Acceptability of the Long-Term In-Home Ventilator Engagement virtual intervention for home mechanical ventilation patients during the COVID-19 pandemic: A qualitative evaluation.

Background: Clinical management of ventilator-assisted individuals (VAIs) was challenged by social distancing rules during the COVID-19 pandemic. In May 2020, the Long-Term In-Home Ventilator Engagement (LIVE) Program was launched in Ontario, Canada to provide intensive digital care case management to VAIs. The purpose of this qualitative study was to explore the acceptability of the LIVE Program hosted via a digital platform during the COVID-19 pandemic from diverse perspectives. Methods: We conducted a qualitative descriptive study (May 2020-April 2021) comprising semi-structured interviews with participants from eight home ventilation specialty centers in Ontario, Canada. We purposively recruited patients, family caregivers, and providers enrolled in LIVE. Content analysis and the theoretical concepts of acceptability, feasibility, and appropriateness were used to interpret findings. Results: A total of 40 individuals (2 VAIs, 18 family caregivers, 20 healthcare providers) participated. Participants described LIVE as acceptable as it addressed a longstanding imperative to improve care access, ease of use, and training provided; feasible for triaging problems and sharing information; and appropriate for timeliness of provider responses, workflows, and perceived value. Negative perceptions of acceptability among healthcare providers concerned digital workload and fit with existing clinical workflows. Perceived benefits accorded to LIVE included enhanced physical and psychological safety in the home, patient-provider relations, and VAI engagement in their own care. Conclusions: Study findings identify factors influencing the LIVE Program's acceptability by patients, family caregivers, and healthcare providers during pandemic conditions including enhanced access to care, ease of case management triage, and VAI safety. Findings may inform the implementation of digital health services to VAIs in non-pandemic circumstances.

Tooth caries classification with quantitative light-induced fluorescence (QLF) images using convolutional neural network for permanent teeth in vivo.

BACKGROUND: Owing to the remarkable advancements of artificial intelligence (AI) applications, AI-based detection of dental caries is continuously improving. We evaluated the efficacy of the detection of dental caries with quantitative light-induced fluorescence (QLF) images using a convolutional neural network (CNN) model. METHODS: Overall, 2814 QLF intraoral images were obtained from 606 participants at a dental clinic using Qraypen C® (QC, AIOBIO, Seoul, Republic of Korea) from October 2020 to October 2022. These images included all the types of permanent teeth of which surfaces were smooth or occlusal. Dataset were randomly assigned to the training (56.0%), validation (14.0%), and test (30.0%) subsets of the dataset for caries classification. Moreover, masked images for teeth area were manually prepared to evaluate the segmentation efficacy. To compare diagnostic performance for caries classification according to the types of teeth, the dataset was further classified into the premolar (1,143 images) and molar (1,441 images) groups. As the CNN model, Xception was applied. RESULTS: Using the original QLF images, the performance of the classification algorithm was relatively good showing 83.2% of accuracy, 85.6% of precision, and 86.9% of sensitivity. After applying the segmentation process for the tooth area, all the performance indics including 85.6% of accuracy, 88.9% of precision, and 86.9% of sensitivity were improved. However, the performance indices of each type of teeth (both premolar and molar) were similar to those for all teeth. CONCLUSION: The application of AI to QLF images for caries classification demonstrated a good performance regardless of teeth type among posterior teeth. Additionally, tooth area segmentation through background elimination from QLF images exhibited a better performance.

Understanding caregiver experiences with disease-modifying therapies for spinal muscular atrophy: a qualitative study.

