What every dentist needs to know about in-house clear aligner therapy.

Clear aligner therapy (CAT) has gained popularity in recent years. As technological advancements increase within the field of dentistry, clinicians have opted to prouce orthodontic appliances within their own offices or clinics, often referred to as in-house CAT. Construction of in-house aligners utilizes 3-dimensional printing devices, potentially offering practitioners enhanced control and improving patient comfort. The aim of this article is to review the materials, methods, advantages, disadvantages, and procedural outcomes associated with the fabrication of aligners within a dental office or clinic.

Identifying And Exploring Bias In Public Opinion On Scarce Resource Allocation During The COVID-19 Pandemic.

The COVID-19 pandemic offers an opportunity to examine public opinion regarding the allocation of scarce medical resources. In this conjoint experiment on a nationally representative sample of US adults, we examined how a range of patient characteristics affect respondents' willingness to allocate a ventilator between two patients with equal likelihood of short-term survival and how this differs by respondents' attributes. Respondents were 5.5 percentage points less likely to allocate a ventilator to a patient with a disability than to a nondisabled patient. Disability bias was correlated with older age cohorts and higher education levels of respondents. Liberal and moderate respondents were more likely to give a ventilator to Black and Asian patients than to White patients. Conservatives were much less likely to allocate a ventilator to transgender patients than to cisgender patients. These findings demonstrate the importance of bias mitigation and civil rights enforcement in health policy making, especially under conditions of scarcity.

Intramuscular ketamine vs. escitalopram and aripiprazole in acute and maintenance treatment of patients with treatment-resistant depression: A randomized double-blind clinical trial.

Objective: Ketamine, an N-methyl D-aspartate (NMDA) receptor antagonist, can promote rapid action in the management of individuals with treatment-resistant depression (TRD) at sub-anesthetic doses. However, few studies have investigated the long-term use of ketamine administered intravenously (IV) and intranasally (IN). We report the design and rationale of a therapeutic trial for assessing the efficacy, safety, and tolerability of repeated-dose intramuscular (IM) ketamine vs. active treatment (escitalopram and aripiprazole) in TRD patients. Methods: A comparative, parallel-group, randomized double-blind trial assessing the efficacy, safety, and tolerability of acute (4 weeks) and maintenance (24 weeks) use of IM ketamine (0.75 mg/kg) vs. active control (escitalopram 15 mg and aripiprazole 5 mg) in individuals with moderate-severe intensity TRD (no psychotic symptoms) with or without suicide risk will be conducted. Patients with TRD (18-40 years) will be randomized and blinded to receive ketamine IM or active treatment at a 1:1 ratio for 4 weeks (active treatment) and 24 weeks (maintenance treatment). Subjects will be assessed using clinical scales, monitored for vital signs (VS) after application of injectable medication, and undergo neuropsychological tests. The primary outcome will be changed on the Montgomery-Åsberg Depression Rating Scale (MADRS) during the course of the trial. The study is in running. Results: This study can potentially yield evidence on the use of IM ketamine in the treatment of depressive disorders as an ultra-rapid low-cost therapy associated with less patient discomfort and reduced use of medical resources, and can elucidate long-term effects on different outcomes, such as neuropsychological aspects. Conclusions: The trial can help promote the introduction of a novel accessible approach for the treatment of complex disease (TRD) and also allow refinement of its long-term use. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT04234776, identifier: NCT04234776.

What every dentist needs to know about clear aligners.

In recent years, the demand for esthetic orthodontic treatment options for adult patients has increased dramatically. Clear aligner therapy (CAT) has become a popular method of orthodontic therapy that now allows for comprehensive treatment with more complex dental movements. Moreover, the increasing role of technology in dental treatments has made CAT more appealing to providers and patients. The aim of this article is to highlight the clinical scope and limitations of CAT and to outline the differences among various clear aligner products.

What every dentist and patient should know about accelerated orthodontic tooth movement.

Within the last few decades, an increasing number of adults have sought orthodontic therapy. One disadvantage of pursuing orthodontic treatment in adulthood is the lengthened time span required to complete tooth movement. The purpose of this article is to review the biologic mechanisms of accelerated tooth movement as well as the literature on nonsurgical and surgical techniques that may reduce the duration of orthodontic treatment.

