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Heterozygous deletions in the ANKS1B gene cause ANKS1B neurodevelopmental syndrome (ANDS), a rare genetic disease characterized by autism spectrum disorder (ASD), attention deficit/hyperactivity disorder, and speech and motor deficits. The ANKS1B gene encodes for AIDA-1, a protein that is enriched at neuronal synapses and regulates synaptic plasticity. Here we report an unexpected role for oligodendroglial deficits in ANDS pathophysiology. We show that Anks1b-deficient mouse models display deficits in oligodendrocyte maturation, myelination, and Rac1 function, and recapitulate white matter abnormalities observed in ANDS patients. Selective loss of Anks1b from the oligodendrocyte lineage, but not from neuronal populations, leads to deficits in social preference and sensory reactivity previously observed in a brain-wide Anks1b haploinsufficiency model. Furthermore, we find that clemastine, an antihistamine shown to increase oligodendrocyte precursor cell maturation and central nervous system myelination, rescues deficits in social preference in 7-month-old Anks1b-deficient mice. Our work shows that deficits in social behaviors present in ANDS may originate from abnormal Rac1 activity within oligodendrocytes. Heterozygous deletions in the ANKS1B gene cause ANKS1B neurodevelopmental syndrome. Here the authors show this syndrome is associated with impaired white matter integrity, and that Anks1b-deficient mouse models display deficits in oligodendrocyte maturation, myelination, and Rac1 function. [ABSTRACT FROM AUTHOR]

Objective: GM2 gangliosidosis is usually fatal by 5 years of age in its 2 major subtypes, Tay‐Sachs and Sandhoff disease. First reported in 1881, GM2 gangliosidosis has no effective treatment today, and children succumb to the disease after a protracted neurodegenerative course and semi‐vegetative state. This study seeks to further develop adeno‐associated virus (AAV) gene therapy for human translation. Methods: Cats with Sandhoff disease were treated by intracranial injection of vectors expressing feline β‐N‐acetylhexosaminidase, the enzyme deficient in GM2 gangliosidosis. Results: Hexosaminidase activity throughout the brain and spinal cord was above normal after treatment, with highest activities at the injection sites (thalamus and deep cerebellar nuclei). Ganglioside storage was reduced throughout the brain and spinal cord, with near complete clearance in many regions. While untreated cats with Sandhoff disease lived for 4.4 ± 0.6 months, AAV‐treated cats lived to 19.1 ± 8.6 months, and 3 of 9 cats lived >21 months. Correction of the central nervous system was so effective that significant increases in lifespan led to the emergence of otherwise subclinical peripheral disease, including megacolon, enlarged stomach and urinary bladder, soft tissue spinal cord compression, and patellar luxation. Throughout the gastrointestinal tract, neurons of the myenteric and submucosal plexuses developed profound pathology, demonstrating that the enteric nervous system was inadequately treated. Interpretation: The vector formulation in the current study effectively treats neuropathology in feline Sandhoff disease, but whole‐body targeting will be an important consideration in next‐generation approaches. ANN NEUROL 2023;94:969–986 [ABSTRACT FROM AUTHOR]

The gangliosidoses are a family of neurodegenerative lysosomal storage diseases that have recently seen promising advances in gene therapy. White matter deficits are well established components of gangliosidosis pathology that are now receiving more attention because they are partially refractory to correction by gene therapy. After a brief synopsis of normal myelinogenesis, this review outlines current viewpoints on the origin of white matter deficits in the gangliosidoses and potential obstacles to treating them effectively by gene therapy. Dysmyelinogenesis (failure of myelin sheaths to form properly) is proposed as the predominant contributor to white matter pathology, but precise mechanistic details are not well understood. The involvement of neuronal storage deficits may extend beyond secondary demyelination (destruction of myelin due to axonal loss) and contribute to dysmyelinogenesis. Preclinical studies in animal models of the gangliosidoses have substantially improved lifespan and quality of life, leading to the initiation of several clinical trials. However, improvement of white matter pathology has lagged behind other metrics and few evidence-based explanations have been proposed to date. Research groups in the field are encouraged to include myelin-specific investigations in future gene therapy work to address this gap in knowledge. [ABSTRACT FROM AUTHOR]

The lysosomal storage disorder, GM1 gangliosidosis (GM1), is a neurodegenerative condition resulting from deficiency of the enzyme β-galactosidase (β-gal). Mutation of the GLB1 gene, which codes for β-gal, prevents cleavage of the terminal β-1,4-linked galactose residue from GM1 ganglioside. Subsequent accumulation of GM1 ganglioside and other substrates in the lysosome impairs cell physiology and precipitates dysfunction of the nervous system. Beyond palliative and supportive care, no FDA-approved treatments exist for GM1 patients. Researchers are critically evaluating the efficacy of substrate reduction therapy, pharmacological chaperones, enzyme replacement therapy, stem cell transplantation, and gene therapy for GM1. A Phase I/II clinical trial for GM1 children is ongoing to evaluate the safety and efficacy of adeno-associated virus-mediated GLB1 delivery by intravenous injection, providing patients and families with hope for the future. [ABSTRACT FROM AUTHOR]

Objectives: The FiCTION trial compared co‐primary outcomes (dental pain and/or infection) and secondary outcomes (child oral health‐related quality of life [COHRQOL], child dental anxiety, cost‐effectiveness, caries development/progression and acceptability) across three treatment strategies (Conventional with Prevention [C + P]; Biological with Prevention [B + P]; Prevention Alone [PA]) for managing caries in children in primary care. COHRQOL and child dental anxiety experiences are reported upon here. Methods: A multi‐centre, 3‐arm, parallel‐group, unblinded patient‐randomized controlled trial of 3‐ to 7‐year‐olds treated under NHS contracts was conducted in 72 general dental practices in England, Wales and Scotland. Child participants (with at least one primary molar with dentinal caries) were randomized (1:1:1) to one of three treatment arms with the intention of being managed according to allocated arm for 3 years (minimum 23 months). Randomization was via a centrally administered system using random permuted blocks of variable length. At baseline and final visit, accompanying parents/caregivers completed a parental questionnaire including COHRQOL (16 item P‐CPQ‐16), and at every visit, child‐ and parental‐questionnaire‐based data were collected for child‐based dental trait and state anxiety. Statistical analyses were conducted on complete cases from the modified intention‐to‐treat (mITT) analysis set. Results: A total of 1144 children were randomized (C + P: 386; B + P: 381; PA: 377). The mITT analysis set included the 1058 children who attended at least one study visit (C + P: 352; B + P: 352; PA: 354). Median follow‐up was 33.8 months (IQR: 23.8, 36.7). The P‐CPQ‐16 overall score could be calculated after simple imputation at both baseline and final visit for 560 children (C + P: 189; B + P: 189; PA: 182). There was no evidence of a difference in the estimated adjusted mean P‐CPQ‐16 at the final visit which was, on average, 0.3 points higher (97.5% CI: −1.1 to 1.6) in B + P than C + P and 0.2 points higher, on average, (97.5% CI: −1.2 to 1.5) in PA than for C + P. Child dental trait anxiety and child dental state anxiety, measured at every treatment visit, showed no evidence of any statistically or clinically significant difference between arms in adjusted mean scores averaged over all follow‐up visits. Conclusions: The differences noted in COHRQOL and child‐based dental trait and dental state anxiety measures across three treatment strategies for managing dental caries in primary teeth were small, and not considered to be clinically meaningful. The findings highlight the importance of including all three strategies in a clinician's armamentarium, to manage childhood caries throughout the young child's life and achieve positive experiences of dental care. [ABSTRACT FROM AUTHOR]

