The quality and readability of online molar incisor hypomineralization patient education materials: a systematic analysis.

BACKGROUND: Molar incisor hypomineralization (MIH) is estimated to affect 14% of children worldwide. It is crucial that patients and their families have access to easily comprehensible and reliable MIH-relevant information. This study aims to determine the quality, reliability and readability of online patient education materials about MIH. METHODS: A systematic search strategy was adopted. Five validated tools were used to assess the content of the 21 websites that satisfied inclusion/exclusion criteria. Data analyses were applied via GraphPad Prism software version 9 (GraphPad Software, San Diego, CA, USA). RESULTS: Five (23.8%) websites only satisfied the criteria for understandability and two (9.5%) websites satisfied the criteria for actionability using the Patient Education Materials Assessment Tool (PEMAT). No website contained the Health on the Net (HON)Code Seal and the mean (SD) Journal of the American Medical Association number of benchmarks per website was 1.33/4 (1.02). All websites failed to reach recommended minimum readability levels. Higher PEMAT scores were associated with 'easier' readability. CONCLUSIONS: Online patient education materials related to MIH are lacking in quality and reliability, and are too difficult for most to read easily. The authors of MIH-related online content should consider reference to quality of information tools when developing patient education materials.

Eruption disturbances in the mixed dentition: orthodontic considerations for primary dental care.

The primary dental care clinician is in a prime position to identify deviations from normal dental development. Disturbances can affect any new erupting tooth. The objective of this narrative review is to describe several situations in which eruption disturbances can arise during the mixed dentition. It will provide an overview of the orthodontic considerations of these disturbances in addition to key summary points on interceptive management, based on the best available evidence.

Effectiveness of tongue-tie assessment tools in diagnosing and fulfilling lingual frenectomy criteria: a systematic review.

It is unclear how effective tongue-tie classification assessment tools are in diagnosing symptomatic tongue-tie and fulfilling lingual frenectomy criteria. The purpose of this systematic review is to determine and evaluate any association between tongue-tie severity, as measured by pre-treatment assessment tools, and post-operative outcome following tongue-tie division. PubMed, EMBASE, and the Cochrane search engines were used to retrieve articles published between 1947 and 2021. Included studies consisted of patients with symptomatic tongue-tie, assessment by either the Coryllos, Kotlow, or Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF) classification tool, and tongue-tie division. A total of 205 abstracts were identified; 31 studies met the criteria for a full-text review, of which, only 14 studies met the criteria for data extraction and analysis. Six studies used the HATLFF, 2 studies used the Kotlow, 5 studies used the Coryllos, and 1 study used a combination of both Kotlow and Coryllos methods. Significant heterogeneity was evident across all studies. No statistical correlation between the two variables could be determined. Although tongue-tie division procedures appear to provide benefits in breastfeeding and speech, there are no data to suggest a statistically significant association between the severity of tongue-tie, and the correct identification of patients who would benefit from tongue-tie division. © 2022 Australian Dental Association.

Successful treatment of babesiosis in a south-western black rhinoceros(Diceros bicornis bicornis).

Under stressful conditions, black rhinoceroses that are sub-clinical carriers of Babesia bicornis can succumb to babesiosis. After 16 days in captivity, a five-year-old female black rhino captured for relocation presented with inappetence, abdominal discomfort and constipation. After chemical immobilisation, dry faecal balls were removed from the rectum, peripheral blood smears were made and blood collected into EDTA tubes. She was treated prophylactically for colic with flunixin meglumine, penicillin and doramectin. Piroplasms were seen on fixed and stained peripheral blood smears. Overnight she developed severe haemoglobinuria, a sign consistent with babesiosis. Subsequently, DNA extracted from a blood specimen reacted with the B. bicornis probe on Reverse Line Blot (RLB) assay, confirming the diagnosis of babesiosis. Specific treatment consisted of 14 ml imidocarb dipropionate (dosage 2.4 mg/kg) administered intramuscularly by pole syringe. Fifteen days later the patient was still moderately anaemic, with the red blood cell (RBC) count, haematocrit and haemoglobin concentration within normal ranges but on microscopic examination there was a marked RBC macrocytosis and polychromasia indicative of a regenerative anaemia. DNA extracted from blood collected at that time did not react with the B. bicornis probe on RLB assay, indicating that treatment with imidocarb had been effective. Once the patient's appetite improved, she started gaining weight. After 82 days in captivity and 65 days after babesiosis had been diagnosed, she was released at the site where she had been captured.

