Etiology of gingival recession - a literature review.

Gum recession is a common problem that in most cases does not cause any bothersome symptoms to the patient. They can affect people of any age and are most often diagnosed on the vestibular surfaces of the teeth. They are manifested by the exposure of part of the root through the apical migration of the gingival margin. Its etiology is not fully understood, but it is known that it consists of many factors. The authors discussed such factors as inflammation, gum biotype, patient's age, mechanical and chemical damage, smoking, presence of tartar, cervical defects and their reconstruction, orthodontic treatment, occlusal overload and iatrogenic factors. Additionally, important risk factors also include genetic predispositions and abnormalities in the immune system. In addition, certain hygiene habits, such as improper brushing techniques or lack of regular check-ups at the dentist, may also contribute to the development of gum recession. Understanding the comprehensive nature of these factors is crucial to the effective treatment and prevention of this common condition. It is also worth taking into account the importance of educating patients on proper oral hygiene and regular dental check-ups to prevent gum recession.

2022 Recommendations of the AFU Lithiasis Committee: Medical management - from diagnosis to treatment.

The morphological-compositional analysis of urinary stones allows distinguishing schematically several situations: dietary, digestive, metabolic/hormonal, infectious and genetic problems. Blood and urine testing are recommended in the first instance to identify risk factors of urinary stone disease in order to avoid recurrence or progression. The other objective is to detect a potential underlying pathology associated with high risk of urinary stone disease (e.g. primary hyperparathyroidism, primary or enteric hyperoxaluria, cystinuria, distal renal tubular acidosis) that may require specific management. Lifestyle-diet measures are the basis of the management of all stone types, but pharmacological treatments may be required. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU 2022] and their adaptability to the French context.

Phase Ib trial of inhaled iloprost for the prevention of lung cancer with predictive and response biomarker assessment.

Introduction: Iloprost, a prostacyclin analog, has lung cancerpreventive activity in preclinical models and improved dysplasia in former smokers in a phase IIb trial. Oral iloprost is currently unavailable. We performed a phase Ib trial of inhaled iloprost in former smokers to assess tolerance and compliance. Methods: Participants self-administered nebulized iloprost (5ug) or placebo four (QID) or two (BID) times daily. As QID dose was well tolerated and due to expiration of the placebo, the BID dosing and placebo were eliminated early on in the trial. Bronchoscopy with biopsyat six standard sites was performed at treatment initiation and two months post-iloprost, with exploratory histological analysis. Bulk RNA sequencing, single cell RNA sequencing and an in vitro assay of epithelial progenitor cell iloprost response were performed on a subset of biopsies in an exploratory investigation of response mechanisms and predictive biomarkers. Results and discussion: Thirty-four of a planned 48 participants were recruited to the trial.Inhaled iloprost was well tolerated with no adverse events > grade 2. Compliance was 67% in the QID group. The trial was not powered to detect histologic response and none was found. Bulk RNA sequencing of biopsies pre/post iloprost suggest that iloprost is immunomodulatory and downregulates cell proliferation pathways. Single cell RNA sequencing showed an increase in CD8-positive T cells with upregulation of genes in interferon γ signaling. In vitro iloprost response by epithelial progenitor cells correlated with histologic response with kappa coefficient of 0.81 (95% CI 0.47, 1.0). Inhaled iloprost was well tolerated with suboptimal compliance. Molecular analysis suggested that iloprosthas immunomodulatory and antiproliferative effects.The progenitor cell iloprost response assay may be a promising avenue to develop predictive biomarkers. Clinical trial registration: https://clinicaltrials.gov/study/NCT02237183, identifier NCT02237183.

[Organization of the work of the «Healthy Moscow¼ pavilions in order to conduct preventive examinations of the adult population in park areas, squares and recreation areas of the city of Moscow].

