Comparative analysis of the trueness of linear measurements using direct and indirect scanning protocols compared to actual clinical measurements.

OBJECTIVES: To assess the trueness of digital measurements using direct and indirect scanning approaches compared to the actual clinical measurements. MATERIALS AND METHODS: The crown length, width, and width/length ratio were measured in 36 anterior maxillary teeth using three different methods. The first was clinically using a digital caliper, the second was by scanning the teeth using a digital scanner and the third was by making an impression of the teeth, constructing a stone cast in the lab, and scanning it to obtain digital measurements. Bland-Altman test and intraclass correlation were used to assess the data and make comparisons. RESULTS: Measurements taken using both approaches were highly reliable, with intraclass correlations ranging from 0.934 to 0.977 (p ≤ 0.000). Bland-Altman plot reflected a minimal mean difference between measurements especially in crown width measurements. Crown width/crown length measurement displayed the highest mean difference. CONCLUSIONS: Both direct and indirect optical surface scans showed similar high trueness in linear measurements of teeth. A higher discrepancy was detected in the crown width/length ratio. CLINICAL SIGNIFICANCE: Digital dentistry is the new era in patient management. The use of conventional impression techniques and physical dental casts is associated with several disadvantages. Scanning dental casts to convert physical records into digital ones has multiple advantages. Optical surface scans (digital models) of the dentition are currently being more broadly used and advocated in the different dental disciplines including the construction of surgical guides for esthetic crown lengthening procedures. The trueness and reliability of linear measurements are of paramount importance to allow for proper fit and predictable outcomes. In this study, the trueness of these linear measurements obtained using direct and indirect methods was compared to the actual clinical measurements.

Prevalence of dilated mid-ascending aorta in individuals 15 years and older: In search of optimal diagnostic criteria and their effect on the burden of disease.

BACKGROUND: Controversy regarding the definition of the upper limit of normal (ULN) for dilated mid-ascending aorta (mAA) stems from variation in criteria, based on several small-sized studies with small datasets of normal subjects (DONS). The present study was carried out to demonstrate this variation in the prevalence of mAA dilation and to identify the optimal definition by creating the largest DONS. METHODS: Echocardiographic studies of patients ≥ 15 years of age performed at a large tertiary care center over 4 years (n = 49,330) were retrospectively evaluated. The leading-edge-to-leading-edge technique was used to measure the mAA in diastole. The largest-to-date DONS (n = 2334) was created, including those who were normal on medical record review, did not have any of the 28 causes of dilated aorta, and had normal echocardiograms. Because age had the strongest correlation with mAA (multivariate adjusted R2 = 0.26), as compared with sex, height, and weight, we created a new ULN based on the DONS with narrow age stratification (10-year intervals). RESULTS: The prevalence of dilated mAA varied between 17% and 23% when absolute criteria were used with sex stratification, and it varied between 6% and 11% when relative criteria (relative to age, body surface area, and sex) were used. Based on new criteria from the DONS, it was 7.6%, with a ULN of 3.07-3.64 cm in women and 3.3-3.91 cm in men. CONCLUSIONS: These data demonstrate the undesirable variation in the prevalence of dilated mAA based on prior criteria and propose a new ULN for dilated mAA.

Determining the periodontal phenotype-Probe transparency versus actual: A diagnostic study.

AIMS: Assessment of the validity of the transparency of the periodontal probe as a tool for determining the periodontal phenotype. MATERIALS AND METHODS: The periodontal phenotype was assessed at the six upper anterior teeth of 75 subjects using two methods. One is through assessing the transparency of the periodontal probe upon insertion into the gingival sulcus. The second method was through the assessment and clustering of the width of keratinized gingiva clinically and the gingival and buccal plate thickness on Cone Beam Computed Tomography scan. RESULTS: The probe transparency approach correctly identified thick periodontal phenotype in most cases (41 out of 43 [95%]). However, this was not the case for thin periodontal phenotype; probe transparency approach identified 64% of the thin sites (261 out of 407) and misclassified nearly one third of the patients. CONCLUSION: The probe transparency approach is a valid approach in identifying the phenotype in subjects with thick phenotype but not in subjects with thin phenotype. CLINICAL SIGNIFICANCE: The definition of periodontal phenotype has recently changed. Accurate designation has been shown to affect treatment outcomes especially esthetic ones in different disciplines of dentistry. Probe transparency is commonly used by clinicians and researchers. Assessment of the validity of this method based on the most recent definition and compared to actual assessment of bone and gingival thickness is of great clinical value.