OBJECTIVE: Spinal muscular atrophy (SMA) is a neuromuscular disorder that manifests with motor deterioration and respiratory complications. The paradigm of care is shifting as disease-modifying therapies including nusinersen, onasemnogene abeparvovec and risdiplam alter the disease trajectory of SMA. The objective of this study was to explore caregivers' experiences with disease-modifying therapies for SMA. DESIGN: Qualitative study including semistructured interviews with caregivers of children with SMA who received disease-modifying therapies. Interviews were audio recorded, transcribed verbatim, coded and analysed using content analysis. SETTING: The Hospital for Sick Children (Toronto, Canada). RESULTS: Fifteen family caregivers of children with SMA type 1 (n=5), type 2 (n=5) and type 3 (n=5) participated. There were two emerging themes and several subthemes (in parentheses): (1) inequities in access to disease-modifying therapies (variable regulatory approvals, prohibitively expensive therapies and insufficient infrastructure) and (2) patient and family experience with disease-modifying therapies (decision making, hope, fear and uncertainty). CONCLUSION: The caregiver experience with SMA has been transformed by the advent of disease-modifying therapies. Consistent and predictable access to disease-modifying therapies is a major concern for caregivers of children with SMA but is influenced by regulatory approvals, funding and eligibility criteria that are heterogenous across jurisdictions. Many caregivers described going to great lengths to access therapies, highlighting issues related to justice, such as equity and access. This diverse population reflects contemporary patients and families with SMA; their broad experiences may inform the healthcare delivery of other emerging orphan drugs.

Cytotoxicity of dental self-curing resin for a temporary crown: an in vitro study.

BACKGROUND: Residual monomer tests using high-performance liquid chromatography and cytotoxicity tests were performed to analyze the effect on the oral mucosa of a self-curing resin for provisional crown production. METHODS: A cytotoxicity test was performed to confirm whether leaked residual monomers directly affected oral mucosal cells. The cytotoxicity of the liquid and solid resin polymers was measured using a water-soluble tetrazolium (WST) test and microplate reader. RESULTS: In the WST assay using a microplate reader, 73.4% of the cells survived at a concentration of 0.2% liquid resin polymer. The cytotoxicity of the liquid resin polymer was low at ≤0.2%. For the solid resins, when 100% of the eluate was used from each specimen, the average cell viability was 91.3% for the solid resin polymer and 100% for the hand-mixed self-curing resin, which is higher than the cell viability standard of 70%. The cytotoxicity of the solid resin polymer was low. CONCLUSION: Because the polymerization process of the self-curing resin may have harmful effects on the oral mucosa during the second and third stages, the solid resin should be manufactured indirectly using a dental model.

Oral chemical burns caused by topical application of policresulen: a case report.

Oral mucosal burns can occur after contact with various chemical agents, and commonly manifest as areas of mucosal sloughing and ulceration. Policresulen (Albothyl, Celltrion Pharm Inc.) is an over-the-counter topical antiseptic that is frequently used to treat stomatitis. Policresulen solution is highly acidic, with an approximate pH of 0.6; it can thus cause mucosal injury when improperly applied in the oral cavity. Here, we present a rare case of an oral mucosal burn resulting from incorrect self-administration of policresulen and emphasize the importance of increasing understanding of this adverse drug event among consumers and health professionals.

Three-dimensional printing of temporary crowns with polylactic acid polymer using the fused deposition modeling technique: a case series.

With recent developments in digital dentistry, research on techniques and materials for three-dimensional (3D) printing is actively underway. We report the clinical applications and outcomes of 3D printing of temporary crowns fabricated with polylactic acid (PLA) using a fused deposition modeling (FDM) printer. Five participants were recruited from among patients scheduled to be treated with a single full-coverage crown at a dental clinic in a university medical center from June to August 2022. We used 3D-printed crowns fabricated with PLA using an FDM printer as temporary crowns and were assessed for discomfort, fracture, and dislodging. The 3D-printed temporary crowns were maintained without fracture, dislodging, or discomfort until the permanent prosthesis was ready. The average time required for printing the temporary crowns was approximately 7 minutes. The 3D printing of temporary crowns with PLA using an FDM printer is a convenient process for dentists. However, these crowns have some limitations, such as rough surface texture and translucency; therefore, the 3D printing process should be improved to produce better prostheses.

Caries detection with tooth surface segmentation on intraoral photographic images using deep learning.

