Malignant melanoma is the most invasive form of skin cancer and today's current diagnosis is based on surgical invasive sampling that can be perceived as frightening for the patient. Therefore, a non-invasive sampling method called Pigmented lesion assay (PLA) was investigated which is based on a sampling using tape-strips (D100 - D-Squame Standard Sampling Discs). The skin consists of three layers, the epidermis, dermis and subcutis, where each layer varies considerably in its anatomy and function. The epidermis is the outermost layer of the skin and the cell contents consist mainly of keratinocytes and melanocytes. Melanoma is a type of skin cancer that occurs when melanocytes, whose function is to develop pigment in the skin, begin to grow out of control. Through the tape method, there is an exchange between the epidermal cell types and the tape, the number of tape-strips applied to the 10 voluntary participants was a total of 5 where the first two were discarded to minimize bacterial contamination. After sampling, an RNA isolation was performed on collected tape-strips and then a cDNA-synthesis was performed. To elucidate the function of the method, a real-time polymerase chain reaction (RT-PCR) analysis was performed on participant samples for amplification of the normal gene filaggrin on the healthy participants. The results showed that the PLA analysis is possible for the detection of interesting genes. Genes that are melanoma-related are LINC, PRAME and CIMP and was amplified on purchased melanoma cells for control of the method in comparison with control genes ACTB and GAPDH.

The purpose of this paper is to explore themes and challenges in developing environmentally sustainable logistical activities. The approach is explorative with a cross sectional design that takes advantage of ten case studies out of selected logistics service providers (LSPs) operating primarily in the Scandinavian countries The findings illustrate the major themes by analyzing current and future activities in developing environmentally sustainable logistical activities. In addition, four categories of challenges are identified: customer priorities, managerial complexity, network imbalance, and technological and legislative uncertainties. It is concluded that there is a great need for a holistic perspective where LSPs and product owners together analyze and design future logistical setups The suggested holistic and integrative model, building on a three-dimensional concurrent engineering framework, provides new opportunities for research. Further research is needed to improve the interrelationship between LSPs and their customers in the development of sustainable logistical solutions This paper puts forward recommendations for the sustainable development of logistics by combining the results from the case studies with a review of related literature. This will be beneficial for managers and policy makers when they approach sustainable logistical challenges. The emergence and synthesis of themes and challenges are critical for a sustainable society. (C) 2016 Elsevier Ltd. All rights reserved

Background: Humans normally follow a 24-hour circadian rhythm where light and darkness facilitates wakefulness during the day respectively sleep during the night. The circadian rhythm reaches its bottom level between three and four in the morning regardless of the necessity of sleep. Because of this, night work means a predisposition to sleep disorders due to the body’s physiology that controls the circadian rhythm. Aim: The aim of this literature review was to illustrate the presence of sleep disorders among night and shift working nurses. Method: A literature study was conducted and fifteen quantitative scientific articles from the databases CINAHL and PubMed were retrieved, selected, reviewed analyzed aend complied. All the reviewed articles based their results using self-assssment forms completed by clinically active nurses. Results: The findings indicated a strong relationship between sleep disorders and night work among nurses. Nurses with continuous night work, or shiftwork with including night shifts, suffered of either; sleep deprivation, decreased sleep quality, insomnia or chronic fatigue. Conclusion: Nurses that work consequently during the night or work shifts with included night shifts, are affected by either sleep deprivation or decreased sleep quality. This indicates that work during the night can lead to some type of sleep disorder.

Purpose 

This study aimed to evaluate the mechanical properties of the different layers of multi-layered zirconia materials produced with different strategies for gaining translucency.

Materials and methods 

Sixty zirconia specimens were prepared in a bar shape from two different partially sintered multi-layered zirconia blanks (KATANA™ Multi-layered Zirconia HTML, Kuraray Noritake Dental, EU) and (IPS e.max® ZirCAD Prime, Ivoclar, USA). The specimens were distributed into two groups based on the material used (n=30) and further subdivided into three subgroups according to the different layers of zirconia blanks: translucent, transition, and dentin (n=10). All specimens were subjected to a static three-point flexural strength test. A one-way ANOVA and a T-test were performed to determine the significant differences among the groups. 

Results 

The different layers of ZirCAD Prime showed significant differences in flexural strength (p=0.001). In contrast, the different layers of KATANA™ HTML showed no significant differences (p=0.437). A T-test was conducted to compare the results from different layers within the same material. The results of the One-Way ANOVA test for the different groups of KATANA™ HTML demonstrated no difference between the groups (p=0.437). 

Conclusion 

Different compositions of different multi-layered zirconia materials result in various mechanical properties. Brand-specific differences are an essential consideration for dentists and dental technicians when using multi-layered zirconia. It is crucial to consider various factors such as type of restoration, positioning of the restoration in the disc (nesting), and restoration to be used anteriorly or posteriorly, and the desired esthetical requirements as the translucency are gained in different ways.   

