Oral Health, Dental Care and Nutritional Habits of Children with Cerebral Palsy during Conductive Education.

OBJECTIVE: Regarding the 2011 census in Hungary, the number of children with movement deficiences can be around 7,000. These children with special health care needs are considered to be a vulnerable group even from a dental point of view. In our dental program, we gain comprehensive information about patients' oral health, health behavior, and monitor dental care. STUDY DESIGN: A total of 199 children went through a full pediatric dental examination, children with cerebral palsy were categorized into five different levels (GMFCS) and children without motor disfunction into two groups. We analyzed the df-t and DMF-T values. Oral hygiene routine, dental care, gingivitis, demographic characteristics, nutritional habits odds ratio to df-t and DMF-T were surveyed. RESULTS: The mean df-t and DMF-T was 1.87 and 1.15 out of a total of 199, and the group that scored worse was the GMFCS II. The mean RI (restorative index) was 18.12% and 27% for decidous and permanent teeth, respectively. The prevalence of gingivitis was 66.7%. CONCLUSION: The results of our research point to the fact that children with cerebral palsy have difficulties in developing and maintaining proper oral health due to their disadvantages and therefore require special care and attention.

Assessing the digital economy: aims, frameworks, pilots, results, and lessons.

The article discusses the motivations for a holistic assessment of the digital economy. It outlines the pilot assessment program initiated by the World Bank Group and describes the assessment frameworks, tools, and processes deployed in selected pilot countries. It identifies the common challenges faced and lessons learned from applying these assessments in different contexts. These challenges include prioritizing digital diagnosis objectives, addressing inequality and poverty issues, securing participation and partnership of stakeholders, addressing implementation challenges, and integrating digital transformation strategy into a country development strategy. Other challenges include harnessing digital innovation and entrepreneurship, mobilizing local demand for the new technologies, engaging business in digital diagnosis, and adopting multi-disciplinary and whole-of-society approaches. The article addresses the implications of these challenges and draws broad lessons and practical recommendations for developing countries and aid agencies.

Short communication: Upper critical temperature-humidity index for dairy calves based on physiological stress variables.

In this study, upper critical values of the temperature-humidity index (THI) were determined in Holstein bull calves (n = 16) based on noninvasive physiological variables. Meteorological and animal-based data were recorded for a 4-d period following a 24-h habituation. The estimated upper critical THI values based on the assessment of respiratory rate, rectal temperature, ear temperature, heart rate, and salivary cortisol concentrations were 82.4, 88.1, 83.0, 78.3, and 88.8, respectively. We inferred that welfare of young calves may be compromised above a THI of 78 and that calves experience significant heat stress above a THI of 88. Based on the present findings, upper critical THI should be considered to minimize the duration of impaired welfare during summer heat stress episodes.

Vitamin D Deficiency Predicts Poor Clinical Outcomes in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy.

BACKGROUND AND AIMS: Resynchronization therapy (CRT) improves mortality and induces reverse remodeling in heart failure (HF) patients with reduced ejection fraction and wide QRS. Nonetheless, some patients do not improve despite the optimal medical therapy and right indications for device implantation. Therefore, finding biomarkers suitable for identification of those patients is crucial. Vitamin D plays a classic hormonal role in the regulation of bone metabolism and also has physiological functions in wide range of nonskeletal tissues. Based on recent studies, low levels of vitamin D seem to directly contribute to pathogenesis and worsening of HF. We planned to assess the role of vitamin D levels on clinical outcomes of HF patients undergoing CRT. METHODS AND RESULTS: We enrolled 136 HF patients undergoing CRT. Total plasma vitamin D levels were measured at baseline and 6 months later. Primary endpoint was 5-year all-cause mortality; secondary endpoint was lack of good clinical response, defined as less than 15% increase of left ventricular ejection fraction after six months. During follow-up, 58 patients reached the primary, and 45 patients reached the secondary endpoint. Vitamin D levels less than 24.13 ng/mL predicted 5-year mortality (p = 0.045) and poor clinical response (p = 0.03) after adjusting to all significant baseline predictors. CONCLUSION: Our study showed that vitamin D deficiency has a significant impact in heart failure patients; it is an independent predictor of lack of midterm clinical response and long-term mortality in patients undergoing CRT. Therefore, monitoring vitamin D status of heart failure patients could be of clinical significance.