Background: The Filling Children's Teeth: Indicated Or Not? (FiCTION) randomised controlled trial (RCT) aimed to explore the clinical- and cost-effectiveness of managing dental caries in children's primary teeth. The trial compared three management strategies: conventional caries management with best practice prevention (C + P), biological management with best practice prevention (B + P) and best practice prevention alone (PA)-based approaches. Recently, the concept of treatment acceptability has gained attention and attempts have been made to provide a conceptual definition, however this has mainly focused on adults. Recognising the importance of evaluating the acceptability of interventions in addition to their effectiveness, particularly for multi-component complex interventions, the trial design included a qualitative component. The aim of this component was to explore the acceptability of the three strategies from the perspectives of the child participants and their parents. Methods: Qualitative exploration, based on the concept of acceptability. Participants were children already taking part in the FiCTION trial and their parents. Children were identified through purposive maximum variation sampling. The sample included children from the three management strategy arms who had been treated and followed up; median (IQR) follow-up was at 33.8 (23.8, 36.7) months. Semi-structured interviews with thirteen child-parent dyads. Interviews were transcribed verbatim and analysed using a framework approach. Results: Data saturation was reached after thirteen interviews. Each child-parent dyad took part in one interview together. The participants were eight girls and five boys aged 5–11 years and their parents. The children's distribution across the trial arms was: C + P n = 4; B + P n = 5; PA n = 4. Three key factors influenced the acceptability of caries management in primary teeth to children and parents: i) experiences of specific procedures within management strategies; ii) experiences of anticipatory dental anxiety and; iii) perceptions of effectiveness (particularly whether pain was reduced). These factors were underpinned by a fourth key factor: the notion of trust in the dental professionals – this was pervasive across all arms. Conclusions: Overall children and parents found each of the three strategies for the management of dental caries in primary teeth acceptable, with trust in the dental professional playing an important role. [ABSTRACT FROM AUTHOR]

Background: The lack of evidence for the effective management of carious lesions in children's primary teeth has caused uncertainty for the dental profession and patients. Possible approaches include conventional and biological management alongside best practice prevention, and best practice prevention alone. The FiCTION trial assessed the effectiveness of these options, and included a qualitative study exploring dental professionals' (DPs) experiences of delivering the different treatment arms. This paper reports on how DPs managed children with carious lesions within FiCTION and how this related to their everyday experiences of doing dentistry. Methods: Overall, 31 DPs from FiCTION-trained dental surgeries in four regions of the UK participated in semi-structured interviews about their experiences of the three treatment arms (conventional management of carious lesions and prevention (C + P), biological management of carious lesions and prevention (B + P) or prevention alone (PA)). A theoretical framework, drawing on social practice theory (SPT), was developed for analysis. Results: Participants discussed perceived effectiveness of, and familiarity with, the three techniques. The C + P arm was familiar, but some participants questioned the effectiveness of conventional restorations. Attitudes towards the B + P arm varied in terms of familiarity, but once DPs were introduced to the techniques, this was seen as effective. While prevention was familiar, PA was described as ineffective. DPs manage children with carious lesions day-to-day, drawing on previous experience and knowledge of the child to provide what they view as the most appropriate treatment in the best interests of each child. Randomisation undermined these normal choices. Several DPs reported deviating from the trial arms in order to treat a patient in a particular way. Participants valued evidence-based dentistry, and expect to use the results of FiCTION to inform future practice. They anticipate continuing to use the full range of treatment options, and to personally select appropriate strategies for individual children. Conclusions: RCTs take place in the context of day-to-day practices of doing dentistry. DPs employ experiential and interpersonal knowledge to act in the best interests of their patients. Randomisation within a clinical trial can present a source of tension for DPs, which has implications for assuring individual equipoise in future trials. [ABSTRACT FROM AUTHOR]

Background: A three-arm parallel group, randomised controlled trial set in general dental practices in England, Scotland, and Wales was undertaken to evaluate three strategies to manage dental caries in primary teeth. Children, with at least one primary molar with caries into dentine, were randomised to receive Conventional with best practice prevention (C + P), Biological with best practice prevention (B + P), or best practice Prevention Alone (PA). Methods: Data on costs were collected via case report forms completed by clinical staff at every visit. The co-primary outcomes were incidence of, and number of episodes of, dental pain and/or infection avoided. The three strategies were ranked in order of mean cost and a more costly strategy was compared with a less costly strategy in terms of incremental cost-effectiveness. Costs and outcomes were discounted at 3.5%. Results: A total of 1144 children were randomised with data on 1058 children (C + P n = 352, B + P n = 352, PA n = 354) used in the analysis. On average, it costs £230 to manage dental caries in primary teeth over a period of up to 36 months. Managing children in PA was, on average, £19 (97.5% CI: -£18 to £55) less costly than managing those in B + P. In terms of effectiveness, on average, there were fewer incidences of, (− 0.06; 97.5% CI: − 0.14 to 0.02) and fewer episodes of dental pain and/or infection (− 0.14; 97.5% CI: − 0.29 to 0.71) in B + P compared to PA. C + P was unlikely to be considered cost-effective, as it was more costly and less effective than B + P. Conclusions: The mean cost of a child avoiding any dental pain and/or infection (incidence) was £330 and the mean cost per episode of dental pain and/or infection avoided was £130. At these thresholds B + P has the highest probability of being considered cost-effective. Over the willingness to pay thresholds considered, the probability of B + P being considered cost-effective never exceeded 75%. Trial registration: The trial was prospectively registered with the ISRCTN (reference number ISRCTN77044005) on the 26th January 2009 and East of Scotland Research Ethics Committee provided ethical approved (REC reference: 12/ES/0047). [ABSTRACT FROM AUTHOR]

The distinction between biological processes of adipose tissue expansion is crucial to understanding metabolic derangements, but a robust method for quantifying adipocyte size has yet to be standardized. Here, we compared three methods for histological analysis in situ: one conventional approach using individual micrographs acquired by digital camera, and two with whole-slide image analysis pipelines involving proprietary (Visiopharm) and open-source software (QuPath with a novel ImageJ plugin). We found that micrograph analysis identified 10-40 times fewer adipocytes than whole-slide methods, and this small sample size resulted in high variances that could lead to statistical errors. The agreement of the micrograph method to measure adipocyte area with each of the two whole-slide methods was substantially less (R² of 0.6644 and 0.7125) than between the two whole-slide methods (R² of 0.9402). These inconsistencies were more pronounced in samples from high-fat diet fed mice. While the use of proprietary software resulted in the highest adipocyte count, the lower cost, ease of use, and minimal variances of the open-source software provided a distinct advantage for measuring the number and size of adipocytes. In conclusion, we recommend whole-slide image analysis methods to consistently measure adipocyte area and avoid unintentional errors due to small sample sizes. [ABSTRACT FROM AUTHOR]