BACKGROUND: Intraoral photographic images are helpful in the clinical diagnosis of caries. Moreover, the application of artificial intelligence to these images has been attempted consistently. This study aimed to evaluate a deep learning algorithm for caries detection through the segmentation of the tooth surface using these images. METHODS: In this prospective study, 2348 in-house intraoral photographic images were collected from 445 participants using a professional intraoral camera at a dental clinic in a university medical centre from October 2020 to December 2021. Images were randomly assigned to training (1638), validation (410), and test (300) datasets. For image segmentation of the tooth surface, classification, and localisation of caries, convolutional neural networks (CNN), namely U-Net, ResNet-18, and Faster R-CNN, were applied. RESULTS: For the classification algorithm for caries images, the accuracy and area under the receiver operating characteristic curve were improved to 0.813 and 0.837 from 0.758 to 0.731, respectively, through segmentation of the tooth surface using CNN. Localisation algorithm for carious lesions after segmentation of the tooth area also showed improved performance. For example, sensitivity and average precision improved from 0.890 to 0.889 to 0.865 and 0.868, respectively. CONCLUSION: The deep learning model with segmentation of the tooth surface is promising for caries detection on photographic images from an intraoral camera. This may be an aided diagnostic method for caries with the advantages of being time and cost-saving.

Association between periodontal disease and diabetes using propensity score matching: The seventh Korea National Health and Nutrition Examination Survey.

The association between periodontitis and diabetes have been assessed by many cross-sectional studies, in which controlling confounding factors is important. Propensity score matching (PSM) may help address this issue. Therefore, we evaluated this relationship in a (PSM) analysis of individuals representing the general Korean population. Periodontitis was significantly associated with diabetes before PSM (odds ratio [OR] = 1.53; 95 % confidence interval (CI) = 1.31-1.80) and after PSM (OR = 1.52; 95 % CI = 1.28-1.80). This study showed the association between periodontitis and diabetes using PSM, suggesting that periodontitis may be positively related with diabetes. We included 9508 adults who were aged ≥ 19 years from the Korea National Health and Nutrition Examination Survey VII (2016-2018) and performed logistic regression analyses before and after PSM. The PSM was based on periodontal disease (yes or no) using a 1:1 match ratio and included 5858 individuals (2929 per group). Confounding variables, such as age, sex, marital status, occupation, education, income, smoking and drinking habits, obesity, hypertension, hypercholesterolemia, and hypertriglyceridemia, were matched and adjusted in the logistic regression analysis.

A useful method of using the healing abutments for interocclusal records in implant overdenture: a case report.

To determine the vertical dimension and centric relation during the construction of implant overdentures, the record base and wax rim may need to be adjusted. The conventional method has several drawbacks, as it requires repeated tightening and loosening of the impression coping. Here, we report a useful and novel method for interocclusal records using the healing abutments in implant overdentures. Our case demonstrates that this method is easier and simpler and prevents gingival collapse.

Current aspects and prospects of glass ionomer cements for clinical dentistry.

Glass ionomer cement (GIC) is a tailor-made material that is used as a filling material in dentistry. GIC is cured by an acid-base reaction consisting of a glass filler and ionic polymers. When the glass filler and ionic polymers are mixed, ionic bonds of the material itself are formed. In addition, the extra polymer anion reacts with calcium in enamel or dentin to increase adhesion to the tooth tissue. GICs are widely used as adhesives for artificial crowns or orthodontic brackets, and are also used as tooth repair material, cavity liner, and filling materials. In this review, the current status of GIC research and development and its prospects for the future have been discussed in detail.

Positive Impact of Multiple-Choice Question Authoring and Regular Quiz Participation on Student Learning.

We previously developed an online multiple-choice question authoring, learning, and self-assessment tool that we termed Quizzical. Here we report statistical analyses over two consecutive years of Quizzical use in a large sophomore-level introductory molecular biology course. Students were required to author two questions during the term and were also afforded opportunities to earn marks for quiz participation. We found that students whose final grade was "A," "B," or "C" exhibited similar patterns of Quizzical engagement. The degree to which students participated was positively associated with performance on formal exams, even if prior academic performance was considered as a covariable. During both terms investigated, students whose Quizzical engagement increased from one exam to the next earned statistically significant higher scores on the subsequent exam, and students who attempted Quizzical questions from earlier in the term scored higher, on average, on the cumulative portion of the final exam. We conclude that the structure and value of the assignment, and the utility of Quizzical as a discipline-independent active-learning and self-assessment tool, enabled students to better master course topics.