Refining the upper limit of normal for the ascending aorta: In search of optimal criteria -- a large database study of normal individuals.

OBJECTIVES: The cutoff for dilated mid-ascending aorta (mAA) is controversial and has several definitions. The present study was carried out to determine the prevalence of mAA dilation based on published definitions and to identify the optimal cutoff. METHODS: Echocardiographic studies of patients >15 years of age performed at a large tertiary care center over 4 years, n = 49,330, were retrospectively evaluated. Leading-edge-to-leading-edge technique was used to measure the mAA in diastole. Several cutoff criteria were included. In addition, we defined normals in our database as those who, after 28 causes of dilated aorta were excluded, were normal both clinically and echocardiographically (n = 2334). RESULTS: The mean age was 64.2 ± 17.1 years, and 31.5% were men. The prevalence of dilated mAA based on absolute criteria with sex stratification varied between 17% and 23% and based on relative criteria (to age, body surface area, and sex) varied between 6% and 11%. It further decreased to 7.6% on the addition of narrow age stratification (10 year intervals) performed on normals in our database. The multivariate adjusted R2 (for variation in mAA diameter) was 0.25 for age, decreasing to 0.12 for weight and 0.07 for sex and height. CONCLUSIONS: The lowest prevalence of 7.6% probably represents the optimal cutoff for dilated mAA because it includes age, which explains most of the variation in mAA, in narrow (10 year) intervals only performed in our normals, which represents the largest sample size to date.

E2f2 Attenuates Apoptosis of Activated T Lymphocytes and Protects from Immune-Mediated Injury through Repression of Fas and FasL.

Targeted disruption of E2f2 in mice causes T-cell hyperactivation and a disproportionate cell cycle entry upon stimulation. However, E2f2-/- mice do not develop a lymphoproliferative condition. We report that E2f2 plays a Fas-dependent anti-apoptotic function in vitro and in vivo. TCR-stimulated murine E2f2-/- T cells overexpress the proapoptotic genes Fas and FasL and exhibit enhanced apoptosis, which is prevented by treatment with neutralizing anti-FasL antibodies. p53 pathway is activated in TCR-stimulated E2f2-/- lymphocytes, but targeted disruption of p53 in E2f2-/- mice does not abrogate Fas/FasL expression or apoptosis, implying a p53-independent apoptotic mechanism. We show that E2f2 is recruited to Fas and FasL gene promoters to repress their expression. in vivo, E2f2-/- mice are prone to develop immune-mediated liver injury owing to an aberrant lymphoid Fas/FasL activation. Taken together, our results suggest that E2f2-dependent inhibition of Fas/FasL pathway may play a direct role in limiting the development of immune-mediated pathologies.

SMARCA4 inactivating mutations cause concomitant Coffin-Siris syndrome, microphthalmia and small-cell carcinoma of the ovary hypercalcaemic type.

SMARCA4 chromatin remodelling factor is mutated in 11% of Coffin-Siris syndrome (CSS) patients and in almost all small-cell carcinoma of the ovary hypercalcaemic type (SCCOHT) tumours. Missense mutations with gain-of-function or dominant-negative effects are associated with CSS, whereas inactivating mutations, leading to loss of SMARCA4 expression, have been exclusively found in SCCOHT. We applied whole-exome sequencing to study a 15-year-old patient with mild CSS who concomitantly developed SCCOHT at age 13 years. Interestingly, our patient also showed congenital microphthalmia, which has never previously been reported in CSS patients. We detected a de novo germline heterozygous nonsense mutation in exon 19 of SMARCA4 (c.2935C > T;p.Arg979*), and a somatic frameshift mutation in exon 6 (c.1236_1236delC;p.Gln413Argfs*88), causing complete loss of SMARCA4 immunostaining in the tumour. The immunohistochemical findings are supported by the observation that the c.2935C > T mutant transcript was detected by reverse transcription polymerase chain reaction at a much lower level than the wild-type allele in whole blood and the lymphoblastoid cell line of the proband, confirming nonsense-mediated mRNA decay. Accordingly, immunoblotting demonstrated that there was approximately half the amount of SMARCA4 protein in the proband's cells as in controls. This study suggests that SMARCA4 constitutional mutations associated with CSS are not necessarily non-truncating, and that haploinsufficiency may explain milder CSS phenotypes, as previously reported for haploinsufficient ARID1B. In addition, our case supports the dual role of chromatin remodellers in developmental disorders and cancer, as well as the involvement of SMARCA4 in microphthalmia, confirming previous findings in mouse models and the DECIPHER database. Finally, we speculate that mild CSS might be under-recognized in a proportion of SCCOHT patients harbouring SMARCA4 mutations. © 2017 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.