Opening up on airways: the purported effect of nasorespiratory obstruction on dentofacial growth.

Nasorespiratory obstruction has been purported to influence dentofacial growth adversely. This has sparked considerable debate for decades with a resurgence in interest in 'airway friendly orthodontics' among both general and specialist dental practitioners. This critical review aims to evaluate the current literature relating to two questions: does nasorespiratory obstruction alter dentofacial growth, and does early intervention targeted at alleviating nasorespiratory obstruction improve dentofacial growth? The strength of association between nasorespiratory obstruction, mouth breathing and a long face is weak. The common methodological flaws in research include unblinded and cross-sectional study designs, a lack of adequate controls, inadequate follow-up, subjective assessments and inadequate statistical power. Vertical dentofacial growth has a strong genetic influence, which implies a relatively minor contribution of environmental factors including airway obstruction. The current evidence does not support recommending procedures, such as adenotonsillectomy and maxillary expansion, with the singular aim of negating a hyperdivergent (vertical) dentofacial growth pattern. In light of low-quality evidence, both the World Health Organization guidelines and ethical principles dictate that greater emphasis is placed on avoiding harm and wastage of resources over alternative options. These findings call for quality improvement in undergraduate and postgraduate curricula and continuing professional development for health professionals.

An assessment of the treatment information contained within the websites of direct-to-consumer orthodontic aligner providers.

BACKGROUND: The use of direct-to-consumer (DTC) orthodontic aligners is growing. The purpose of this study was to evaluate the quality of information contained within the websites of DTC orthodontic aligner providers. METHODS: Websites that satisfied inclusion criteria were assessed for the presence of specific treatment-related features. Four validated quality of information instruments and readability tools were used to evaluate the content of the websites. Descriptive statistical analyses and intra-examiner reliability tests were performed. RESULTS: Twenty-one websites were evaluated. Few websites referred to the need for pre-treatment dental health (38.1%) and indefinite post-treatment retention (23.8%). Most websites (95.2%) were categorized as either 'poor' or 'very poor' according to their DISCERN scores. DISCERN items regarding information bias and treatment risks scored particularly poorly. Cohen's kappa intra-examiner reliability testing for DISCERN scores was 0.81-0.89. Three websites honoured two out of the four Journal of the American Medical Association benchmarks and 18 honoured one benchmark only. The readability scores indicated 'difficult to read' content. CONCLUSIONS: The quality of information contained within the websites of DTC orthodontic aligner providers is poor. Patient consent for DTC aligner treatment based solely on the information contained within the websites is likely to be invalid.

Long-term outcome of incidental cystic liver tumors in the general population.

Aim of this study was to investigate frequency, incidence and risk factors of liver cysts in the general population in a longitudinal survey. Cyst frequency was investigated in 607 adult volunteers (288 women, 319 men, mean age 55 years) using strong T2-weighted magnetic resonance imaging. Risk factors were investigated for occurrence, frequency and size of cystic lesions at baseline. Incidence and physiological growing of the lesions were observed in a 5-years follow-up. At baseline, 431 volunteers had 1,479 cysts (71.0%). The mean number of cysts per person was 3.4 ± 9.0. The mean size of cysts was 13.1 ± 11.7 mm. Women had a higher number of cysts than men (p = 0.026). Older and male volunteers demonstrated a higher cyst frequency (p = 0.002 and p = 0.025). Per one-year increase in age the chance for a liver cyst increased by 2%. Four-hundred seventeen volunteers had cysts in the follow-up, in 24.6% new lesions had occurred. Lesion size significantly increased in follow-up (p < 0.001). Age and male sex were associated with the occurrence of at least one liver cyst. Women had a higher average number of cysts. Cystic lesion progression is a physiological phenomenon in the long-term follow-up.

