Nuclear receptors in vascular biology

Nuclear receptors sense a wide range of steroids and hormones (estrogens, progesterone, androgens, glucocorticoid, and mineralocorticoid), vitamins (A and D), lipid metabolites, carbohydrates, and xenobiotics. In response to these diverse but critically important mediators, nuclear receptors regulate the homeostatic control of lipids, carbohydrate, cholesterol, and xenobiotic drug metabolism, inflammation, cell differentiation and development, including vascular development. The nuclear receptor family is one of the most important groups of signaling molecules in the body and as such represent some of the most important established and emerging clinical and therapeutic targets. This review will highlight some of the recent trends in nuclear receptor biology related to vascular biology

Apical Periodontitis in Vital and Nonvital Teeth: Clinical and Radiographic Features

Apical periodontitis (AP) is a common inflammatory condition predominantly caused by the response of the immune system to microbial invasion within the root canal system. Contrary to conventional perception, AP may occur in vital teeth with inflamed pulp; adding complexity to diagnosis and treatment. AP, due to its frequent lack of symptoms and reliance on radiographic evaluation for detection, often presents diagnostic challenges. In addition, AP pathogenesis involves complex interactions between microbial virulence and host immune response at the cellular and molecular levels. Comprehensive diagnostic procedures, including patient history, clinical examination, and radiographic evaluation, are essential for early detection and necessary intervention, with the recognition of clinical signs and symptoms underscoring the importance of regular dental evaluations. The current review primarily discusses the radiographic and clinical features of AP in vital and non-vital teeth; introducing a new taxonomic classification to improve diagnostic precision and treatment outcomes. Moreover, it proposes different treatment categories/options for the management of AP, based on pulp status as well as clinical and radiographic findings; emphasizing vital pulp therapy and root canal treatment for vital and non-vital teeth with AP, respectively. Furthermore, the global and regional epidemiology of AP is presented, along with its association with systemic health conditions; e.g., cardiovascular diseases, diabetes mellitus, and adverse pregnancy outcomes. Moreover, future research directions are advocated to improve the efficacy and predictability of diagnosis and treatments; paving the path for clinicians in early detection, accurate diagnosis, and effective management of AP to enhance oral health outcomes

Mortality Risk Related to Heatwaves in Dezful City, Southwest of Iran

Background: We aimed to evaluate the impact of heatwaves on daily deaths due to non-accidental, cardiovascular and respiratory causes in the city of Dezful in Iran from 2013 to 2019. Method: We collected daily ambient temperature and mortality and defined 2 types of heatwaves by combining daily temperature ⩾90th in each month of the study period or since 30 years with duration ⩾2 and 3 days. We used a distributed lag non-linear model to study the association between each type of heatwave definition, and deaths due to non-accidental, cardiovascular and respiratory causes with lags up to 13 days. Results: There was no discernible correlation in this area, despite the fact that heatwaves raised the risk of death from cardiovascular causes and lowered the risk from respiratory causes. On the other hand, the risk of total non-accidental mortality on days with the heatwaves is significantly higher than normal days. In main effects, the heatwaves have a significant relationship with the risk of total non-accidental mortality (in the first heatwave definition, Cumulative Excess Risk (CER) in lag0-2 was 10.4 and in second heatwave definition, CER values in lag0, 0-2, and 0-6 were 12.4, 29.2, and 38.8 respectively). Also, in added effects, heatwaves have a significant relationship with the risk of total non-accidental mortality (in the first heatwave definition, CER in lag0 and 0-2 were 1.79 and 4.11 and in the second heatwave definition, CER values in lag0, 0-2, and 0-6 were 7.76, 18.35 and 24.87 respectively). In addition, heatwaves appeared to contribute to a cumulative excess risk of non-accidental death among the male group as well as the older adults. Conclusion: However, the results showed that heatwaves could have detrimental effects on health, even in populations accustomed to the extreme heat. Therefore, early warning systems which monitor heatwaves should provide the necessary warnings to the population, especially the most vulnerable groups

Lípidos hepáticos y séricos en ratas Wistar alimentadas con nuevos lípidos estructurados que contienen ácido linoleico conjugado y ácido linolénico conjugado

Conjugated linoleic acid (CLA) and conjugated linolenic acid (CLnA) have been known to have several health-promoting effects. The aim of this study was to introduce a novel structured lipid (SL) including both CLA and CLnA (cis9, trans11, cis13-18:3, punicic acid) into one triacylglycerol (TAG) molecule through enzymatic interesterification and investigate its effect on body weight, liver and serum lipids in Wistar rats. CLA oil, pomegranate seed oil (as a rich source of CLnA) and soybean oil (as a negative control) were applied as other experimental oils. The rats were fed the oils at 1500 mg/kg body weight per day via oral gavage for 45 days. Gas chromatography analysis showed that SL included CLnA and CLA in roughly equal concentrations. The in vivo study revealed that SL had the greatest effect on the reduction in liver lipid weight (4.65 g/100g of liver) and liver TAG (13.28 mg/g) compared to soybean oil (8.7 g/100g and 18.8 mg/g, respectively). High density lipoprotein cholesterol (HDL-C) in the serum of rats which were fed CLA oil significantly (p < 0.05) increased (from 0.95 to 1.14 mmol/l). Pomegranate seed oil reduced low density lipoprotein cholesterol (LDL-C) and total cholesterol (about 40% and 24% reduction, respectively). A remarkable TAG reduction (p < 0.05) was observed in all treated rats.Se sabe que el ácido linoleico conjugado (CLA) y el ácido linolénico conjugado (CLnA) tienen varios efectos positivos para la salud. El objetivo de este estudio fue producir un nuevo lípido estructurado (SL) que incluye tanto CLA como CLnA (cis9, trans11, cis13-18:3, ácido púnico) en una molécula de triacilglicerol (TAG) a través de la interesterificación enzimática e investigar su efecto en el cuerpo, peso, lípidos hepáticos y séricos en ratas Wistar. El aceite de CLA, el aceite de semilla de granada (como una fuente rica de CLnA) y el aceite de soja (como control negativo) se aplicaron como otros aceites experimentales. Las ratas fueron alimentadas con los aceites a razón de 1500 mg/kg de peso corporal por día mediante sonda oral durante 45 días. El análisis por cromatografía de gases mostró que SL incluía CLnA y CLA en una concentración aproximadamente igual. El estudio in vivo reveló que SL tuvo el mayor efecto sobre la reducción del peso de lípidos hepáticos (4,65 g/100 g de hígado) y TAG hepático (13,28 mg/g) en comparación con el aceite de soja (8,7 g/100 g and 18,8 mg/g, respectivamente). El colesterol de lipoproteínas de alta densidad (HDL-C) en suero de ratas que fueron alimentadas con aceite de CLA significativamente (p < 0.05) aumentó (de 0.95 a 1.14 mmol/l) y el aceite de semilla de granada podría reducir el colesterol de lipoproteínas de baja densidad (LDL-C) y colesterol total (aproximadamente 40% y 24% de reducción, respectivamente). Se observó una notable reducción de TAG (p < 0.05) en todas las ratas tratadas

