Impact of Oral Hygiene Discontinuation on Supragingival and Salivary Microbiomes.

The purpose of the present study was to characterize and compare supragingival and salivary microbiotas during a 10-d period of oral hygiene discontinuation. We tested the hypothesis that the composition of the salivary microbiota will reflect local microbial changes associated with accumulated biofilm formation and maturation. Pooled supragingival plaque (n = 145) and stimulated saliva (n = 145) samples were collected and plaque and gingival indices were recorded from 29 orally healthy individuals at baseline, during oral hygiene discontinuation (days 4, 7, and 10), and 14 d after resumption of oral hygiene. Supragingival and salivary microbiotas were processed by next-generation sequencing (Human Oral Microbe Identification using Next Generation Sequencing) and microbial community profiles were compared. Microbial composition of supragingival plaque samples collected after 4, 7, and 10 d of oral hygiene discontinuation, as well as 14 d after reuptake of oral hygiene, differed significantly from baseline samples, by a 3-fold increase in relative abundance Leptotrichia species and a 2-fold decrease in Streptococcus species (adjusted P < 0.01). In saliva samples, a significant increase in relative abundance of Leptotrichia species (adjusted P < 0.01) was evident at day 7 but completely reversed 14 d after resumption of oral hygiene. While the salivary microbiota was resistant to accumulated local biofilm formation, data from this study showed that compositional changes of supragingival microbiotas were not reversed 14 d after resumption of oral hygiene, despite the restoration of plaque to baseline levels. (ClinicalTrials.gov UCPH_OI_002, NCT02913235). Knowledge Transfer Statement: Data from this study showed compositional changes of supragingival microbiotas as a consequence of a 10-d period of oral hygiene discontinuation, that was not reversed 14 d after resumption of oral hygiene. Notably, oral hygiene discontinuation was associated with a significant increase in relative abundance of potential cariogenic Leptotrichia species and a decrease in Streptococcus species. Thus, findings from this study highlight the necessity of regular oral hygiene in the maintenance of oral homeostasis.

Clinical value of 11C-methionine positron emission tomography in persistent primary hyperparathyroidism-A case report with a mediastinal parathyroid adenoma.

INTRODUCTION: Primary hyperparathyroidism (PHPT) is a common endocrine disorder caused by pathologic growth of one or more of the parathyroid glands. Parathyroidectomies (PTX) in patients with PHPT are procedures with low morbidity, few complications, and a high cure rate. However, the parathyroid glands may be found at various anatomical locations and occasionally they are intrathoracic. CASE PRESENTATION: We present a 57-year-old patient with PHPT. Before the first and second operation, the preoperative imaging indicated pathologic parathyroid tissue in the neck. Due to postoperative persistent hypercalcemia we performed a 11C-methionine positron emission tomography (11C-MET-PET/CT). The scan showed a focus with increased activity in the mediastinum. Due to persistent disease, an ectopic parathyroid gland in the mediastinum was suspected. At a third operation, the parathyroid adenoma was resected through an anterolateral thoracotomy. Biochemical values normalized and bone mineral density improved postoperatively. Hence, an ectopic localization of a parathyroid gland should be considered during the preoperative planning of a PTX, especially in the re-operative setting. A multidisciplinary effort is necessary to address an intrathoracic adenoma. CONCLUSION: Ectopic parathyroid glands should be suspected when positive sestaMIBI uptake is seen in the mediastinum and other types of imaging (e.g. contrast enhanced CT scan or PET-CT) may confirm the finding of an ectopic parathyroid adenoma. From the present case and previous studies we found 11C-MET-PET/CT valuable in difficult PHPT cases.

Incidence, 10-year recidivism rate and prognostic factors for cholesteatoma.

