Comparison of effectiveness of oral hygiene instruction methods in improving plaque scores among 8-9-year children: a randomized controlled trial.

PURPOSE: The relative effectiveness of different methods used for delivery of information regarding oral health in children has not been widely raised in the literature. This study aimed at evaluating the effect of verbal oral hygiene instruction (OHI) against the verbal instruction supplemented by three different methods (written, teeth teaching model, and videotape) on the mean plaque scores and to determine factors that may influence the effectiveness of methods used. METHODS: Prospective-comparative randomized controlled trial carried out on 120 children aged 8-9 years. Participants were randomly divided into four groups (verbal, verbal and written, verbal and teeth teaching model, and verbal and video). Plaque Control Index was evaluated at baseline and 4 weeks after OHI. ANOVA and post hoc, t test, and ANCOVA were used for statistical analysis. RESULTS: A statistically significant decrease of the mean percentage of plaque scores was found indicating the effectiveness of different methods of delivery of OHI (p < 0.01, 0.001). Verbal supported by teaching model was the most statistically effective method (p < 0.001) followed by the verbal (p < 0.001). There was a significant difference in the improvement in plaque score (p < 0.001) between the four methods of OHI after controlling for age, gender, monthly income, mother's and father's educational levels and plaque index before delivery of OHI. CONCLUSIONS: Regardless of the method used, a gradient of effectiveness was observed in improving plaque scores. Verbal instruction supplemented by teaching model was the most effective. Effectiveness was influenced by monthly income, mother's and father's educational levels and plaque index before OHI.

Proctored preceptorship model for learning eTEP repair for inguinal hernia for general surgery residents.

BACKGROUND: Enhanced-view total extra-peritoneal (eTEP) inguinal hernia repair is a technically demanding procedure with a steep learning curve. AIM: Examine the feasibility and effectiveness of an instructor approach to teaching residents how to perform laparoscopic eTEP independently following a dedicated course of individual teaching. METHODS: Prospective analysis of eTEP procedures performed by residents between March 2018 and September 2020. Six residents dispersed into three groups-Group A: two junior residents, Group B: two mid-level residents and Group C: two senior residents. All residents performed a unilateral IHR comprised of five core steps. Data reviewed for each procedure included the time of each step, total time and autonomy degree as assessment for every step: 1st degree-dependent (physical assistance), 2nd degree-partially dependent (vocal assistance) and 3rd degree-independent. Early and late procedures were divided at 50% of cases. RESULTS: Participants performed 44 procedures (220 steps). Late procedures presented with a significant improvement in all degrees of autonomy (1st degree p = 0.002, 2nd degree p = 0.007 and 3rd degree p < 0.0001) and in every step (Step 1 p = 0.015, Step 2 p = 0.006, Step 3 p < 0.0001, Step 4 p < 0.0001, Step 5 p = 0.002). There was no significant difference in surgery duration between early and late procedures (p = 0.32). At early procedures, junior residents needed significantly higher rates of physical intervention (1st degree) compared to the senior residents (p = 0.004). Conversely, there was no significant difference in 2nd degree of autonomy (p = 0.46), 3rd degree (p = 0.06) and surgery duration (p = 0.16). The last three procedures performed by all participants had no significant difference between the seniority groups in autonomy (1st degree p = 0.1, 2nd degree p = 0.18 and 3rd degree p = 0.1). CONCLUSION: Dedicated course with an individual instructor's approach is effective in achieving competence, autonomy and confidence in performing eTEP in a short time.

The Added Value of Technetium-99 m Sestamibi Scan in Patients with Primary Hyperparathyroidism and Positive Ultrasound.