European Society of Endodontology position statement: Management of deep caries and the exposed pulp

This position statement on the management of deep caries and the exposed pulp represents the consensus of an expert committee, convened by the European Society of Endodontology (ESE). Preserving the pulp in a healthy state with sustained vitality, preventing apical periodontitis and developing minimally invasive biologically based therapies are key themes within contemporary clinical endodontics. The aim of this statement was to summarize current best evidence on the diagnosis and classification of deep caries and caries‐induced pulpal disease, as well as indicating appropriate clinical management strategies for avoiding and treating pulp exposure in permanent teeth with deep or extremely deep caries. In presenting these findings, areas of controversy, low‐quality evidence and uncertainties are highlighted, prior to recommendations for each area of interest. A recently published review article provides more detailed information and was the basis for this position statement (Bjørndal et al. 2019, International Endodontic Journal, doi:10.1111/iej.13128). The intention of this position statement is to provide the practitioner with relevant clinical guidance in this rapidly developing area. An update will be provided within 5 years as further evidence emerges

Current and Emerging Innovations in Minimally Invasive Caries and Endodontic Treatments

Deep carious lesions frequently lead to pulpal exposure and require subsequent root canal treatment in order to save the tooth. Unfortunately, this treatment is often unsuccessful in the long term with periapical disease as the result. New insights into the biological processes associated with pulpal healing and innovations in biocompatible capping agents have led to new treatment strategies, which can keep teeth vital and functional for longer. Dentine is a bioactive substance that releases growth factors when demineralised by carious processes, which has a positive effect on the regeneration of the pulp. Controlling caries in cavitated carious lesions should be attempted using methods which are aimed at biofilm removal and control. Only when cavitated carious dentine lesions are either non-cleansable, or can no longer be sealed, are restorative interventions indicated. Carious tissue is removed purely to create conditions suitable for long-lasting restoration. Bacterially contaminated or demineralised tissue close to the pulp does not need to be removed. To ascertain the state of the pulp, the symptoms observed are critical in determining the most appropriate treatment modality and often with only partial removal of inflamed pulp tissue, the remainder of the pulp can heal. The evidence and, therefore, these recommendations support minimally invasive carious lesion management in conjunction with less invasive endodontic treatment to preserve tooth tissue and maintain pulp viability and function in the long term.</p

Underutilization of Social Insurance among the Poor: Evidence from the Philippines

Many developing countries promote social health insurance as a means to eliminate unmet health needs. However, this strategy may be ineffective if there are barriers to fully utilizing insurance.We analyzed the utilization of social health insurance in 30 hospital districts in the central regions of the Philippines between 2003 and 2007. Data for the study came from the Quality Improvement Demonstration Study (QIDS) and included detailed patient information from exit interviews of children under 5 years of age conducted in seven waves among public hospital districts located in the four central regions of the Philippines. These data were used to estimate and identify predictors of underutilization of insurance benefits--defined as the likelihood of not filing claims despite having legitimate insurance coverage--using logistic regression.Multivariate analyses using QIDS data from 2004 to 2007 reveal that underutilization averaged about 15% throughout the study period. Underutilization, however, declined over time. Among insured hospitalized children, increasing length of stay in the hospital and mother's education, were associated with less underutilization. Being in a QIDS intervention site was also associated with less underutilization and partially accounts for the downward trend in underutilization over time.The surprisingly high level of insurance underutilization by insured patients in the QIDS sites undermines the potentially positive impact of social health insurance on the health of the marginalized. In the Philippines, where the largest burden of health care spending falls on households, underutilization suggests ineffective distribution of public funds, failing to reach a significant proportion of households which are by and large poor. Interventions that improve benefit awareness may combat the problem of underutilization and should be the focus of further research in this area

Effective practices of international volunteering for health : perspectives from partner organizations

Abstract: The demand for international volunteer experiences to promote global health and nutrition is increasing and numerous studies have documented the experiences of the international volunteers who travel abroad; however, little is known about effective practices from the perspective of partner organizations. This study aims to understand how variables such as the skill-level of volunteers, the duration of service, cultural and language training, and other key variables affect partner organizations’ perceptions of volunteer effectiveness at promoting healthcare and nutrition..