OBJECTIVE: Cholesteatoma patients have a high risk of recurrence with complications, and knowledge exchange is a prerequisite for improving treatment. This study aimed to apply appropriate statistics to provide meaningful and transferable results from cholesteatoma surgery, to highlight independent prognostic factors, and to assess the incidence rate. METHODS: Incidence rates were assessed for the district of Aarhus, Denmark. From 147 patients operated on mainly with canal wall up mastoidectomies for debuting cholesteatomas, 10-year Kaplan-Meier recidivism rates were calculated and independent prognostic factors for the recidivism were identified by Cox multivariate regression analyses. RESULTS: Incidence rate was 6.8 per 100 000 per year. The 10-year cumulative recidivism rate was 0.44 (95 per cent confidence interval, 0.37-0.53). Independent prognostic factors for the recidivism were: age below 15 years (hazard ratio = 2.2; p > z = 0.002), cholesteatoma localised to the mastoid (hazard ratio = 1.7; p > z = 0.04), stapes erosion (hazard ratio = 1.9; p > z = 0.02) and incus erosion (hazard ratio = 1.9; p > z = 0.04). CONCLUSION: The recidivism rate is influenced by several factors that are important to observe, both in the clinic and when comparing results from surgery.

Comparison of two pH meters used for skin surface pH measurement: the pH meter 'pH900' from Courage & Khazaka versus the pH meter '1140' from Mettler Toledo.

BACKGROUND/AIMS: Measurement of skin surface pH is used in clinical research to evaluate hazardous shifts in pH following external exposures and to evaluate the state of diseased skin with acute or chronic changes. It is therefore important to measure skin surface pH as precisely as possible. The aim of this study was to compare two commercially available pH meters used for skin surface pH measurement, to reveal differences between them in measured skin pH on the forearm. METHODS: The first pH meter (pH900) had a pointed electrode and a stabilisation period of 3 s. The second pH meter (pH meter 1140) had a circular electrode and no fixed stabilisation period. Twelve healthy subjects (6 male and 6 female Caucasians) entered the study. The pH measurements were performed once an hour from 8 a.m. to 3 p.m. on both forearms in five areas from the elbow to the "wristwatch" zone. In each area, three measurements were performed next to each other with both pH meters (15 measurements per arm per hour per pH meter). RESULTS: The pH900 has a higher measuring level and a higher variation than the pH meter 1140. CONCLUSION: A skin surface pH meter with a circular electrode and with no fixed stabilisation period is preferable. It is recommended that the pH meter be allowed to stabilise for at least 7 s before the result is read.

Females have lower skin surface pH than men. A study on the surface of gender, forearm site variation, right/left difference and time of the day on the skin surface pH.

BACKGROUND/AIMS: It is of great interest to describe the many functions and properties of the skin in order to better understand reactions that result in different skin abnormalities, as a prerequisite in the development of skin products and topical medicines. Skin surface pH is considered a critical parameter of skin wellbeing and is typically studied on the forearm skin. Despite many previous investigations, this is an extensive field that still needs a great deal of research. The aim of our study was to investigate gender related differences, differences between right and left arms, anatomical variation and daytime variation in skin surface pH. METHODS: Skin surface pH was measured on the flexor surface of the forearm on eleven healthy volunteers (6 men and 5 women). A Mettler Toledo pH meter (pH meter 1140) was used. The subjects were measured once every hour from 8 a.m. to 3 p.m. in five areas from the elbow to the wrist. In each of the five areas, three measurements were performed next to each other, and the mean of these was used in subsequent calculations. RESULTS: A statistically significant difference in skin pH between men (mean pH=5.80) and women (mean pH=5.54) was found, with women being more acidic than men (P<0.01). No difference between right and left arm was found. In men, the area closest to the wrist had significantly lower pH values compared with the proximal sites. This was not the case in women. Skin surface pH decreased during normal working hours in both genders. CONCLUSION: Spontaneous skin surface pH was found to be significantly lower in women, as compared to men--albeit, the difference was small and of unknown relevance. Nevertheless, comparative studies on skin surface pH should be balanced with respect to gender. There appeared to be no right/left difference and no systematic change during the working day. Also, measurements should not be conducted close to the wrist.

A randomized and double-blind comparison of isradipine and spirapril as monotherapy and in combination on the decline in renal function in patients with chronic renal failure and hypertension.