Background: As a recognised effective and economical agent for dental caries prevention, fluoride has been used in many different fluoridation schemes implemented across the world. Considering the narrow ‘dose-gap’ between the benefit of caries reduction and the risk of dental fluorosis, it is recommended that fluoride intake is monitored by measuring urinary fluoride excretion. The aim of this scoping review is to map the current literature/evidence on fluoride intake and excretion studies in relation to the study population, settings, type of study design, methodology, and analytical approach. Methods: Embase/Ovid, MEDLINE/Ovid, CINAHL/EBSCO, Scopus/Elsevier were searched for relevant articles until April 2018. Studies were included if they reported intake and excretion of fluoride in healthy humans of all age groups. Findings were explored using a narrative synthesis to summarise studies characteristics and outcome measures. Results: Removal of duplicates from the originally 2295 identified records yielded 1093 studies of which 206 articles were included. Only 21.6% of the studies were conducted in children (<8-year-olds). Most studies (38.8%) used drinking water concentration as a proxy for fluoride intake, whereas only 11.7% measured fluoride intake from all sources. Of the 72 studies that measured dietary fluoride intake, only 10 reported the validity of the employed dietary assessment method. Only 14 studies validated the urine sample collection methods. No information on the validity of the employed analytical method was reported by the majority (64.6%) of studies. Only a small proportion (8.7%) of the included studies investigated the association between fluoride intake and excretion. Conclusion: The findings reveal much variability in terms of conducting the studies and reporting the findings, illustrating a high heterogeneity in data collection across settings and populations. Future studies should provide more detail on sampling technique, measurement protocols (including validation), and on clearly defining the relationship between intake and urinary excretion of fluoride. [ABSTRACT FROM AUTHOR]

The aim was to compare potential methods for fluoride analysis in microlitre-volume plasma samples containing nano-gram amounts of fluoride. Methods: A group of 4 laboratories analysed a set of standardised biological samples as well as plasma to determine fluoride concentration using 3 methods. In Phase-1, fluoride analysis was carried out using the established hexamethyldisiloxane (HMDS)-diffusion method (1 mL-aliquot/analysis) to obtain preliminary measurement of agreement between the laboratories. In Phase-2, the laboratories analysed the same samples using a micro-diffusion method and known-addition technique with 200 µL-aliquot/analysis. Coefficients of Variation (CVs) and intra-class correlation coefficients (ICCs) were estimated using analysis of variance to evaluate the amount of variation within- and between-laboratories. Based on the results of the Phase-2 analysis, 20 human plasma samples were analysed and compared using the HMDS-diffusion method and known-addition technique in Phase-3. Results: Comparison of Phase-1 results showed no statistically significant difference among the laboratories for the overall data set. The mean between- and within-laboratory CVs and ICCs were < 0.13 and ≥0.99, respectively, indicating very low variability and excellent reliability. In Phase-2, the overall results for between-laboratory variability showed a poor CV (1.16) and ICC (0.44) for the micro-diffusion method, whereas with the known-addition technique the corresponding values were 0.49 and 0.83. Phase-3 results showed no statistically significant difference in fluoride concentrations of the plasma samples measured with HMDS-diffusion method and known- addition technique, with a mean (SE) difference of 0.002 (0.003) µg/mL. In conclusion, the known-addition technique could be a suitable alternative for the measurement of fluoride in plasma with microlitre-volume samples. [ABSTRACT FROM AUTHOR]

Limited knowledge is available on total fluoride exposure, excretion and retention in infants, despite the first year of human life being the critical period for dental development and risk of dental fluorosis. This study investigated total daily fluoride intake (TDFI), excretion (TDFE) and retention (TDFR) in infants living in fluoridated and non-fluoridated water areas at pre- and post-weaning stages of development. Healthy infants, aged 0–12 months, were recruited and their TDFI (mg/kg body weight (BW) per d), from diet and toothpaste ingestion, was assessed over a 3-d period using a dietary diary and tooth-brushing questionnaire. TDFE (mg/kg BW per d) was estimated by collecting 48-h urine and faeces. TDFR (mg/kg BW per d) was estimated by subtracting TDFE from TDFI. A total of forty-seven infants completed the study: sixteen at pre-weaning and thirty-one at post-weaning stages, with a mean age of 3·4 and 10·0 months, respectively. TDFI was lower in the non-fluoridated area (P <0·001) and at the pre-weaning stage (P =0·002) but higher in formula-fed infants (P <0·001). TDFE was mainly affected by type of feeding, with higher excretion in formula-fed infants (P <0·001). TDFR was lower in the non-fluoridated area (P <0·001) and at the pre-weaning stage (P <0·001) but higher in formula-fed infants (P =0·001). In conclusion, a relatively large proportion of fluoride intake is retained in the body in weaned infants. This is an important consideration in fluoride-based prevention programmes, with goals to maximise caries prevention while minimising the risk of dental fluorosis. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Enamel formation is a vulnerable developmental process, susceptible to environmental influences such as excessive systemic fluoride (F) exposure and infant/childhood disease. This study determined prevalence and extent of developmental enamel defects (DDE) and dental fluorosis in 8‐year‐old Nigerians and explored associations with key predictors. Methods: A sample of 322 healthy 8‐year‐olds (155 males, 167 females) from primary schools in lower and higher water F areas of (i) rural and (ii) urban parts of Oyo State in south‐west Nigeria (n = 4 areas) (in which the mean (SD) F concentration of community water supplies ranged from 0.07 (0.02) to 2.13 (0.64) mg F/L) were dentally examined using modified DDE (mDDE) and Thylstrup and Fejerskov (TF) indices. Drinking waters, cooking waters and toothpaste samples were analysed for F concentration using a F ion‐selective electrode (F‐ISE). Information on infant/childhood diseases, infant feeding and tooth cleaning practices was obtained from parents/legal guardians. Data were analysed using ANOVA, chi‐square tests, Spearman correlation and binary logistic regression as appropriate. Results: Mean (SD) F concentration of actual drinking and actual cooking waters consumed by participants was 0.25 (0.20) and 0.24 (0.14) mg F/L respectively in the urban higher F area; 1.11 (1.00) and 1.16 (1.02) mg F/L, respectively in the rural higher F area (P < .05). Overall, mouth prevalence of DDE in the permanent dentition was 61.2% with a mean (SD) of 2.4 (2.2) index teeth affected. Dental fluorosis mouth prevalence was 29.8% with a mean of 2.1 (3.7) teeth affected. Prevalence and extent of DDE and dental fluorosis were greater in higher F than lower water F areas (P < .001). A weak positive correlation was seen between extent of dental fluorosis and drinking water F concentration (ρ = 0.28). The absence of infant/childhood disease was associated with a lower risk of DDE being present (P = .001), with an odds ratio of 0.43 (95% CI = 0.26, 0.71). Gender was a statistically significant (P = .014) predictor for dental fluorosis with females having a higher risk OR 1.94 (95% CI = 1.14, 3.28) of dental fluorosis than males. Conclusions: In these Nigerian 8‐year‐olds (n = 322), mouth prevalence of DDE was 61.2% (mean (SD) teeth affected = 2.4 (2.2)), and a key positive predictor was a history of infant/childhood disease. With 29.8% of these children exhibiting dental fluorosis (mean (SD) teeth affected = 2.1(3.7)), drinking water F concentration was identified as a positive predictor, along with gender, with females more at risk of dental fluorosis than males. [ABSTRACT FROM AUTHOR]