Web-based information on orthodontic clear aligners: a qualitative and readability assessment.

BACKGROUND: Data regarding the quality of information (QOI) related to orthodontic clear aligners (OCAs) on the internet are lacking. The aim of the present investigation was to assess the quality and readability of websites providing information regarding OCAs to prospective patients. METHODS: Three search terms were entered separately into three search engines. Four validated QOI instruments were used to determine the QOI and readability of the content contained within the websites that satisfied predetermined criteria. Descriptive statistical analyses and intrarater testing for DISCERN scores were calculated. RESULTS: Forty-nine websites satisfied inclusion/exclusion criteria. General dentists (44.9%) and specialist orthodontists (26.5%) authored the majority of websites. One website contained the Health on the Net (HON) code seal. Cohen's kappa for DISCERN scores was good (0.87). The overall mean (SD) DISCERN score was 38.55 (8.00)/80, range 26-60. The websites authored by 'Direct-to-consumer' OCA providers recorded the lowest DISCERN mean score (33/80). One website contained all four Journal of the American Medical Association (JAMA) benchmarks. The mean (SD) Flesch Reading Ease score was 53.92 (9.08), range 36-82.5. CONCLUSIONS: The QOI of the website content related to OCAs is poor and is 'fairly difficult' to read. Website authors should consider using QOI instruments and readability tools to enable the delivery of evidence-based and easily readable information regarding OCAs to prospective patients.

The function of the nuclear envelope in nuclear protein accumulation.

The mechanism by which proteins accumulate in the cell nucleus is not yet known. Two alternative mechanisms are discussed here: (a) selective unidirectional entry of karyophilic proteins through the nuclear pores, and (b) free diffusion of all proteins through the nuclear pores and specific binding of nuclear proteins to nondiffusible components of the nucleoplasm. We present experiments designed to distinguish between these alternatives. After mechanical injury of the Xenopus oocyte nuclear envelope, nuclear proteins were detected in the cytoplasm by immunohistochemical methods. In a second approach, nuclei from X. borealis oocytes were isolated under oil, the nuclear envelopes were removed, and the pure nucleoplasm was injected into the vegetal pole of X. laevis oocytes. With immunohistochemical methods, it was found that each of five nuclear proteins rapidly diffuses out of the injected nucleoplasm into the surrounding cytoplasm. The subsequent transport and accumulation in the intact host nucleus could be shown for the nuclear protein N1 with the aid of a species-specific mAb that reacts only with X. borealis N1. Purified and iodinated nucleoplasmin was injected into the cytoplasm of Xenopus oocytes and its uptake into the nucleus was studied by biochemical methods.

[Targeted therapies and their indications in solid neoplasias]. / Les thérapies ciblées et leurs indications dans les tumeurs solides.

Targeted therapies are widely used in cancer because of their effectiveness, even in tumours that are resistant to conventional chemotherapy such as kidney or hepatocellular carcinomas. There are different families classified according to their mode of action. The antiangiogenics block tumor angiogenesis by acting on VEGF or its receptor. The main molecules are bevacizumab, sunitinib, and sorafinib. HER inhibitors work by blocking these receptors, which control different signaling intracellular pathways, and include an inhibitor of HER2, trastuzumab, and various inhibitors of HER1, or EGFR, including cetuximab, erlotinib, and gefitinib. Inhibitors of KIT, a membrane receptor, are mainly represented by imatinib, an inhibitor of tyrosine kinase. Finally, mTOR inhibitors act on the signaling pathway PI3K/AKT/mTOR, and key molecules are temsirolimus, everolimus, and deforolimus.

The extraction of first, second or third permanent molar teeth and its effect on the dentofacial complex.