Mineralization-inducing potentials of calcium silicate-based pulp capping materials in human dental pulp cells.

BACKGROUND: To provide a long-term bacterial seal through the formation of reparative dentin bridge, calcium silicate-based pulp capping materials have been used at sites of pulpal exposure. The aim of this study was to evaluate the mineralization-inducing potentials of calcium silicate-based pulp capping materials (ProRoot MTA [PR], Biodentine [BD], and TheraCal LC [TC]) in human dental pulp cells (HDPCs). METHODS: Specimens of test materials were placed in deionized water for various incubation times to measure the pH variation and the concentration of calcium released. The morphology of HDPCs cultured on the specimens was examined using a confocal laser scanning microscope (CLSM). Alizarin red S staining and alkaline phosphatase assays were used to evaluate mineralization-inducing potentials of the capping materials. RESULTS: BD showed the highest calcium release in all test periods, followed by PR and TC. (p<0.05). All experimental groups showed high alkalinity after 1 day, except at 14 days. BD showed the highest cell viability compared with PR and TC after 1 and 3 days, while TC showed the lowest value (p<0.05). The CLSM analysis showed that cells were well adhered and expressed actin filaments for all pulp capping materials. Mineralization by PR and BD groups was higher than that by TC group based on alizarin red S staining. BD showed significantly higher alkaline phosphatase activity than PR and TC, while TC showed the lowest value (p<0.05). CONCLUSION: Within the limitations of the in vitro study, BD had higher mineralization-inducing potential than PR and TC.

The therapeutic potential of induced hepatocyte-like cells generated by direct reprogramming on hepatic fibrosis.

BACKGROUND: Until now, there is no effective anti-fibrotic therapy available for liver cirrhosis. Stem cell therapies have been studied for the treatment of hepatic fibrosis. However, the use of embryonic stem cells or induced pluripotent stem cells (iPSC) has limitations such as ethical concern or malignancy potential. Induced hepatocyte-like cells (iHEPs) generated by direct reprogramming technology may overcome these limitations. METHODS: In this study, we generated iHEPs by direct reprogramming from mouse embryonic fibroblast (MEF) either using specific transcription factors such as c-Myc and Klf-4 (type A), or adding small molecules to HNF1α (type B). RESULTS: We investigated the effect of iHEPs on acute liver injury and chronic hepatic fibrosis animal models induced by CCl4 intra-peritoneal injection in BALB/C nude mice. In acute liver injury model, serum AST/ALT levels peaked at 24 h after CCl4 injection. Intra-splenic transplantation of iHEPs significantly attenuated CCl4-induced acute liver injury. GFP-labeled iHEPs (type A) migrated to the liver after intra-splenic transplantation that was confirmed by Western blotting and immunofluorescence staining. We found that GFP and albumin were co-localized in migrated iHEPs in the liver suggesting migrated iHEPs were functional. In chronic hepatic fibrosis mice experiment, transplantation of either type A or type B iHEPs significantly attenuated liver fibrosis induced by CCl4 injection for 10 weeks. CONCLUSIONS: Our study suggests that iHEPs may be used as a novel therapeutic strategy for the treatment of hepatic fibrosis.

The channel-kinase TRPM7 regulates antigen gathering and internalization in B cells.