Objectives Risk of development of dental fluorosis may increase with even a short-term increase in fluoride (F) intake during tooth formation. Considering the wide variations in F concentrations of different food and drinks, it is important to assess short-term differences in F intake and consequently fractional urinary F excretion (FUFE) in children, which provide an indication of F body burden. Therefore, the aim of this study was to investigate weekly variation in total daily F intake (TDFI) and its sources and fractional urinary F excretion (FUFE) in 4- to 6-year-olds living in a fluoridated area in the UK. Methods Sixty-one children were surveyed twice with a 1-week gap between surveys. Dietary F intake was assessed by 'food-diary' and 'duplicate-plate collection'. Toothbrushing expectorate (saliva/toothpaste) was collected to estimate F intake from toothpaste ingestion. TDFI was calculated from dietary F intake and toothpaste ingestion. Daily urinary F excretion (DUFE) was estimated by collecting 24-h urine samples and FUFE was calculated from DUFE and TDFI [FUFE = (DUFE/TDFI) × 100]. Results The overall mean TDFI, DUFE and FUFE for all children were 0.056 (SD 0.036) mg/kgbw/day, 0.018 (SD 0.007) mg/kgbw/day and 39 (SD 20)%, respectively. The mean (95% CI) difference between the 2 weeks studied was 0.004 (−0.004, 0.011) mg/kgbw/day for TDFI, 0.002 (−0.001, 0.004) mg/kgbw/day for DUFE and 1 (−6, 8)% for FUFE. Conclusions Mean TDFI and FUFE did not vary statistically significantly with week and therefore one set of data collection from a group of children living in a temperate climate could be sufficient to monitor F exposure and F body burden in community prevention programmes for oral health. [ABSTRACT FROM AUTHOR]

It is important to monitor systemic fluoride (F) intake from foods, drinks and inadvertent toothpaste ingestion in order to minimise the risk of dental fluorosis while maximising caries prevention. In the UK, an F database containing the F content of commercially available foods and drinks was compiled from 518 products analysed using an acid-diffusion method and F-ion-selective electrode. The individual products analysed ranged from <0.01 µg F/100 g for butter/margarine (miscellaneous foods group) to 1,054.20 µg F/100 g for canned sardines (fish group). These findings, along with the wide range of F contents found within the food groups, highlight the need for comprehensive F content labelling of food and drink products. [ABSTRACT FROM AUTHOR]

Background Children in Gaza Strip suffer from a high prevalence of dental fluorosis. Aims To estimate and compare total daily fluoride (F) intake ( TDFI) and investigate the relative contributions of different sources of F to TDFI, in 3- to 4-year-old children in Gaza Strip, exposed to low (<0.7 mg/litre), moderate (0.7-1.2 mg/litre) or high (>1.2 mg/litre) F concentrations in tap water. Design A 3-day food diary and samples of tap water, drinks, foods, toothpastes and toothbrushing expectorate were collected from 216 children receiving low ( n = 81), moderate ( n = 72) or high ( n = 63) F concentrations in tap water. F concentration of samples was analysed using an F-ion-selective electrode. TDFI from all sources was estimated. Data were analysed by anova and Tukey's test. Results The mean (± SD) F concentration in low, moderate and high F tap waters was 0.21(±0.15), 0.91(±0.13) and 1.71(±0.35) mg/litre, respectively. Mean (± SD) TDFI was 0.02(±0.01), 0.04(±0.01) and 0.05(±0.03) mg/kg bw/day, respectively ( P < 0.0001). Foods made the largest contribution (63.9%) to TDFI. Conclusion Total daily fluoride (F) intake increased as F concentration in tap water increased. Foods were the primary source of F. Programmes for monitoring fluoride expose should consider the fluoride concentration of water used for food preparation and local dietary behaviours. [ABSTRACT FROM AUTHOR]

ObjectiveThere are few data on the dietary intake of children in Libya, and none on free sugars intake. The present study aimed to report the intake of macronutrients and eating habits of relevance to dental health in a group of Libyan schoolchildren and to investigate any gender differences for these variables.DesignDietary information was obtained from a randomly selected sample using an estimated 3 d food diary. Dietary data were coded using food composition tables and entered into a Microsoft® Access database. Intakes of energy, macronutrients, sugars and the amount of acidic items consumed were determined using purpose-written programs.SettingBenghazi, Libya.SubjectsSchoolchildren aged 12 years.ResultsOne hundred and eighty children (ninety-two boys and eighty-eight girls) completed the study. Their mean age was 12·3 (sd 0·29) years. The average daily energy intake was 7·01 (sd 1·54) MJ/d. The percentage contributions to energy intake from protein, fat and carbohydrate were 16 %, 30 % and 54 %, respectively. Total sugars contributed 20·4 % of the daily energy intake, and free sugars 12·6 %. The median daily intake of acidic items was 203 g/d, and of acidic drinks was 146 g/d. There were no statistically significant differences in nutrient intakes between genders. Intake of acidic items was higher in girls (P < 0·001).ConclusionsThe contribution to energy intake from macronutrients was in accordance with global nutrition guidelines. The acidic drinks intake was low compared with other populations, while free sugars intake was above the recommended threshold of 10 % of energy intake. [ABSTRACT FROM PUBLISHER]

Introduction Fluorosis is endemic throughout the East African Rift valley, including parts of Tanzania. The aim of the study was to identify all cases of deforming juvenile skeletal fluorosis ( JSF) in a northern Tanzanian village and to document the extent of dental fluorosis ( DF). Methods Door-to-door prevalence survey of all residents of the village. Residents were assessed for the presence of DF and JSF. Those with JSF and randomly selected controls from the same age range were further assessed for possible JSF risk factors. Results The village had a population of 1435. DF was endemic within the population, being present in 911 (75.5%; 95% CI, 73.0-77.9) of dentate individuals who were examined ( n = 1207). JSF was present in 56 of 1263 people examined, giving a prevalence of 4.4% (95% CI, 3.3-5.6) and was more common in males. Low body mass index, drinking predominantly well water 3 years previously, not being weaned on bananas, the use of fluoride salts in cooking during childhood and drinking more cups of tea per day were independent predictors of JSF. Conclusions Juvenile skeletal fluorosis is a common and preventable public health problem. Providing clean, low-fluoride, piped water to affected communities is of obvious health benefit. [ABSTRACT FROM AUTHOR]

Background: There is a lack of evidence for effective management of dental caries (decay) in children's primary (baby) teeth and an apparent failure of conventional dental restorations (fillings) to prevent dental pain and infection for UK children in Primary Care. UK dental schools' teaching has been based on British Society of Paediatric Dentistry guidance which recommends that caries in primary teeth should be removed and a restoration placed. However, the evidence base for this is limited in volume and quality, and comes from studies conducted in either secondary care or specialist practices. Restorations provided in specialist environments can be effective but the generalisability of this evidence to Primary Care has been questioned. The FiCTION trial addresses the Health Technology Assessment (HTA) Programme's commissioning brief and research question "What is the clinical and cost effectiveness of restoration caries in primary teeth, compared to no treatment?" It compares conventional restorations with an intermediate treatment strategy based on the biological (sealing-in) management of caries and with no restorations. Methods/Design: This is a Primary Care-based multi-centre, three-arm, parallel group, patient-randomised controlled trial. Practitioners are recruiting 1461 children, (3-7 years) with at least one primary molar tooth where caries extends into dentine. Children are randomized and treated according to one of three treatment approaches; conventional caries management with best practice prevention, biological management of caries with best practice prevention or best practice prevention alone. Baseline measures and outcome data (at review/treatment during three year follow-up) are assessed through direct reporting, clinical examination including blinded radiograph assessment, and child/parent questionnaires. The primary outcome measure is the incidence of either pain or infection related to dental caries. Secondary outcomes are; incidence of caries in primary and permanent teeth, patient quality of life, cost-effectiveness, acceptability of treatment strategies to patients and parents and their experiences, and dentists' preferences. Discussion: FiCTION will provide evidence for the most clinically-effective and cost-effective approach to managing caries in children's primary teeth in Primary Care. This will support general dental practitioners in treatment decision making for child patients to minimize pain and infection in primary teeth. The trial is currently recruiting patients. [ABSTRACT FROM AUTHOR]