Aim: The aim of this study is to investigate how Swedish dental care is represented in the media, since it is an important factor that can affect the public's trust in dental care. Material & method: To investigate what was written and how much was written in both general and negative sense about dental care in the Swedish press between 2007 - 2018, two source selections were used. One selection was called the broad source selection and included all Swedish editorial press in retriever's media archive. The second source selection was called the limited source selection and included only six powerful sources. The material was analyzed both quantitatively and qualitatively using Media content analysis. Result: The overall publicity on dental care in general sense was at its most 2008, thereafter it decreased at a steady pace. The negative reporting has been uneven with clear increases in some years that can be attributed to specific events relating to dental care. In the negative reporting it was written about dentists who got rid of their license and that in dental care there is carelessness, malpractice, over-treatment and cheating. But mostly, it was written negatively about the functioning of the dental care system and that dental care is expensive. Conclusion: By comparing available customer satisfaction and trust measurements with the negative and general media reporting, we were unable to conclude that media reporting has affected public trust between 2007-2018. We found, among other things, that when it was written negatively about dental care, criticism was mainly directed at private dental care, despite this trust and customer satisfaction levels were higher for private dental care compared to public dental care during the same period. Further studies are needed to investigate how media reports affects peoples trust in dental care.

Purpose

 To evaluate the impact of implant length on failure rates between short (<10 mm) and long (≥10 mm) dental implants.

Materials and methods

A search was undertaken in three electronic databases, complemented by manual search of some journals. Implant failure was the outcome evaluated, with the estimate of relative effect expressed in risk ratio (RR). Heterogeneity among studies was evaluated by I²statistic. Inverse variance method was used for random- or fixed-effects models. Quality assessment of the studies was performed, and a funnel plot was drawn. A meta-regression was performed in order to verify how the RR was associated with the follow-up time.

Results

The reviews included 353 publications. Altogether, there were 25,490 short implants and 159,435 long implants. Pairwise meta-analysis showed that short implants had a higher risk of failure than long implants (RR 2.437, p<0.001). The meta-regression observed that the follow-up time did not have any effect of the RR of failure between short and long implants. A sensitivity analysis plotting together only the studies with follow-up up until 7 years, resulted in an estimated increase of 0.6 in RR for every additional month of follow-up.

Conclusion

Short implants showed (< 10 mm) a 2.5 times higher risk of failure than long implants (≥ 10 mm). Implant failure is multifactorial and the implant length is only one of the many factors contributing to the loss of implant. A good treatment plan and the patient’s general health should be taken into account when planning for an implant treatment.

Keywords: dental implant, failure, implant length, systematic review, meta-analysis

The present review aimed to evaluate the impact of implant length on failure rates between short (<10 mm) and long (>= 10 mm) dental implants. An electronic search was undertaken in three databases, as well as a manual search of journals. Implant failure was the outcome evaluated. Meta-analysis was performed in addition to a meta-regression in order to verify how the risk ratio (RR) was associated with the follow-up time. The review included 353 publications. Altogether, there were 25,490 short and 159,435 long implants. Pairwise meta-analysis showed that short implants had a higher failure risk than long implants (RR 2.437, p < 0.001). There was a decrease in the probability of implant failure with longer implants when implants of different length groups were compared. A sensitivity analysis, which plotted together only studies with follow-up times of 7 years or less, resulted in an estimated increase of 0.6 in RR for every additional month of follow-up. In conclusion, short implants showed a 2.5 times higher risk of failure than long implants. Implant failure is multifactorial, and the implant length is only one of the many factors contributing to the loss of an implant. A good treatment plan and the patient's general health should be taken into account when planning for an implant treatment.

Development of biocompatible surfaces are considered a great challenge within the medical research. In general a medical implant will be coated of a layer of non-specific proteins a few seconds after implantation. This happens regardless of the construction material of the implant. The adsorbed protein layer will activate a host-defense mechanism, known as the foreign body reaction, which evidently will result in a fibrous non-vesicular capsule that isolates the implant from its goal tissues. The development of biocompatible surface is an interesting research field. It is important to use a surface coating that does not contribute to an inflammatory response or adhesion of unwanted cells. Macrophages is a cell line that is naturally involved in the immune system in the body, which is interesting for such studies. The aim of this study is to examine cell adhesion and inflammatory response of a macrophage cell line in vitro. The investigation was performed using surfaces modified by polydopamine (PDA), polyethyleneglycol (PEG) and protease and combination thereof. RAW 264.7- cells is a mouse macrophage cell-line. The investigation of cell adhesion was performed using cells in contact with different surface coatings and evaluated by photographing the surfaces at various occasions. The cells ability to adhesion and the inflammatory response was studied in different fetal sera concentrations. The result show no difference in cell adhesion at different fetal sera concentrations. The RAW 264.7-cells adhesion varied for the different surface coatings. The RAW 264.7 cells showed a stronger adherence when the surface coating was done purely by diffusion. The RAW 264.7 cells preliminary showed no inflammatory response related to the tested surface coatings.