BACKGROUND: Neck ultrasound (US) and Technetium-99 m Sestamibi (MIBI) scan are the most commonly used imaging studies for preoperative localization of parathyroid adenomas. The aim of this study was to determine the added value of MIBI scan and its effect on the operative plan via a hypothetical model where a stepwise approach is conducted and MIBI is considered only after the ultrasound is evaluated. METHODS: Patients who underwent parathyroidectomy for primary hyperparathyroidism (PHPT) between 2012 and 2019 at two tertiary centers were included. Data collected included demographic data, preoperative workup, operative findings and follow-up. The added value of MIBI scans was determined for patients with positive ultrasound. RESULTS: A total of 513 patients with positive US result and a MIBI scan were included. If a stepwise approach was conducted then MIBI scan would not change the operative plan in 492 (95.9%). Among the remaining 21 patients, MIBI scan would correctly change the ultrasound-based operative plan in only 12 (2.3%) patients, while incorrectly change the plan in 9 (1.8%), resulting in unnecessary exploration of the contralateral side. In patients with sonographic appearance of a parathyroid gland larger than 1.2 cm, MIBI scan would correctly change the operative plan in only 1 of the 287 (0.35%) patients. CONCLUSIONS: Our study suggests that the routine use of MIBI scans may have limited added value in patients with PHPT and a positive neck ultrasound, especially in those with adenoma size larger than 1.2 cm. Positive ultrasound alone may be sufficient for the preoperative localization of parathyroid disease.

Characteristics of mandibular injuries caused by bullets and improvised explosive devices: a comparative study.

The purpose of this study was to investigate the difference in mandibular trauma caused by two mechanisms for the delivery of missile injuries: firearms and improvised explosive devices (IEDs). The data investigated included sex, age, mechanism of injury, and other clinical and radiographic manifestations. Seventy consecutive patients, predominantly male, with a mean age of 28.6±14 years (range 2-60 years) were enrolled: 38 patients (54.3%) sustained mandibular fractures caused by bullet injuries and 32 patients (45.7%) had mandibular fractures caused by IED explosion injuries. The study revealed that the differences in most of the investigated variables were not statistically significant; the only significant differences were the incidence of trauma to other body regions and the presence of retained foreign bodies. The effect on the mandible of IED explosion resembles that of bullets. Bullet injuries are associated with a relatively higher number of mandibular sites involved and more bilateral fractures, in addition to more extensive bone loss. IEDs, on the other hand, cause more multisystem injuries and result in more retained foreign bodies.

Life in the balance - a mechanistic view of the crosstalk between autophagy and apoptosis.

Cellular stress triggers a fascinating decision-making process in cells; they can either attempt to survive until the stress is resolved through the activation of cytoprotective pathways, such as autophagy, or can commit suicide by apoptosis in order to prevent further damage to surrounding healthy cells. Although autophagy and apoptosis constitute distinct cellular processes with often opposing outcomes, their signalling pathways are extensively interconnected through various mechanisms of crosstalk. The physiological relevance of the autophagy-apoptosis crosstalk is not well understood, but it is presumed to facilitate a controlled and well-balanced cellular response to a given stress signal. In this Commentary, we explore the various mechanisms by which autophagy and apoptosis regulate each other, and define general paradigms of crosstalk on the basis of mechanistic features. One paradigm relates to physical and functional interactions between pairs of specific apoptotic and autophagic proteins. In a second mechanistic paradigm, the apoptosis or autophagy processes (as opposed to individual proteins) regulate each other through induced caspase and autolysosomal activity, respectively. In a third paradigm unique to autophagy, caspases are recruited and activated on autophagosomal membranes. These mechanistic paradigms are discernible experimentally, and can therefore be used as a practical guide for the interpretation of experimental data.

The autophagy protein Atg12 associates with antiapoptotic Bcl-2 family members to promote mitochondrial apoptosis.

Autophagy and apoptosis constitute important determinants of cell fate and engage in a complex interplay in both physiological and pathological settings. The molecular basis of this crosstalk is poorly understood and relies, in part, on "dual-function" proteins that operate in both processes. Here, we identify the essential autophagy protein Atg12 as a positive mediator of mitochondrial apoptosis and show that Atg12 directly regulates the apoptotic pathway by binding and inactivating prosurvival Bcl-2 family members, including Bcl-2 and Mcl-1. The binding occurs independently of Atg5 or Atg3 and requires a unique BH3-like motif in Atg12, characterized by interaction studies and computational docking. In apoptotic cells, knockdown of Atg12 inhibited Bax activation and cytochrome c release, while ectopic expression of Atg12 antagonized the antiapoptotic activity of Mcl-1. The interaction between Atg12 and Bcl-2 family members may thus constitute an important point of convergence between autophagy and apoptosis in response to specific signals.