Members of the transient receptor potential (TRP) family of ion channels are cellular sensors involved in numerous physiological and pathological processes. We identified the TRP subfamily M member 7 (TRPM7) channel-kinase as a previously uncharacterized regulator of B cell activation. We showed that TRPM7 played a critical role in the early events of B cell activation through both its ion channel and kinase functions. DT40 B cells deficient in TRPM7 or expressing a kinase-deficient mutant of TRPM7 showed defective gathering of antigen and prolonged B cell receptor (BCR) signaling. We showed that lipid metabolism was altered in TRPM7-deficient cells and in cells expressing a kinase-deficient mutant of TRPM7 and suggest that PLC-γ2 may be a target of the kinase activity of TRPM7. Primary B cells that expressed less TRPM7 or were treated with a pharmacological inhibitor of TRPM7 also displayed defective antigen gathering and increased BCR signaling. Finally, we demonstrated that blocking TRPM7 function compromised antigen internalization and presentation to T cells. These data suggest that TRPM7 controls an essential process required for B cell affinity maturation and the production of high-affinity antibodies.

Esthetic enhancement of a traumatized anterior tooth with a combination of forced eruption and tooth alignment: a case report.

Exposing sound structure of a subgingivally fractured tooth using orthodontic extrusion is considered to be a conservative way to re-establish biologic width without sacrificing esthetics or jeopardizing periodontal support of neighboring teeth. When a misaligned tooth is traumatically involved, a more comprehensive approach combining tooth extrusion and re-alignment may be necessary for a successful restorative outcome. This case report describes a successful esthetic management of a patient with complicated crown-root fracture on the maxillary right central incisor and pre-existing malocclusion in the maxillary anterior region. Forced eruption along with re-alignment of teeth by orthodontic movement seems to allow re-positioning of the fracture line to a favorable position and correction of crowding, providing a better esthetic result.

Inferring gene network from candidate SNP association studies using a Bayesian graphical model: application to a breast cancer case-control study from ontario.

BACKGROUND/AIMS: Gene network analysis can be a very valuable approach for elucidating complex dependence between functional SNPs in a candidate genetic pathway and for assessing their association with a disease of interest. Even when the number of SNPs evaluated is relatively small (<20), the number of potential gene networks induced by the SNPs can be very large and the contingency tables representing their joint distribution very sparse. METHODS: In this paper, we propose a Bayesian model determination for gene network analysis using decomposable discrete graphical models combined with Reversible Jump Markov chain Monte Carlo. We show the application of this approach in a study of 13 SNPs in the DNA repair pathway and their association with breast cancer from a case-control study conducted in Ontario, Canada. RESULTS: The strength of associations among the SNPs and between the SNPs and the disease status is evaluated by computing the posterior probability of any pair of variables. The corresponding gene network is reconstructed by retaining pair-wise associations with the highest posterior probabilities. In our real data analysis, we found evidence for a particular association between one SNP in the gene POLL and the disease status and also several interesting patterns of association between the SNPs themselves. CONCLUSION: This general statistical framework could serve as a basis for prioritizing genes and SNPs that play a major role in breast cancer etiology and to better understand their complex interactions in a specific genetic pathway.

Safety of antiviral medication for the treatment of herpes during pregnancy.

QUESTION: One of my patients is a pregnant woman in her first trimester with a history of recurrent genital herpes. She is concerned about whether use of her antiviral medication will adversely affect her baby. What should I tell her? ANSWER: Studies have shown that the use of acyclovir or valacyclovir is not associated with an increase in birth defects. Limited data exist for famciclovir and therefore it would not be considered a first-line choice for treatment of herpes during pregnancy.

Identification of two types of naturally-occurring intertypic recombinants of Epstein-Barr virus.

Two Epstein-Barr virus (EBV) types, type 1 and type 2, maintain the same allelic specificity at four genomic loci encoding the EBNA2, -3A, -3B, and -3C proteins. We have previously described 16 EBV-transformed B-lymphoblastoid cell lines derived from Korean cancer patients, and the EBNA2 types of the EBV isolates therein. In this study, the allelic types of the EBNA2, -3A, -3B, and -3C genes of these EBV isolates were determined. We report the identification of two distinct types of naturally occurring intertypic recombinants, one with genotype EBNA2 type 1/EBN3A, -3B, -3C type 2 and the other with genotype EBNA2, -3A type 1/EBNA3B, -3C type 2. The existence of these intertypic recombinants indicates that various intertypic EBV strains may be circulating in the human population, in addition to typical EBV-1 and EBV-2 strains.