Effect of ovulation rate and timing of ovulation after different hormone treatments on pregnancy rate in dairy cows.

Primiparous and multiparous lactating crossbred dairy cows with a mature corpus luteum and a follicle with >10 mm in diameter were treated with cloprostenol. Those cows that showed oestrus within 5 days after treatment were inseminated (Group P). The other cows (Group PG) were treated with GnRH 2 days after cloprostenol treatment and timed artificial insemination (AI) was performed on the consecutive day, or were inseminated (Group G) after detected oestrus and treated with GnRH immediately after AI. The control cows (Group C) after detected oestrus were only inseminated. All of the AIs using frozen semen were done between 6 and 7 a.m. while the ultrasonographic examinations after AI were performed between 4 to 6 p.m. The ovaries of each cow were scanned by means of transrectal ultrasonography from the day of AI until ovulation. Daily blood samples were collected for progesterone measurements. The ovulation and pregnancy rates among the groups changed between 84.6% and 95.5%, as well as 44.4% and 60%, respectively, however the differences were not statistically significant. All the cows were evaluated according to date of ovulation after AI and the pregnancy rate was 55.4% (Group 1: ovulation occurred between AI and 9-11 h after AI), 54.5% (Group 2: ovulation occurred between 9-11 h and 33-35 h after AI) and 35.5% (Group 3: ovulation occurred between 33-35 h and 57-59 h after AI), respectively. There was a trend (P=0.087) for 2.2 greater odds of staying open among cows inseminated between 33 to 35 h and 57 to 59 h before ovulation compared to cows inseminated within 9 to 11 h before ovulation. If ovulation occurred before AI, the pregnancy rate was only 22.2%, therefore determination of optimal time for AI is of great importance.

Short communication: Heart rate variability, step, and rumination behavior of dairy cows milked in a rotary milking system.

Step behavior, heart rate (HR), the high-frequency (HF) component of heart rate variability (HRV), the ratio of the low-frequency (LF) and HF components (LF/HF ratio) as well as rumination behavior during milking were investigated in dairy cows milked in a high-capacity rotary milking system (n = 49) to study animals' stress responses to the milking process. Cardiac parameters were analyzed for undisturbed standing (baseline) and for the stages of the morning, afternoon, and evening milking processes (i.e., driving animals from the barn to the pre-milking holding pen, pre-milking holding pen, preparation, milking, and waiting after milking in the milking stall). During driving, HR was greater than during all other stages. After driving, a gradual decrease in HR was observed. The HF decreased during driving, indicating a decrease in vagal tone compared with baseline. When animals were in the holding pen, vagal tone decreased, whereas sympathetic tone increased with lower values than recorded for baseline and driving. During preparation, HF values were still lower than those recorded for baseline. The recovery of the autonomic activity was observed following preparation as indicated by increased HF and decreased LF/HF ratio during milking and waiting stages. During milking, 53.1% of the animals ruminated. The frequency of steps was greater during preparation (3.7 ± 1.8 steps/min) than during milking (0.7 ± 0.4 steps/min) and waiting after milking (1.6 ± 1.0 steps/min). Our results suggest that being in the holding pen is stressful for cows; however, vagal predominance from the onset of milking, the low frequency of steps, and the high prevalence of rumination during milking suggest a possible welfare benefit of the investigated rotary milking system.

Electron paramagnetic resonance spectroscopic studies of the electron transfer reaction of Hantzsch ester and a pyrylium salt.

The oxidation of Hantzsch ester by a pyrylium cation takes place via electron-proton-electron transfer. The reaction was investigated with EPR spectroscopy using TEMPO and DMPO for inhibition and spin trapping, respectively, of the radicals appearing during the reaction. The present in-depth EPR study of the radical reactions of a NADH analogue indicate a complex electron transfer mechanism in the title reaction.

