Effect of intervention using a messaging app on compliance and duration of treatment in orthodontic patients

Abstract

Objectives

This study aims to determine the effectiveness of a messaging app (WeChat) in improving patients' compliance and reducing the duration of orthodontic treatment (DOT).

Materials and methods

A randomized controlled trial was performed in a dental hospital and a clinic from August 2012 to May 2015. Orthodontic patients were included at the beginning of treatment. Patients with multiphase treatment or braceless technique were excluded. Participants were randomized to WeChat group (received regular reminders and educational messages) or control group (received conventional management) and were followed up until the treatment was completed. Primary outcome measure was DOT. Others were late and failed attendance, bracket bond failure, and oral hygiene condition.

Results

One hundred twelve patients in each group participated and completed the trial. DOT in WeChat group were 7.3 weeks shorter (P = 0.007). There were less failed attendance (3.1 vs. 10.9 %, P < 0.001), late attendance (20.1 vs. 29.9 %, P < 0.001), and bracket bond failure (11.8 vs. 16.1 %, P < 0.001) in WeChat group than control. There was no difference in orthodontic plaque index nor modified gingivitis index between the two groups before and after treatment. Number of failed attendances was identified as an independent factor affecting DOT (P = 0.004; HR = 0.89, 95 % CI 0.84 to 0.95).

Conclusions

The intervention with WeChat is effective in reducing the treatment duration and bracket bond failure, and improving the attendance in orthodontic patients.

Clinical relevance

DOT can be reduced by improving patient's compliance. The messaging app is useful for outpatient education and management.

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Lymph node density predicts lung metastases in oral squamous cell carcinoma

The association between lymph node density and survival free of lung metastases in oral squamous cell carcinoma (SCC), has not been investigated so far to our knowledge. Lymph node density ≧ 0.07 has been reported by a multicentre international study to be a significant predictor of shorter survival in patients with oral SCC who have invaded nodes. We investigated whether a lymph node density of ≧ 0.07 correlates with shorter overall survival, survival free of distant metastases, and survival free of lung metastases, in patients with oral SCC and invaded lymph nodes.

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New 3-dimensional single photon emission computed tomographic images in the assessment of the viability of microvascularised bone grafts after mandibular reconstruction

Reconstruction of mandibular defects is one of the most difficult procedures in maxillofacial surgery. Scapular, iliac crest, and fibular grafts are preferred,1 but lack of viability is common and leads to necrosis, resorption of bone, and a poor outcome. The critical period for the diagnosis of a failed graft is the first two weeks after transplantation, and bone scintigraphy or single photon-emission computed tomographic (SPECT) images are useful in the assessment of the viability of mandibular grafts.

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Lymph node density predicts lung metastases in oral squamous cell carcinoma

The association between lymph node density and survival free of lung metastases in oral squamous cell carcinoma (SCC), has not been investigated so far to our knowledge. Lymph node density ≧ 0.07 has been reported by a multicentre international study to be a significant predictor of shorter survival in patients with oral SCC who have invaded nodes. We investigated whether a lymph node density of ≧ 0.07 correlates with shorter overall survival, survival free of distant metastases, and survival free of lung metastases, in patients with oral SCC and invaded lymph nodes.

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New 3-dimensional single photon emission computed tomographic images in the assessment of the viability of microvascularised bone grafts after mandibular reconstruction

Reconstruction of mandibular defects is one of the most difficult procedures in maxillofacial surgery. Scapular, iliac crest, and fibular grafts are preferred,1 but lack of viability is common and leads to necrosis, resorption of bone, and a poor outcome. The critical period for the diagnosis of a failed graft is the first two weeks after transplantation, and bone scintigraphy or single photon-emission computed tomographic (SPECT) images are useful in the assessment of the viability of mandibular grafts.

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Oral health and HIV infection among female sex workers in Abidjan, Côte d’Ivoire

Abstract

Background

Worldwide, female sex workers (FSW) represent a vulnerable population for oral diseases due to many risk factors including HIV infection and drug abuse. In sub-Saharan Africa, little is known about the burden of oral diseases and their determinants in vulnerable populations. The aim of the study was to estimate the prevalence and associated factors of oral diseases among FSW.

Methods

A cross sectional study was conducted among FSW who attended a dedicated non-profit clinic in Abidjan, Côte d'Ivoire from June to August 2013. Data about the presence of dental caries, periodontitis and oral-mucosal lesions were collected by a dentist during an oral examination. Behavioural information related to oral hygiene habits as well as tobacco and alcohol consumption were collected through a standardized questionnaire. Information related to HIV infection including HIV diagnosis, last known CD4 count and antiretroviral therapy were documented through a medical chart review. Logistic regression models were used to identify factors associated with oral diseases.

Results

A total of 249 FSW with a median age of 29 years, [Inter Quartile Range (IQR) = 23–36] and a median duration of sex work of 24 months [IQR 9–60]) were included. Current tobacco use and hazardous alcohol use were reported in 21.7 % and 19.7 % of FSW, respectively. The estimated prevalence of HIV infection was 33.7 % [95 % confidence interval (CI); 27.8 – 39.6]) and 82.1 % of HIV-infected FSW were on antiretroviral therapy . The prevalence of dental caries, periodontitis and oral-mucosal lesions were 62.3 % [95 % CI 55.5 – 67.5], 14.5 % [95 % CI 10.2 – 18.9] and 8.2 % [95 % CI 4.8 – 11.5], respectively. In multivariate analysis, periodontitis, oral-mucosal lesions and HIV infection were associated with odds ratio of 2.6 [95 % CI, 1.2–5.8]) and 50.0 [95 % CI; 6.4–384.6].

Conclusions

This study showed a high prevalence of oral diseases among FSW in Abidjan. HIV infection was common and significantly associated with periodontal diseases and oral-mucosal lesions. There is a need to integrate regular screening and treatment of oral lesions into the medical follow-up of FSW along with strategies for HIV prevention.

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Effect of intervention using a messaging app on compliance and duration of treatment in orthodontic patients

Abstract

Objectives

This study aims to determine the effectiveness of a messaging app (WeChat) in improving patients' compliance and reducing the duration of orthodontic treatment (DOT).

Materials and methods

A randomized controlled trial was performed in a dental hospital and a clinic from August 2012 to May 2015. Orthodontic patients were included at the beginning of treatment. Patients with multiphase treatment or braceless technique were excluded. Participants were randomized to WeChat group (received regular reminders and educational messages) or control group (received conventional management) and were followed up until the treatment was completed. Primary outcome measure was DOT. Others were late and failed attendance, bracket bond failure, and oral hygiene condition.

