customization by others. Our results provide a blueprint for the establishment of the Galaxy framework as an ideal solution for the emerging field of proteogenomics.

The reliability of using postero-anterior cephalometry and cone-beam CT to determine transverse dimensions in clinical practice.

AIM: This study primarily aimed to assess the accuracy of classically-advocated reference points for the measurement of transverse jaw-base and dental relationships using conventional Postero-Anterior Cephalometry (PAC) and Cone-Beam Computed Tomography (CBCT). METHOD: PAC and CBCT images were collected from 31 randomly selected orthodontic patients (12 males, 19 females), all of whom had a full permanent dentition. The transverse widths of the maxilla, mandible and the dentition were measured using reference points on both image modalities. Confidence intervals, intra-class coefficients and Bland Altman plots were used to assess the measurement differences derived from the two acquirement methods. RESULTS: Measurements on PAC and CBCT images demonstrated statistically significant differences in the majority of the assessed variables. The interjugal (J-J) width was one of only two variables which did not demonstrate a statistically significant difference on image comparison. The mean differences of the antegonial width (Ag-Ag) (-4.44mm, 95% CI -5.38 to -3.51) represented the greatest difference between the imaging techniques. The application of these points to a transverse skeletal analysis (J-J/Ag-Ag ratio) revealed that five of the 31 subjects (16%) recorded 'false positive' readings according to the derived data. CONCLUSION: It is recommended that clinicians are cautious when interpreting and making decisions related to transverse dimensions derived from a PAC. The PAC has a higher tendency to falsely identify individuals who require maxillary expansion procedures based on conventional clinical criteria. The errors primarily associated with identifying structures which represent the width of the mandible are significant in both PAC and CBCT techniques and require further investigation. It is postulated that the confounding effects of overlying soft tissues have a sianificant impact on a clinician's ability to identify relevant landmarks.

The validity of transverse intermaxillary analysis by traditional PA cephalometry compared with cone-beam computed tomography.

AIM: To assess the validity of using jugale (J) and Antegonion (Ag) on Posterior-Anterior cephalograms (PAC) as landmarks for transverse intermaxillary analysis when compared with Cone Beam Computed Tomography (CBCT). MATERIAL AND METHODS: Conventional PAC and CBCT images were taken of 28 dry skulls. Craniometric measurements between the bilateral landmarks, Antegonion and Jugale, were obtained from the skulls using a microscribe and recorded as the base standard. The corresponding andmarks were identified and measured on CBCT and PAC and compared with the base standard measurements. The accuracy and reliability of the measurements were statistically evaluated and the validity was assessed by comparing the ability of the two image modalities to accurately diagnose an arbitrarily selected J-J/Ag-Ag ratio. All measurements were repeated at least 7 weeks apart. Intra-class correlations (ICC) and Bland-Altman plots were used to analyse the data. RESULTS: All three methods were shown to be reliable as all had a mean error of less than 0.5 mm between repeated measurements. When compared with the base standard, CBCT measurements were shown to have higher agreement (ICC: 0.861-0.964) compared with measurements taken from PAC (ICC: 0.794-0.796). When the arbitrary J-J/Ag-Ag ratio was assessed, 18 per cent of cases were incorrectly diagnosed with a transverse discrepancy on the PAC compared with the CBCT which incorrectly diagnosed 8.7 per cent. CONCLUSION: CBCT was shown to be more reliable in assessing intermaxillary transverse discrepancy compared with PAC when using J-J/Ag-Ag ratios.

An evaluation of gingival phenotype and thickness as determined by indirect and direct methods.

OBJECTIVES: To evaluate gingival phenotype (GP) and thickness (GT) using visual, probing, and ultrasound (US) methods and to assess the accuracy and consistency of clinicians to visually identify GP. MATERIALS AND METHODS: The GP and GT of maxillary and mandibular anterior teeth in 29 orthodontic patients (mean age 25 ± 7.5 years) were assessed using probing and US by a single examiner. General dentist and dental specialist assessors (n = 104) were shown intraoral photographs of the patients, including six repeated images, and asked to identify the GP via a questionnaire. RESULTS: An increasing trend in GT values of thin, medium, and thick biotype probe categories was found, though this was not statistically significant (P = .188). Comparison of probing method to determinations of GT made by US yielded slight agreement (κ = 0.12). Using the visual method, assessors' identification of the second GP determination ranged from poor to moderate agreement (κ = 0.29 to κ = 0.53). CONCLUSIONS: The probe method is sufficient in differentiating between different categories of GP. However, further research is required to assess the sensitivity of the probe method in recognizing phenotypes in the most marginal of cases. Assessors using the visual method lack the ability to identify GP accurately and consistently among themselves.