Background: Studies show that nurses' experiences of alleviating suffering in patients in palliative stage of illness place high demands on the nurse's knowledge and skills to be able to handle complex medical and psychosocial challenges. Aim: The aim of the literature review was to describe nurses' experiences of alleviating suffering in patients in palliative care. Method: The literature review is based on the results of ten scientific articles with a qualitative approach. The databases PubMed and Cinahl have been used to identify articles relevant to the purpose. The articles were quality reviewed based on SBU's template and analysed using Popenoe's criteria for data analysis. Results: Two categories were identified: A challenging task and the importance of good professional preconditions. Six subcategories were identified as follows: Difficulties in communication, Fears and uncertainty about symptom relief, Institutional related obstacles, Importance of knowledge and experience, Importance of getting to know the patient, and Importance of good teamwork. Conclusion: The result of the study highlights that nurses play a crucial role in alleviating suffering in palliative care but that they face a variety of challenges. With the right conditions and resources, nurses can succeed in providing the best possible relief of suffering. It is essential that nurses working in palliative care continue to be provided with the support and knowledge necessary to ensure that they can meet these challenges effectively.  

Background: Culture is a concept that is individual and is also constantly changing. Transcultural nursing is however complex and includes several concepts. A multicultural society require high demands on nurses to be flexible in transcultural care. The goal is that the nurse and the patient must create a relationship that contributes to the existence where the patient can feel safe and have confidence in the Swedish health care system. Aim: The aim is to describe nurses' experiences of transcultural nursing in Sweden. Method: A literature review based on 11 scientific articles with qualitative approach that emerged in two different databases. Existing articles have undergone a thematic analysis. Results: After analyzing all the articles six different themes appeared that consisted communication barriers, education, person-centered care, gender roles and relatives. In addition, a number of categories emerged within each theme. Conclusion: It is important that the nurse sees the patient's culture from an individual context when one encounters patients of different nationalities, sexualities, social classes and cultures. The nurse should be sensitive and receptive to patient's different needs to build a trustful relationship.

The aim of this present record-based retrospective study was to investigate the influence of the crown-implant ratio (CIR) and implant inclination in relation to the occlusal plane on the marginal bone loss (MBL) around dental implants supporting single crowns in the posterior region of the jaws. All the cases of implant-supported single crowns in the premolar and molar regions were initially considered for inclusion. Only implants not lost, with baseline radiographs taken within 12 months after implant placement and with a minimum of 36 months of radiological follow-up, were considered for the analysis of MBL. Univariate linear regression models were used to compare MBL over time between 12 clinical covariates, after which a linear mixed-effects model was built. After the exclusion of 49 cases, a total of 316 implant-supported single crowns in 234 patients were included. The results from the statistical models suggested that implant inclination and anatomical- and clinical CIR (the main related factors investigated in the study) were not statistically significantly related to MBL over time. Age (older people), tooth region (premolar), and bruxism (bruxers) had a statistically significant influence on MBL over time.

Aim: To investigate dental biofilm bacteria for growth and acid production in different environments. The occurrence of inherent buffering capacity by alkali production in an artificial consortium and oral consortium was also examined. Materials and method: Fresh isolates of Actinomyces, Lactobacillus paracasei, Streptococcus mutans, Streptococcus intermedius and Streptococcus oralis were incubated in growth media with neutral or acidic initial pH and with and without glucose and/ or urea. Growth was monitored by measuring optical density at 600nm. Acid and alkali production was monitored using a pH meter. Results: L. paracasei and S. intermedius showed growth independent of pH and a more acidic final pH at acidic than neutral initial pH. S. oralis and Actinomyces showed a greater growth at neutral pH and had an acid production insensitive to an acidic environment. All species reached a final pH below the critical pH for enamel (5.5) independent of initial pH. Growth was unaffected by glucose. In oral consortium, the final pH was less acidic in the medium with glucose and urea compared to in the medium with only glucose. Conclusion: All species showed acidic and aciduric properties and may contribute to tooth demineralization. Further studies with a larger number of measurements are needed to assess the cariogenicity of these species with a higher reliability. Alkali production in saccharolytic species may affect the plaque pH. Further studies are needed to assess the occurrence of alkali production in saccharolytic species related to caries and its effects on the pH in the biofilm.