Results

One hundred twelve patients in each group participated and completed the trial. DOT in WeChat group were 7.3 weeks shorter (P = 0.007). There were less failed attendance (3.1 vs. 10.9 %, P < 0.001), late attendance (20.1 vs. 29.9 %, P < 0.001), and bracket bond failure (11.8 vs. 16.1 %, P < 0.001) in WeChat group than control. There was no difference in orthodontic plaque index nor modified gingivitis index between the two groups before and after treatment. Number of failed attendances was identified as an independent factor affecting DOT (P = 0.004; HR = 0.89, 95 % CI 0.84 to 0.95).

Conclusions

The intervention with WeChat is effective in reducing the treatment duration and bracket bond failure, and improving the attendance in orthodontic patients.

Clinical relevance

DOT can be reduced by improving patient's compliance. The messaging app is useful for outpatient education and management.

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Immunological adjuvant effect of the peptide fraction from the larvae of Musca domestica

Background: The larvae of Musca domestica (Diptera: Muscidae) have been used traditionally for malnutritional stagnation, decubital necrosis, osteomyelitis, ecthyma and lip scald and also to treat coma and gastric cancer in the traditional Chinese medicine. Its immunomodulatory effects in naïve mice in relation to the traditional uses were also reported. However, the immunological adjuvant potentials of this insect have not yet been studied. Methods: The peptide fraction from the larvae of Musca domestica L. (MDPF) was evaluated for its adjuvant potentials on the immune responses to ovalbumin (OVA) and avian influenza vaccine (rL–H5) by determining antigen-specific antibody titers, splenocyte proliferation, activity of natural killer (NK) cell, the secretion of cytokines from splenocytes in the immunized mice. Results: MDPF significantly enhanced not only the concanavalin A (Con A)-, lipopolysaccharide (LPS)- and antigen-stimulated splenocyte proliferation, but serum antigen-specific IgG, IgG1, IgG2a, and IgG2b antibody titers in the mice immunized with OVA and rL–H5. MDPF also remarkably promoted the killing activities of NK cells in splenocytes from the mice immunized with rL–H5. Furthermore, MDPF significantly promoted the production of Th1 (IL-2 and IFN-γ) and Th2 (IL-10) cytokines from splenocytes in the immunized mice. Conclusions: The results indicated that MDPF had a potential to increase both cellular and humoral immune responses and elicit a balanced Th1/Th2 response, and that MDPF may be a safe and efficacious vaccine adjuvant candidate.

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Difference in resistance to Salmonella enteritidis infection among allelic variants of TLR4 (903, 1832) in SPF chickens

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An Inducible, Large-Intestine-Specific Transgenic Mouse Model for Colitis and Colitis-Induced Colon Cancer Research

Abstract

Background

Animal models are an important tool to understand intestinal biology. Our laboratory previously generated C57BL/6-Tg(Car1-cre)5Flt transgenic mice (CAC) with large-intestine-specific Cre recombinase (Cre) expression as a model to study colon health.

Aim

To expand the utility of the CAC mouse model by determining the impact of chemically induced colitis on CAC transgene expression.

Methods

CAC mice were crossed to Rosa reporter mice (Rosa26R ^flox/flox ) with a lox-STOP-lox signal controlling β-galactosidase (βgal) expression and then further crossed with Apc^CKO/CKO mice in some experiments to delete Apc alleles (Apc^Δ580 ). Initially, 8-week-old CAC^Tg/WT;Rosa26R ^flox/WT;Apc ^Δ580/WT mice were treated with dextran sulfate sodium (DSS) in drinking water (5 days, 0, 0.65, 1.35, or 2.0 %). Colon tissue damage and βgal labeling were analyzed 10 day after stopping DSS. Next, 8-week-old CAC^Tg/WT;Rosa26R^flox/flox mice were treated with 0 or 1.35 % DSS, and colonic βgal labeling was assessed at 30 day post-DSS treatment. Finally, 10-week-old CAC^Tg/WT;Apc ^Δ580/WT mice were treated with DSS (0 or 2 %) for 5 days and colonic tumors were analyzed at 20 weeks.

Results

CAC^Tg/WT;Rosa26R ^flox/WT;Apc ^Δ580/WT mice had a DSS dose-dependent increase in colon epithelial damage that correlated with increased epithelial βgal labeling at 10 days (r ² = 0.9, β = 0.75). The βgal labeling in CAC^Tg/WT;Rosa26R^flox/flox mice colon remained high at 30 days, especially in the crypts of the healed ulcer. DSS also increased colon tumor incidence and multiplicity in CAC^Tg/WT;Apc ^Δ580/WT mice.

Conclusions

DSS-mediated epithelial damage induces a persistent, Cre-mediated recombination of floxed alleles in CAC mice. This enables the examination of gene function in colon epithelium during experimental colitis and colitis-induced colon cancer.

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Optimization of a Fungally Bioaugmented Biomixture for Carbofuran Removal in On-Farm Biopurification Systems

Abstract

Biomixtures comprise the active part of biopurification systems (BPS) for the removal of pesticide-containing wastewater from agricultural origin. Considering that biomixtures contain an important amount of lignocellulosic substrates, their bioaugmentation with degrading ligninolytic fungi represents a promising way to improve BPS. The fungus Trametes versicolor was employed for the bioaugmentation of rice husk-compost-soil (GCS) biomixtures in order to optimize the removal of the highly toxic insecticide/nematicide carbofuran (CFN). Composition of biomixtures has not been optimized before, and usually, a volumetric composition of 50:25:25 (lignocellulosic substrate:humic component:soil) is employed. Optimization of the biomixture composition was performed with a central composite design, using the volumetric content of rice husk (pre-colonized by the fungus) and the volumetric ratio compost/soil as design variables. Performance of biomixtures was comprehensively assayed considering CFN removal, the production of toxic transformation products (3-hydroxycarbofuran/3-ketocarbofuran), the ability to mineralize [¹⁴C]carbofuran, and the residual toxicity in the matrix. According to the models, the optimal volumetric composition of the GCS biomixture is 30:43:27, which maximizes removal and mineralization rate, and minimizes the accumulation of transformation products. Results support the value of assessing new biomixture formulations according to the target pesticide in order to obtain their optimal performance, before their use in BPS.