Fluoridated toothpaste is effective for dental caries control, yet may be a risk factor for dental fluorosis. This study aimed to quantify fluoride ingestion from toothpaste by children and to investigate the effects of age, gender, and social class on the amount of fluoride ingested per toothbrushing session. Sixty-one children, 4-6 yr of age, were recruited: 38 were from low socio-economic ( LSE) areas of Newcastle, UK, and 23 were from high socio-economic ( HSE) areas of Newcastle, UK. All expectorated saliva, rinse water (if used), and residual toothpaste were collected after brushing at home and were analysed for fluoride. Of the children, 74% and 69% from HSE and LSE areas, respectively, claimed that they brushed twice per day. The mean ( SD) weight of toothpaste dispensed was 0.67 (0.36) g. The mean (SD) amount of fluoride ingested per toothbrushing session and per day was 17.0 (14.7) and 29.3 (32.8) μg kg−1 of body weight, respectively. Daily fluoride intake per kilogram of body weight did not differ significantly between children from LSE and HSE areas. Fluoride intake per toothbrushing session was significantly influenced by weight of toothpaste, its fluoride concentration, and the child's age. Whilst the average amount of toothpaste used per toothbrushing session was more than twice the recommended amount (of 0.25 g), only one child had a daily fluoride intake that exceeded the tolerable upper intake level of 0.1 mg kg−1 of body weight for this age group. [ABSTRACT FROM AUTHOR]

Objectives To measure the fluoride ( F) content of infant foods and drinks requiring reconstitution with liquids prior to consumption and to determine the impact of water F concentration on their F content, as consumed, by measuring F content before and after preparation. Methods In total, 58 infant powdered formula milks, dry foods and concentrated drinks were prepared with deionized water (<0.02 ppm F) nonfluoridated (0.13 ppm F) and fluoridated (0.90 ppm F) water. The F concentrations of drink samples were measured directly using a fluoride-ion-selective electrode after addition of TISAB III, and food samples and formula milks measured indirectly by an acid diffusion method. Results The overall range of F concentrations of all the nonreconstituted samples, in their prepreparation dry or concentrated forms, was from 0.06 to 2.99 μg/g with the highest F concentration for foods found in the dry 'savoury meals' (a combination of vegetables and chicken or cheese or rice) group. However, when the samples were reconstituted with nonfluoridated water, the mean F concentrations of prepared 'concentrated juices', 'pasta and rice', 'breakfast cereals', 'savoury meals' and 'powdered infant formula milks' were 0.38, 0.26, 0.18, 0.16 and 0.15 μg/g, respectively. The corresponding mean F concentrations were 0.97, 1.21, 0.86, 0.74 and 0.91 μg/g, respectively, when the same samples were prepared with fluoridated water. Conclusion Although some nonreconstituted infant foods/drinks showed a high F concentration in their dry or concentrated forms, the concentration of F in prepared foods/drinks primarily reflected the F concentration of liquid used for their preparation. Some infant foods/drinks, when reconstituted with fluoridated water, may result in a F intake in infants above the suggested optimum range (0.05-0.07 mg F/kg body weight) and therefore may put infants at risk of developing dental fluorosis. Further research is necessary to determine the actual F intake of infants living in fluoridated and nonfluoridated communities using reconstituted infant foods and drinks. [ABSTRACT FROM AUTHOR]

Maguire A, Omid N, Abuhaloob L, Moynihan PJ, Zohoori FV. Fluoride content of Ready-to-Feed (RTF) infant food and drinks in the UK. Community Dent Oral Epidemiol 2012; 40: 26-36. © 2011 John Wiley & Sons A/S Abstract - Background: The level of Fluoride exposure needed to cause dental fluorosis is not known precisely. An awareness of total F intake from all sources, especially during the critical stages of dental development during infancy and early childhood, is important in preventing the development of dental fluorosis. Objectives: The aim of the study was to measure F content of ready-to-feed (RTF) infant drinks and foods in the UK. Methods: In total, 122 infant foods were analysed for F concentrations, in triplicate, indirectly by an acid diffusion method and 25 infant drinks analysed directly using an F-ion-selective electrode after addition of TISABIII. Results: The median (range) F concentration was 0.110 (0.030-0.221) μg/g for breakfast cereals, 0.112 (0.040-1.200) μg/g for savoury meals, 0.056 (0.030-0.379) μg/g for desserts, 0.044 (0.020-0.191) μg/g for fruits, 0.196 (0.040-0.397) μg/g for baked goods, 0.069 (0.050-0.148) μg/ml for juices, 0.016 (0.009-0.030) μg/ml for milks and 0.041 (0.022-0.069) μg/ml for waters. The median (range) F concentration of all RTF infant foods and drinks by recommended age of consumption was 0.029 (0.010-0.245), 0.088 (0.020-0.500), 0.108 (0.100-0.510) and 0.108 (0.060-1.200) μg/g for infants from birth, 4+ month, 6+ month and 10+ month, respectively. Conclusion: The results suggest that the F concentrations of UK-marketed RTF infant foods, drinks and formula milk are not sufficiently high to be a risk factor for dental fluorosis, if consumption is within the limits recommended for infants and young children. [ABSTRACT FROM AUTHOR]

International Journal of Paediatric Dentistry 2011; 22: 68-76 Background. The change towards a more Westernised diet in Libya may increase the risk of caries and erosion in children. Aims. To investigate any association between dental caries, dental erosion, and potential dietary risk factors in Libyan schoolchildren. Methods. A random sample of 791 schoolchildren aged 12 years underwent dental examination for caries and erosion and completed a questionnaire to provide dietary data. Dental caries was assessed using the WHO (Oral Health Surveys: Basic Methods, 1997) criteria. Erosion was assessed using UK National Diet and Nutrition Survey (NDNS, Young People Aged 4-18 years. Volume 2: Report of the Oral Health Survey, 2000) criteria. Associations between caries and dietary variables were investigated through bivariate and multivariate analyses. Results. Of the 791 12-year olds, 57.8% (457) had caries experience and 40.8% (323) had experience of erosion. One hundred and ninety-two subjects (42%) of the subjects with caries experience also had erosion, whilst 131 subjects (39.2%) of the 334 without caries had clinical signs of erosion ( P = 0.464; OR, 1.123; 95% CI, 0.842, 1.497). There was no statistically significantly relationship between dental caries and dental erosion. Frequency of consumption of fruit-based sugared drinks was statistically significantly positively associated with experience of caries ( P = 0.002). Conclusions. Dental caries experience was associated with frequency of consumption of sugared dietary items but not with dental erosion. [ABSTRACT FROM AUTHOR]

Background: The quantification of fluorosis using fluorescence imaging (QLF) hardware and stain analysis software has been demonstrated in selected populations with good correlation between fluorescent image metrics and TF Index scores from photographs. The aim of this study was to evaluate the ability of QLF to quantify fluorosis in a population of subjects (aged 11-13) participating in an epidemiological caries and fluorosis survey in fluoridated and non-fluoridated communities in Northern England. Methods: Fluorescent images of the maxillary incisors were captured together with standardized photographs were scored blind for fluorosis using the TF Index. Subjects were excluded from the analysis if there were restorations or caries on the maxillary central incisors. Results: Data were available for 1774 subjects (n=905 Newcastle, n=869 Manchester). The data from the fluorescence method demonstrated a significant correlation with TF Index scores from photographs(Kendall's tau = 0.332 p<0.0001). However, a number of additional confounding factors such as the presence of extrinsic stain or increased enamel translucency on some subjects without fluorosis or at low levels of fluorosis severity had an adverse impact on tooth fluorescence and hence the outcome variable. This in conjunction with an uneven distribution of subjects across the range of fluorosis presentations may have resulted in the lower than anticipated correlations between the fluorescent imaging metrics and the photographic fluorosis scores. Nevertheless, the fluorescence imaging technique was able to discriminate between a fluoridated and non-fluoridated population (p<0.001).Conclusion: Despite confounding factors the fluorescence imaging system may provide a useful objective, blinded system for the assessment of enamel fluorosis when used adjunctively with photographic scoring. [ABSTRACT FROM AUTHOR]