ANAT: a tool for constructing and analyzing functional protein networks.

Genome-scale screening studies are gradually accumulating a wealth of data on the putative involvement of hundreds of genes in various cellular responses or functions. A fundamental challenge is to chart the molecular pathways that underlie these systems. ANAT is an interactive software tool, implemented as a Cytoscape plug-in, for elucidating functional networks of proteins. It encompasses a number of network inference algorithms and provides access to networks of physical associations in several organisms. In contrast to existing software tools, ANAT can be used to infer subnetworks that connect hundreds of proteins to each other or to a given set of "anchor" proteins, a fundamental step in reconstructing cellular subnetworks. The interactive component of ANAT provides an array of tools for evaluating and exploring the resulting subnetwork models and for iteratively refining them. We demonstrate the utility of ANAT by studying the crosstalk between the autophagic and apoptotic cell death modules in humans, using a network of physical interactions. Relative to published software tools, ANAT is more accurate and provides more features for comprehensive network analysis. The latest version of the software is available at http://www.cs.tau.ac.il/~bnet/ANAT_SI.

Systems biology analysis of programmed cell death.

Systems biology, a combined computational and experimental approach to analyzing complex biological systems, has recently been applied to understanding the pathways that regulate programmed cell death. This approach has become especially crucial because recent advances have resulted in an expanded view of the network, to include not just a single death module (apoptosis) but multiple death programs, including programmed necrosis and autophagic cell death. Current research directions in the systems biology field range from quantitative analysis of subprocesses of individual death pathways to the study of interconnectivity among the various death modules of the larger network. These initial studies have provided great advances in our understanding of programmed cell death and have important clinical implications for drug target research.

Amplification of c-myc and c-erbB-2 proto-oncogenes in human solid tumors: frequency and clinical significance.

Molecular probes for cellular proto-oncogenes have recently been extensively used in order to search for functional and structural alterations in tumor tissues. Variable, and sometimes contradictory, results have been obtained regarding the frequency and clinical significance of amplification of the c-myc and c-erbB-2 proto-oncogenes in different series of human solid tumors. We addressed this question by performing Southern blotting analysis on 131 primary adult solid tumors of various tissues and 5 metastases of unknown origin, using molecular probes for both genes. Amplification of c-myc was found in 5 of the primary tumors, and amplification of c-erbB-2 in 5 others. In 2 tumors of the latter group, the c-erbB-2 gene was also rearranged. The distribution of these 10 tumors with regard to clinical stage and course of the disease did not point to an association between the amplification events and specific stage or prognosis. We concluded that, in this series, the amplification of both proto-oncogenes was occasional and was not a prognostic marker.

Sporadic amplification of the HER2/neu protooncogene in adenocarcinomas of various tissues.

The HER2/neu protooncogene was found to be amplified in 6 of 109 primary adenocarcinoma tumors. No HER2/neu amplification was found in 29 other primary nonadenocarcinomatous tumors. In two colon tumors, in addition to the amplification, DNA rearrangement of HER2/neu gene was also observed. The rearrangement was explored in detail in one tumor and it was shown to be confined to the 3' region of the gene. Moreover, this tumor expressed an aberrant HER2/neu polypeptide with a molecular weight of 190,000, which is larger by approximately 5,000 than the molecular weight of the normal HER2/neu protein. The aberrant HER2/neu protein was immunoprecipitated with site-specific antibodies against a synthetic peptide from the COOH-terminal end of the normal HER2/neu protein; it also displayed intrinsic protein tyrosine kinase activity leading to self-phosphorylation.