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Lymph node density predicts lung metastases in oral squamous cell carcinoma

The association between lymph node density and survival free of lung metastases in oral squamous cell carcinoma (SCC), has not been investigated so far to our knowledge. Lymph node density ≧ 0.07 has been reported by a multicentre international study to be a significant predictor of shorter survival in patients with oral SCC who have invaded nodes. We investigated whether a lymph node density of ≧ 0.07 correlates with shorter overall survival, survival free of distant metastases, and survival free of lung metastases, in patients with oral SCC and invaded lymph nodes.

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New 3-dimensional single photon emission computed tomographic images in the assessment of the viability of microvascularised bone grafts after mandibular reconstruction

Reconstruction of mandibular defects is one of the most difficult procedures in maxillofacial surgery. Scapular, iliac crest, and fibular grafts are preferred,1 but lack of viability is common and leads to necrosis, resorption of bone, and a poor outcome. The critical period for the diagnosis of a failed graft is the first two weeks after transplantation, and bone scintigraphy or single photon-emission computed tomographic (SPECT) images are useful in the assessment of the viability of mandibular grafts.

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Oral health and HIV infection among female sex workers in Abidjan, Côte d’Ivoire

Abstract

Background

Worldwide, female sex workers (FSW) represent a vulnerable population for oral diseases due to many risk factors including HIV infection and drug abuse. In sub-Saharan Africa, little is known about the burden of oral diseases and their determinants in vulnerable populations. The aim of the study was to estimate the prevalence and associated factors of oral diseases among FSW.

Methods

A cross sectional study was conducted among FSW who attended a dedicated non-profit clinic in Abidjan, Côte d'Ivoire from June to August 2013. Data about the presence of dental caries, periodontitis and oral-mucosal lesions were collected by a dentist during an oral examination. Behavioural information related to oral hygiene habits as well as tobacco and alcohol consumption were collected through a standardized questionnaire. Information related to HIV infection including HIV diagnosis, last known CD4 count and antiretroviral therapy were documented through a medical chart review. Logistic regression models were used to identify factors associated with oral diseases.

Results

A total of 249 FSW with a median age of 29 years, [Inter Quartile Range (IQR) = 23–36] and a median duration of sex work of 24 months [IQR 9–60]) were included. Current tobacco use and hazardous alcohol use were reported in 21.7 % and 19.7 % of FSW, respectively. The estimated prevalence of HIV infection was 33.7 % [95 % confidence interval (CI); 27.8 – 39.6]) and 82.1 % of HIV-infected FSW were on antiretroviral therapy . The prevalence of dental caries, periodontitis and oral-mucosal lesions were 62.3 % [95 % CI 55.5 – 67.5], 14.5 % [95 % CI 10.2 – 18.9] and 8.2 % [95 % CI 4.8 – 11.5], respectively. In multivariate analysis, periodontitis, oral-mucosal lesions and HIV infection were associated with odds ratio of 2.6 [95 % CI, 1.2–5.8]) and 50.0 [95 % CI; 6.4–384.6].

Conclusions

This study showed a high prevalence of oral diseases among FSW in Abidjan. HIV infection was common and significantly associated with periodontal diseases and oral-mucosal lesions. There is a need to integrate regular screening and treatment of oral lesions into the medical follow-up of FSW along with strategies for HIV prevention.

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Effect of intervention using a messaging app on compliance and duration of treatment in orthodontic patients

Abstract

Objectives

This study aims to determine the effectiveness of a messaging app (WeChat) in improving patients' compliance and reducing the duration of orthodontic treatment (DOT).

Materials and methods

A randomized controlled trial was performed in a dental hospital and a clinic from August 2012 to May 2015. Orthodontic patients were included at the beginning of treatment. Patients with multiphase treatment or braceless technique were excluded. Participants were randomized to WeChat group (received regular reminders and educational messages) or control group (received conventional management) and were followed up until the treatment was completed. Primary outcome measure was DOT. Others were late and failed attendance, bracket bond failure, and oral hygiene condition.

Results

One hundred twelve patients in each group participated and completed the trial. DOT in WeChat group were 7.3 weeks shorter (P = 0.007). There were less failed attendance (3.1 vs. 10.9 %, P < 0.001), late attendance (20.1 vs. 29.9 %, P < 0.001), and bracket bond failure (11.8 vs. 16.1 %, P < 0.001) in WeChat group than control. There was no difference in orthodontic plaque index nor modified gingivitis index between the two groups before and after treatment. Number of failed attendances was identified as an independent factor affecting DOT (P = 0.004; HR = 0.89, 95 % CI 0.84 to 0.95).

Conclusions

The intervention with WeChat is effective in reducing the treatment duration and bracket bond failure, and improving the attendance in orthodontic patients.

Clinical relevance

DOT can be reduced by improving patient's compliance. The messaging app is useful for outpatient education and management.

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Immunological adjuvant effect of the peptide fraction from the larvae of Musca domestica

Background: The larvae of Musca domestica (Diptera: Muscidae) have been used traditionally for malnutritional stagnation, decubital necrosis, osteomyelitis, ecthyma and lip scald and also to treat coma and gastric cancer in the traditional Chinese medicine. Its immunomodulatory effects in naïve mice in relation to the traditional uses were also reported. However, the immunological adjuvant potentials of this insect have not yet been studied. Methods: The peptide fraction from the larvae of Musca domestica L. (MDPF) was evaluated for its adjuvant potentials on the immune responses to ovalbumin (OVA) and avian influenza vaccine (rL–H5) by determining antigen-specific antibody titers, splenocyte proliferation, activity of natural killer (NK) cell, the secretion of cytokines from splenocytes in the immunized mice. Results: MDPF significantly enhanced not only the concanavalin A (Con A)-, lipopolysaccharide (LPS)- and antigen-stimulated splenocyte proliferation, but serum antigen-specific IgG, IgG1, IgG2a, and IgG2b antibody titers in the mice immunized with OVA and rL–H5. MDPF also remarkably promoted the killing activities of NK cells in splenocytes from the mice immunized with rL–H5. Furthermore, MDPF significantly promoted the production of Th1 (IL-2 and IFN-γ) and Th2 (IL-10) cytokines from splenocytes in the immunized mice. Conclusions: The results indicated that MDPF had a potential to increase both cellular and humoral immune responses and elicit a balanced Th1/Th2 response, and that MDPF may be a safe and efficacious vaccine adjuvant candidate.