AIMS: Treatment of hypertension in patients with chronic renal failure has been shown to postpone the decline in renal function. Treatment with an ACE inhibitor has been shown to be superior to conventional antihypertensive treatment, but it is not known how an ACE inhibitor compares to treatment with a calcium channel blocker or to treatment with a combination of these drugs. The aim of the study was to evaluate the rate of decline in GFR in patients with chronic renal failure and hypertension treated with isradipine and spirapril as monotherapy and in combination. METHODS: Sixty patients with chronic renal failure and hypertension were enrolled in the study. After enrollment, patients were followed prospectively for 6 months in the outpatient clinic on their usual antihypertensive medication, and then randomized to a double-blinded comparison of either spirapril 6 mg daily, isradipine 5 mg daily or spirapril 3 mg and isradipine 2.5 mg daily. After randomization, patients were followed for 21 months or until the need for dialysis. Every 3 months before and 3.5 months after randomization the glomerular filtration rate was measured by 51Cr-EDTA clearance and the effective renal plasma flow evaluated using the renal clearance of paraaminohippuric acid. RESULTS: Blood pressure and the decline in glomerular filtration rate did not differ between the groups before randomization. After randomization, the mean decline in the glomerular filtration rate was -0.32 ml/(min x month x 1.73 m2) in the spirapril group, -0.58 ml/(min x month x 1.73 m2) in the isradipine group and -0.14 ml/(min x month x 1.73 m2) in the combination group (p = 0.38). Twelve patients, 4 in each group, reached end-stage renal failure. No significant difference was found with respect to diastolic (p = 0.10) or systolic blood pressure (p = 0.08) during the treatment period, but a trend towards a better blood pressure control in the combination group was present. During treatment, the rate of decline in renal plasma flow did not differ significantly between the groups (p = 0.09), neither did the changes in filtration fraction (FF) (p = 0.58) nor the mean FF (p = 0.22) during the treatment. CONCLUSIONS: Our study indicated differences between the 3 treatment modalities in favor of combined therapy with respect to both the rate of decline in GFR and blood pressure control, but the differences where insignificant. Thus, the treatments might differ, but we were unable to confirm this because of large variation in GFR and small sample size.

Glomerular filtration rate estimated from the uptake phase of 99mTc-DTPA renography in chronic renal failure.

BACKGROUND: The purpose of the study was to compare the estimation of glomerular filtration rate (GFR) from 99mTc-DTPA renography with that estimated from the renal clearance of 51Cr-EDTA, creatinine and urea. METHODS: Fifty patients with reduced renal function (serum creatinine between 150 and 600 micromol/l) were enrolled in the study. GFR was estimated from the uptake phase of 99mTc-DTPA renography (GFR(DTPA)). The renal clearance of 51Cr-EDTA (GFR(EDTA)) was used as the reference method. Creatinine clearance (C(Cr)), urea clearance (C(Ur)) and the mean of urea and creatinine clearance (C(Cr+Ur)/2) were also calculated from urine collected during a period of 24 h. Limits of agreement were used for method comparison. RESULTS: The limit of agreement between GFR(DTPA) and GFR(EDTA) was 2 +/- 17 ml/min. The mean difference did not deviate significantly from zero. The other clearance techniques had larger limits of agreement and a mean difference significantly different from zero. Furthermore, C(Ur) and C(Cr+Ur)/2 had systematic deviations of the differences, indicating that C(Ur) and C(Cr+Ur)/2 are poor estimates of GFR. CONCLUSION: The limit of agreement between GFR(DTPA) and GFR(EDTA) are acceptable and, therefore, GFR estimated from 99mTc-DTPA renography is acceptable for clinical use in patients with reduced renal function. Furthermore, the method is simple and less time consuming compared with renal clearance techniques.

No prediction of recurrence of meningiomas by PCNA and Ki-67 immunohistochemistry.