Trends in orthodontic management strategies for patients with congenitally missing lateral incisors and premolars.

OBJECTIVES: To identify changes in orthodontic management strategies in patients with hypodontia seen in 2000, 2010, and 2017/2018 (during a 1-year period). MATERIALS AND METHODS: An assessment of the panoramic radiographs of 3701 patients from a Western Australian private practice identified 276 individuals demonstrating hypodontia. The location of missing teeth, age, sex, type of malocclusion, and the management strategies (space closure or opening) for each patient were noted. RESULTS: Most hypodontia involved agenesis of three or fewer teeth (90%). Maxillary lateral incisors and mandibular second premolars were the most commonly missing teeth. Female preponderance was noted. When considering treatment, the odds ratio for orthodontic space opening and prosthetic replacement in 2000 was 3.266 (P value = 7e-04; 95% confidence interval [CI], 1.464-4.633) compared with patients seen in 2010 and 1.632 (P value = 7e-04; 95% CI, 0.811-2.434) compared with patients in 2017/2018. For patients demonstrating bilateral absence of maxillary lateral incisors, the odds ratio for orthodontic space opening was 3.185 (P value = 0.0215; 95% CI, 1.182-9.243) compared with counterparts with unilateral agenesis. None of the factors investigated were significantly associated with the types of treatment planned/provided for the patients with missing mandibular second premolars. CONCLUSIONS: Maxillary lateral incisors and mandibular second premolars were the most commonly missing teeth. A trend away from space opening and prosthetic replacement toward orthodontic space closure was observed from 2000 to 2017/2018. This may reflect a change in attitude toward prosthetic replacement options and/or greater optimism with biomechanical strategies since the implementation of temporary anchorage devices to assist in space closure.

Comparison of active self-ligating brackets and conventional pre-adjusted brackets.

BACKGROUND: Active self-ligating brackets may be more efficient than conventional pre-adjusted brackets. AIMS: To determine if self-ligating brackets are more efficient than conventional pre-adjusted brackets when used in a specialist practice setting. METHODS: Seven hundred and sixty two patients, consecutively treated with fixed appliances, were evaluated retrospectively. All patients were treated by one orthodontist in a private orthodontic practice. Three hundred and eighty three patients were treated using a conventional pre-adjusted bracket system and 379 patients were treated with active self-ligating brackets. The total treatment time, number of appointments, appointment intervals, number of bracket breakages and number of unscheduled emergency appointments were recorded. Pretreatment characteristics identified by the ICON were related to these variables. RESULTS: The average treatment duration was 15.7 months (Range: 4.1-40.5 months; SD: 5.6 months). Comparable amounts of time were spent in rectangular and round archwires by both appliances. Overall, there was no statistically significant difference between the durations of treatment with active self-ligating brackets and conventional pre-adjusted brackets. The number of debonded brackets and other emergency visits was significantly higher in patients treated with active self-ligating brackets. The treatment characteristics associated with prolonged treatment were: extraction of teeth, a Class II molar relationship and the degree of maxillary crowding or spacing. CONCLUSIONS: Active self-ligating brackets appear to offer no measurable advantages in orthodontic treatment time, number of treatment visits and time spent in initial alignment over conventional pre-adjusted orthodontic brackets.

Accuracy and validity of space analysis and irregularity index measurements using digital models.