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Difference in resistance to Salmonella enteritidis infection among allelic variants of TLR4 (903, 1832) in SPF chickens

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An Inducible, Large-Intestine-Specific Transgenic Mouse Model for Colitis and Colitis-Induced Colon Cancer Research

Abstract

Background

Animal models are an important tool to understand intestinal biology. Our laboratory previously generated C57BL/6-Tg(Car1-cre)5Flt transgenic mice (CAC) with large-intestine-specific Cre recombinase (Cre) expression as a model to study colon health.

Aim

To expand the utility of the CAC mouse model by determining the impact of chemically induced colitis on CAC transgene expression.

Methods

CAC mice were crossed to Rosa reporter mice (Rosa26R ^flox/flox ) with a lox-STOP-lox signal controlling β-galactosidase (βgal) expression and then further crossed with Apc^CKO/CKO mice in some experiments to delete Apc alleles (Apc^Δ580 ). Initially, 8-week-old CAC^Tg/WT;Rosa26R ^flox/WT;Apc ^Δ580/WT mice were treated with dextran sulfate sodium (DSS) in drinking water (5 days, 0, 0.65, 1.35, or 2.0 %). Colon tissue damage and βgal labeling were analyzed 10 day after stopping DSS. Next, 8-week-old CAC^Tg/WT;Rosa26R^flox/flox mice were treated with 0 or 1.35 % DSS, and colonic βgal labeling was assessed at 30 day post-DSS treatment. Finally, 10-week-old CAC^Tg/WT;Apc ^Δ580/WT mice were treated with DSS (0 or 2 %) for 5 days and colonic tumors were analyzed at 20 weeks.

Results

CAC^Tg/WT;Rosa26R ^flox/WT;Apc ^Δ580/WT mice had a DSS dose-dependent increase in colon epithelial damage that correlated with increased epithelial βgal labeling at 10 days (r ² = 0.9, β = 0.75). The βgal labeling in CAC^Tg/WT;Rosa26R^flox/flox mice colon remained high at 30 days, especially in the crypts of the healed ulcer. DSS also increased colon tumor incidence and multiplicity in CAC^Tg/WT;Apc ^Δ580/WT mice.

Conclusions

DSS-mediated epithelial damage induces a persistent, Cre-mediated recombination of floxed alleles in CAC mice. This enables the examination of gene function in colon epithelium during experimental colitis and colitis-induced colon cancer.

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Optimization of a Fungally Bioaugmented Biomixture for Carbofuran Removal in On-Farm Biopurification Systems

Abstract

Biomixtures comprise the active part of biopurification systems (BPS) for the removal of pesticide-containing wastewater from agricultural origin. Considering that biomixtures contain an important amount of lignocellulosic substrates, their bioaugmentation with degrading ligninolytic fungi represents a promising way to improve BPS. The fungus Trametes versicolor was employed for the bioaugmentation of rice husk-compost-soil (GCS) biomixtures in order to optimize the removal of the highly toxic insecticide/nematicide carbofuran (CFN). Composition of biomixtures has not been optimized before, and usually, a volumetric composition of 50:25:25 (lignocellulosic substrate:humic component:soil) is employed. Optimization of the biomixture composition was performed with a central composite design, using the volumetric content of rice husk (pre-colonized by the fungus) and the volumetric ratio compost/soil as design variables. Performance of biomixtures was comprehensively assayed considering CFN removal, the production of toxic transformation products (3-hydroxycarbofuran/3-ketocarbofuran), the ability to mineralize [¹⁴C]carbofuran, and the residual toxicity in the matrix. According to the models, the optimal volumetric composition of the GCS biomixture is 30:43:27, which maximizes removal and mineralization rate, and minimizes the accumulation of transformation products. Results support the value of assessing new biomixture formulations according to the target pesticide in order to obtain their optimal performance, before their use in BPS.

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Oral health and HIV infection among female sex workers in Abidjan, Côte d’Ivoire

Abstract

Background

Worldwide, female sex workers (FSW) represent a vulnerable population for oral diseases due to many risk factors including HIV infection and drug abuse. In sub-Saharan Africa, little is known about the burden of oral diseases and their determinants in vulnerable populations. The aim of the study was to estimate the prevalence and associated factors of oral diseases among FSW.

Methods

A cross sectional study was conducted among FSW who attended a dedicated non-profit clinic in Abidjan, Côte d'Ivoire from June to August 2013. Data about the presence of dental caries, periodontitis and oral-mucosal lesions were collected by a dentist during an oral examination. Behavioural information related to oral hygiene habits as well as tobacco and alcohol consumption were collected through a standardized questionnaire. Information related to HIV infection including HIV diagnosis, last known CD4 count and antiretroviral therapy were documented through a medical chart review. Logistic regression models were used to identify factors associated with oral diseases.

Results

A total of 249 FSW with a median age of 29 years, [Inter Quartile Range (IQR) = 23–36] and a median duration of sex work of 24 months [IQR 9–60]) were included. Current tobacco use and hazardous alcohol use were reported in 21.7 % and 19.7 % of FSW, respectively. The estimated prevalence of HIV infection was 33.7 % [95 % confidence interval (CI); 27.8 – 39.6]) and 82.1 % of HIV-infected FSW were on antiretroviral therapy . The prevalence of dental caries, periodontitis and oral-mucosal lesions were 62.3 % [95 % CI 55.5 – 67.5], 14.5 % [95 % CI 10.2 – 18.9] and 8.2 % [95 % CI 4.8 – 11.5], respectively. In multivariate analysis, periodontitis, oral-mucosal lesions and HIV infection were associated with odds ratio of 2.6 [95 % CI, 1.2–5.8]) and 50.0 [95 % CI; 6.4–384.6].

Conclusions

This study showed a high prevalence of oral diseases among FSW in Abidjan. HIV infection was common and significantly associated with periodontal diseases and oral-mucosal lesions. There is a need to integrate regular screening and treatment of oral lesions into the medical follow-up of FSW along with strategies for HIV prevention.

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Effect of intervention using a messaging app on compliance and duration of treatment in orthodontic patients

Abstract

Objectives

This study aims to determine the effectiveness of a messaging app (WeChat) in improving patients' compliance and reducing the duration of orthodontic treatment (DOT).