In modern conditions of global threats caused by infectious risks, the importance of programs and preventive examinations of the working-age population is increasing, which make it possible to identify groups of people at increased risk in the formation of health disorders, and to obtain objective data on the dynamics of morbidity and mortality of the population, to conduct long-term monitoring. The uniqueness of this project lies in the fact that it is based on a patient-centered approach that involves the individualization of the patient's diagnosis, professional counseling about risk factors and a healthy lifestyle, accompanying the patient until the completion of the examination, diagnosis and treatment. The organization of preventive examinations of the population within the framework of the Healthy Moscow program was the result of coordinated work and the realization of the professional potential of various services in the healthcare system, education, science and public administration. The successful experience of implementing the Healthy Moscow program can be scaled up to other cities and regions of Russia, which will contribute to the development of the country's healthcare system and improve the quality of life.

[The problems of implementing strategies of prevention in The Russian Federation: The new considerations of old truths (publications review)].

Over the last decades, with purpose of increasing efficiency of medical and preventive activities, the search, development, implementation and improvement of new methods and models of health care system functioning and management of medical organizations is carried out. Purpose of the study - to analyze mechanisms of implementing strategies of medical prevention in the Russian Federation. The publications on implementation of strategies of medical prevention in the Russian Federation were analyzed. The data analysis testifies that improvement of preventive activities at the level of ambulatory polyclinic care is initiated in many subjects of the Russian Federation. However, efficiency of these innovations remains relatively low. The conclusion is made that high morbidity and mortality of non-communicable diseases testify the most urgent need in optimizing prevention system.

[Public health and medical prevention centers in modern conditions of non-infectious and infectious risks].

The article provides an assessment of the validity of the formation of a new nomenclature unit within the framework of the population health protection system - the Centers for Public Health and Medical Prevention. The analysis of new directions of activity of the health care center, structural and functional transformations is carried out. The article presents a detailed description of promising areas of activity based on the use of various modern information and communication technologies, and also reflects the possibility of constructive interactions of the health care center with various social institutions. The role of government initiatives aimed at preventing non-communicable diseases, including in increasing the motivation of the population to adhere to a healthy lifestyle, is shown. The potential possibility of the developed conceptual approaches in the field of strategy and tactics of disease prevention from the point of view of protecting public health, including reproductive health, has been determined.

A Breakthrough in Understanding the Pathogenesis of Molar Hypomineralisation: The Mineralisation-Poisoning Model.

Popularly known as "chalky teeth", molar hypomineralisation (MH) affects over 1-in-5 children worldwide, triggering massive amounts of suffering from toothache and rapid decay. MH stems from childhood illness and so offers a medical-prevention avenue for improving oral and paediatric health. With a cross-sector translational research and education network (The D3 Group; thed3group.org) now highlighting this global health opportunity, aetiological understanding is urgently needed to enable better awareness, management and eventual prevention of MH. Causation and pathogenesis of "chalky enamel spots" (i.e., demarcated opacities, the defining pathology of MH) remain unclear despite 100 years of investigation. However, recent biochemical studies provided a pathomechanistic breakthrough by explaining several hallmarks of chalky opacities for the first time. This article outlines these findings in context of previous understanding and provides a working model for future investigations. The proposed pathomechanism, termed "mineralisation poisoning", involves localised exposure of immature enamel to serum albumin. Albumin binds to enamel-mineral crystals and blocks their growth, leading to chalky opacities with distinct borders. Being centred on extracellular fluid rather than enamel-forming cells as held by dogma, this localising pathomechanism invokes a new type of connection with childhood illness. These advances open a novel direction for research into pathogenesis and causation of MH, and offer prospects for better clinical management. Future research will require wide-ranging inputs that ideally should be coordinated through a worldwide translational network. We hope this breakthrough will ultimately lead to medical prevention of MH, prompting global health benefits including major reductions in childhood tooth decay.