Transcriptome profiling shows gene regulation patterns in a flavonoid pathway in response to exogenous phenylalanine in Boesenbergia rotunda cell culture.

BACKGROUND: Panduratin A extracted from Boesenbergia rotunda is a flavonoid reported to possess a range of medicinal indications which include anti-dengue, anti-HIV, anti-cancer, antioxidant and anti-inflammatory properties. Boesenbergia rotunda is a plant from the Zingiberaceae family commonly used as a food ingredient and traditional medicine in Southeast Asia and China. Reports on the health benefits of secondary metabolites extracted from Boesenbergia rotunda over the last few years has resulted in rising demands for panduratin A. However large scale extraction has been hindered by the naturally low abundance of the compound and limited knowledge of its biosynthetic pathway. RESULTS: Transcriptome sequencing and digital gene expression (DGE) analysis of native and phenylalanine treated Boesenbergia rotunda cell suspension cultures were carried out to elucidate the key genes differentially expressed in the panduratin A biosynthetic pathway. Based on experiments that show increase in panduratin A production after 14 days post treatment with exogenous phenylalanine, an aromatic amino acid derived from the shikimic acid pathway, total RNA of untreated and 14 days post-phenylalanine treated cell suspension cultures were extracted and sequenced using next generation sequencing technology employing an Illumina-Solexa platform. The transcriptome data generated 101, 043 unigenes with 50, 932 (50.41%) successfully annotated in the public protein databases; including 49.93% (50, 447) in the non-redundant (NR) database, 34.63% (34, 989) in Swiss-Prot, 24,07% (24, 316) in Kyoto Encyclopedia of Genes and Genomes (KEGG) and 16.26% (16, 426) in Clusters of Orthologous Groups (COG). Through DGE analysis, we found that 14, 644 unigenes were up-regulated and 14, 379 unigenes down-regulated in response to exogenous phenylalanine treatment. In the phenylpropanoid pathway leading to the proposed panduratin A production, 2 up-regulated phenylalanine ammonia-lyase (PAL), 3 up-regulated 4-coumaroyl:coenzyme A ligase (4CL) and 1 up-regulated chalcone synthase (CHS) were found. CONCLUSIONS: This is the first report of Boesenbergia rotunda de novo transcriptome data that could serve as a reference for gene or enzyme functional studies in the Zingiberaceae family. Although enzymes that are directly involved in the panduratin A biosynthetic pathway were not completely elucidated, the data provides an overall picture of gene regulation patterns leading to panduratin A production.

Validation of a quantitative instrument measuring critical success factors and acceptance of Casemix system implementation in the total hospital information system in Malaysia.

OBJECTIVES: This study aims to address the significant knowledge gap in the literature on the implementation of Casemix system in total hospital information systems (THIS). The research focuses on validating a quantitative instrument to assess medical doctors' acceptance of the Casemix system in Ministry of Health (MOH) Malaysia facilities using THIS. DESIGNS: A sequential explanatory mixed-methods study was conducted, starting with a cross-sectional quantitative phase using a self-administered online questionnaire that adapted previous instruments to the current setting based on Human, Organisation, Technology-Fit and Technology Acceptance Model frameworks, followed by a qualitative phase using in-depth interviews. However, this article explicitly emphasises the quantitative phase. SETTING: The study was conducted in five MOH hospitals with THIS technology from five zones. PARTICIPANTS: Prior to the quantitative field study, rigorous procedures including content, criterion and face validation, translation, pilot testing and exploratory factor analysis (EFA) were undertaken, resulting in a refined questionnaire consisting of 41 items. Confirmatory factor analysis (CFA) was then performed on data collected from 343 respondents selected via stratified random sampling to validate the measurement model. RESULTS: The study found satisfactory Kaiser-Meyer-Olkin model levels, significant Bartlett's test of sphericity, satisfactory factor loadings (>0.6) and high internal reliability for each item. One item was eliminated during EFA, and organisational characteristics construct was refined into two components. The study confirms unidimensionality, construct validity, convergent validity, discriminant validity and composite reliability through CFA. After the instrument's validity, reliability and normality have been established, the questionnaire is validated and deemed operational. CONCLUSION: By elucidating critical success factor and acceptance of Casemix, this research informs strategies for enhancing its implementation within the THIS environment. Moving forward, the validated instrument will serve as a valuable tool in future research endeavours aimed at evaluating the adoption of the Casemix system within THIS, addressing a notable gap in current literature.