Materials and methods

A randomized controlled trial was performed in a dental hospital and a clinic from August 2012 to May 2015. Orthodontic patients were included at the beginning of treatment. Patients with multiphase treatment or braceless technique were excluded. Participants were randomized to WeChat group (received regular reminders and educational messages) or control group (received conventional management) and were followed up until the treatment was completed. Primary outcome measure was DOT. Others were late and failed attendance, bracket bond failure, and oral hygiene condition.

Results

One hundred twelve patients in each group participated and completed the trial. DOT in WeChat group were 7.3 weeks shorter (P = 0.007). There were less failed attendance (3.1 vs. 10.9 %, P < 0.001), late attendance (20.1 vs. 29.9 %, P < 0.001), and bracket bond failure (11.8 vs. 16.1 %, P < 0.001) in WeChat group than control. There was no difference in orthodontic plaque index nor modified gingivitis index between the two groups before and after treatment. Number of failed attendances was identified as an independent factor affecting DOT (P = 0.004; HR = 0.89, 95 % CI 0.84 to 0.95).

Conclusions

The intervention with WeChat is effective in reducing the treatment duration and bracket bond failure, and improving the attendance in orthodontic patients.

Clinical relevance

DOT can be reduced by improving patient's compliance. The messaging app is useful for outpatient education and management.

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Immunological adjuvant effect of the peptide fraction from the larvae of Musca domestica

Background: The larvae of Musca domestica (Diptera: Muscidae) have been used traditionally for malnutritional stagnation, decubital necrosis, osteomyelitis, ecthyma and lip scald and also to treat coma and gastric cancer in the traditional Chinese medicine. Its immunomodulatory effects in naïve mice in relation to the traditional uses were also reported. However, the immunological adjuvant potentials of this insect have not yet been studied. Methods: The peptide fraction from the larvae of Musca domestica L. (MDPF) was evaluated for its adjuvant potentials on the immune responses to ovalbumin (OVA) and avian influenza vaccine (rL–H5) by determining antigen-specific antibody titers, splenocyte proliferation, activity of natural killer (NK) cell, the secretion of cytokines from splenocytes in the immunized mice. Results: MDPF significantly enhanced not only the concanavalin A (Con A)-, lipopolysaccharide (LPS)- and antigen-stimulated splenocyte proliferation, but serum antigen-specific IgG, IgG1, IgG2a, and IgG2b antibody titers in the mice immunized with OVA and rL–H5. MDPF also remarkably promoted the killing activities of NK cells in splenocytes from the mice immunized with rL–H5. Furthermore, MDPF significantly promoted the production of Th1 (IL-2 and IFN-γ) and Th2 (IL-10) cytokines from splenocytes in the immunized mice. Conclusions: The results indicated that MDPF had a potential to increase both cellular and humoral immune responses and elicit a balanced Th1/Th2 response, and that MDPF may be a safe and efficacious vaccine adjuvant candidate.

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Difference in resistance to Salmonella enteritidis infection among allelic variants of TLR4 (903, 1832) in SPF chickens

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An Inducible, Large-Intestine-Specific Transgenic Mouse Model for Colitis and Colitis-Induced Colon Cancer Research

Abstract

Background

Animal models are an important tool to understand intestinal biology. Our laboratory previously generated C57BL/6-Tg(Car1-cre)5Flt transgenic mice (CAC) with large-intestine-specific Cre recombinase (Cre) expression as a model to study colon health.

Aim

To expand the utility of the CAC mouse model by determining the impact of chemically induced colitis on CAC transgene expression.

Methods

CAC mice were crossed to Rosa reporter mice (Rosa26R ^flox/flox ) with a lox-STOP-lox signal controlling β-galactosidase (βgal) expression and then further crossed with Apc^CKO/CKO mice in some experiments to delete Apc alleles (Apc^Δ580 ). Initially, 8-week-old CAC^Tg/WT;Rosa26R ^flox/WT;Apc ^Δ580/WT mice were treated with dextran sulfate sodium (DSS) in drinking water (5 days, 0, 0.65, 1.35, or 2.0 %). Colon tissue damage and βgal labeling were analyzed 10 day after stopping DSS. Next, 8-week-old CAC^Tg/WT;Rosa26R^flox/flox mice were treated with 0 or 1.35 % DSS, and colonic βgal labeling was assessed at 30 day post-DSS treatment. Finally, 10-week-old CAC^Tg/WT;Apc ^Δ580/WT mice were treated with DSS (0 or 2 %) for 5 days and colonic tumors were analyzed at 20 weeks.

Results

CAC^Tg/WT;Rosa26R ^flox/WT;Apc ^Δ580/WT mice had a DSS dose-dependent increase in colon epithelial damage that correlated with increased epithelial βgal labeling at 10 days (r ² = 0.9, β = 0.75). The βgal labeling in CAC^Tg/WT;Rosa26R^flox/flox mice colon remained high at 30 days, especially in the crypts of the healed ulcer. DSS also increased colon tumor incidence and multiplicity in CAC^Tg/WT;Apc ^Δ580/WT mice.

Conclusions

DSS-mediated epithelial damage induces a persistent, Cre-mediated recombination of floxed alleles in CAC mice. This enables the examination of gene function in colon epithelium during experimental colitis and colitis-induced colon cancer.

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Optimization of a Fungally Bioaugmented Biomixture for Carbofuran Removal in On-Farm Biopurification Systems

Abstract

Biomixtures comprise the active part of biopurification systems (BPS) for the removal of pesticide-containing wastewater from agricultural origin. Considering that biomixtures contain an important amount of lignocellulosic substrates, their bioaugmentation with degrading ligninolytic fungi represents a promising way to improve BPS. The fungus Trametes versicolor was employed for the bioaugmentation of rice husk-compost-soil (GCS) biomixtures in order to optimize the removal of the highly toxic insecticide/nematicide carbofuran (CFN). Composition of biomixtures has not been optimized before, and usually, a volumetric composition of 50:25:25 (lignocellulosic substrate:humic component:soil) is employed. Optimization of the biomixture composition was performed with a central composite design, using the volumetric content of rice husk (pre-colonized by the fungus) and the volumetric ratio compost/soil as design variables. Performance of biomixtures was comprehensively assayed considering CFN removal, the production of toxic transformation products (3-hydroxycarbofuran/3-ketocarbofuran), the ability to mineralize [¹⁴C]carbofuran, and the residual toxicity in the matrix. According to the models, the optimal volumetric composition of the GCS biomixture is 30:43:27, which maximizes removal and mineralization rate, and minimizes the accumulation of transformation products. Results support the value of assessing new biomixture formulations according to the target pesticide in order to obtain their optimal performance, before their use in BPS.