Histones are a family of proteins that form nucleosomes when packing DNA in the cell. The complex of histones and DNA named chromatin. In addition to histones, chromatin consists of proteins that are non-histones, which contribute to chromatin stability and gene activity. Histones, with molecular weights of 11-21 kDa, include five main classes: H1, H2A, H2B, H3, H4, forming a complex with each other by ionic bonding. The histone complex consists of (H2A-H2B) flanked with (H3-H4) tetramers. Since histones consist of basic amino acids such as arginine and lysine, they are positively charged, which facilitates binding with DNA which is negatively charged. Histones are considered antimicrobial peptides (AMPs) because they can neutralize bacterial endotoxin. The purpose of the study was to purify histones from wheat germ and characterize these, and study their effect on bacterial growth. Wheat germ was used because they are rich in chromatin. The method for isolation of histones was based on low ionic strength using three different buffers, as well as acid extraction of chromatin with sulfuric acid. To characterize histones, SDS-PAGE electrophoresis was performed and to study their bacterial inhibition, E. coli bacteria were used. The result showed a poor yield of histones, but the main classes of different histones could be separated and characterized by SDS-PAGE. Some samples showed an antibacterial effect. Optimization of the extraction is necessary to increase the yield and thus be able to better study the antibacterial effect of histones. Presumably, it is homogenization that limits the yield and possibly also modification of the acid extract to prevent aggregation.

Keywords: Antimicrobial peptides, acid extraction, chromatin, DNA, histones, ionic strength, purification, wheat germ

The use of vaccines has been one of the most successful public health interventions ever undertaken to prevent infectious diseases and deaths worldwide.  Adjuvants are a substance that is often added to vaccines whose purpose is to stimulate the immune system in a more effective way.  Adjuvants are particles like phagocytes of macrophages and thus increase energy requirements and induce changes in the metabolism of macrophages.  The aim of this work was to investigate whether aluminum (Al)-adjuvants affect macrophage metabolism by measuring intracellular glucose in macrophages after incubation with the Al adjuvant. In this study, the glucose content of macrophages in already collected samples from three healthy donors was examined. Human peripheral monocytes differentiated and polarized into M0-, M1-, and M2-macrophages. A luminescence based method was used in this study to investigate macrophage glucose content before and after incubation of different concentrations with Al adjuvants. The results showed that macrophages' glucose production changes after incubation with the Al adjuvant. M2 macrophages had the largest increase in glucose after the addition of low concentrations of the Al adjuvant. The results of this study are preliminary and several further trials are needed to be able to draw conclusions about a significant increase in glucose concentration in macrophages after exposure and thus phagocytosis of Al adjuvants.

Zonulin, also known as prehaptoglobin, is a precursor to haptoglobin and may affect the permeability of tight junctions of the intestine. Elevated zonulin concentration in plasma may be a potential marker of celiac disease and other autoimmune diseases, such as insulin-dependent diabetes, multiple sclerosis and rheumatoid arthritis. This research mainly focused on evaluating the stability of zonulin: Whether the zonulin levels differ between serum, heparin plasma and EDTA plasma, and if repeated cycles of freezing and thawing and cold storage affected the concentration of zonulin in plasma or serum. The zonulin concentration in EDTA plasma was also investigated by adding calcium. To determine the concentration of zonulin, competitive ELISA was used. This study includes 20 participants who met the following selection criteria: over 18-year-old, not pregnant, not medicated and not gluten intolerant. Additionally, three test tubes (serum tubes, EDTA plasma and heparin plasma tubes) were taken from each participant. Blood samples were treated differently before the ELISA assay. The results showed that the concentration of zonulin is significantly higher in serum compared to heparin plasma and EDTA plasma. This study also showed that the concentration of zonulin in plasma and serum increases significantly during repeated freeze-thaw cycles. Cold storage also caused a significant increase of zonulin in serum. The results further illustrate that the addition of calcium to EDTA plasma causes an increase of the concentration of zonulin, the levels are higher than in the corresponding serum samples and there is no significant correlation between zonulin in serum and zonulin in EDTA plasma with calcium additive. This study shows that it is important that zonulin is determined in serum, not in plasma, and that repeated freeze-thaw cycles as well as cold storage of samples should be avoided as it can dramatically affect the zonulin concentration.

Aim: The aim of this study was to evaluate the efficacy of a novel fluoride varnish (NFPV, Fluor Protector S) in preventing development of white spot lesions in adolescents undergoing treatment with fixed orthodontic appliances. Material and methods: 185 patients aged between 12 and 18 years planned for orthodontic treatment with fixed appliance were randomized into varnish or placebo group. The varnish group received a varnish with the active ingredient ammonium fluoride and the placebo group received a similar varnish but without ammonium fluoride. All patients received treatment with fixed orthodontic appliance in the upper arch for a period of more than one year, and before bonding all patients had three intra-oral photos. Varnish in both groups was applied on the maxillary anterior teeth and premolars during every check-up at the orthodontic clinic (every 6 weeks). After debond, the composite on the teeth was carefully removed using carbide bur and three new intra-oral photos were taken. Finally, white spot lesions (WSL) were evaluated and scored on a monitor in a dark room using Gorelick scoring index. Results: 66 patients of the 185 patients were debonded and represent the final number of patients included in present master thesis. The incidence of WSL after debond was 19.9% in the test group and 18.1% in the placebo group, respectively. No statistically significant difference between the groups was recorded. Conclusion: Based on the limited amount of the patients in present master thesis, the null hypothesis was confirmed, there is no additional benefit to apply ammonium fluoride varnish during treatment with fixed orthodontic appliance to reduce the incidence of WSL.