The extraction of permanent molar teeth was first introduced in 1976 as a substitution for premolar extraction in cases with mild crowding. Since then, a number of studies have investigated the effect of permanent molar extraction on dentofacial harmony. Undertaking the procedure of molar extraction is most commonly recommended in response to factors such as: gross caries, large restorations and root-filled teeth, along with its application in the management of anterior open bite and reduction in crowding in facial regions. It has been indicated, however, that before undertaking the extraction of molar teeth it is important to investigate the potential influence of the procedure on other molars, with particular consideration of their eruption path. This is due to the doubt as to the effect of the exact molar teeth extraction and their consequences. In light of this, This review was undertaken to investigate and compare the effect of first, second and the third molar teeth extraction and their subsequent dentofacial complex changes.

[Cholangiocarcinoma: epidemiology and global management]. / Cholangiocarcinomes: épidémiologie et prise en charge globale.

SCOPE: Cholangiocarcinoma, or biliary tract tumors, are rare tumors for which survival is short, as diagnosis is often made at an advanced stage. Indeed, diagnosis remains difficult, since symptoms are often unspecific and appear at latest stages. This article presents an update of recent data and therapeutic options. CURRENT SITUATION AND SALIENT POINTS: Several etiologic factors have been identified, but for most patients, none of these factors can be found. Prognosis is often poor, and remains difficult to establish because of the lack of sufficient large-scale studies looking at the impact on preexisting tumor characteristics on overall survival. Surgery remains when possible the gold standard. When tumor removal is impossible, due to a local extension, the appropriate care of patients remains to be defined. Chemotherapy has been proposed with evidence of objective response but limited data on its ability to prolong overall survival and to enhance quality of life. Active chemotherapies appear to be made from combination of an antimetabolite, such as 5-fluorouracile or gemcitabine, and a platinum drug. PERSPECTIVES: In the near future, indications of chemotherapy could be enlarged and targeted therapy might also be used, since several molecules have been tested in preclinical studies, and be offered to patients in clinical trials.

FTZ-F1-related orphan receptors in Xenopus laevis: transcriptional regulators differentially expressed during early embryogenesis.

Orphan receptors of the FTZ-F1-related group of nuclear receptors (xFF1r) were identified in Xenopus laevis by isolation of cDNAs from a neurula stage library. Two cDNAs were found, which encode full length, highly related receptor proteins, xFF1rA and B, whose closet relative known so far is the murine LRH-1 orphan receptor. xFF1rA protein expressed by a recombinant vaccinia virus system specifically binds to FTZ-F1 response elements (FRE; PyCAAGGPyCPu). In cotransfection studies, xFF1rA constitutively activates transcription, in a manner dependent on the number of FREs. The amounts of at least four mRNAs encoding full-length receptors greatly increase between gastrula and early tailbud stages and decrease at later stages. At early tailbud stages, xFTZ-F1-related antigens are found in all nuclei of the embryo.

Regulation of the DNA-binding and transcriptional activities of Xenopus laevis NFI-X by a novel C-terminal domain.

The nuclear factor I (NFI) family consists of sequence-specific DNA-binding proteins that activate both transcription and adenovirus DNA replication. We have characterized three new members of the NFI family that belong to the Xenopus laevis NFI-X subtype and differ in their C-termini. We show that these polypeptides can activate transcription in HeLa and Drosophila Schneider line 2 cells, using an activation domain that is subdivided into adjacent variable and subtype-specific domains each having independent activation properties in chimeric proteins. Together, these two domains constitute the full NFI-X transactivation potential. In addition, we find that the X. laevis NFI-X proteins are capable of activating adenovirus DNA replication through their conserved N-terminal DNA-binding domains. Surprisingly, their in vitro DNA-binding activities are specifically inhibited by a novel repressor domain contained within the C-terminal part, while the dimerization and replication functions per se are not affected. However, inhibition of DNA-binding activity in vitro is relieved within the cell, as transcriptional activation occurs irrespective of the presence of the repressor domain. Moreover, the region comprising the repressor domain participates in transactivation. Mechanisms that may allow the relief of DNA-binding inhibition in vivo and trigger transcriptional activation are discussed.