Management of adult pancreatic injuries: a practice management guideline from the Eastern Association for the Surgery of Trauma

BACKGROUND: Traumatic injury to the pancreas is rare but is associated with significant morbidity and mortality, including fistula, sepsis, and death. There are currently no practice management guidelines for the medical and surgical management of traumatic pancreatic injuries. The overall objective of this article is to provide evidence-based recommendations for the physician who is presented with traumatic injury to the pancreas. METHODS: The MEDLINE database using PubMed was searched to identify English language articles published from January 1965 to December 2014 regarding adult patients with pancreatic injuries. A systematic review of the literature was performed, and the Grading of Recommendations Assessment, Development and Evaluation framework was used to formulate evidence-based recommendations. RESULTS: Three hundred nineteen articles were identified. Of these, 52 articles underwent full text review, and 37 were selected for guideline construction. CONCLUSION: Patients with grade I/II injuries tend to have fewer complications; for these, we conditionally recommend nonoperative or nonresectional management. For grade III/IV injuries identified on computed tomography or at operation, we conditionally recommend pancreatic resection. We conditionally recommend against the routine use of octreotide for postoperative pancreatic fistula prophylaxis. No recommendations could be made regarding the following two topics: optimal surgical management of grade V injuries, and the need for routine splenectomy with distal pancreatectomy.

Acetylsalicylic Acid Resistance After Simultaneous Pancreas-Kidney Transplantation.

BACKGROUND: The most common conditions leading to death after simultaneous pancreas-kidney transplantations (SPKs) are cardiovascular diseases. The aim of this study was to test the platelet aggregation inhibitor acetylsalicylic acid (ASA) resistance in patients after SPKs, including investigations into the triggering factors. METHODS: Thirty-two patients (22 men, 10 women; overall age, 47.4 ± 8.6 years) were involved in our study and took 100 mg ASA per day. We used optical platelet aggregometry to detect resistance. RESULTS: Resistance occurred in 40.6% of the study group. However, with the use of logistic regression analysis, the examined 24 factors did not show any significant correspondence with resistance. CONCLUSIONS: The incidence of ASA resistance seems to be higher compared with other groups, but the triggering effect is still unproved. Clarifying this question should be important regarding the mortality- and morbidity-reducing capacity of antiplatelet drugs in the management of cardiovascular conditions.

Smoking and Psoriasis as Synergistic Risk Factors in Periodontal disease.

In the literature both smoking and psoriasis are discussed as predisposing factors for chronic periodontal disease. It is also known that smoking leads to deterioration in both psoriasis and periodontal disease. However, up to now, the only study to address the question what effect the co-occurrence of psoriasis and smoking has on the periodontal status of the individual, was a previous study of ours. In the present study, we repeated our measurements in an extended sample. 82 psoriatic patients and 117 controls participated, who all received a full-mouth examination so that their periodontal status could be determined. The analysis was aimed at finding out about to what extent the individual risk factors (i.e. smoking and psoriasis) increased the chance of the occurrence of the advanced stages of periodontal disease. The odds ratio for smoking was 1,32 (p = 0,465), and 1,85 for psoriasis (p = 0,163). In those patients who smoked, the odds ratio was 6,22 (p < 0,001), which is three times higher than the simple combination of odds. This suggests that the risk factors are in a synergistic relationship.

Stress preconditioning of semen before cryopreservation improves fertility and increases the number of offspring born: a prospective randomised study using a porcine model.