Background: To determine the association between social deprivation and the prevalence of caries (including caries lesions restricted to enamel) and enamel fluorosis in areas that are served by either fluoridated or non-fluoridated drinking water using clinical scoring, remote blinded, photographic scoring for caries and fluorosis. The study also aimed to explore the use of remote, blinded methodologies to minimize the effect of examiner bias. Methods: Subjects were male and female lifetime residents aged 11-13 years. Clinical assessments of caries and fluorosis were performed on permanent teeth using ICDAS and blind scoring of standardized photographs of maxillary central incisors using TF Index (with cases for fluorosis defined as TF > 0). Results: Data from 1783 subjects were available (910 Newcastle, 873 Manchester). Levels of material deprivation (Index of Multiple Deprivation) were comparable for both populations (Newcastle mean 35.22, range 2.77-78.85; Manchester mean 37.04, range 1.84-84.02). Subjects in the fluoridated population had significantly less caries experience than the non-fluoridated population when assessed by clinical scores or photographic scores across all quintiles of deprivation for white spot lesions: Newcastle mean DMFT 2.94 (clinical); 2.51 (photo), Manchester mean DMFT 4.48 (clinical); 3.44 (photo) and caries into dentine (Newcastle Mean DMFT 0.65 (clinical); 0.58 (photo), Manchester mean DMFT 1.07 (clinical); 0.98 (photo). The only exception being for the least deprived quintile for caries into dentine where there were no significant differences between the cities: Newcastle mean DMFT 0.38 (clinical); 0.36 (photo), Manchester mean DMFT 0.45 (clinical); 0.39 (photo). The odds ratio for white spot caries experience (or worse) in Manchester was 1.9 relative to Newcastle. The odds ratio for caries into dentine in Manchester was 1.8 relative to Newcastle. The odds ratio for developing fluorosis in Newcastle was 3.3 relative to Manchester. Conclusions: Water fluoridation appears to reduce the social class gradient between deprivation and caries experience when considering caries into dentine. However, this was associated with an increased risk of developing mild fluorosis. The use of intra-oral cameras and remote scoring of photographs for caries demonstrated good potential for blinded scoring. [ABSTRACT FROM AUTHOR]

Monitoring of blood flows in arteriovenous fistulae and arteriovenous grafts is recommended to predict access thrombosis. The ultrasound dilution technique (UDT) is the gold standard. We compare a recently described haemoglobin dilution technique (HDT) with the UDT in measurement of vascular access flow. Access blood flow was measured in 67 stable dialysis patients using HDT by bedside Hemocue (Hemocue AB, Ängelholm, Sweden) and laboratory measurement. Access blood flow was then measured by UDT in the same dialysis session. Median flow rate by UDT was 950 ml/min (IQR 490-1,440 ml/min), by Hemocue HDT 935 ml/min (IQR 475-1,395 ml/min, p = 0.534), and by laboratory haemoglobin HDT 920 ml/min (IQR 463-1,378 ml/min). Bland-Altman plots demonstrated poor agreement between UDT and HDT (limits of agreement for Hemocue HDT -22.7 to 20.1%, for laboratory HDT -21.2 to 20.4%). HDT can be used to measure vascular access flow but requires validation against clinical outcomes before being recommended as an alternative to UDT. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

We compared the parameters related to glucose homeostasis, and liver and muscle proteomes in fluorosis-susceptible (A/J; S) and fluorosis-resistant (129P3/J; R) mice in response to fluoride (F) exposure and exercise. Ninety male mice (45 R-mice and 45 S-mice) were randomized into three groups: (SI; RI) No-F, No-Exercise, (SII; RII) 50 ppm F, No-Exercise, (SIII; RIII) 50 ppm F, Exercise. Overall, mean F concentrations in the plasma and femur were significantly higher in R-mice compared with S-mice. In R-mice, exercise resulted in an increase in F accumulation in the femur. In S-mice, the mean plasma glucose level was significantly higher in Group II compared with Groups I and III. There was an increase in liver proteins involved in energy flux and antioxidant enzymes in non-exercise groups (I, II) of S-mice in comparison with the corresponding groups of R-mice. The results also showed a decrease in muscle protein expression in Group I S-mice compared with their R-mice counterparts. In conclusion, the findings suggest an increased state of oxidative stress in fluorosis-susceptible mice that might be exacerbated by the treatment with F. In addition, fluorosis-susceptible mice have plasma glucose levels higher than fluorosis-resistant mice on exposure to F, and this is not affected by exercise. [ABSTRACT FROM AUTHOR]

Objective. The reduced use of sugars-containing (SC) liquid medicines has increased the use of other dose forms, potentially resulting in more widespread dental effects, including tooth wear. The aim of this study was to assess the erosive potential of 97 paediatric medicines in vitro. Methods. The study took the form of in vitro measurement of endogenous pH and titratable acidity (mmol). Endogenous pH was measured using a pH meter, followed by titration to pH 7.0 with 0.1-m NaOH. Results. Overall, 55 (57%) formulations had an endogenous pH of <5.5. The mean ( ± SD) endogenous pH and titratable acidity for 41 SC formulations were 5.26  ± 1.30 and 0.139  ± 0.133 mmol, respectively; for 56 sugars-free (SF) formulations, these figures were 5.73  ± 1.53 and 0.413  ± 1.50 mmol ( P > 0.05). Compared with their SC bioequivalents, eight SF medicines showed no significant differences for pH or titratable acidity, while 15 higher-strength medicines showed lower pH ( P = 0.035) and greater titratable acidity ( P = 0.016) than their lower-strength equivalents. Chewable and dispersible tablets ( P < 0.001), gastrointestinal medicines ( P = 0.002) and antibiotics ( P = 0.007) were significant predictors of higher pH. In contrast, effervescent tablets ( P < 0.001), and nutrition and blood preparations ( P = 0.021) were significant predictors of higher titratable acidity. Conclusions. Paediatric SF medicines were not more erosive than SC medicines in vitro; a more significant predictor of their erosive potential was dose form. [ABSTRACT FROM AUTHOR]

