Blended learning in postgraduate oral medical and surgical training - An overall concept and way forward for teaching in LMICs.

E-learning programmes have become established in postgraduate oral medical education and training. Internet and literature researches show a variety of good concepts that provide an attractive alternative to face-to-face training. What is missing is an overall concept in which continuing education and training are offered in bundled form in various teaching and learning formats. We discuss the blended learning concept which offers the best options, which has been proven by scientific studies. Using the example of the International Medical College (IMC) at the University of Duisburg-Essen, a blended learning overall concept for postgraduate continuing education is presented.

Use of bioengineered human commensal gut bacteria-derived microvesicles for mucosal plague vaccine delivery and immunization.

Plague caused by the Gram-negative bacterium, Yersinia pestis, is still endemic in parts of the world today. Protection against pneumonic plague is essential to prevent the development and spread of epidemics. Despite this, there are currently no licensed plague vaccines in the western world. Here we describe the means of delivering biologically active plague vaccine antigens directly to mucosal sites of plague infection using highly stable microvesicles (outer membrane vesicles; OMVs) that are naturally produced by the abundant and harmless human commensal gut bacterium Bacteroides thetaiotaomicron (Bt). Bt was engineered to express major plague protective antigens in its OMVs, specifically Fraction 1 (F1) in the outer membrane and LcrV (V antigen) in the lumen, for targeted delivery to the gastrointestinal (GI) and respiratory tracts in a non-human primate (NHP) host. Our key findings were that Bt OMVs stably expresses F1 and V plague antigens, particularly the V antigen, in the correct, immunogenic form. When delivered intranasally V-OMVs elicited substantive and specific immune and antibody responses, both in the serum [immunoglobulin (Ig)G] and in the upper and lower respiratory tract (IgA); this included the generation of serum antibodies able to kill plague bacteria. Our results also showed that Bt OMV-based vaccines had many desirable characteristics, including: biosafety and an absence of any adverse effects, pathology or gross alteration of resident microbial communities (microbiotas); high stability and thermo-tolerance; needle-free delivery; intrinsic adjuvanticity; the ability to stimulate both humoral and cell-mediated immune responses; and targeting of primary sites of plague infection.

Food-grade delivery system for controlled gene expression in Lactococcus lactis.

A food-grade system for the delivery of desired genes to Lactococcus lactis, their inducible expression, and their transfer to related strains was established. Based on the thermosensitive pG(+)host replicon, two types of plasmid vectors were constructed which contained sections of either the chromosomal leu operon of L. lactis or the tel operon from the lactococcal sex factor. Genes cloned into the leu or tel sequences of these vectors were delivered to the homologous regions of the chromosome or the sex factor through two single crossovers, leading to integration of the recombinant plasmids and subsequent excision of the vector portions. Inducible transcription of integrated genes was achieved by using the nisin-controlled expression (NICE) system. To establish the signal transduction genes nisRK in L. lactis, the vectors pLNG1363 (targeted to the chromosome) and pUK500 (targeted to the sex factor) were constructed. Fusions of six different peptidase genes (pep) from Lactobacillus delbrueckii with the nisin-inducible promoter P(nisA) were delivered to the sex factor with derivatives of the vector pUK300. Food-grade recombinants of L. lactis were constructed which had the nisRK genes and individual P(nisA)::pep fusions integrated either separately into the chromosome and the sex factor or simultaneously into the sex factor. With both types of recombinants, expression of P(nisA)::pep fusions after induction with nisin was demonstrated. Depending on the loci used for integration of nisRK, variable induction rates were observed. Furthermore, an engineered sex factor carrying a P(nisA)::pepI fusion was transfered by conjugation between two strains of L. lactis at a frequency of 4 x 10(-4).

Introduction of peptidase genes from Lactobacillus delbrueckii subsp. lactis into Lactococcus lactis and controlled expression.

Peptidases PepI, PepL, PepW, and PepG from Lactobacillus delbrueckii subsp. lactis, which have no counterparts in Lactococcus lactis, and peptidase PepQ were examined to determine their potential to confer new peptidolytic properties to lactococci. Controllable expression of the corresponding genes (pep genes) was achieved by constructing translational fusions with the promoter of the nisA gene (P(nisA)). A suitable host strain, UKLc10, was constructed by chromosomal integration of the genes encoding the NisRK two-component system into the fivefold peptidase-deficient mutant IM16 of L. lactis. Recombinants of this strain were used to analyze growth, peptidase activities, peptide utilization, and intracellular protein cleavage products. After nisin induction of P(nisA)::pep fusions, all of the peptidases were visible as distinct bands in protein gels. Despite the fact that identical transcription and translation signals were used to express the pep genes, the relative amounts of individual peptidases varied considerably. All of the peptidases exhibited activities in extracts of recombinant UKLc10 clones, but only PepL and PepG allowed the clones to utilize specific peptide substrates as sources of essential amino acids. In milk medium, induction of pepG and induction of pepW resulted in growth acceleration. The activities of all five peptidases during growth in milk medium were revealed by high-performance liquid chromatography analyses of intracellular amino acid and peptide pools.