Objective To investigate in 10 orthodontic journals how many randomized controlled trials (RCTs) considered the Hawthorne effect, and if considered, to determine whether it was related to the patients or the therapists involved in the trial and, finally, to discuss the Hawthorne effect in an educational way. Materials and methods A search was performed on the Medline database, via PubMed, for publication type ‘randomized controlled trial’ published for each journal between 1 August 2007 and 31 July 2017. The American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, Australian Orthodontic Journal, Dental Press Journal of Orthodontics, European Journal of Orthodontics, Journal of Orthodontics, Journal of Orofacial Orthopedics, Korean Journal of Orthodontics, Orthodontics and Craniofacial Research and Progress in Orthodontics were assessed. Two independent reviewers extracted the data and identified whether the Hawthorne effect was considered or discussed in the articles and whether the Hawthorne effect was related to the behaviour of the patients, the therapists, or both. Results The initial search generated 502 possible trials. After applying the inclusion and exclusion criteria, 290 RCTs were included and assessed. The Hawthorne effect was considered or discussed in 10 of 290 RCTs (3.4%), and all were related to the patients’ and none to the therapists’ behaviour. Conclusions The Hawthorne effect reported in orthodontic RCTs was suboptimal. The researchers’ lack of knowledge about this phenomenon is evident, despite evidence that the Hawthorne effect may cause over-optimistic results or false-positive bias.

Objective: To analyse in 10 orthodontic journals how many randomized controlled trials (RCTs) performed 'single-', 'double-', 'triple-', or 'outcome assessors blinding' and to evaluate, from the number of RCTs that did not conduct blinding, how many could actually have achieved it. Material and methods: Randomized controlled trials published in 10 orthodontic journals between 1 September 2012 and 28 February 2018 were included. A search was performed in PubMed and conducted for publication type 'randomized controlled trial' for each journal. Two reviewers independently analysed each RCT and registered that blinding was performed and included which specific type. It was also evaluated whether misclassifications of blinding items occurred and whether it was possible to achieve blinding among the RCTs that did not perform blinding. Results: After applying the inclusion criteria, 203 RCTs were assessed, and 61.6 per cent of them had used blinding, with the main type being 'outcome assessors blinding' (40.4%) followed by 'single-blinding' (15.3%), 'double-blinding' (2.5%), and 'triple-blinding' (3.4%). In 38.4 per cent of the trials, no blinding was performed; however, 79.4 per cent of them could have achieved blinding. Fifteen RCTs (7.3%) misclassified the blinding in relation to single-, double-, or triple-blinding. Journals followed the CONSORT (AJODO, EJO, JO, OCR) published together significantly more RCTs that performed blinding than journals not following the CONSORT. Conclusions: Blinding of outcome assessors was the most frequent type, as orthodontic trials are often of intervention design and thereby difficult to mask for patients and trial staff. The misclassifications of blinding items may indicate suboptimal knowledge among researchers and peer-reviewers regarding the definitions for diverse blinding types.

Objective: To examine: (I) the current evidence of the impact of fixed orthodontic appliances on the development of halitosis in patients undergoing orthodontic treatment, and (II) the influence of different orthodontic bracket systems on halitosis. Material and methods: Three electronic databases (PubMed, Scopus, and Cochrane Library) were searched prior to March 15, 2018. The review was systematically conducted and reported according to the Cochrane Handbook and the PRISMA statement. Only Randomised Clinical Trials (RCTs) were considered. Selected full-text papers were independently assessed by four investigators and any disagreements were resolved by consensus. The Cochrane Handbook was used to grade the risk of bias and the quality of evidence was rated according to GRADE. Results: Out of 363 identified studies, three RCTs on halitosis and fixed orthodontic appliances met the inclusion criteria. The risk of bias in the three studies was rated as high and the quality of evidence was rated as very low. Conclusions/clinical implications: There is a lack of scientific evidence that subjects with fixed orthodontic appliances develop halitosis during treatment. Additional well-conducted RCTs with extended periods of assessment are needed as well as consensus concerning cut-off values for the diagnosis of halitosis.