Immunohistochemistry for the expression of the proliferation markers proliferating cell nuclear antigen (PCNA) and Ki-67 was studied in 16 non recurring meningiomas, 11 meningiomas recurring as benign tumors, 6 recurring as atypical meningiomas and in 9 recurring as malignant meningiomas. Non recurring meningiomas were defined in this study as tumors without recurrence at least 8 years after surgery. In addition 16 benign recurrences, 14 atypical- and 12 malignant meningiomas were studied. In each group great variation of labeling indices (LI) = per cent of tumor cells labeled was observed, especially of PCNA LIs. The non recurring meningiomas displayed lower mean LI for PCNA and Ki-67 than did the recurring meningiomas of all groups but the differences were not statistically significant. The same pattern was seen when totally resected tumors were studied alone. Benign-, atypical-, and malignant meningiomas had labeling indices that were related to the grade of malignancy. Only PCNA LIs of atypical- and malignant meningiomas were statistically significantly higher than PCNA LIs of non recurring meningiomas. The study indicates that PCNA and Ki-67 are of minor value as predictors of recurrence of benign meningiomas.

Sertoli cells of intratubular germ cell neoplasia express beta 2 microglobulin.

The cells in intratubular germ cell neoplasia in the vicinity of 38 germ cell tumors of the testis, including 20 pure seminomas, were studied for the expression of beta 2-microglobulin (beta 2m), the constant component of all HLA class I molecules. Immunohistochemistry using antibodies towards beta 2m, vimentin, placental alkaline phosphatase, and ferritin was employed. Whereas the intratubular cells in normal testis are beta 2m negative, beta 2m positive cells were identified in intratubular germ cell neoplasia tubules in 55 per cent of all tumors and in 60 per cent of the seminomas. The tubules with beta 2m positive cells were located in areas with invasive tumor or in the vicinity of such areas. The beta 2m positive cells were identified as Sertoli cells by morphology and by their staining with anti-vimentin. Neoplastic germ cells, identified by morphology and staining with anti-placental alkaline phosphatase and anti-ferritin were beta 2-microglobulin negative. The most intensely beta 2m-stained Sertoli cells were found in tubules with high concentrations of neoplastic germ cells. Intensely stained Sertoli cells were also found in 'Sertoli cell only' tubules inside invasive tumors and in areas without lymphocytic infiltration. The cells in adjacent normal tubules were beta 2m negative.

[Systolic blood pressure at rest and during submaximal and maximal exercise on ergometer bicycle. The value of automatic and auscultatory determination]. / Systolisk blodtryk i hvile og under submaksimal og maksimal arbejdsbelastning på ergometercykel. Voerdien af automatisk og auskultatorisk bestemmelse.

Fifteen normal subjects participated in this comparison of systolic blood pressure measurement determined both automatically (AU) with the Kivex Ergometrics 900 and by the standard auscultatorically method (AM). Maximal exercise, was achieved by work performed on an electronically braked ergometer bicycle. In the first part of this study, simultaneous measurements of systolic blood pressure were made by the Kivex device and by the standard method at rest, every minute during exercise, and one minute after stopping exercise. The differences (two standard deviations) between AU and AM (n = 229) were +/- 19 mmHg at rest, +/- 15 mmHg at submaximal level, and +/- 49 mmHg at maximal exercise level. The acceptable difference was determined to +/- 15 mmHg by Bland and Altman. In the second part of this study, the differences between simultaneously measured auscultatoric systolic blood pressure by two observers (n = 205) was +/- 10 mmHg at rest, +/- 9 mmHg at submaximal level, and +/- 10 mmHg at the maximal exercise level. It can therefore be concluded that Kivex automatic blood pressure device, Ergometrics 900, is unable to measure accurately systolic blood pressure with sufficient agreement in normal subjects at the maximal stress level or at rest. However, at the submaximal exercise level, the Kivex device was able to measure systolic blood pressure with an acceptable agreement with the standard method. Therefore, the blood pressure results obtained by the Kivex device are highly influenced by the exercise level. The agreement between two observers using standard auscultatory method for systolic blood pressure measurement was found to be acceptable at all levels of exercise.

[Captopril renography in the diagnosis of renovascular hypertension]. / Captopril-renografi ved diagnosticering af renovaskulaer hypertension.