The aim of the present study was to investigate the effect of applying sublethal stress treatment at room temperature, before cryopreservation (hydrostatic pressure (HP): 40MPa, 80min) of 34 boar ejaculate samples, on post-thawed motility and sow fertility. Sows (n=102) were randomly allocated into equal groups inseminated with HP-treated or untreated frozen-thawed semen. Sows were inseminated twice, 10h apart, with 6×10(9) spermatozoa per dose without oestrus synchronisation. Rates of non-return of oestrus and pregnancy, and total numbers of piglets and live piglets were significantly higher (P<0.05) in the HP-treated group. There was also a numerical, albeit non-significant (P>0.05), improvement in the farrowing rate in the HP-treated group. Although the number of live piglets per litter decreased approximately 15% in both groups by 42 days after farrowing, but this remained significantly higher in the HP-treated group. Although total and progressive sperm motility were significantly (P<0.001) higher in the HP-treated group, there were no significant differences (P>0.05) in these parameters between pregnant and non-pregnant sows in either group; thus motility can indicate, but not predict, improved fertility. In conclusion, HP treatment, with sperm cryopreservation, increases in vitro sperm motility and improves reproductive performance without adversely affecting the health of the piglets.

A retrospective screening and epidemiological study of oncological and other diseases in the oral and maxillofacial region at the University of Szeged, Department of Oral Medicine (1960-2014).

The Department of Oral Medicine at the University of Szeged was responsible for the stomato-oncological care of the population of three counties (with a population of 1,7 M at an average) in the period 1960-201 4. The present report summarizes the incidence of oral medicine diseases during this period. The overall number of new out-patients at the Department of Oral Surgery between 1960 and 2014 was 338,200. These patients were dental and oral surgical patients who presented spontaneously or were referred from the general practice, or stomato-oncological patients referred from general dental practices in-the three counties. Of the 338,200 new cases, 9,482 (2.8%) were benign tumors, 5438 (1.6%) premalignancies and 5,145 (1.5%) malignant tumors. This means a total of 20,065 tumor cases (5.9%) in the examined period, of which 10,579 (3.1 %) were premalignancies and malignancies. 14,446 patients presented with other diseases of the oral mucous membrane (5.8%, data available from 1974). Data on the number of stomato-oncological control patients in any given year are available from 1970 on. In the period 1970-2014, the total number of check-up patients was 117,268, this is the 76,97% of the departments overall number of patients. As for the tendencies, in the representative period of 1960-2004, the number of new benign tumors 15-fold, premalignancies 30-fold, and malignant tumors exhibited an 25-fold increase, while the number of other conditions affecting the oral mucosa showed a 14-fold increase.

One mutation, two phenotypes: a single nonsense mutation of the CTSC gene causes two clinically distinct phenotypes.

BACKGROUND: Papillon-Lefévre syndrome (PLS; OMIM 245000) and Haim-Munk syndromes (HMS; OMIM 245010) are phenotypic variants of the same rare disease caused by mutations of the cathepsin C (CTSC) gene, and they exhibit autosomal recessive inheritance. AIMS: To identify diseases caused by mutations of the CTSC gene in two Hungarian patients and to perform haplotype analysis to elucidate any familial relationship between them. METHODS: Mutation screening and polymorphism analysis were performed by direct sequencing of the CTSC gene. RESULTS: Mutation screening of the CTSC gene from the two patients revealed the presence of the same homozygous nonsense mutation (c.748C/T; p.Arg250X). However, one patient exhibited the PLS phenotype and the other the HMS phenotype. Although these patients were not aware that they were related, haplotype analysis, especially the genotypes of the rs217116 and the rs217115 polymorphisms, clearly indicated that the patients carry the same haplotype, whereas the unrelated healthy controls carried several different haplotypes. CONCLUSIONS: Our results demonstrate that PLS and HMS are phenotypic variants of the same disease and, additionally, exclude the presence of a putative genetic modifier factor within the CTSC gene that is responsible for the development of the two phenotypes. We suggest that this putative genetic modifier factor is located outside the CTSC gene, or alternatively, that the development of the different phenotypes is the consequence of different environmental or lifestyle factors.

Anti-irritant and anti-inflammatory effects of glycerol and xylitol in sodium lauryl sulphate-induced acute irritation.