BACKGROUND: Digital copies of study models may avoid the storage and retrieval issues of plaster study models, but measurements made on digital models may not be as accurate as measurements made on traditional study models. AIM: To determine the reliability and validity of tooth size-arch length discrepancies (TALD), irregularity indices and arch lengths (four- and six-segment analyses) measured directly on study models with digital calipers with the same measurements measured on digital copies of the study models with proprietary software. METHODS: The irregularity indices and TALDs (four- and six-segments) were measured on 50 sets of pretreatment plaster models. The plaster models were measured using manual calipers with a digital readout. The models were then couriered to OrthoCAD and digital copies emailed to the authors. The digital models were measured with the proprietary software provided with the digital models. Repeat measurements of the TALDs and the irregularity indices were subjected to intraclass correlations (ICC) to assess the reliability. The least squares means of variation was used to assess validity and the impact of measuring arch length (four- and six-segments) on the digital models, and the implications on the TALDs. RESULTS: There were high correlations (ICC) ranging from 98.6-99.9 per cent for both the irregularity indices and the TALDs. The choice of manual over computer and four-segment over six-segment analysis had a significant effect when measuring lower arch lengths (p < 0.05), but they had no effect on the upper arch findings. CONCLUSIONS: Reliable measurements of the irregularity index and the TALD can be made on digital models. Computer measurements of TALDs on digital models were more consistent than manual measurements of TALDs on plaster models. Six-segment analyses of lower arch lengths on digital and plaster models gave more consistent findings than the four-segment analyses.

Caffeine use in a Super Rugby game and its relationship to post-game sleep.

OBJECTIVE: To examine the relationship between regular game-related caffeine consumption on sleep after an evening Super Rugby game. METHODS: Twenty elite rugby union players wore a wrist-activity monitor to measure sleep for three days before, three days after and on the night of an evening Super Rugby game (19:00-21:00). Players ingested caffeine as they would normally (i.e. before and sometimes during a game) and saliva samples were collected before (17:00) and after (21:30) the game for caffeine concentration. RESULTS: Compared to the nights leading up to the game, on the night of the game, players went to bed 3 h later (23:08 ± 66 min vs 02:11 ± 114 min; p < .001) and had 1:30 hh:mm less sleep (5:54 ± 2:59 vs 8:02 ± 1:24 hh:mm; p < .05) and four players did not sleep after the game. Post-game caffeine saliva concentrations were greater than pre-game levels in 17 players (Pre-game 0.40 µg/mL vs Post-game 2.77 µg/mL; p < .001). The increase in caffeine saliva concentrations was moderately associated with an increase in sleep latency (p < .05), a decrease in sleep efficiency (p < .05), and a trend for a decrease in sleep duration (p = .06) on game night. CONCLUSION: Caffeine consumption before a Super Rugby game markedly increases post-game saliva caffeine levels. This may contribute to the observed 3.5 h delay in time at sleep onset and the 1.5 h reduction in sleep duration on the night of the game. This study highlights the need for a strategic approach to the use of caffeine within a Super Rugby team considering the potential effect on post-game sleep.

Influence of lips on the perception of malocclusion.

INTRODUCTION: The purpose of the study was to determine the influence of variations in the size of the vermilion borders of the upper and lower lips on the perception of the attractiveness of various occlusal traits. METHODS: Ten occlusal traits and 3 upper and 3 lower vermilion variations, placed in combinations on a facial image, were used in a questionnaire. Statistical analyses for attractiveness and social and sex attributes were performed for various occupational groups. RESULTS: The occlusion, vermilion border of the upper and lower lips separately, and the raters' occupations were all highly significant in influencing attractiveness, social perceptions, and perceived sex of the images (P < .01). All occlusal traits were perceived as more attractive with a thicker vermilion border. Thin vermilion borders and more severe irregularity were associated with unattractiveness, aggressiveness, and masculine traits. CONCLUSIONS: This study demonstrates that the thickness of the vermilion border has a profound effect on how people rate the attractiveness of the dentition. Therefore, treatment plans that could affect lip vermilion might result in improved dental alignment but also deterioration in overall attractiveness. Orthodontists placed more emphasis on the teeth than other occupation groups; this demonstrated an occupational bias.

Facial asymmetry assessment in adults using three-dimensional surface imaging.

BACKGROUND: The use of three-dimensional (3D) surface imaging is becoming more popular and accepted in the fields of Medicine and Dentistry. The present study aims to develop a technique to automatically localise and quantify soft-tissue asymmetry in adults using 3D facial scans. This may be applied as a diagnostic tool to monitor growth and dynamic changes and to evaluate treatment outcomes. METHODS: 3D facial surface data were captured from 55 adults comprising 28 symmetrical faces and 27 asymmetrical faces using a 3dMDface system. A landmark-independent method, which compared the original and the mirrored 3D facial data, was developed to quantify the asymmetry. A Weibull distribution-based probabilistic model was generated from the root-mean-square (RMS) error data for the symmetrical group to designate a level of asymmetry which represented a normal range. RESULTS: Statistically significant (p < 0.0001) differences in the RMS error values were found when comparing symmetrical with asymmetrical groups and a similarly significant difference was identified between the lower and the upper face of the asymmetrical group. CONCLUSIONS: The proposed 3D imaging-based method of identifying and quantifying facial soft-tissue asymmetry was fast and effective. The Weibull distribution-based comparison of a person's asymmetry with respect to a large sample of symmetrical faces may also be used to evaluate growth, soft-tissue compensations and surgical outcomes.

