Nanogel-Based Filler-Matrix Interphase for Polymerization Stress Reduction.

A novel filler-resin matrix interphase structure was developed and evaluated for dental composite restoratives. Nanogel additives were chemically attached to the filler surface to use this created interphase as a potential source of compliance to minimize stress development during polymerization. In addition, we evaluated the effects of free nanogel dispersion into the resin matrix, combined or not with nanogel-modified fillers. Nanogels with varied characteristics were synthesized (i.e., size, 5 and 11 nm; glass transition temperature, 28 °C to 65 °C). Glass fillers were treated with trimethoxyvinylsilane and further reacted with thiol-functionalized nanogels via a free radical thiol-ene reaction. γ-Methacryloxypropyltrimethoxysilane-surface treated fillers were used as a control. Composites were formulated with BisGMA/TEGDMA resin blend with 60 wt% fillers with nanogel-modified fillers and/or free nanogel additives at 15 wt% in the resin phase. Polymerization kinetics, polymerization stress, volumetric shrinkage, and rheological and mechanical properties were evaluated to provide comprehensive characterization. Nanogel-modified fillers significantly reduced the polymerization stress from 2.2 MPa to 1.7 to 1.4 MPa, resulting in 20% stress reduction. A significantly greater nanogel content was required to generate the same magnitude stress reduction when the nanogels were dispersed only in the resin phase. When the nanogel-modified filler surface treatment and resin-dispersed nanogel strategies were combined, there was a stress reduction of 50% (values of 1.2 to 1.1 MPa). Polymerization rate and volumetric shrinkage were significantly reduced for systems with nanogel additives into the resin. Notably, the flexural modulus of the materials was not compromised, although a slight reduction in flexural strength associated with the nanogel-modified interphase was observed. Overall, modest amounts of free nanogel additives in the resin phase can be effectively combined with a limited nanogel content filler-resin interphase to lower volumetric shrinkage and dramatically reduce overall polymerization stress of composites.

APOL1 Polymorphisms in a Deceased Donor and Early Presentation of Collapsing Glomerulopathy and Focal Segmental Glomerulosclerosis in Two Recipients.

Two common polymorphisms in APOL1 (G1 and G2) are conserved in persons of African ancestry, and the presence of two polymorphisms (commonly referred to as risk variants) has been identified as a risk factor for chronic kidney disease and focal seg-mental glomerulosclerosis. In kidney transplantation, deceased donors with two APOL1 risk variants carry an increased risk of renal allograft failure in the recipient. An emerging question is whether these data should influence deceased donor assessment or be used to refine prediction of allograft survival. We present the first detailed report of two cases of recipient glomerular disease in the first year following transplant from a deceased donor later defined as carrying two APOL1 risk variants. A possible "second hit" predisposing to renal disease in these recipients is discussed, one with active cytomegalovirus infection concurrent with collapsing glomerulopathy and renal failure and the other with chronic, slowly healing wound infection and focal segmental glomeru-losclerosis but stable renal function. In retrospect, awareness of the donor APOL1 risk alleles would not have influenced donor selection and ultimately did not influence posttransplant management. These case reports inform further discussion of the value of APOL1 testing for deceased donors.

Protein Quantitative Trait Loci Analysis Identifies Genetic Variation in the Innate Immune Regulator TOLLIP in Post-Lung Transplant Primary Graft Dysfunction Risk.

The authors previously identified plasma plasminogen activator inhibitor-1 (PAI-1) level as a quantitative lung injury biomarker in primary graft dysfunction (PGD). They hypothesized that plasma levels of PAI-1 used as a quantitative trait could facilitate discovery of genetic loci important in PGD pathogenesis. A two-stage cohort study was performed. In stage 1, they tested associations of loci with PAI-1 plasma level using linear modeling. Genotyping was performed using the Illumina CVD Bead Chip v2. Loci meeting a p < 5 × 10(-4) cutoff were carried forward and tested in stage 2 for association with PGD. Two hundred ninety-seven enrollees were evaluated in stage 1. Six loci, associated with PAI-1, were carried forward to stage 2 and evaluated in 728 patients. rs3168046 (Toll interacting protein [TOLLIP]) was significantly associated with PGD (p = 0.006). The increased risk of PGD for carrying at least one copy of this variant was 11.7% (95% confidence interval 4.9-18.5%). The false-positive rate for individuals with this genotype who did not have PGD was 6.1%. Variants in the TOLLIP gene are associated with higher circulating PAI-1 plasma levels and validate for association with clinical PGD. A protein quantitative trait analysis for PGD risk prioritizes genetic variations in TOLLIP and supports a role for Toll-like receptors in PGD pathogenesis.

Preoperative plasma club (clara) cell secretory protein levels are associated with primary graft dysfunction after lung transplantation.