BACKGROUND: Glycerol is known to possess anti-irritant and hydrating properties and previous studies suggested that xylitol may also have similar effects. OBJECTIVE: Our aim was to study whether different concentrations of these polyols restore skin barrier function and soothe inflammation in sodium lauryl sulphate (SLS)-induced acute irritation. METHODS: The experiments were performed on male SKH-1 hairless mice. The skin of the dorsal region was exposed to SLS (5%) for 3 h alone or together with 5% or 10% of glycerol respectively. Further two groups received xylitol solutions (8.26% and 16.52% respectively) using the same osmolarities, which were equivalent to those of the glycerol treatments. The control group was treated with purified water. Transepidermal water loss (TEWL) and skin hydration were determined. Microcirculatory parameters of inflammation were observed by means of intravital videomicroscopy (IVM). Furthermore, accumulation of neutrophil granulocytes and lymphocytes, the expression of inflammatory cytokines and SLS penetration were assessed, as well. RESULTS: Treatment with the 10% of glycerol and both concentrations of xylitol inhibited the SLS-induced elevation of TEWL and moderated the irritant-induced increase in dermal blood flow and in the number of leucocyte-endothelial interactions. All concentrations of the applied polyols improved hydration and prevented the accumulation of lymphocytes near the treatment site. At the mRNA level, neither glycerol nor xylitol influenced the expression of interleukin-1 alpha. However, expression of interleukin-1 beta was significantly decreased by the 10% glycerol treatment, while expression of tumour necrosis factor-alpha decreased upon the same treatment, as well as in response to xylitol. Higher polyol treatments decreased the SLS penetration to the deeper layers of the stratum corneum. CONCLUSION: Both of the analysed polyols exert considerable anti-irritant and anti-inflammatory properties, but the effective concentration of xylitol is lower than that of glycerol.

Hydrodynamic Trapping of Swimming Bacteria by Convex Walls.

Swimming bacteria display a remarkable tendency to move along flat surfaces for prolonged times. This behavior may have a biological importance but can also be exploited by using microfabricated structures to manipulate bacteria. The main physical mechanism behind the surface entrapment of swimming bacteria is, however, still an open question. By studying the swimming motion of Escherichia coli cells near microfabricated pillars of variable size, we show that cell entrapment is also present for convex walls of sufficiently low curvature. Entrapment is, however, markedly reduced below a characteristic radius. Using a simple hydrodynamic model, we predict that trapped cells swim at a finite angle with the wall and a precise relation exists between the swimming angle at a flat wall and the critical radius of curvature for entrapment. Both predictions are quantitatively verified by experimental data. Our results demonstrate that the main mechanism for wall entrapment is hydrodynamic in nature and show the possibility of inhibiting cell adhesion, and thus biofilm formation, using convex features of appropriate curvature.

Evaluation and management of blunt traumatic aortic injury: a practice management guideline from the Eastern Association for the Surgery of Trauma

BACKGROUND: Blunt traumatic aortic injury (BTAI) is the second most common cause of death in trauma patients. Eighty percent of patients with BTAI will die before reaching a trauma center. The issues of how to diagnose, treat, and manage BTAI were first addressed by the Eastern Association for the Surgery of Trauma (EAST) in the practice management guidelines on this topic published in 2000. Since that time, there have been advances in the management of BTAI. As a result, the EAST guidelines committee decided to develop updated guidelines for this topic using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework recently adopted by EAST. METHODS: A systematic review of the MEDLINE database using PubMed was performed. The search retrieved English language articles regarding BTAI from 1998 to 2013. Letters to the editor, case reports, book chapters, and review articles were excluded. Topics of investigation included imaging to diagnose BTAI, type of operative repair, and timing of operative repair. RESULTS: Sixty articles were identified. Of these, 51 articles were selected to construct the guidelines. CONCLUSION: There have been changes in practice since the publication of the previous guidelines in 2000. Computed tomography of the chest with intravenous contrast is strongly recommended to diagnose clinically significant BTAI. Endovascular repair is strongly recommended for patients without contraindications. Delayed repair of BTAI is suggested, with the stipulation that effective blood pressure control must be used in these patients.(AU)

Caries and ABO secretor status in a Hungarian population of children and adolescents: an exploratory study.