Medical prevention center for chronic diseases in the medical consortium of Wenling city / 中华医院管理杂志

" Medical prevention integration" is the practical need of the construction of healthy China and the focus of the construction of medical consortium in the future. Taking the practice of four chronic disease specific medical prevention centers of Wenling County medical consortium as an example, the authors analyzed their practices and experience in coordinating county advantageous resources, establishing organizational structure, and implementing chronic disease specific prevention and control based on informatization. The " medical prevention integration" system constructed by this mode optimized chronic disease service content, improved service capacity and service quality, and achieved in improving satisfaction. This mode could improve the effect and satisfaction of chronic disease management, improve the prevention and treatment efficiency of chronic diseases, and practice the whole cycle health management of chronic diseases.

Pathogenesis of Molar Hypomineralisation: Aged Albumin Demarcates Chalky Regions of Hypomineralised Enamel.

Molar hypomineralisation (MH) is becoming globally recognised as a significant public health problem linked to childhood tooth decay. However, with causation and pathogenesis unclear after 100 years of investigation, better pathological understanding is needed if MH is to become preventable. Our studies have implicated serum albumin in an extracellular pathomechanism for chalky enamel, opposing longheld dogma about systemic injury to enamel-forming cells. Hypothesising that chalky enamel arises through developmental exposure to serum albumin, this study used biochemical approaches to characterise demarcated opacities from 6-year molars. Addressing contradictory literature, normal enamel was found to completely lack albumin subject to removal of surface contamination. Querying surface permeability, intact opacities were found to lack salivary amylase, indicating that "enamel albumin" had become entrapped before tooth eruption. Thirdly, comparative profiling of chalky and hard-white enamel supported a dose-response relationship between albumin and clinical hardness of opacities. Moreover, albumin abundance delineated chalky enamel from white transitional enamel at opacity borders. Finally, addressing the corollary that enamel albumin had been entrapped for several years, clear signs of molecular ageing (oxidative aggregation and fragmentation) were identified. By establishing aged albumin as a biomarker for chalky enamel, these findings hold methodological, clinical, and aetiological significance. Foremost, direct inhibition of enamel-crystal growth by albumin (here termed "mineralisation poisoning") at last provides a cogent explanation for the clinical presentation of demarcated opacities. Together, these findings justify pursuit of an extracellular paradigm for the pathogenesis of MH and offer exciting new prospects for alleviating childhood tooth decay through medical prevention of MH.

Pathogenesis of Molar Hypomineralisation: Hypomineralised 6-Year Molars Contain Traces of Fetal Serum Albumin.

Molar Hypomineralisation (MH) is gaining cross-sector attention as a global health problem, making deeper enquiry into its prevention a research priority. However, causation and pathogenesis of MH remain unclear despite 100 years of investigation into "chalky" dental enamel. Contradicting aetiological dogma involving disrupted enamel-forming cells (ameloblasts), our earlier biochemical analysis of chalky enamel opacities implicated extracellular serum albumin in enamel hypomineralisation. This study sought evidence that the albumin found in chalky enamel reflected causal events during enamel development rather than later association with pre-existing enamel porosity. Hypothesising that blood-derived albumin infiltrates immature enamel and directly blocks its hardening, we developed a "molecular timestamping" method that quantifies the adult and fetal isoforms of serum albumin ratiometrically. Applying this novel approach to 6-year molars, both isoforms of albumin were detectable in 6 of 8 chalky opacities examined (corresponding to 4 of 5 cases), indicating developmental acquisition during early infancy. Addressing protein survival, in vitro analysis showed that, like adult albumin, the fetal isoform (alpha-fetoprotein) bound hydroxyapatite avidly and was resistant to kallikrein-4, the pivotal protease involved in enamel hardening. These results shift primary attention from ameloblast injury and indicate instead that an extracellular mechanism involving localised exposure of immature enamel to serum albumin constitutes the crux of MH pathogenesis. Together, our pathomechanistic findings plus the biomarker approach for onset timing open a new direction for aetiological investigations into the medical prevention of MH.

Therapeutic cancer prevention: achievements and ongoing challenges - a focus on breast and colorectal cancer.