Inherent recipient factors, including pretransplant diagnosis, obesity and elevated pulmonary pressures, are established primary graft dysfunction (PGD) risks. We evaluated the relationship between preoperative lung injury biomarkers and PGD to gain further mechanistic insight in recipients. We performed a prospective cohort study of recipients in the Lung Transplant Outcomes Group enrolled between 2002 and 2010. Our primary outcome was Grade 3 PGD on Day 2 or 3. We measured preoperative plasma levels of five biomarkers (CC-16, sRAGE, ICAM-1, IL-8 and Protein C) that were previously associated with PGD when measured at the postoperative time point. We used multivariable logistic regression to adjust for potential confounders. Of 714 subjects, 130 (18%) developed PGD. Median CC-16 levels were elevated in subjects with PGD (10.1 vs. 6.0, p<0.001). CC-16 was associated with PGD in nonidiopathic pulmonary fibrosis (non-IPF) subjects (OR for highest quartile of CC-16: 2.87, 95% CI: 1.37, 6.00, p=0.005) but not in subjects with IPF (OR 1.38, 95% CI: 0.43, 4.45, p=0.59). After adjustment, preoperative CC-16 levels remained associated with PGD (OR: 3.03, 95% CI: 1.26, 7.30, p=0.013) in non-IPF subjects. Our study suggests the importance of preexisting airway epithelial injury in PGD. Markers of airway epithelial injury may be helpful in pretransplant risk stratification in specific recipients.

Research into glaucoma and ethnicity (ReGAE) 4: trabeculectomy for advanced glaucoma: the surgical journey of African-Caribbean patients.

AIM: To explore the experiences of African-Caribbean patients with advanced glaucoma. METHODS: Semi-structured qualitative interviews were used to elicit patients' subjective experiences of becoming a glaucoma patient, receiving treatment, undergoing surgery, and its aftermath. Interview transcripts underwent narrative analysis. RESULTS: The surgeon-patient relationship was central to developing effective coping strategies. Participants described their experiences in terms of what they considered were their responsibilities as patients to the surgeon-patient relationship. They also defined the surgeon's responsibilities and obligations. CONCLUSIONS: The use of patient narratives provides a valuable resource for enhancing communication skills and relationship-centred care in the hospital eye service.

A study of the use of aspirin in the secondary prevention of myocardial infarction in Trinidad and Tobago

OBJECTIVE: To determine the knowledge, attitude to and practice of aspirin prescribing by physicians, dispensing by pharmacies and usage by patients in the secondary prevention of myocardial infarction (MI) during the period September 1998 to August 1999. DESIGN AND METHODS: 119 doctors registered with the Trinidad and Tobago Medical Association were administered a questionnaire via a telephone interview on their prescription of aspirin in the secondary prevention of MI. Ninety-four registered pharmacies were administered a similar questionnaire to assess availability of aspirin. Seventy-three patients attending the San Fernando General Hospital (SFGH) and 82 patients from the Eric Williams Medical Sciences Complex (EWMSC) Cardiology clinic with a history of MI were each administered a questionnaire on their use of aspirin. RESULTS: Forty-three doctors (36.1 percent, 95 percent CI: 27.5-45.4) prescribed the recommended dose of 75-100 mg of aspirin for the secondary prevention of MI. Of the 82 patients interviewed from EMSC, 28 (34.2 percent) were taking the recommended dose, as compared with 11 (15.19 percent) patients from SFGH. Throughout Trinidad and Tobago, only 51 pharmacies (54.3 percent, 95 percent CI 43.7-64.6) stocked the required dose. CONCLUSIONS: The prescribing habits, availability and use of the recommended dose of aspirin in the secondary prevention of MI are unacceptable and clearly indicate an urgent need to improve the management of MI.(Au)

Evaluación del registro materno doméstico: estudio colaborativo de la OMS / Evaluation of the home-based maternal record: a WHO collaborative study

Trece centros de ocho países (Egipto, Filipinas, india, Pakistán, Senegal, Sri Lanka, Yemen y Zambia) participaron el el estudio colaborativo de la OMS para evaluar el registro materno doméstico (RMD). La evaluación reveló que el empleo del RMD tuvo efectos favorables en la utilización de los servicios de salud y la continuidad de la atención de salud de las mujeres durante su período reproductivo. Cuando se adaptó a las condiciones locales de riesgo, los puntos de corte de esas condiciones y los recursos disponibles, el RMD logró fomentar la autoatención por las madres y sus familias y aumentar la identificación oportuna de las personas en riesgo que debían ser enviadas a otros servicios de atención especial. La introducción del RMD aumentó los diagnósticos de mujeres embarazadas y recién nacidos en riesgo y su envío a otros niveles de atención, mejoró la planificación familiar y la educación sanitaria, condujo a un aumento de la inmunización con toxoide tetánico y proporcionó un instrumento para reunir información de salud en la comunidad. El RMD gustó a las madres, participaban más en el cuidado de su propia salud y la de sus hijos. Además de la adaptación del RMD a las condiciones locales, la capacidad y la participación del personal de salud (incluyendo el de los niveles secundario y terciario) desde el comienzo del programa del RMD influyeron en el éxito del registro en fomentar la atención de salud de la madre y el niño. También mejoro la recopilación de datos basados en la comunidad y la conexión de las redes para la remisión de pacientes

Se publica en inglés en el Bull. WHO. Vol. 71(5), 1993