ABO blood group antigen (ABGA) secretion into the saliva and other body fluids is a well-known phenomenon, and there is evidence to suggest a link between secretor status and the appearance of caries. It has been proposed that secretion of these antigens into the saliva might be caries-preventive, however, this proposition is still a matter of debate. Our aim was to examine the relationship between caries experience and secretor status in a group of Hungarian children and adolescents in a cross-sectional study. Altogether 130 children and adolescents participated in the study (aged 6-18 years). Participants were divided into two groups according to dentition (i.e. mixed and permanent). ABGA were determined from saliva. The DMF-T and dmf-t (decayed, missing, and filled) indices were calculated, as well as the oral health hygiene index-simplified plaque index. Association of these indices with secretor status was examined. In mixed dentition, the mean dmf-t values were significantly lower in the secretor group (2.1 ± 0.52 SEM), as compared to the nonsecretor group (3.8 ± 0.93 SEM; p < 0.05, Mann-Whitney U test). The finding that children of mixed dentition are apparently better protected against caries suggests that the assumed protective effect might be associated with deciduous teeth, but given the general paucity of knowledge about this topic, further research is indicated.

Fitness cost associated with resistance to fluoroquinolones is diverse across clones of Klebsiella pneumoniae and may select for CTX-M-15 type extended-spectrum ß-lactamase.

Lowered fitness cost associated with resistance to fluoroquinolones was recently demonstrated to influence the clonal dynamics of methicillin-resistant Staphylococcus aureus (MRSA) in the health care setting. We investigated whether or not a similar mechanism impacts Klebsiella pneumoniae. The fitness of K. pneumoniae isolates from major international hospital clones (ST11, ST15, ST147) already showing high-level resistance to fluoroquinolones and of strains from three minor clones (ST25, ST274, ST1028) in which fluoroquinolone resistance was induced in vitro was tested in a propagation assay. Strains from major clones showed significantly less fitness cost than three of four fluoroquinolone-resistant derivatives of minor clone isolates. In addition, plasmids with CTX-M-15 type extended-spectrum ß-lactamase (ESBL) genes were all retained in both major and minor clone isolates, irrespective of the strains' level of fluoroquinolone resistance, while each plasmid harboring SHV-type ESBLs had been lost during the induction of resistance. Major clone K. pneumoniae strains harbored more amino acid substitutions in the quinolone resistance determining regions (QRDRs) of the gyrA and parC genes than minor clone isolates. The presence of an active efflux system could be demonstrated in all fluoroquinolone-resistant derivatives of originally SHV-producing minor clone isolates but not in any CTX-M-15-producing strain. Further investigations are needed to expand and confirm our findings on a larger sample. In addition, a long-term observation of our ciprofloxacin-resistant minor clone isolates is required in order to elucidate whether or not they are capable of restoring their fitness while concomitantly retaining high minimum inhibitory concentration (MIC) values.

Examination of carbohydrate metabolism parameters after simultaneous pancreas-kidney transplantation.

End-stage renal failure, a frequent complication of type 1 diabetes mellitus, requires renal replacement therapy. Our team examined the laboratory parameters of carbohydrate metabolism in 18 patients with type 1 diabetes at 10 to 89 months after simultaneous pancreas-kidney transplantation. We compared these results with those of 17 patients with type 1 diabetes who had formerly received kidney-alone transplantations, and were undergoing insulin treatment, as well as with those of 16 metabolically healthy controls. The hemoglobin A1c (HbA1c) and blood glucose levels of the pancreas-kidney transplant recipients were within the normal ranges, not differing significantly from those of the healthy controls. In contrast, the HbA1c and glucose levels were significantly elevated among kidney transplanted diabetic subjects. However, fasting and 2-hour insulin levels of pancreas-kidney transplant patients were significantly higher than those of the controls, indicating insulin resistance. According to these results, the insulin secretion by the pancreas graft sufficiently compensated for insulin resistance. Thus 10 to 89 months after successful pancreas-kidney transplantation, carbohydrate metabolism by type 1 diabetic patients was well controlled without antidiabetic therapy.