CYP3A5 Genotype and Time to Reach Tacrolimus Therapeutic Levels in Renal Transplant Children.

BACKGROUND: CYP3A5 gene polymorphism rs776746 has been associated with lower tacrolimus dose requirements and bioavailability in both adults and children. This variant causes a loss of CYP3A5 activity owing to a splice site variant leading to a truncated inactive enzyme. The aim of this study was to determine if the rs776746 gene polymorphism is related to the time to reach tacrolimus therapeutic levels in renal transplant children. METHODS: A prospective study was performed in renal transplant children receiving tacrolimus as part of their immunosuppressive regime. CYP3A5 genotype was determined by direct sequencing. Tacrolimus trough levels and serum creatinine at 1 week and 1 month after renal transplantation was obtained from clinical chart. RESULTS: A total of 42 patients were included; 19 (45.2%) were female, 23 (54.8%) received living-donor transplants, and 21 patients expressed CYP3A5*1/*1 or CYP3A5*1/*3. Tacrolimus dose was higher in expressers at week 1 (0.13 vs 0.10 mg/kg/d; P = .011), and week 4 after transplantation (0.17 vs 0.09 mg/kg/d; P < .0001). At 4 weeks after renal transplantation, only 9 patients from the expressers group (42.8%) had levels ≥7 ng/mL, in contrast to 18 in the nonexpressers group (85.7%; Fisher exact P = .008). CONCLUSIONS: Tacrolimus dose was significant higher in functional CYP3A5 expressers. Only 42.8% of such expressers had tacrolimus trough levels ≥7 ng/mL at 1 month after transplantation despite dose adjustments. Long-term follow up is needed to address the consequences of early post-transplantation bioavailability differences due to CYP3A5 genotype.

The relationship between satisfaction with mouth and number, position and condition of teeth: studies in Brazilian adults.

The objective of this study was to analyse adults' subjective perception of satisfaction in relation to number, position and condition of natural teeth. Subjective perception of satisfaction was assessed by interview. Dental status was assessed. Two types of survey were carried out in Brazil: a longitudinal and a cross-sectional survey. The longitudinal study commenced in 1990, with 227 dentate people aged 45-54 years, of two social classes. Of the 227 subjects examined in 1990, 126 were re-examined and interviewed 3 years later. The cross-sectional survey used the same methods used for the longitudinal study. Six hundred and fifty-seven dentate males aged from 35 to 54 years were examined and interviewed. There was a positive correlation between satisfaction and position of teeth. Premolar pairs had a higher correlation with satisfaction in both studies. Anterior teeth were the most significant predictors of satisfaction. There was no difference in the percentage of satisfied persons between the baseline and follow-up studies. The results indicate that adults with three premolar pairs and intact anterior sextants were satisfied with their oral status. Keeping a certain number of teeth, depending on their position and condition, gave more satisfaction than having the missing teeth replaced with partial dentures.

The relationship between satisfaction with mouth and number and position of teeth.

A number of studies have suggested that many people are satisfied with less than 28 natural teeth. This review assesses the evidence. The main conclusion was that less than a complete dentition can satisfy oral functional needs. Missing posterior teeth were not very important from a subjective aspect. The demand for replacement of missing teeth is related to the position of missing teeth. Most studies agree that individuals were more concerned about missing anterior teeth and having anterior rather than posterior teeth replaced. Aesthetics is more important than function for a great majority of individuals. However, certain socio-demographic factors, such as age, can change the subjective need for replacement of missing teeth. Some studies have assessed the social and psychological impacts on oral health status. The position of missing teeth was assessed, in terms of groups of missing teeth, anterior or posterior, that would affect an individuals' subjective need for replacement by partial prosthesis. Large numbers of people that have free end removable partial dentures made do not wear them because subjective needs are lower than normatively determined needs for replacement of missing teeth. Some studies have proposed alternatives to the replacement of missing teeth, such as the shortened dental arch concept.

Labial incompetence: a marker for progressive bone resorption in silastic chin augmentation.

Bone erosion below silicone rubber implants is a wellknown sequela, occurring in a majority of patients undergoing augmentation genioplasty. It is generally considered to be self-limiting and with minimal adverse consequences. However, if bone erosion progresses to the extent to which teeth are jeopardized or alterations in sensibility of the mental nerve occur, removal of the implant is indicated. Osteoplastic genioplasty may be required to restore aesthetic contour to the chin and to avoid functional anomalies that may occur from explantation. A number of factors have been identified that contribute to this phenomenon; however, speculation regarding its etiology has not acknowledged the functional aberration of a tensed mentalis muscle. A study of six patients with aesthetically positioned and appropriately sized Silastic implants revealed a correlation between preoperative baseline labial incompetence and mentalis muscle hyperactivity and progressive bony erosion. One patient had grade II erosion and four patients had grade III erosion, one with the exposure of dental roots. The sixth patient with mentalis muscle strain, subsequent to attempts to contain her lower denture, also had severe resorption. Such findings suggest that attention should be paid to an alternative approach in microgenic patients presenting with lip strain, since labial incompetence appears to be a reliable marker for ongoing mandibular resorption following Silastic augmentation. Furthermore, since most patients are asymptomatic until significant erosion occurs or are satisfied and do not return, in those individuals with labial incompetence who have already had Silastic chin implants, consideration should be given to routine follow-up examination and radiographs.

A case of cheiloplasty--1864.

Six hundred twenty thousand American soldiers were killed in the Civil War--almost as many fatalities as in all wars from the American Revolution through Vietnam. Those soldiers who did not immediately succumb to their wounds often had injuries that taxed the skills and imagination of the surgeon. A case of extensive destruction of the lower face is presented.