Nuclear accumulation of S-adenosylhomocysteine hydrolase in transcriptionally active cells during development of Xenopus laevis.

The oocyte nuclear antigen of the monoclonal antibody 32-5B6 of Xenopus laevis is subject to regulated nuclear translocation during embryogenesis. It is distributed in the cytoplasm during oocyte maturation, where it remains during cleavage and blastula stages, before it gradually reaccumulates in the nuclei during gastrulation. We have now identified this antigen to be the enzyme S-adenosylhomocysteine hydrolase (SAHH). SAHH is the only enzyme that cleaves S-adenosylhomocysteine, a reaction product and an inhibitor of all S-adenosylmethionine-dependent methylation reactions. We have compared the spatial and temporal patterns of nuclear localization of SAHH and of nuclear methyltransferase activities during embryogenesis and in tissue culture cells. Nuclear localization of Xenopus SAHH did not temporally correlate with DNA methylation. However, we found that SAHH nuclear localization coincides with high rates of mRNA synthesis, a subpopulation colocalizes with RNA polymerase II, and inhibitors of SAHH reduce both methylation and synthesis of poly(A)(+) RNA. We therefore propose that accumulation of SAHH in the nucleus may be required for efficient cap methylation in transcriptionally active cells. Mutation analysis revealed that the C terminus and the N terminus are both required for efficient nuclear translocation in tissue culture cells, indicating that more than one interacting domain contributes to nuclear accumulation of Xenopus SAHH.

Incidence of injuries in the New Zealand national rugby league sevens tournament.

This study investigated the incidence, site, nature and causes of injuries sustained in the New Zealand national rugby league sevens tournament. A total of 218 players competing in 47 matches were studied. All injuries sustained within the tournament were prospectively recorded. Injuries were categorised according to the severity assessment at the time of the injury. Information obtained included the time, site, nature and cause of the injury. The incidence of injury was 497.6 per 1000 playing hours. More than 40% (216.1 per 1000) of injuries sustained occurred within the lower limbs. The shoulder was the single most commonly injured site (78.6 per 1000). Sprains were the most common injury type (189.9 per 1000). The ball-carrier sustained significantly more (p<0.05) injuries than the tackling player (216.1 per 1000 [43.4%] versus 117.8 per 1000 [23.7%]). There were significantly more injuries on the first day of competition than on the second day of competition (600.4 per 1000 [76.3%] versus 320.9 per 1000 [23.7%]). The findings of higher injury rates on the first day of competition and during the second period of matches suggest that playing intensity and player fatigue may contribute to injuries in rugby league sevens.

The pattern of retinoic acid receptor gamma (RAR gamma) expression in normal development of Xenopus laevis and after manipulation of the main body axis.

Nuclear receptors are a prerequisite for the transduction of retinoid signals in vertebrate embryogenesis. We have raised an antiserum against the X. laevis retinoic acid receptor gamma (xRAR gamma), which specifically detects a polypeptide with an M(r) of 54 x 10(3) in embryos at gastrula and neurula stages. The antiserum reveals xRAR gamma as a nuclear protein in the head endomesoderm, the neuroectoderm of the hindbrain region, and the entire posterior region during neurula stages. Explanted animal caps express low amounts of xRAR gamma in the absence of mesoderm induction. Treatment of animal caps with activin leads to an increase of the amount and to a regionalization of the xRAR gamma expression. In exogastrulae and in Keller sandwiches, the pattern of expression in the endomesoderm is as expected by analogy to the normal embryo and therefore independent of the vertical contact between the germ layers. A planar signal coming from the dorsal mesoderm is sufficient to impose region-specific expression of xRAR gamma in the neuroectoderm of Keller sandwiches.

xGCNF, a nuclear orphan receptor is expressed during neurulation in Xenopus laevis.