The constant increase of cancer incidence and the huge costs of new treatments make cancer prevention a crucial goal in order to maintain sustainable public health systems across the world. Carcinogenesis is a multistep process, which allows time for active intervention with natural or synthetic agents to stop or reverse the pathological process. Cancer prevention medicine can be considered to be treatment of premalignant cells or preneoplastic conditions. Clearly such interventions require well-defined risk classification so that personalized strategies and specific treatments can be applied to cohorts with a documented increased cancer risk, and not to the general population as a whole. Further development of these strategies in an efficient and timely manner requires investment in the discovery and validation of surrogate cancer biomarkers with both prognostic and predictive value to detect and monitor the efficacy of interventions in clinical trials and beyond. In the field of cancer prevention medicine, breast and colon cancer demonstrates the strongest clinical evidence that pharmacological intervention can lower cancer risk. Here, we offer an overview of the major clinical achievements for these cancers and the critical issues to improve implementation and clinical uptake of efficacious therapies, as well as further developments needed in the field of preventive medicine.

Injury effect of navy new concept weaponry on combatants and its medical prevention / 第二军医大学学报

New concept weaponry have much greater damage effects than traditional weaponry, not only destroying military equipment and communication systems, but also severely injurying combatants. Typical new concept weaponry, including shipborne laser weapons, electromagnetic pulse weapons and infrasonic weapons, holds destructive power by special light, sound, or electromagnetic wave. This paper expounds the injury effects of new concept weapons on combatants and its medical protection measures, so as to provide reference for the health service support under the condition of new concept weapons.

[The Efficiency of Screening of Glaucoma within the Framework of Dispensarization of Patients with Chronic Non-Infectious Diseases].

The development of program of dispensarization of individuals with main chronic non-infectious diseases causing premature death and disability in population is one of strategies of health care system. According the rules of dispensarization, glaucoma, the most severe disease of eye resulting in blindness in case of absence of treatment, is included into listing of main chronic non-infectious diseases. The questionnaire including 35 questions for ophthalmologists of primary medical care was elaborated with purpose of evaluation efficiency of screening of glaucoma within the framework of dispensarization of individuals with chronic non-infectious diseases. The anonymous questionnaire survey of 62 ophthalmologists of primary medical care was carried out. the study demonstrated that the dispensarization system is considered as efficient by 37% of respondents and as an ineffective one -- by 63% of physicians. Nowadays, 32% of respondents more often diagnose glaucoma stage I, 63% 0 glaucoma stage I--II and 5% -- glaucoma stage II--III. The glaucoma is diagnosed by 68% of physicians during self-dependent visits of patients and by 32% during dispensarization. The implementation of tonometry within the framework of dispensarization of adult population is considered by 18% of respondents as a measure that increased diagnosing of glaucoma at early stage. The glaucoma is diagnosed more often at later stages is considered by 50% of respondents and 32% of respondents diagnose glaucoma more often at implementation of tonometry within the framework of dispensarization. The study permitted to conclude that nowadays glaucoma is more frequently diagnosed at early stage though predominantly at self-dependent visit of patients. This occurrence indicates on either inadequate dispensarization coverage of population or low quality of its i9mplementation. The alteration of basic principle of glaucoma screening is required meaning transition from mass screening model with application of tonometry providing high percentage of errors to target screening with application of broadened complex of diagnostic techniques.

[The Actual Approaches to Reformation of Medical Organizations Providing Out-Patient Care to Population].

The article presents analysis of the system of organization of primary medical sanitary care in the Russian Federation, its strong and weak aspects are emphasized. The main indices of out-patient care of population and their dynamics are considered. The necessity of system development is substantiated with the purpose of supporting accessibility and quality of medical care in out-patient conditions. The concept of development of organizational functional model of primary medical sanitary care in actual conditions is presented. The main principles of the proposed model are founded on implementation of structural transformation of polyclinics with organization of departments of general practitioner practice, specialized consultative care, medical prevention, diagnostic, medical rehabilitation, medical social care, day-time hospital.

Effects of numerical information on intention to participate in cervical screening among women offered HPV vaccination: a randomised study.