A Computational Approach Using Bioinformatics to Screening Drug Targets for Leishmania infantum Species.

BACKGROUND: The development of new therapeutic strategies to treat patients for leishmaniasis has become a priority. The antileishmanial activity of the strychnobiflavone flavonoid was recently demonstrated against Leishmania amazonensis and Leishmania infantum amastigotes and promastigotes. The biological effect of this molecule was identified due to its capacity to interfere in the parasite mitochondrial membrane; however, the underlying molecular mechanism remains unclear. METHODS AND RESULTS: In this study, a computational approach using bioinformatics was performed to screen biological targets of strychnobiflavone in L. infantum. Computational programs, such as the target fishing approach and molecular docking assays, were used. Results showed that the putative pathway targeted by strychnobiflavone in L. infantum is the methylglyoxal degradation superpathway, and one hydrolase-like protein was predicted to be the molecular target of this flavonoid in the parasites. CONCLUSION: In this context, this study provides the basis for understanding the mechanism of action of strychnobiflavone in L. infantum and presents a strategy based on bioinformatics programs to screen targets of other molecules with biological action against distinct pathogens.

Functional organic cation transporters mediate osteogenic response to metformin in human umbilical cord mesenchymal stromal cells.

BACKGROUND: Compelling evidence indicates that metformin, a low-cost and safe orally administered biguanide prescribed to millions of type 2 diabetics worldwide, induces the osteoblastic differentiation of mesenchymal stromal cells (MSCs) through the 5' adenosine monophosphate (AMP)-activated protein kinase (AMPK) pathway. As a highly hydrophilic cationic compound, metformin uptake is facilitated by cell membrane organic cation transporters (OCTs) of the solute carrier 22A gene family. We hypothesized that to effectively enhance osteogenic differentiation, and ultimately bone regeneration, metformin must gain access into functional OCT-expressing MSCs. METHODS: Data was obtained through immunoblotting, cellular uptake, mineralization and gene expression assays. RESULTS: We demonstrate for the first time that functional OCTs are expressed in human-derived MSCs from umbilical cord Wharton's jelly, an inexhaustible source of nonembryonic MSCs with proven osteogenic potential. A clinically relevant concentration of metformin led to AMPK activation, enhanced mineralized nodule formation and increased expression of the osteogenic transcription factor Runt-related transcription factor 2 (RUNX2). Indeed, targeting OCT function through pharmacological and genetic approaches markedly blunted these responses. CONCLUSIONS: Our findings indicate that functional OCT expression in UC-MSCs is a biological prerequisite that facilitates the intracellular uptake of metformin to induce an osteogenic effect. Future pre-clinical studies are warranted to investigate whether the expression of functional OCTs may serve as a potential biomarker to predict osteogenic responses to metformin.

Disparity in opinions on lip protrusiveness in contemporary African American faces.

OBJECTIVE: In accordance with the changing demographics in the United States, orthodontists working on various ethnic populations should be more conscious when using the standardized profile analyses for the African American patient. The objective of this study was to examine whether the perception of lip protrusiveness in modern African American faces has changed. For this purpose, we investigated the most favorable African American lip profile using the opinions of 10 experienced and 10 newly trained younger orthodontists. METHODS: Attractiveness was converted to a number on visualized analog scales. Comparative ranks on 16 African American profiles, with focus on lip protrusiveness and thickness, were made among the groups. Mixed-effects linear regression models were fit and group differences were estimated. RESULTS: Younger orthodontists favored a more protrusive lip profile, and the variance in their perceptions was narrower than those of older orthodontists. Measurements related to upper lip protrusion showed the strongest correlation to attractiveness (r = -0.82). The association with attractiveness decreased linearly as the protrusiveness of the upper lip increased. Steiner's E-line was the most influential reference for determining the level of attractiveness for the older orthodontists, whereas upper lip protrusion was the most influential factor for the young orthodontists. CONCLUSIONS: An adequate level of lip protrusiveness and thickness should be essential for maintaining attractive esthetics in African American patients. Yet, a new set of standards for prominent lips in this population is necessary to reflect the current trend in the concept of a beautiful face in the modern world.