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Oral health and HIV infection among female sex workers in Abidjan, Côte d’Ivoire

Abstract

Background

Worldwide, female sex workers (FSW) represent a vulnerable population for oral diseases due to many risk factors including HIV infection and drug abuse. In sub-Saharan Africa, little is known about the burden of oral diseases and their determinants in vulnerable populations. The aim of the study was to estimate the prevalence and associated factors of oral diseases among FSW.

Methods

A cross sectional study was conducted among FSW who attended a dedicated non-profit clinic in Abidjan, Côte d'Ivoire from June to August 2013. Data about the presence of dental caries, periodontitis and oral-mucosal lesions were collected by a dentist during an oral examination. Behavioural information related to oral hygiene habits as well as tobacco and alcohol consumption were collected through a standardized questionnaire. Information related to HIV infection including HIV diagnosis, last known CD4 count and antiretroviral therapy were documented through a medical chart review. Logistic regression models were used to identify factors associated with oral diseases.

Results

A total of 249 FSW with a median age of 29 years, [Inter Quartile Range (IQR) = 23–36] and a median duration of sex work of 24 months [IQR 9–60]) were included. Current tobacco use and hazardous alcohol use were reported in 21.7 % and 19.7 % of FSW, respectively. The estimated prevalence of HIV infection was 33.7 % [95 % confidence interval (CI); 27.8 – 39.6]) and 82.1 % of HIV-infected FSW were on antiretroviral therapy . The prevalence of dental caries, periodontitis and oral-mucosal lesions were 62.3 % [95 % CI 55.5 – 67.5], 14.5 % [95 % CI 10.2 – 18.9] and 8.2 % [95 % CI 4.8 – 11.5], respectively. In multivariate analysis, periodontitis, oral-mucosal lesions and HIV infection were associated with odds ratio of 2.6 [95 % CI, 1.2–5.8]) and 50.0 [95 % CI; 6.4–384.6].

Conclusions

This study showed a high prevalence of oral diseases among FSW in Abidjan. HIV infection was common and significantly associated with periodontal diseases and oral-mucosal lesions. There is a need to integrate regular screening and treatment of oral lesions into the medical follow-up of FSW along with strategies for HIV prevention.

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Effect of intervention using a messaging app on compliance and duration of treatment in orthodontic patients

Abstract

Objectives

This study aims to determine the effectiveness of a messaging app (WeChat) in improving patients' compliance and reducing the duration of orthodontic treatment (DOT).

Materials and methods

A randomized controlled trial was performed in a dental hospital and a clinic from August 2012 to May 2015. Orthodontic patients were included at the beginning of treatment. Patients with multiphase treatment or braceless technique were excluded. Participants were randomized to WeChat group (received regular reminders and educational messages) or control group (received conventional management) and were followed up until the treatment was completed. Primary outcome measure was DOT. Others were late and failed attendance, bracket bond failure, and oral hygiene condition.

Results

One hundred twelve patients in each group participated and completed the trial. DOT in WeChat group were 7.3 weeks shorter (P = 0.007). There were less failed attendance (3.1 vs. 10.9 %, P < 0.001), late attendance (20.1 vs. 29.9 %, P < 0.001), and bracket bond failure (11.8 vs. 16.1 %, P < 0.001) in WeChat group than control. There was no difference in orthodontic plaque index nor modified gingivitis index between the two groups before and after treatment. Number of failed attendances was identified as an independent factor affecting DOT (P = 0.004; HR = 0.89, 95 % CI 0.84 to 0.95).

Conclusions

The intervention with WeChat is effective in reducing the treatment duration and bracket bond failure, and improving the attendance in orthodontic patients.

Clinical relevance

DOT can be reduced by improving patient's compliance. The messaging app is useful for outpatient education and management.

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Immunological adjuvant effect of the peptide fraction from the larvae of Musca domestica

Background: The larvae of Musca domestica (Diptera: Muscidae) have been used traditionally for malnutritional stagnation, decubital necrosis, osteomyelitis, ecthyma and lip scald and also to treat coma and gastric cancer in the traditional Chinese medicine. Its immunomodulatory effects in naïve mice in relation to the traditional uses were also reported. However, the immunological adjuvant potentials of this insect have not yet been studied. Methods: The peptide fraction from the larvae of Musca domestica L. (MDPF) was evaluated for its adjuvant potentials on the immune responses to ovalbumin (OVA) and avian influenza vaccine (rL–H5) by determining antigen-specific antibody titers, splenocyte proliferation, activity of natural killer (NK) cell, the secretion of cytokines from splenocytes in the immunized mice. Results: MDPF significantly enhanced not only the concanavalin A (Con A)-, lipopolysaccharide (LPS)- and antigen-stimulated splenocyte proliferation, but serum antigen-specific IgG, IgG1, IgG2a, and IgG2b antibody titers in the mice immunized with OVA and rL–H5. MDPF also remarkably promoted the killing activities of NK cells in splenocytes from the mice immunized with rL–H5. Furthermore, MDPF significantly promoted the production of Th1 (IL-2 and IFN-γ) and Th2 (IL-10) cytokines from splenocytes in the immunized mice. Conclusions: The results indicated that MDPF had a potential to increase both cellular and humoral immune responses and elicit a balanced Th1/Th2 response, and that MDPF may be a safe and efficacious vaccine adjuvant candidate.

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Difference in resistance to Salmonella enteritidis infection among allelic variants of TLR4 (903, 1832) in SPF chickens

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An Inducible, Large-Intestine-Specific Transgenic Mouse Model for Colitis and Colitis-Induced Colon Cancer Research

Abstract

Background

Animal models are an important tool to understand intestinal biology. Our laboratory previously generated C57BL/6-Tg(Car1-cre)5Flt transgenic mice (CAC) with large-intestine-specific Cre recombinase (Cre) expression as a model to study colon health.

Aim

To expand the utility of the CAC mouse model by determining the impact of chemically induced colitis on CAC transgene expression.