OBJECTIVES: To investigate the effects of different types of information about benefits and harms of cervical screening on intention to participate in screening among women in the first cohorts offered human papilloma virus (HPV) vaccination. DESIGN: Randomised survey study. SETTING: Denmark. SUBJECTS: A random sample of women from the birth cohorts 1993, 1994 and 1995 drawn from the general population. INTERVENTIONS: A web-based questionnaire and information intervention. We randomised potential respondents to one of the following four different information modules about benefits and harms of cervical screening: no information; non-numerical information; and two numerical information modules. Moreover, we provided HPV-vaccinated women in one of the arms with numerical information about benefits and harms in two steps: firstly, information without consideration of HPV vaccination and subsequently information conditional on HPV vaccination. MAIN OUTCOME MEASURE: Self-reported intention to participate in cervical screening. RESULTS: A significantly lower proportion intended to participate in screening in the two groups of women receiving numerical information compared to controls with absolute differences of 10.5 (95% CI: 3.3-17.6) and 7.7 (95% CI: 0.4-14.9) percentage points, respectively. Among HPV-vaccinated women, we found a significantly lower intention to participate in screening after numerical information specific to vaccinated women (OR of 0.38). CONCLUSIONS: Women are sensitive to numerical information about the benefits and harms of cervical screening. Specifically, our results suggest that HPV-vaccinated women are sensitive to information about the expected changes in benefits and harms of cervical screening after implementation of HPV vaccination. KEY POINTS Women were less likely to participate in cervical screening when they received numerical information about benefits and harms compared to non-numerical or no information. Specifically, numerical information about the potential impact of the reduced risk of cervical cancer among HPV-vaccinated women reduced the intention to participate among vaccinated women.

Secondary medical prevention after primary vascular surgery between 1996 and 2006: a shift towards more evidence-based treatment.

OBJECTIVE: The implementation of evidence-based secondary medical prevention in peripheral arterial disease (PAD) patients has received increasing attention in recent years, but population-based data are sparse. This study examined the use of secondary medical prophylaxis in unselected symptomatic PAD patients in Denmark. DESIGN: A nationwide follow-up study based on individual-level record linkages of population-based healthcare registers was performed. PARTICIPANTS: All patients who underwent primary vascular reconstruction in Denmark between 1996 and 2006 with a minimum of 6 months of follow-up were included (n = 16,492). METHODS: Data were obtained from prescriptions that were filled six months after primary vascular reconstruction (±90 days). The use of secondary medical prevention was examined according to calendar year and place of residence. RESULTS: The use of lipid-lowering drugs increased from 32.2% in 1996 to 76.1% in 2006 (adjusted relative risk (RR) 1.95, 95% CI 1.81-2.10). The overall use of antihypertensive therapy was unchanged during the study period, but treatment shifted from diuretics/calcium antagonists towards angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists. The use of combination therapy (concomitant lipid-lowering, antiplatelet and any antihypertensive therapies) increased from 29.1% in 1996 to 67.6% in 2006 (adjusted RR 1.95, 95% CI 1.80-2.12). This shift in the use of secondary medical prevention was independent of sociodemographic and clinical factors. No substantial differences in pharmacological use based on place of residence were observed. CONCLUSION: The use of evidence-based secondary medical prevention, especially lipid-lowering drugs, increased substantially among symptomatic PAD patients in Denmark from 1996 to 2006. However, recommendations in current clinical guidelines suggest that room for improvement remains.

The Study of the Thought of the Medical Prevention of F C Yen and its Practical Significance / 中华医学教育探索杂志

The establishment and development of the modern medical education in China was related with F. C. Yen, M. D., a famous medical educator, a public hygiene expert and the originator of the modern medical education in China. He made a correct assessment of the deep distress situation in China in the first half of the 20th century. Taking public health education as the most important thing in China at his time, he did his utmost to spread the idea of medical prevention. Based on many years of his experience of teaching and management, he formed a complete set of all-round construction of the modern medical education in China. This paper aims at discussing the theoretical and practical significance of his idea of medical prevention by analyzing his activities of the medical education.