The value of renography before and after angiotensin converting enzyme inhibition with captopril (captopril renography) as a test for renovascular hypertension was studied in fourteen hypertensive patients. The captopril renography was performed with 99mTc-DTPA by means of a gammacamera, allowing determination of single kidney glomerular filtration rate (SKGFR). In all patients determination of renal vein plasma renin concentration and renal angiography were carried out. Eleven patients showed an elevated unilateral renin secretion. All of these had a significant decrease of SKGFR in one or both kidneys after captopril. Three patients without a lateralized renal renin secretion showed no change in SKGFR. In five patients with presumed essential hypertension there was no change in SKGFR during captopril renography. Captopril renography with 99mTc-DTPA gammacamera renography is a promising tool for identification of unilateral increased renin secretion in hypertensive patients suspected of renovascular hypertension.

Acute unilateral obstruction of ureter. Disparity in divided renal function calculated from 131I-hippuran and 99mTc-DTPA renography.

Fifteen patients with acute unilateral obstruction of ureter and 30 control patients were studied with simultaneous 131I-Hippuran and 99mTc-DTPA gamma camera renography. In severe outflow obstruction the relative function of the obstructed kidney was higher when calculated with Hippuran than with DTPA. No difference was found in the control subjects. This means that the glomerular filtration rate of an obstructed kidney may be relatively more reduced than the renal blood flow. Therefore, measurement of the single kidney fraction of total glomerular filtration rate has to be calculated with a glomerular filtered tracer, e.g., 99mTc-DTPA.

Reliability of a 99mTc-DTPA gamma camera technique for determination of single kidney glomerular filtration rate. A comparison to plasma clearance of 51Cr-EDTA in one-kidney patients, using the renal clearance of inulin as a reference.

In a recent paper we described a method for calculation of single kidney glomerular filtration rate (SKGFR) from the 99mTc-DTPA renogram obtained by gamma camera. Determination of the injected dose and collection of urine or blood was not needed. In this paper the reliability of the method was compared to other methods for estimation of GFR in 20 unilaterally nephrectomized patients. The renal clearance of inulin served as reference measure of GFR. The values for SKGFR obtained from the renograms and from the estimated endogenous creatinine clearances according to serum creatinine concentration and a nomogram were both accurate. The reliability of the renography method was significantly better judged by less variance in the estimates. SKGFR calculated from the plasma clearance of 51Cr-EDTA overestimated the renal clearance of inulin on an average by 11.3%. No difference was found in the variance of the values obtained from the renograms and from the plasma clearances of 51Cr-EDTA compared to the renal clearance of inulin. Apart from the inaccuracy in the GFR values calculated from the plasma clearance of 51Cr-EDTA, the reliability of these two methods was equal. The day to day variation of SKGFR estimated from the renograms in 24 patients (48 kidneys) with SKGFR values from 5 to 76 ml/min was 8.8%. This equals the day to day variation in the plasma clearance of 51Cr-EDTA.

99mTc-DTPA gamma-camera renography: normal values and rapid determination of single-kidney glomerular filtration rate.

A method for 99mTc-diethylenetriaminepentaacetate (DTPA) gamma-camera renography is presented. From each renogram, an uptake index (UI) proportional to the single-kidney glomerular filtration rate (SKGFR) is defined. If the proportionality factor between UI and SKGFR is the same in all patients, UI can be used as an accurate measure of SKGFR. In order to test this, 99mTc-DTPA renography was performed in 101 patients with glomerular filtration rates (GFR) varying between 4 and 172 ml/min. The sum of the right- and left-kidney UIs correlated well with the total GFR calculated from the simultaneously measured plasma clearance of 99mTc-DTPA after a single injection. The correlation coefficient was 0.97. The method was tested in a prospective study of 57 patients. The total GFR estimated from the renograms was not significantly different from the GFR calculated from the plasma clearance of 99mTc-DTPA. The coefficient of variation--a combination of inaccuracy and imprecision in the estimates as well as in the reference values-was 11.8% at a GFR of 100 ml/min. It is concluded that, in adults, the SKGFR can be calculated as part of the clinical routine from 99mTc-DTPA gamma-camera renography without determining the injected dose or collecting urine or blood samples. Normal values for some parameters of the renogram obtained in 25 normal subjects are given.