The influence of pulmonary staple line reinforcement on air leaks.

OBJECTIVES: Although uncommon, prolonged postoperative air leaks are a troublesome complication of lung surgery. This study was performed to determine if buttressing pulmonary staple lines would reduce air leakage at varying airway pressures, and if there was a difference between buttressing materials. METHODS: Using cadaver lungs, the development of air leak from staple lines was evaluated at incremental airway pressures. Unreinforced staples were compared to staples reinforced with bovine pericardium and staples reinforced with expanded polytetrafluorethylene (ePTFE). RESULTS: Unreinforced staple lines began to leak air at an airway pressure of 20 mm Hg, and > 90% leaked at a pressure of 35 mm Hg. Both bovine pericardium and ePTFE significantly reduced the incidence of air leak at these airway pressures. At higher airway pressures, ePTFE was superior to bovine pericardium. CONCLUSION: Staple line reinforcement with either material protects against air leak. Patients at risk for elevated airway pressures and/or postoperative ventilator support should be considered for utilization of these staple reinforcing materials.

A histological and micro-CT investigation in to the effect of NGF and EGF on the periodontal, alveolar bone, root and pulpal healing of replanted molars in a rat model - a pilot study.

BACKGROUND: This study aims to investigate, utilising micro-computed tomography (micro-CT) and histology, whether the topical application of nerve growth factor (NGF) and/or epidermal growth factor (EGF) can enhance periodontal, alveolar bone, root and pulpal tissue regeneration while minimising the risk of pulpal necrosis, root resorption and ankylosis of replanted molars in a rat model. METHODS: Twelve four-week-old male Sprague-Dawley rats were divided into four groups: sham, collagen, EGF and NGF. The maxillary right first molar was elevated and replanted with or without a collagen membrane impregnated with either the growth factors EGF or NGF, or a saline solution. Four weeks after replantation, the animals were sacrificed and the posterior maxilla was assessed using histological and micro-CT analysis. The maxillary left first molar served as the control for the corresponding right first molar. RESULTS: Micro-CT analysis revealed a tendency for all replanted molars to have reduced root length, root volume, alveolar bone height and inter-radicular alveolar bone volume. It appears that the use of the collagen membrane had a negative effect while no positive effect was noted with the incorporation of EGF or NGF. Histologically, the incorporation of the collagen membrane was found to negatively affect pulpal, root, periodontal and alveolar bone healing with pulpal inflammation and hard tissue formation, extensive root resorption and alveolar bone fragmentation. The incorporation of EGF and NGF did not improve root, periodontal or alveolar bone healing. However, EGF was found to improve pulp vascularisation while NGF-improved pulpal architecture and cell organisation, although not to the level of the control group. CONCLUSIONS: Results indicate a possible benefit on pulpal vascularisation and pulpal cell organisation following the incorporation of EGF and NGF, respectively, into the alveolar socket of replanted molars in the rat model. No potential benefit of EGF and NGF was detected in periodontal or root healing, while the use of a collagen membrane carrier was found to have a negative effect on the healing response.

Oral health of children with juvenile idiopathic arthritis.

OBJECTIVE: s. To estimate dental disease indices and temporomandibular joint (TMJ) dysfunction in children with juvenile idiopathic arthritis (JIA). METHODS: Indices were recorded for dental caries, bacterial dental plaque, gingival inflammation, and TMJ dysfunction in children with JIA and matched controls. RESULTS: There was no significant difference in dental caries experience or the mean plaque score between children with JIA and controls. The mean gingivitis score for the permanent teeth only was significantly greater in the JIA children compared with the controls (p = 0.02). There was a significantly greater proportion of children with JIA with signs of both left and right TMJ dysfunction (p = 0.05, p = 0.02) and symptoms (p = 0.0001, p = 0.0001) compared with controls. CONCLUSION: The low caries rate was attributed to the fact that children with JIA had received preventive dental care from an early age combined with sugar free medication.