Small Myristoylated Protein-3, Identified as a Potential Virulence Factor in Leishmania amazonensis, Proves to be a Protective Antigen against Visceral Leishmaniasis.

In a proteomics approach conducted with Leishmania amazonensis, parasite proteins showed either an increase or a decrease in their expression content during extensive in vitro cultivation, and were related to the survival and the infectivity of the parasites, respectively. In the current study, a computational screening was performed to predict virulence factors among these molecules. Three proteins were selected, one of which presented no homology to human proteins. This candidate, namely small myristoylated protein-3 (SMP-3), was cloned, and its recombinant version (rSMP-3) was used to stimulate peripheral blood mononuclear cells (PBMCs) from healthy subjects living in an endemic area of leishmaniasis and from visceral leishmaniasis patients. Results showed high interferon-γ (IFN-γ) production and low levels of interleukin 10 (IL-10) in the cell supernatants. An in vivo experiment was then conducted on BALB/c mice, which were immunized with rSMP-3/saponin and later challenged with Leishmania infantum promastigotes. The rSMP-3/saponin combination induced high production of protein-specific IFN-γ, IL-12, and granulocyte-macrophage colony-stimulating factor (GM-CSF) by the spleen cells of the immunized mice. This pattern was associated with protection, which was characterized by a significant reduction in the parasite load in distinct organs of the animals. Altogether, these results have revealed that this new virulence factor is immunogenic in both mice and humans, and have proven its protective efficacy against visceral leishmaniasis in a murine model.

Antileishmanial activity of a naphthoquinone derivate against promastigote and amastigote stages of Leishmania infantum and Leishmania amazonensis and its mechanism of action against L. amazonensis species.

Leishmaniasis has become a significant public health issue in several countries in the world. New products have been identified to treat against the disease; however, toxicity and/or high cost is a limitation. The present work evaluated the antileishmanial activity of a new naphthoquinone derivate, Flau-A [2-(2,3,4-tri-O-acetyl-6-deoxy-ß-L-galactopyranosyloxy)-1,4-naphthoquinone], against promastigote and amastigote-like stages of Leishmania amazonensis and L. infantum. In addition, the cytotoxicity in murine macrophages and human red cells was also investigated. The mechanism of action of Flau-A was assessed in L. amazonensis as well as its efficacy in treating infected macrophages and inhibiting infection of pretreated parasites. Results showed that Flau-A was effective against promastigotes and amastigote-like forms of both parasite species, as well as showed low toxicity in mammalian cells. Results also highlighted the morphological and biochemical alterations induced by Flau-A in L. amazonensis, including loss of mitochondrial membrane potential, as well as increased reactive oxygen species production, cell shrinkage, and alteration of the plasma membrane integrity. The present study demonstrates for the first time the antileishmanial activity of Flau-A against two Leishmania species and suggests that the mitochondria of the parasites may be the main target organelle. Data shown here encourages the use of this molecule in new studies concerning treatment against Leishmania infection in mammalian hosts.

Suppressing Crack Formation in Particulate Systems by Utilizing Capillary Forces.

Cracks, formed during the drying of particulate films, can reduce the effectiveness or even render products useless. We present a novel, generic approach to suppress crack formation in thin films made from hard particle suspensions, which are otherwise highly susceptible to cracking, using the capillary force between particles present when a trace amount of an immiscible liquid is added to a suspension. This secondary liquid preserves the particle cohesion, modifying the structure and increasing the drying rate. Crack-free films can be produced at thicknesses much greater than the critical cracking thickness for a suspension without capillary interactions, and even persists after sintering. This capillary suspension strategy is applicable to a broad range of materials, including suspensions of metals, semiconductive and ceramic oxides, or glassy polymeric particles, and can be easily implemented in many industrial processes since it is based on well-established unit operations. Promising fields of application include ceramic foils and printed electronic devices.

An in silico functional annotation and screening of potential drug targets derived from Leishmania spp. hypothetical proteins identified by immunoproteomics.