Reliability of single kidney glomerular filtration rate measured by a 99mTc-DTPA gamma camera technique.

The reliability of a previously published method for determination of single kidney glomerular filtration rate (SKGFR) by means of technetium-99m-diethylenetriaminepenta-acetate (99mTc-DTPA) gamma camera renography was evaluated. The day-to-day variation in the calculated SKGFR values was earlier found to be 8.8%. The technique was compared to the simultaneously measured renal clearance of inulin in 19 unilaterally nephrectomized patients with GFR varying from 11 to 76 ml/min. The regression line (y = 1.04 X -2.5) did not differ significantly from the line of identity. The standard error of estimate was 4.3 ml/min. In 17 patients the inter- and intraobserver variation of the calculated SKGFR values was 1.2 ml/min and 1.3 ml/min, respectively. In 21 of 25 healthy subjects studied (age range 27-29 years), total GFR calculated from the renograms was within an established age-dependent normal range of GFR.

Simultaneous measurement of renal clearance and plasma clearance of 99mTc-labelled diethylenetriaminepenta-acetate, 51Cr-labelled ethylenediaminetetra-acetate and inulin in man.

The present investigation was undertaken to study the kinetics of 99mTc-labelled diethylenetriaminepenta-acetate (DTPA) as compared with inulin and 51Cr-labelled ethylenediaminetetra-acetate (EDTA). Twenty patients with various degrees of decreased renal function were studied. The renal clearance, plasma clearance and volume of distribution of all three tracers were measured after a simultaneous single injection. The average renal clearance ratio 99mTc-DTPA to inulin was 0.97; the average renal clearance ratio 99mTc-DTPA to 51Cr-EDTA was 1.02. In all patients the plasma clearance of inulin exceeded that of 99mTc-DTPA. No difference was seen between the plasma clearance of 99mTc-DTPA and 51Cr-EDTA. The plasma clearance of all three tracers overestimated the simultaneously measured renal clearance; on average this was, for 99mTc-DTPA 5.7 ml/min, for 51Cr-EDTA 6.0 ml/min and for inulin 8.1 ml/min. The plasma clearance of 99mTc-DTPA correlated well with the renal clearance of inulin, but overestimated this by 3.5 ml/min on average. The volume of distribution of inulin was less than that of 99mTc-DTPA and 51Cr-EDTA. No difference was seen between the volume of distribution of 99mTc-DTPA and 51Cr-EDTA. It is concluded that the difference in the kinetics of 99mTc-DTPA and 51Cr-EDTA in patients with decreased renal function was small and without clinical relevance.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of four commercial Tc-99m(Sn)DTPA preparations used for the measurement of glomerular filtration rate: concise communication.

To find a commercially available DTPA preparation that could be used for the measurement of glomerular filtration rate (GFR), the plasma clearances of four different Tc-99m(Sn)DTPA preparations were compared with that of Cr-51 EDTA using a single-injection technique. One preparation yielded results identical to those obtained with Cr-51 EDTA, whereas the others underestimated the GFR to a varying degree. It is concluded that Tc-99m DTPA can be used to estimate the GFR, but that the accuracy will depend on the commercial source.

99mTc-DTPA scintillation-camera renography: a new method for estimation of single-kidney function.

A new method of combined serial scintigraphy and renography, using a scintillation camera and 99mTc-DTPA is evaluated. Renographic curves, corresponding to light-pen "areas of interest" over the renal parenchyma, were processed. "Blood-background" curves were recorded from an external detector over the temporal region of the head and also from an "area of interest" corresponding to the aorta and inferior vena cava. The uptake phase of the renogram was always linear. The sum of the slopes of the uptake phase of both kidneys correlated well with the measured glomerular filtration rate in 25 patients with renal insufficiency of various degrees. Single-kidney function estimated from the slopes correlated reasonably well with single-kidney function estimated from 131I-Hippuran renography with external detectors. The method described minimizes errors in the estimation of single-kidney function, and both anatomic and functional information is obtained.