AIMS: To identify if lower incisor movements after orthodontic treatment are due to the relapse of the orthodontic treatment or due to natural growth. SUBJECTS AND METHODS: The subjects consisted of 92 patients who have had orthodontic treatment, divided into three groups, group 1: 38 individuals had no retainer in the lower jaw. Group 2: 24 individuals had a retainer 0.028 inch, a spring hard wire bonded to the mandibular canines only. Group 3: 30 individuals had a 0.0195-inch Twist-Flex wire, bonded to all mandibular incisors and canines. Study models before orthodontic treatment (T0), immediately after orthodontic treatment (T1), 6 years after orthodontic treatment (T2), and 12 years after orthodontic treatment (T3) were used for the measurements. The wires in groups 2 and 3 were removed after mean 2.6 years (SD 1.49). Little Irregularity Index (LII), inter-canine distance, available mandibular anterior space, and number of crowded incisors were registered. A Tooth Displacement Index (TDI) was developed to measure the tooth displacement directions at T0 and T3. RESULTS: The LII showed equal values before treatment (T0) and at the follow-up registrations (T2 and T3). But about 25 per cent of the tooth displacements at T2 and T3 did not exist before treatment, at T0. This indicates usual growth changes and not relapse of the orthodontic treatment. CONCLUSION: As about 25 per cent of the displaced incisors can be considered as an effect of natural growth, not a relapse of the orthodontic treatment, it is valuable to use a displacement index in combination with other variables for investigations of stability after orthodontic treatment. Importance of the present study is that it is possible to differ between relapse and usual growth changes.

Mycoplasma genitalium is an intracellular bacteria that is sexually transmitted. In women, M.genitalium causes urinary urgency and cervicit, and in males, mainly non-gonococcal urethritis, NGU. The first choice for the treatment of M. genitalium is macrolides, for example azithromycin. Second-hand treatment is the fluoroquinolones. The aim of this study was to describe mutations in the quinolone resistance determining region (QRDR) in the Topisomerase IV (parC gene) and in the DNA gyrase subunit A (gyrA gene) in M.genitalium positive isolates which also carries macrolide resistance in clinical samples within Region Skane. The method being used for analysing the mutations was DNA-sequencing. In addition, an optimization analysis was performed on different parameters (primer concentration, annealing temperature and cycles) of conventional PCR to achieve good sequencing results. A fisher's exact test with GraphPad QuickCalcs was also made to see how frequent fluoroquinolone mutations for each gene respectively are in this study compared to a study made in Melbourne, Australia. Mutations in QRDR were found in both parC gene (C234T, G248T, G259A, and G259T) and gyrA gene (G295A). The results for the optimization analysis showed that using 0.2 μM primer concentration to PCR mix for PCR, 58ºC annealing temperature and 50 cycles was considered most appropriate. The result from GraphPad QuickCalcs showed no difference in frequency between the studies concerning mutation in both genes and is statistically significant at significance level 0.05 with two-tailed test. The central purpose of describing mutations in the QRDR region aims to provide knowledge of mutations linked to fluoroquinolone resistance in M.genitalium isolates.

Aim: The aim of this study was to find if there is a correlation between AAA and chronic periodontitis in regards to their relation with the help of a questionnaire. Material and methods: Men that have undergone screening in the Vascular Centre at Skånes University Hospital in Malmö, Sweden were invited to participate in this study via telephone. The questionnaire was formulated mainly with questions from the study conducted in Self-reported measures for Surveillance of Periodontitis (Eke et al. 2013). Questions asking the respondents about tobacco habits, if they suffered other diseases, medication, and more were added as part of this study. Captured data was analysed using IBM SPSS Statistics 25 (SPSS Inc., Chicago, IL, USA). Normal distribution was not assumed for the analyses. Values were processed with Mann-Whitney U test and χ2-test. P-value < 0.05 was accepted as statistically significant Results: A total of 300 individuals were contacted, of which 65 (21.7%) were included in the study. Of these, 42 (64.6 %) were controls and 23 (35.4 %) had AAA. Bone loss was more commonly present in AAA group (37.9%) versus control (11.9%) (p= 0.010) Conclusion: A weak link between chronic periodontitis and AAA may be suggested, however more studies with larger cohorts and potentially clinically verified periodontitis diagnosis, are necessary to establish this potential link more firmly.

Background: The transition from student to nurse has proven to be problematic. This is partly because there is a gap between theory and practice, and that there are differences in the social culture between university and professional life. A study by the National Board of Health has shown that newly qualified nurses have shortcomings in the care of critically ill patients, operate technical equipment, education and support for patients and the role of supervisor. The first three months of work is the most stressful and 30-65 percent of newly graduated nurses change jobs during the first year and this affect the health service. Therefore, there is introductory programs. There is often a socialization process that allows graduated nurses to become a part of a culture within the profession. Aim: To enlighten the transition from student to (registered) nurse. Method: A literature review that includes ten qualitative studies. The articles have been read, reviewed and analyzed to then be compiled. Database searches were made in PubMed and Cinahl. Result: Newly graduated nurses felt that the transition from study to the professional life was diffucult. They said that they lacked knowledge in key areas and that they could not live up to what was expected of them. Introduction was seen as an important part and affected the ability to evolve. Socialization occurs through different phases. Conclusion: Support and assistance proved to be a big part to feel welcome at the workplace. However, there were expectations that newly qualified nurses could not live up to and this could lead to uncertainty. The experience of the profession can also be influenced by society’s image.