Nuclear orphan receptors are DNA binding proteins that share the domain structure of the nuclear hormone receptor superfamily, although ligands are unknown. We have identified an orphan receptor in Xenopus laevis and named it xGCNF based on its high degree of sequence homology to the previously described murine germ cell nuclear factor (mGCNF). In gel-electrophoresis mobility shift analysis experiments in vitro translated xGCNF and mGCNF proteins both bind specifically as homodimers to the same response element, a direct repeat of the half-site consensus AGGTCA with zero spacing (DRO). Transcripts of xGCNF are found in oocytes and in much smaller amounts in the testes. In developmental Northern blots and RNase protection using RNA from different embryonic stages, zygotic expression of xGCNF peaks at midneurula. From late gastrula to midneurula stages, an anterior to posterior concentration gradient of the RNA was observed in whole mount in situ analysis. This antero-posterior gradient of expression was also observed in exogastrulae, both in the ectoderm and mesoderm. In the midneurula embryo, the mRNA was predominantly found in the neural plate and neural crest. Transcription of xGCNF in animal cap explants occurred independent of mesoderm induction.

Anteroposterior patterning and organogenesis of Xenopus laevis require a correct dose of germ cell nuclear factor (xGCNF).

The germ cell nuclear factor of Xenopus laevis (xGCNF; NR6A1) is a nuclear orphan receptor that is predominantly expressed during neurula and late tailbud stages. As a strategy to analyze the role of xGCNF in embryogenesis, we have induced a gain of function by overexpression of full-length (fl) GCNF and a functional inhibition by a dominant-negative (dn) GCNF. Early events of embryogenesis including gastrulation and neurulation were not affected and the expression of several early mesodermal markers was normal. Yet specific defects were observed upon organogenesis. Ectopic posterior overexpression of the full-length xGCNF caused posterior defects and disturbed somite formation. In contrast, expression of dnGCNF interfered with differentiation of the neural tube and affected the differentiation of anterior structures, including the cement gland and the eyes. Embryos affected by dnGCNF were rescued by coexpression of flGCNF. After expression of dnGCNF, mRNA encoding the the retinoic acid receptor xRAR gamma 2 was selectively suppressed anteriorly. From the distinct phenotypes obtained, we conclude that GCNF has an essential function in anteroposterior differentiation during organogenesis.

A naturally occurring short variant of the FTZ-F1-related nuclear orphan receptor xFF1rA and interactions between domains of xFF1rA.

The FTZ-F1-related nuclear orphan receptors xFF1rA and B were identified previously in Xenopus laevis by cDNA cloning. In addition to two cDNAs that encode full-length receptor proteins, a third cDNA encodes a form of xFF1rA truncated at the C terminus. Transcripts encoding the short form of the receptor are present at much lower levels than mRNAs encoding the full-length receptors. Significant activation of reporter genes in xFF1rA-transfected HeLa cells requires two or more copies of a FTZ-F1-responsive element (FRE). However, in vitro, recombinant xFF1rA protein binds FRE monomers and dimers with apparently equal affinity. In cotransfection studies, full-length xFF1rA activates transcription, in contrast to xFF1rAshort. In vitro, xFF1rAshort binds to FRE with a lower efficiency than xFF1rA. A partial truncation of the E domain reduces the DNA-binding activity of domain C, suggesting that parts of the E domain might interact with the DNA-binding domain C. In parallel with the loss of DNA-binding efficiency, such truncations lead to loss of transcriptional activation. For transcriptional activation, either the A/B domain or the complete E domain is required, as shown by recombination of different domains of xFF1rA with the DNA-binding domain of Gal4. Coexpression of the truncated form xFF1rAshort decreases transcriptional activation by xFF1rA, but not by the active Gal4-xFF1rA fusion protein that contains domain E. This indicates that xFF1rAshort interferes with xFF1A by competition for FRE binding. An excess of xFF1rAshort is required, presumably due to its poor FRE-binding activity. The function of the E domain in regulating DNA-binding and transcriptional activation is discussed.