Measuring customer satisfaction on the cleanliness of food premises using fuzzy conjoint analysis: A pilot test.

Determining the level of customer satisfaction in cleanliness regarding a product or service is a significant aspect of businesses. However, the availability of feedback tools for consumers to evaluate the cleanliness of a restaurant is a crucial issue as several aspects of cleanliness need to be evaluated collectively. To overcome this issue, this study designed a survey instrument based on the standard form used for grading the food premises and transformed it into a seven Likert scale questionnaire and consists of seven questions. This study employed fuzzy conjoint analysis to measure the level of satisfaction in cleanliness in food premises. This pilot study recruited 30 students in Universiti Teknologi MARA (UiTM) Seremban 3. The student's perception was represented by the scores calculated based on their degree of similarities and corresponding levels of satisfaction, whereby, only scores with the highest degree of similarity were selected. Furthermore, this study identified the aspects of hygiene that assessed based on the customers' satisfaction upon visiting the premises. The results indicated that the fuzzy conjoint analysis produced a similar outcome as the statistical mean, thus, was useful for the evaluation of customer satisfaction on the cleanliness of food premises.

Prevalence and risk factors for anabolic-androgenic steroid abuse among Jordanian collegiate students and athletes.

BACKGROUND: The study was conducted to measure the extent of androgenic steroids abuse among two targeted groups in Jordan, college students and athletes, and the risk factors associated with this abuse. METHODS: Five hundred and three Jordanian collegiate students and 154 bodybuilding athletes completed a three section questionnaire that investigated demographic information, prevalence of anabolic-androgenic steroids (AAS) and attitude towards steroids abuse. RESULTS: Of the investigated collegiate students, 4.2% were current users, while the percentage rose to 26% among the athletes; the mean age of users in the two groups was 19.9 and 28.1 years, respectively. Almost one-third of the students started abusing AAS before the age of 15 years while more than half of the athletes started between the ages of 15 and 18 years. Knowing where and how to get the drugs has not been a problem for either the students or the athletes as their friends and coaches were the major sources. The main reasons for using AAS have been found to help improving athletic performance and physical appearances. CONCLUSION: Abusing AAS is starting to become a public health concern that implies the need to implement educational programmes, which will educate and warn adolescents and mentors about the negative side effects of AAS abuse on the health of users.

Pneumatosis of the esophagus and intestines with portal venous air: a rare presentation.

Pneumatosis intestinalis is a radiographic finding that represents a spectrum of conditions ranging from benign disease to abdominal sepsis and death. Along with portal venous gas, it is generally considered an ominous sign prompting emergency operative intervention. We report a rare case showing that nonoperative therapy can be considered in a seriously ill patient with esophageal, gastric and portal venous air.

Influence of Differential Calcification in the Descending Thoracic Aorta on Aortic Pulse Pressure.

PURPOSE: Multiple studies have shown pulse pressure (PP) to be a strong predictor of aortic calcification. However, no studies are available that correlate PP with aortic calcification at the segmental level. METHODS: We identified 37 patients with aortic PP measured during cardiac catheterization. Their noncontrast chest computed tomography scans were evaluated for the presence of calcium in different segments (ascending aorta, arch of aorta [arch], descending aorta) and quantified. Patients with calcification (Calcified Group A) were compared against patients without calcification (Noncalcified Group B) in terms of PP, calcification and compliance. RESULTS: The mean of the total calcium score was higher in the descending aorta than the arch or ascending aorta (691 vs 571 vs 131, respectively, P<0.0001). PP had the strongest correlation with calcification in the descending aorta (r=0.47, P=0.004). Calcified Group A had a much higher PP than Noncalcified Group B, with the greatest difference in the descending aorta (20 mmHg, P<0.0001), lesser in the ascending aorta (10 mmHg, P=0.12) and the least in the arch (5 mmHg, P=0.38). Calcified Group A patients also had much lower compliance than Noncalcified Group B patients, with the greatest difference among groups seen in the descending aorta (0.7 mL/mmHg, P=0.002), followed by the ascending aorta, then arch. CONCLUSIONS: These are the first data to evaluate the relative impact of aortic segments in PP. Finding the greatest amount of calcification along with greatest change in PP and compliance in the descending aorta makes a case that the descending aorta plays a major role in PP as compared to other segments of the thoracic aorta.