Methods

CAC mice were crossed to Rosa reporter mice (Rosa26R ^flox/flox ) with a lox-STOP-lox signal controlling β-galactosidase (βgal) expression and then further crossed with Apc^CKO/CKO mice in some experiments to delete Apc alleles (Apc^Δ580 ). Initially, 8-week-old CAC^Tg/WT;Rosa26R ^flox/WT;Apc ^Δ580/WT mice were treated with dextran sulfate sodium (DSS) in drinking water (5 days, 0, 0.65, 1.35, or 2.0 %). Colon tissue damage and βgal labeling were analyzed 10 day after stopping DSS. Next, 8-week-old CAC^Tg/WT;Rosa26R^flox/flox mice were treated with 0 or 1.35 % DSS, and colonic βgal labeling was assessed at 30 day post-DSS treatment. Finally, 10-week-old CAC^Tg/WT;Apc ^Δ580/WT mice were treated with DSS (0 or 2 %) for 5 days and colonic tumors were analyzed at 20 weeks.

Results

CAC^Tg/WT;Rosa26R ^flox/WT;Apc ^Δ580/WT mice had a DSS dose-dependent increase in colon epithelial damage that correlated with increased epithelial βgal labeling at 10 days (r ² = 0.9, β = 0.75). The βgal labeling in CAC^Tg/WT;Rosa26R^flox/flox mice colon remained high at 30 days, especially in the crypts of the healed ulcer. DSS also increased colon tumor incidence and multiplicity in CAC^Tg/WT;Apc ^Δ580/WT mice.

Conclusions

DSS-mediated epithelial damage induces a persistent, Cre-mediated recombination of floxed alleles in CAC mice. This enables the examination of gene function in colon epithelium during experimental colitis and colitis-induced colon cancer.

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Effect of intervention using a messaging app on compliance and duration of treatment in orthodontic patients

Abstract

Objectives

This study aims to determine the effectiveness of a messaging app (WeChat) in improving patients' compliance and reducing the duration of orthodontic treatment (DOT).

Materials and methods

A randomized controlled trial was performed in a dental hospital and a clinic from August 2012 to May 2015. Orthodontic patients were included at the beginning of treatment. Patients with multiphase treatment or braceless technique were excluded. Participants were randomized to WeChat group (received regular reminders and educational messages) or control group (received conventional management) and were followed up until the treatment was completed. Primary outcome measure was DOT. Others were late and failed attendance, bracket bond failure, and oral hygiene condition.

Results

One hundred twelve patients in each group participated and completed the trial. DOT in WeChat group were 7.3 weeks shorter (P = 0.007). There were less failed attendance (3.1 vs. 10.9 %, P < 0.001), late attendance (20.1 vs. 29.9 %, P < 0.001), and bracket bond failure (11.8 vs. 16.1 %, P < 0.001) in WeChat group than control. There was no difference in orthodontic plaque index nor modified gingivitis index between the two groups before and after treatment. Number of failed attendances was identified as an independent factor affecting DOT (P = 0.004; HR = 0.89, 95 % CI 0.84 to 0.95).

Conclusions

The intervention with WeChat is effective in reducing the treatment duration and bracket bond failure, and improving the attendance in orthodontic patients.

Clinical relevance

DOT can be reduced by improving patient's compliance. The messaging app is useful for outpatient education and management.

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Immunological adjuvant effect of the peptide fraction from the larvae of Musca domestica

Background: The larvae of Musca domestica (Diptera: Muscidae) have been used traditionally for malnutritional stagnation, decubital necrosis, osteomyelitis, ecthyma and lip scald and also to treat coma and gastric cancer in the traditional Chinese medicine. Its immunomodulatory effects in naïve mice in relation to the traditional uses were also reported. However, the immunological adjuvant potentials of this insect have not yet been studied. Methods: The peptide fraction from the larvae of Musca domestica L. (MDPF) was evaluated for its adjuvant potentials on the immune responses to ovalbumin (OVA) and avian influenza vaccine (rL–H5) by determining antigen-specific antibody titers, splenocyte proliferation, activity of natural killer (NK) cell, the secretion of cytokines from splenocytes in the immunized mice. Results: MDPF significantly enhanced not only the concanavalin A (Con A)-, lipopolysaccharide (LPS)- and antigen-stimulated splenocyte proliferation, but serum antigen-specific IgG, IgG1, IgG2a, and IgG2b antibody titers in the mice immunized with OVA and rL–H5. MDPF also remarkably promoted the killing activities of NK cells in splenocytes from the mice immunized with rL–H5. Furthermore, MDPF significantly promoted the production of Th1 (IL-2 and IFN-γ) and Th2 (IL-10) cytokines from splenocytes in the immunized mice. Conclusions: The results indicated that MDPF had a potential to increase both cellular and humoral immune responses and elicit a balanced Th1/Th2 response, and that MDPF may be a safe and efficacious vaccine adjuvant candidate.

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Difference in resistance to Salmonella enteritidis infection among allelic variants of TLR4 (903, 1832) in SPF chickens

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Effect of intervention using a messaging app on compliance and duration of treatment in orthodontic patients

Abstract

Objectives

This study aims to determine the effectiveness of a messaging app (WeChat) in improving patients' compliance and reducing the duration of orthodontic treatment (DOT).

Materials and methods

A randomized controlled trial was performed in a dental hospital and a clinic from August 2012 to May 2015. Orthodontic patients were included at the beginning of treatment. Patients with multiphase treatment or braceless technique were excluded. Participants were randomized to WeChat group (received regular reminders and educational messages) or control group (received conventional management) and were followed up until the treatment was completed. Primary outcome measure was DOT. Others were late and failed attendance, bracket bond failure, and oral hygiene condition.

Results

One hundred twelve patients in each group participated and completed the trial. DOT in WeChat group were 7.3 weeks shorter (P = 0.007). There were less failed attendance (3.1 vs. 10.9 %, P < 0.001), late attendance (20.1 vs. 29.9 %, P < 0.001), and bracket bond failure (11.8 vs. 16.1 %, P < 0.001) in WeChat group than control. There was no difference in orthodontic plaque index nor modified gingivitis index between the two groups before and after treatment. Number of failed attendances was identified as an independent factor affecting DOT (P = 0.004; HR = 0.89, 95 % CI 0.84 to 0.95).

Conclusions

The intervention with WeChat is effective in reducing the treatment duration and bracket bond failure, and improving the attendance in orthodontic patients.

Clinical relevance

DOT can be reduced by improving patient's compliance. The messaging app is useful for outpatient education and management.