A mobile stroke unit (MSU) is an advanced ambulance equipped with specialized technology and trained healthcare personnel to provide on-site diagnosis and treatment for stroke patients. Providing efficient access to healthcare (in a viable way) requires optimizing the placement of MSUs. In this study, we propose a time-efficient method based on a genetic algorithm (GA) to find the most suitable ambulance sites for the placement of MSUs (given the number of MSUs and a set of potential sites). We designed an efficient encoding scheme for the input data (the number of MSUs and potential sites) and developed custom selection, crossover, and mutation operators that are tailored according to the characteristics of the MSU allocation problem. We present a case study on the Southern Healthcare Region in Sweden to demonstrate the generality and robustness of our proposed GA method. Particularly, we demonstrate our method's flexibility and adaptability through a series of experiments across multiple settings. For the considered scenario, our proposed method outperforms the exhaustive search method by finding the best locations within 0.16, 1.44, and 10.09 minutes in the deployment of three MSUs, four MSUs, and five MSUs, resulting in 8.75x, 16.36x, and 24.77x faster performance, respectively. Furthermore, we validate the method's robustness by iterating GA multiple times and reporting its average fitness score (performance convergence). In addition, we show the effectiveness of our method by evaluating key hyperparameters, that is, population size, mutation rate, and the number of generations.

Social impact, defined as an effect on society, culture, quality of life, community services, or public policy beyond academia, is widely considered as a relevant requirement for scientific research, especially in the field of health care. Traditionally, in health research, the process of knowledge transfer is rather linear and one-sided and has not recognized and integrated the expertise of practitioners and those who use services. This can lead to discrimination or disqualification of knowledge and epistemic injustice. Epidemic injustice is a situation wherein certain kinds of knowers and knowledge are not taken seriously into account to define a situation. The purpose of our article is to explore how health researchers can achieve social impact for a wide audience, involving them in a non-linear process of joint learning on urgent problems recognized by the various stakeholders in public health. In participatory health research impact is not preordained by one group of stakeholders, but the result of a process of reflection and dialog with multiple stakeholders on what counts as valuable outcomes. This knowledge mobilization and winding pathway embarked upon during such research have the potential for impact along the way as opposed to the expectation that impact will occur merely at the end of a research project. We will discuss and illustrate the merits of taking a negotiated, discursive and flexible pathway in the area of community-based health promotion.

Abstract: One of the dentists' assignments is to work according to scientific evidence and proven clinical expertise. To achieve this goal, one must stay updated . The purpose of this study was to examine the scientific articles in the Swedish dental journal Tandläkartidningen. The empirical material consisted of articles in the scientific section of Tandläkartidningen between 2008 to 2017. The data gathering and categorization was done by two reviewers according to a prepared template. These articles formed the basis for analysis in order to examine trends and subject-specific spreading, but also a categorization of the authors´ gender and nationality. The method used and the type of every article was also categorized. These data were compiled in the statistical program IBM SPSS Statistics 25. The results showed that oral medicine (12.6%), material science and technology (9.1%), cariology (8.2%) periodontology (7.7%), prosthetics (6.9%) were the five most published subjects in the journal .Article type distribution was 61% review articles, 14% doctoral thesis summary, 10% debate articles, 9% scientific original articles and 6% case descriptions. If the 10-years period was divided into two, ie 2008-2012 and 2013-2017, an increase was seen regarding female authors from 40.5% between 2008-2012 and 43.5% during the period 2013-2017. The majority of authors were female authors in the period 2015-2017 in Sweden. In summary, it can be concluded that there is a certain spread in dental subjects published in the journal where some subjects dominate over this period. Most often, the authors were men, although the proportion of female writers has increased over time. To create an overview of subjects that dominate and to see clearer trends about authors, a longer time range needs to be analyzed.

Syftet med denna litteraturstudie är att beskriva patienters upplevelse av att leva som HIV-positiva eller AIDS sjuka samt de förväntningar patienterna har på vårdpersonal i samband med vård/omvårdnad. Som teoretisk ram har Antonovsky, A (1991) salutogena begrepp KASAM använts. Efter innehållsanalys framkom det 5 kategorier av upplevelser och 3 kategorier rörande förväntningar. De kategorier som rör upplevelser är, att känna frustration och beroende, att pendla mellan hopp och hopplöshet samt självmordstankar, att kunna hantera sitt föränderliga jag och att känna socialt stöd. De kategorier som rör förväntningar är, att känna professionalism/kompetens, att få omsorgsfull behandling och trygghet och att känna delaktighet/individuell omvårdnad. Resultatet som framkom visar på brister i omvårdnad när det gäller att kunna tillgodose patienternas behov och förväntningar.