Leishmaniasis is a parasitic disease caused by the protozoan of the Leishmania genus. While no human vaccine is available, drugs such as pentavalent antimonials, pentamidine and amphotericin B are used for treat the patients. However, the high toxicity of these pharmaceutics, the emergence of parasite resistance and/or their high cost have showed to the urgent need of identify new targets to be employed in the improvement of the treatment against leishmaniasis. In a recent immunoproteomics approach performed in the Leishmania infantum species, 104 antigenic proteins were recognized by antibodies in sera of visceral leishmaniasis (VL) dogs. Some of them were later showed to be effective diagnostic markers and/or vaccine candidates against the disease. Between these proteins, 24 considered as hypothetical were identified in the promastigote and amastigote-like extracts of the parasites. The present study aimed to use bioinformatics tools to select new drug targets between these hypothetical proteins. Their cellular localization was predicted to be seven membrane proteins, as well as eight cytoplasmic, three nuclear, one mitochondrial and five proteins remained unclassified. Their functions were predicted as being two transport proteins, as well as five with metabolic activity, three as cell signaling and fourteen proteins remained unclassified. Ten hypothetical proteins were well-annotated and compared to their homology regarding to human proteins. Two proteins, a calpain-like and clavaminate synthase-like proteins were selected by using Docking analysis as being possible drug targets. In this sense, the present study showed the employ of new strategies to select possible drug candidates, according their localization and biological function in Leishmania parasites, aiming to treat against VL.

Highly conductive, printable pastes from capillary suspensions.

We have used the capillary suspension phenomenon to design conductive pastes for printed electronic applications, such as front side metallization of solar cells, without non-volatile, organic additives that often deteriorate electrical properties. Adding a small amount of a second, immiscible fluid to a suspension creates a network of liquid bridges between the particles. This capillary force-controlled microstructure allows for tuning the flow behavior in a wide range. Yield stress and low-shear viscosity can be adjusted such that long-term stability is provided by inhibiting sedimentation, and, even more importantly, narrow line widths and high aspect ratios are accessible. These ternary mixtures, called capillary suspensions, exhibit a strong degree of shear thinning that allows for conventional coating or printing equipment to be used. Finally, the secondary fluid, beneficial for stability and processing of the wet paste, completely evaporates during drying and sintering. Thus, we obtained high purity silver and nickel layers with a conductivity two times greater than could be obtained with state-of-the-art, commercial materials. This revolutionary concept can be easily applied to other systems using inorganic or even organic conductive particles and represents a fundamental paradigm change to the formulation of pastes for printed electronics.

Evaluation of adjuvant activity of fractions derived from Agaricus blazei, when in association with the recombinant LiHyp1 protein, to protect against visceral leishmaniasis.

The development of effective prophylactic strategies to prevent leishmaniasis has become a high priority. No less important than the choice of an antigen, the association of an appropriate adjuvant is necessary to achieve a successful vaccination, as the majority of the tested antigens contain limited immunogenic properties, and need to be supplemented with immune response adjuvants in order to boost their immunogenicity. However, few effective adjuvants that can be used against leishmaniasis exist on the market today; therefore, it is possible to speculate that the research aiming to identify new adjuvants could be considered relevant. Recently, Agaricus blazei extracts have proved to be useful in enhancing the immune response to DNA vaccines against some diseases. This was based on the Th1 adjuvant activity of the polysaccharide-rich fractions from this mushroom. In this context, the present study evaluated purified fractions derived from Agaricus blazei as Th1 adjuvants through in vitro assays of their immune stimulation of spleen cells derived from naive BALB/c mice. Two of the tested six fractions (namely F2 and F4) were characterized as polysaccharide-rich fractions, and were able to induce high levels of IFN-γ, and low levels of IL-4 and IL-10 in the spleen cells. The efficacy of adjuvant action against L. infantum was evaluated in BALB/c mice, with these fractions being administered together with a recombinant antigen, LiHyp1, which was previously evaluated as a vaccine candidate, associated with saponin, against visceral leishmaniasis (VL). The associations between LiHyp1/F2 and LiHyp1/F4 were able to induce an in vivo Th1 response, which was primed by high levels of IFN-γ, IL-12, and GM-CSF, by low levels of IL-4 and IL-10; as well as by a predominance of IgG2a antibodies in the vaccinated animals. After infection, the immune profile was maintained, and the vaccines proved to be effective against L. infantum. The immune stimulatory effects in the BALB/c mice proved to be similar when comparing the F2 and F4 fractions with a known Th1 adjuvant (saponin), though animals vaccinated with saponin did present a slight to moderate inflammatory edema on their hind footpads. In conclusion, the F2 and F4 fractions appear to induce a Th1-type immune response and, in this context, they could be evaluated in association with other protective antigens against Leishmania, as well as in other disease models.