Quantitative measurement of volume changes induced by oral plastic surgery: validation of an optical method using different geometrically-formed specimens.

The purpose of this research was to study the validity and variability of a projection Moiré system, measuring volume differences of geometrically different formed specimens mimicking localized alveolar ridge defects. Nine pairs of specimens were fabricated, each of which simulated a preoperative ridge defect and a corresponding surgically-corrected postoperative ridge defect. All specimen pairs had a mathematically defined form which allowed the accurate assessment of their volume differences by a mechanical 3-D coordinate measuring machine or by a software-controlled milling machine. Measurements achieved with these methods were used as the references for comparison. Six specimen pairs, A1 to A6, possessed a simple rectangular geometrical form which facilitated their fabrication. Three specimen pairs, B1 to B3, were milled and consisted of geometrically more complex 3-D sculptured surfaces, which came closest to a true imitation of a localized ridge defect. An optical measurement system in the form of the projection Moiré was utilized, applying a 4-phase shift technique, and results obtained with this device were regarded as test volumes. The absolute variability of the test volume measurements differed between 0.397 mm3 to 15.872 mm3, corresponding to a relative variability of 0.83% to 2.83%. The mean of the relative variability was within 1.68% for the "A" specimens and 2.15% for the "B" specimens. However, the difference was not significant, probably due to the limited number of "B" specimens. The systematic error of the Moiré measurements in relation to the reference methods was surprisingly low, ranging from -0.12 mm3 to 7.67 mm3. The relative systematic error, expressed as a percentage of reference volume, ranged between 0.06% and -2.23%. The mean of the relative error for the more complex "B" specimens was 1.37%, which was less accurate in comparison to the more simply formed "A" specimens with a relative systematic error of 0.35%. Therefore, in this in vitro model it was possible to measure volume differences of geometrically different formed specimens, mimicking localized alveolar ridge defects, with a validity within 2.2% and with a variability of less than 2.8%.

[The reproducibility of the manual checkbite in the wearers of complete dentures]. / Reproduzierbarkeit der Handbissnahme bei Totalprothesenträgern.

Thirty-six new complete dentures were remounted by means of check bite records at the time of placement. The mandibular position was recorded three times in each patient by two clinicians using Bite Compound, a thermoplastic material, for the records. After individual transverse horizontal axis localization, the dentures were mounted in an articulator, and subsequently three-dimensional, electronic and computerized measurements were made with a special measuring instrument. In intraindividual comparison the reproducibility of the check bite records resulted in a mean value of 0.37 +/- 0.33 mm, whereby maximum deviations of up to 1.8 mm were observed. Repeated insertion of the maxillary dentures into the hardened impressions of the thermoplastic compound led to an error of 0.04 +/- 0.06 mm. The results of the two clinicians differed only slightly.

[The reproducibility of arrow-point registration in full-dentition subjects depending on the recording material]. / Reproduzierbarkeit der Pfeilwinkelregistrierung bei Vollbezahnten in Abhängigkeit vom Registratmaterial.

The reproducibility of the intraoral central bearing point method was measured in 46 dentate subjects with a healthy stomatognathic system. Nine complete registrations were carried out on each volunteer, while three different materials were used for fixing the upper to the lower jaw. The occlusal records were examined in the condylar area on a specially designed articulator. Two therapists took part in this study. The shifts of the condylar spheres in all three spatial directions were found as follows: Ramitec 0.14 +/- 0.16 mm, Super-Bite 0.15 +/- 0.14 mm and Bite Compound 0.15 +/- 0.16 mm. The movements of the condylar spheres in space were calculated. They amounted to 0.28 +/- 0.23 mm when using Ramitec, 0.28 +/- 0.20 mm when using Super Bite and 0.31 +/- 0.23 mm when using Bite Compound. Statistically, the differences between the data of the three materials were not significant. Also, the results of our random sample were independent of the therapist.

[The reproducibility of the abutment angle recording in the remounting of complete dentures]. / Reproduzierbarkeit der Pfeilwinkelregistrierung bei der Remontage von Total-Prothesen.

Upon insertion, 40 newly made full dentures could be remounted three times in succession by each of two therapists by means of the intraoral central bearing point method. The records were measured electronically and by computer in a special measuring articulator in the right and left condylar area. The shift of the condylar spheres in the three different records was smaller than about 0.3 +/- 0.2 mm in all three spatial directions. From this we calculated the movement of the spheres in space to be about 0.5 +/- 0.3 mm. The results of our random samples were independent of the therapist, the patients' age or sex, the period for which the patients had been edentulous, the sliding of the dental prostheses on the tegmentum or the anatomical shape of the alveolar ridges.