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Immunological adjuvant effect of the peptide fraction from the larvae of Musca domestica

Background: The larvae of Musca domestica (Diptera: Muscidae) have been used traditionally for malnutritional stagnation, decubital necrosis, osteomyelitis, ecthyma and lip scald and also to treat coma and gastric cancer in the traditional Chinese medicine. Its immunomodulatory effects in naïve mice in relation to the traditional uses were also reported. However, the immunological adjuvant potentials of this insect have not yet been studied. Methods: The peptide fraction from the larvae of Musca domestica L. (MDPF) was evaluated for its adjuvant potentials on the immune responses to ovalbumin (OVA) and avian influenza vaccine (rL–H5) by determining antigen-specific antibody titers, splenocyte proliferation, activity of natural killer (NK) cell, the secretion of cytokines from splenocytes in the immunized mice. Results: MDPF significantly enhanced not only the concanavalin A (Con A)-, lipopolysaccharide (LPS)- and antigen-stimulated splenocyte proliferation, but serum antigen-specific IgG, IgG1, IgG2a, and IgG2b antibody titers in the mice immunized with OVA and rL–H5. MDPF also remarkably promoted the killing activities of NK cells in splenocytes from the mice immunized with rL–H5. Furthermore, MDPF significantly promoted the production of Th1 (IL-2 and IFN-γ) and Th2 (IL-10) cytokines from splenocytes in the immunized mice. Conclusions: The results indicated that MDPF had a potential to increase both cellular and humoral immune responses and elicit a balanced Th1/Th2 response, and that MDPF may be a safe and efficacious vaccine adjuvant candidate.

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Difference in resistance to Salmonella enteritidis infection among allelic variants of TLR4 (903, 1832) in SPF chickens

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Effect of intervention using a messaging app on compliance and duration of treatment in orthodontic patients

Abstract

Objectives

This study aims to determine the effectiveness of a messaging app (WeChat) in improving patients' compliance and reducing the duration of orthodontic treatment (DOT).

Materials and methods

A randomized controlled trial was performed in a dental hospital and a clinic from August 2012 to May 2015. Orthodontic patients were included at the beginning of treatment. Patients with multiphase treatment or braceless technique were excluded. Participants were randomized to WeChat group (received regular reminders and educational messages) or control group (received conventional management) and were followed up until the treatment was completed. Primary outcome measure was DOT. Others were late and failed attendance, bracket bond failure, and oral hygiene condition.

Results

One hundred twelve patients in each group participated and completed the trial. DOT in WeChat group were 7.3 weeks shorter (P = 0.007). There were less failed attendance (3.1 vs. 10.9 %, P < 0.001), late attendance (20.1 vs. 29.9 %, P < 0.001), and bracket bond failure (11.8 vs. 16.1 %, P < 0.001) in WeChat group than control. There was no difference in orthodontic plaque index nor modified gingivitis index between the two groups before and after treatment. Number of failed attendances was identified as an independent factor affecting DOT (P = 0.004; HR = 0.89, 95 % CI 0.84 to 0.95).

Conclusions

The intervention with WeChat is effective in reducing the treatment duration and bracket bond failure, and improving the attendance in orthodontic patients.

Clinical relevance

DOT can be reduced by improving patient's compliance. The messaging app is useful for outpatient education and management.

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Immunological adjuvant effect of the peptide fraction from the larvae of Musca domestica

Background: The larvae of Musca domestica (Diptera: Muscidae) have been used traditionally for malnutritional stagnation, decubital necrosis, osteomyelitis, ecthyma and lip scald and also to treat coma and gastric cancer in the traditional Chinese medicine. Its immunomodulatory effects in naïve mice in relation to the traditional uses were also reported. However, the immunological adjuvant potentials of this insect have not yet been studied. Methods: The peptide fraction from the larvae of Musca domestica L. (MDPF) was evaluated for its adjuvant potentials on the immune responses to ovalbumin (OVA) and avian influenza vaccine (rL–H5) by determining antigen-specific antibody titers, splenocyte proliferation, activity of natural killer (NK) cell, the secretion of cytokines from splenocytes in the immunized mice. Results: MDPF significantly enhanced not only the concanavalin A (Con A)-, lipopolysaccharide (LPS)- and antigen-stimulated splenocyte proliferation, but serum antigen-specific IgG, IgG1, IgG2a, and IgG2b antibody titers in the mice immunized with OVA and rL–H5. MDPF also remarkably promoted the killing activities of NK cells in splenocytes from the mice immunized with rL–H5. Furthermore, MDPF significantly promoted the production of Th1 (IL-2 and IFN-γ) and Th2 (IL-10) cytokines from splenocytes in the immunized mice. Conclusions: The results indicated that MDPF had a potential to increase both cellular and humoral immune responses and elicit a balanced Th1/Th2 response, and that MDPF may be a safe and efficacious vaccine adjuvant candidate.

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Difference in resistance to Salmonella enteritidis infection among allelic variants of TLR4 (903, 1832) in SPF chickens

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Effect of intervention using a messaging app on compliance and duration of treatment in orthodontic patients

Abstract

Objectives

This study aims to determine the effectiveness of a messaging app (WeChat) in improving patients' compliance and reducing the duration of orthodontic treatment (DOT).

Materials and methods

A randomized controlled trial was performed in a dental hospital and a clinic from August 2012 to May 2015. Orthodontic patients were included at the beginning of treatment. Patients with multiphase treatment or braceless technique were excluded. Participants were randomized to WeChat group (received regular reminders and educational messages) or control group (received conventional management) and were followed up until the treatment was completed. Primary outcome measure was DOT. Others were late and failed attendance, bracket bond failure, and oral hygiene condition.

Results

One hundred twelve patients in each group participated and completed the trial. DOT in WeChat group were 7.3 weeks shorter (P = 0.007). There were less failed attendance (3.1 vs. 10.9 %, P < 0.001), late attendance (20.1 vs. 29.9 %, P < 0.001), and bracket bond failure (11.8 vs. 16.1 %, P < 0.001) in WeChat group than control. There was no difference in orthodontic plaque index nor modified gingivitis index between the two groups before and after treatment. Number of failed attendances was identified as an independent factor affecting DOT (P = 0.004; HR = 0.89, 95 % CI 0.84 to 0.95).

Conclusions

The intervention with WeChat is effective in reducing the treatment duration and bracket bond failure, and improving the attendance in orthodontic patients.

Clinical relevance

DOT can be reduced by improving patient's compliance. The messaging app is useful for outpatient education and management.

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