Casual hook up sex during the first year of college: Prospective associations with attitudes about sex and love relationships.

This study examined bidirectional relationships among emerging adults' involvement in casual hook up sex and attitudes about sex and love relationships. At the start and end of their first year in college, undergraduates (N = 163) responded to measures of sexual behavior, sexual attitudes, and attitudes about love relationships. In cross-sectional analyses, attitudes about sex and love both were associated with involvement in casual hook up sex. In prospective analyses, initial attitudes about sexual instrumentality uniquely predicted involvement in later hook up sex, even after controlling for past hook up sex. Furthermore, involvement in hook up sex during the first year of college predicted greater sexual permissiveness and comfort with casual genital contact, even after controlling for initial sexual attitudes and hook up behaviors. None of the associations between attitudes and behavior were qualified by gender. Experiences of causal hook up sex appear to have implications primarily for emerging adults' attitudes about sexual interactions rather than their attitudes about love relationships.

Differences on psychosocial outcomes between male and female caregivers of children with life-limiting illnesses.

This secondary analysis of data examined the psychosocial outcomes of meaning in caregiving, self-esteem, optimism, burden, depression, spirituality, and posttraumatic growth in 273 parents caring for children with life-limiting illnesses to (a) determine if there were gender differences and (b) identify gender-specific correlations among these outcomes. Findings suggest that significant gender differences exist. Women reported higher average scores compared with men for meaning in caregiving, depression, burden, and posttraumatic growth and lower average scores for optimism. Correlations also revealed some significant differences. Health care professionals need to be aware of gender differences and tailor their interventions appropriately.

A change will do us good: threats diminish typical preferences for male leaders.

The current research explores role congruity processes from a new vantage point by investigating how the need for change might shift gender-based leadership preferences. According to role congruity theory, favorability toward leaders results from alignment between what is desired in a leadership role and the characteristics stereotypically ascribed to the leader. Generally speaking, these processes lead to baseline preferences for male over female leaders. In this research, the authors propose that a shift in gender-based leadership preferences will emerge under conditions of threat. Because the psychological experience of threat signals a need for change, individuals will favor candidates who represent new directions in leadership rather than consistency with past directions in leadership. Specifically, they find that threat evokes an implicit preference for change over stability (Experiment 1) and gender stereotypes align women with change but men with stability (Experiments 2a and 2b). Consequently, the typical preference for male leaders is diminished, or even reversed, under threat (Experiments 3 and 4). Moreover, the shift away from typical gender-based leadership preferences occurs especially among individuals who highly legitimize the sociopolitical system (Experiment 4), suggesting that these preference shifts might serve to protect the underlying system.

Experimental tests of an attitudinal theory of the gender gap in voting.

This research examined the hypothesis that gender gaps in voting stem from differences in the extent to which men and women agree with candidates' issue stances. Two initial experiments portraying candidates by their sex and attitudes and a third experiment that also included information about political party produced the predicted attitudinal gender-congeniality effect: Participants of each sex reported greater likelihood, compared with participants of the other sex, of voting for the candidate who endorsed positions typically favored more by their own sex than the other sex. In addition, this gender-congeniality effect was present among Republican and independent participants but absent among Democratic participants because Democratic men as well as women favored candidates who advocated the positions typically favored by women. Interpretation invoked the importance of group interest based on gender as an influence on women's voting.