Objectives: Due to increased consumption of pre-packaged drinks, tap water may no longer be the principal source of water intake and consequently fluoride intake. Little is known about the importance of solid foods as fluoride sources and how the relative contribution of foods/drinks to fluoride intake is affected by residing in fluoridated or non-fluoridated areas. This study investigated the relative contributions of different dietary sources to dietary fluoride intake and compared this in children residing in optimally artificially fluoridated, sub-optimally artificially fluoridated, and non-fluoridated areas.Methods: Thirty-three healthy children aged 6 years were recruited from fluoridated and non-fluoridated communities and categorised into three groups based on fluoride content of home tap water: optimally fluoridated (< or =0.7 mgF/L), sub-optimally fluoridated (> or =0.3 to < or =0.7 mgF/L) and non-fluoridated (50.3 mgF/L) drinking water. A 3-day dietary diary collected dietary information. Samples of foods/drinks consumed were collected and analyzed for fluoride content.Results: Drinks provided 59%, 55% and 32% of dietary fluoride intake in optimally, sub-optimally and non-fluoridated areas respectively. Tap water, fruit squashes and cordials (extremely sweet non-alcoholic fruit flavoured drink concentrates) prepared with tap water, as well as cooked rice, pasta and vegetables were important sources of fluoride in optimally and sub-optimally fluoridated areas. Carbonated soft drinks and bread were the most important contributors to dietary fluoride intake in the non-fluoridated area.Conclusion: The main contributory sources to dietary fluoride differ between fluoridated and non-fluoridated areas. Estimating total fluoride intake from levels of fluoride in tap water alone is unlikely to provide a reliable quantitative measure of intake. Studies monitoring dietary fluoride exposure should consider intake from all foods and drinks. [ABSTRACT FROM AUTHOR]

Material and methods: Dental examinations were carried out on 354 boys aged 5-6 years, and 862 boys aged 12-14 years, attending 40 schools in Riyadh. The prevalence of dental erosion was assessed using diagnostic criteria similar to those employed in the 1993 UK National Survey of Child Dental Health. Results: Pronounced dental erosion (into dentine or dentine and pulp) was observed in 34% of 5-6 year olds and 26% of 12-14 year olds. Information on food and drink consumed and dietary habits was obtained by means of a questionnaire. Parents reported that 65% of 5-6 year old boys took a drink to bed. Water was the commonest drink consumed (37%) followed by carbonated soft drinks (21%). One third of parents reported that their son had something to eat in bed or during the night and 60% of this was sweet food or confectionery. Seventy per cent of 12-14 year old boys reported consuming drinks at night; these Were mainly water (30%), carbonated soft drinks (27%) and tea or coffee, with sugar (18%). Forty-six per cent of the 12-14 year olds reported that they ate in bed at least once a week and 54% of this was sweet food or confectionery, When the dental examination and questionnaire results were correlated, a statistically significant relationship was found between the number of primary maxillary incisors with pronounced erosion of their palatal surfaces and the consumption of carbonated soft drinks at night (P=0.015). A significant relationship was also found between the number of permanent maxillary incisors with pronounced erosion on their palatal surfaces and the frequency of drinks at night (P=0.020), as well as the duration of drinks retained in the mouth (P=0.038). Conclusion: It is concluded that dental erosion is more common in the primary and permanent dentitions of Saudi Arabian boys compared with results for similar age groups from the United Kingdom. [ABSTRACT FROM AUTHOR]

This study involved 354 boys aged 5-6 years and 862 boys aged 12-14 years, attending 40 schools in Riyadh. All children were examined at school by a single dental examiner, using criteria similar to those employed in the survey of children's dental health in the United Kingdom. The prevalence of dental trauma in 354 Saudi boys aged 5-6 years was 33%. The most common type of dental trauma was fracture of enamel (71%) followed by loss of tooth due to trauma (13%), fracture into enamel and dentine (7%), discolouration (5%), pulp involvement (4%). No relationship between the degree of overjet and the occurrence of dental trauma in the primary dentition was observed. The prevalence of dental trauma in 862 12-14-year-old boys was 34%. The commonest dental trauma was fracture of enamel (74%) followed by fracture into enamel and dentine (15%), fracture into enamel-dentine and pulp (5%), loss of tooth due to trauma (3%), and discolouration (0.4%). A significant relationship (P=0.02) between the increased overjet (> or = 6 mm) and the occurrence of dental trauma in the permanent dentition was reported. The present study found no evidence of dental care provided for traumatised primary incisors in 5-6-year-old boys. The treatment of dental trauma in 12-14-year-old boys was negligible (2.4%). The present Saudi Arabian study showed higher prevalence of dental trauma in 5-6- and 12-14-year-old boys than the reported results of the United Kingdom Children's Dental Health Survey of the same age groups. [ABSTRACT FROM AUTHOR]

Summary. The medication regimens of 243 children aged 1-16 years were analysed. The children were resident in five Districts in the Northern Region, England and were taking medication orally in liquid or syrup form for chronic disease. 39% of the children were under 5 years of age and 44% were aged 5-11 years, with slightly more males in most age groups. Epilepsy, chronic renal disease and cystic fibrosis were the most common medical problems for which the medicines were prescribed long-term. The duration of medication ranged between 3 months and 12 years; the average duration varied according to the disease and the type of medicine. Most of the anticonvulsants and vitamins had been used for 2 years or more, whereas most of the anti-asthmatic drugs were used for a period of up to a year only. Twenty six (39%) of the 67 different preparations used contained sugar, 19 (28%) were sugar-free, and the sweetening agent in the remainder varied according to how they were prescribed. Specificity of prescribing was the major determinant in the dispensing of either the sugar-containing or the sugar-free medicines. Résumé. Les traitements médicamentaux de 243 enfants âgés de 1-16 ans ont été analysés. Ces enfants habitaient le Nord de l'Angleterre et prenaient ces médicaments par voie orale sous forme de sirop ou de liquide, pour une pathologie chronique. Trente-neuf pour cent de ces enfants avaient moin de 5 ans et 44% étaient âgés de 5-11 ans, avec une majorité de garçons dans la plupart des groupes d'âge. l'épilepsie, des maladies rénales chroniques, et des fibroses kystiques étaient les maladies les plus fréquentes, pour lesquelles des médicaments étaient prescrits à long terme. La Durée du traitement variat entre 3 et 12 ans; la durée moyenne était fonction de la maladie et du type de médicament. La plupart des anticonvulsivants et des vitamines avaient été prescrits depuis 2 ans ou plus, alors que la majorité des médicaments, contre l'asthme, ne l'étaient que depuis un an au plus. Vingt-six (39%) des 67 préparations utilisées comprenaient du sucre, 19 (22%) étaient sans sucre et l'agent édulcorant, dans les autres, variait en fonction de leur prescription. La spécificité de la prescription était le facteur déterminant dans l'obtention de médicaments avec ou sans sucre. Zusammenfassung. Die Arzneimittelverabreichung an 243 Kindern im Alter von 1-16 Jahren werden analysiert. Diese chronisch kranken Kinder, Einwohner von 5 Regionen im nördlichen England, nahmen regelmässimg flüssige Arzneimittel ein. Das ALter von 39% dieser Kinder war unter unter 5 Jahren, 44% zwischen 5 und 11 Jahren. In beiden Altersgrupen waren etwas mehr Buben als Mädchen. Epilepsie, chronische Nierenkrankheiten und Zystic Fibrosis waren die heufigsten Erkrankungen für welche langfristig Medikamente verschrieben wurden. Die Dauer der Verabreichung reichte von 3 Monate bis 12 Jahren. Die mittlere Verabreichungs-dauer war abhängig von Art der Erkrankungen und des Medikamentes. Die meisten Krampfmittel und Vitamine wurden für 2 Jahre und mehr verschrieben. Antiasthmatische Medikamente wurden nur bis zu 1 Jahr verschrieben. 26 (39%) der 67 verschiedenen Präperate beinhalten Zucker, 19 (28%) waren zucker-frei, verschiedentliche Süsstoffe angewendet. Die medizinische-pharmakologische Indikation war bestimment ob zuckerhaltige oder Zuckerfreie Medikament verschrieben wurdern. Resumen. La medicación de 243 niños de 1-16 años de edad fue analizada. Los niños residían en cinco distritos de la región norte de Inglaterra que tomaban medicación oral en forma liquida o de jarabe para el tratamiento de enfermedades crónicas. El 39% de los niños tenían menos de 5 años de edad y 44% tenían menos de 5-11 años de edad con ligeramente más varones en todos los grupos etários. Los problemas médicos más comúnes fueron epilepsia, enfermedad renal crónica y fibrosis quística. La duración de la medicación oscilo entre los 3 meses y 12 años, la duración promedio varió de acuerdo a la enfermedad y tipo de medicación. La mayoria de los anticonvulsivos y vitaminas habían sido utilizados por 2 años o más mientras que las drogas antiasmáticas habían sido utilizadas por solo un año. Veintiseis (39%) de las 67 diferentes preparaciones usadas contenían azúcar, 19 (28%) no tenian azúcar, y el edulcorante en los demás variaron de acuerdo a como eran prescritos. La especificidad de la prescripción fue la mayor determinante en la dispensación de loas medicanas con o sin azúcar. [ABSTRACT FROM AUTHOR]

This paper discusses the heating of soil in sports grounds to reduce cancellations in poor weather conditions. The correct type of drainage is vital to a pitch but it is even more important if the owner is considering installing a soil-warming system. Various designs of system are investigated from the original research through to installation, while considering their running costs and effect on turf. The alternatives to undersoil heating are examined as well as new systems which have yet to appear in major sports grounds. The fundamental approach to heat transfer is applied to the heating of buried pipes. Conclusions reached include the fact that soil warming of some kind makes economic sense. [ABSTRACT FROM PUBLISHER]

The history of the vole type of tubercle bacillus and of the Medical Research Council's trial of vole bacillus vaccine in 1950 is summarized. Fifteen years after this trial 110 vaccinated subjects were re-examined. Seventeen were found to have granulomatous lesions at the vaccination site. The clinical and histological features of the lesions are described. No bacteria could be demonstrated in the lesions histologically or by inoculation of voles. The lesions responded to the administration of antituberculous drugs. The term lupus murinus is proposed for the dermatological lesion induced by primary inoculation with live Mycobacterium tuberculosis var. muris. [ABSTRACT FROM AUTHOR]

Four patients with advanced mycosis fungoides presenting at the tumour stage were selected for treatment with the combination of cyclophosphamide and chlorpromazine. Cyclophosphamide was given alone initially and in 3 of the patients remissions occurred which lasted between 5 to 8 months. The fourth, Case 4, did not respond to cyclophosphamide alone. In all 4 patients when cyclophosphamide was given with chlorpromazine, longer remissions, lasting 3 to 18 months, occurred. It seems from this series that tumour growth is inhibited when chlorpromazine and cyclophosphamide are administered together, and that the combination of the 2 drugs produces longer remissions than cyclophosphamide alone. [ABSTRACT FROM AUTHOR]

Five patients with chronic discoid lupus erythematosus who had never received antimalarial drugs were given amodiaquine and serial electro-oculograms (E.O.G.s) recorded. In four of the five there was a significant drop in the E.O.G. values within a month of starting treatment, with complete return to normal values within two months of stopping the drug. No visual symptoms or ophthalmoscopic abnormality were noted during the period of the investigation. [ABSTRACT FROM AUTHOR]

The article presents information on a trial of amopyroquin in the treatment of chronic discoid lupus erythematosus. In this trial the dosage was 150 mg. per diem, the minimum recommended. All of the sixteen patients had chronic discoid lupus erythematosus for periods varying from 6 months to 23 years. Each had received either one or more antimalarial drugs in the past. Each patient was seen once weekly at the outset, and then every two weeks throughout the remainder of the trial. Prior to treatment in the trial a medical history was taken and a general examination was made.

Scope and purposeThis guideline is intended to assist practitioners with decision making about the use of topical fluoride caries-preventive agents. It presents evidence-based clinical recommendations on professionally applied and prescription strength, home-use topical fluoride agents for caries prevention. Three clinical questions on the use of topical fluoride caries-preventive agents are addressed: In primary and permanent teeth, does the use of a topical fluoride compared to no topical fluoride reduce the incidence of new lesions, or arrest or reverse existing coronal and/or root caries?For primary and permanent teeth, is one topical fluoride agent more effective than another in reducing the incidence of, or arresting or reversing coronal and/or root caries?Does the use of prophylaxis before application of topical fluoride reduce the incidence of caries to a greater extent than topical fluoride application without prophylaxis?Sodium, stannous and acidulated phosphate fluoride for professional and prescription home use, including varnishes, gels, foams, rinses and prophylaxis pastes were evaluated.MethodologyThe previous version of this review (2006 ADA policy) was based on assimilation of evidence from systematic reviews. However, this update synthesises primary evidence collected through systematic review and appraisal of the literature.The Cochrane Library and Medline (via PubMed) were searched. Relevant systematic reviews and other selected articles were hand-searched.Two reviewers independently screened titles and abstracts, with one reviewer assessing all manuscripts in full for meeting the inclusion criteria. Two different members of the expert panel then approved the exclusion list. Discrepancies were resolved through discussion with the Chair of the workgroup. The USPSTF grading system was used.Review and updatingFive-year interval update in line with the ADA policy.Recommendations For individuals at risk of dental caries: 2.26% fluoride varnish or 1.23% fluoride (APF) gel, or prescription strength, home-use 0.5% fluoride gel or paste, or 0.09% fluoride mouth rinse for children who are aged six or over.The panel judged that the benefits outweighed the potential for harm for all professionally applied and prescription strength, home-use topical fluoride agents and age groups except for children aged under six years. Only 2.26% fluoride varnish was recommended for children less than six years old, as the panel considered the risk of adverse events (particularly nausea and vomiting) associated with swallowing all other professionally applied topical fluoride agents outweighed the potential benefits.There was insufficient data to answer the question on arresting and reversing coronal and/or root caries, so these outcomes were not addressed in the clinical recommendations.Research recommendationsThese focused on development of standard methodologies for well-designed trials with standardised reporting and trial registration. Specific areas for research included: investigation of mechanisms of fluoride action and effects against a background fluoride exposure; investigation of specific sub-groups such as high-risk elderly; research on specific products; measure and outcome development for arrested caries; economics and dissemination/implementation to realise guideline use. [ABSTRACT FROM AUTHOR]

An understanding of all aspects of fluoride metabolism is critical to identify its biological effects and avoid fluoride toxicity in humans. Fluoride metabolism and subsequently its body retention may be affected by physiological responses to acute exercise. This pilot study investigated the effect of exercise on plasma fluoride concentration, urinary fluoride excretion and fluoride renal clearance following no exercise and three exercise intensity conditions in nine healthy adults after taking a 1-mg Fluoride tablet. After no, light, moderate and vigorous exercise, respectively, the mean (SD) baseline-adjusted i) plasma fluoride concentration was 9.6(6.3), 11.4(6.3), 15.6(7.7) and 14.9(10.0) ng/ml; ii) rate of urinary fluoride excretion over 0-8 h was 46(15), 44(22), 34(17) and 36(17) μg/h; and iii) rate of fluoride renal clearance was 26.5(9.0), 27.2(30.4), 13.1(20.4) and 18.3(34.9) ml/min. The observed trend of a rise in plasma fluoride concentration and decline in rate of fluoride renal clearance with increasing exercise intensity needs to be investigated in a larger trial. This study, which provides the first data on the effect of exercise with different intensities on fluoride metabolism in humans, informs sample size planning for any subsequent definitive trial, by providing a robust estimate of the variability of the effect. [ABSTRACT FROM AUTHOR]