Abstract Objectives: To evaluate the space-maintaining capacity of a titanium mesh or a bioresorbable mesh after periosteal expansion and to assess bone formation under a titanium mesh or a bioresorbable mesh on the lateral border of the mandible by qualitative and quantitative histological analysis. Material and methods: In 13 rabbits, a self-inflatable soft tissue expander was placed intraorally, bilaterally under the mandibular periosteum via an extra oral approach. After 2 weeks, the expanders were removed and a particulated onlay bone graft was placed and covered by a titanium mesh or a bioresorbable mesh. After 3 months, the animals were sacrificed and specimens were collected for histology. Results: The osmotic soft tissue expander created a subperiosteal pocket and a ridge of new bone had formed at the edges of the expanded periosteum in all sites. After the healing period of 3 months, soft tissue dehiscence was recorded in two of the sites with bioresorbable meshes. The mean bone fill was 65% under the titanium mesh and 85% under the bioresorbable mesh (P<0.05). There was no significant difference between the titanium mesh and the bioresorbable mesh regarding the height of the meshes, mesh area and mineralized bone area. Scanning electron microscopy shows that new bone is growing in direct contact with the resorbable mesh and the titanium mesh. Conclusion: This study confirms that an osmotic soft tissue expander creates a surplus of periosteum and soft tissue and that new bone can be generated under a titanium mesh or bioresorbable mesh.

About 30 % of individuals in the Swedish population will at some stage during life have treatment with orthodontic appliances. In more severe cases, when orthodontic treatment is not considered sufficient enough to correct the malocclusion, the orthodontic treatment is combined with orthognathic surgery. For these cases, a satisfying jaw relation is achieved by surgically moving the maxilla and/or the mandible into a pre-planned position.Patients due to be treated with orthognathic surgery often suffer from an impaired masticatory function, symptoms from the masti- catory muscles or temporomandibular joints (temporomandibular disorders), headaches as well as dissatisfaction with their facial aesthetics.Since orthognathic treatment is expensive, in many cases arduous to the patient and not without complications, it is important to assess the treatment outcome and if this is satisfying for the patients. Previous studies that have examined the outcome after ortho- gnathic treatment have had diverging study designs and have come to different conclusions with regard to both temporomandibular disorders and masticatory function.The overall aim of this thesis was to assess and compare the frequencies of temporomandibular disorders and the masticatory function in patients with dentofacial deformities before and after orthognathic treatment.The thesis is based on the following studies:paper i is a systematic literature review aiming to, in an evidence- based approach, answer the question whether orthognathic treatment affects the prevalence of signs and symptoms of temporomandibular disorders. The review encompasses the period from January 1966 to April 2006 and was further extended to May 2013 in the frame story of this thesis.Conclusions in Paper I and the complementary survey• There is insufficient scientific evidence for a decrease of sub diagnoses of temporomandibular disorders after orthognathic treatment.• There is limited scientific evidence for a reduction of masticatory muscle pain on palpation after orthognathic treatment.• There is insufficient scientific evidence for an effect on temporomandibular joint pain on palpation and temporomandibularjoint sounds from orthognathic surgery.• Further controlled, well-designed studies assessing temporomandibular disorders before and after orthognathic treatment are needed to consolidate strong evidence considering treatment outcomes.papers II and III are studies comparing frequencies of temporomandibular disorders in patients with dentofacial deformities with a control group. The patients were referred for a combined orthodontic and orthognathic treatment to correct their malocclusion. The control group comprised individuals with normal occlusion or minor malocclusion traits not in need of orthodontic treatment. In Paper III, temporomandibular disorders were longitudinally analysed by assessing and comparing frequencies before and after orthognathic treatment. All individuals in the studies were diagnosed according to the research diagnostic criteria for temporomandibular disorders.Conclusions in Papers II and III• Patients due to be treated with orthognathic surgery had more signs and symptoms of temporomandibular disorders and a higher frequency of diagnosed temporomandibular disorders compared with the age- and gender matched control group.• Patients with dentofacial deformities, corrected by orthodontic treatment in conjunction with orthognathic surgery, had a positive treatment outcome in respect of myofascial pain and arthralgia.• After treatment the frequency of temporomandibular disorders in the treatment group was low and at an equivalent level of that in the control group.paper iV evaluates the self-estimated masticatory ability and the masticatory performance before and after orthognathic treatment in the same individuals as in Paper II and III.Conclusions in Paper IV• Masticatory ability and performance increased after orthognathic treatment.• The number of occlusal contacts and severity of overall symptoms of TMD influenced both the masticatory ability and performance.• Open bite had a negative effect on masticatory performance.Key conclusions and clinical implications:Patients with dentofacial deformities diagnosed with temporomandibular disorders do in most cases benefit from orthognathic treatment. In addition, masticatory ability and performance, which is impaired in patients with dentofacial deformities, improve after treatment. Thus, patients with dentofacial deformities that are to be treated with orthodontics in combination with orthognathic surgery can be recommended the treatment in order to relieve symptoms of TMD and impaired mastication.

Objective: To answer the question whether temporomandibular disorders (TMD) were more common in a group of individuals referred for orthognathic surgery than in a control group. The null hypothesis was that neither the frequency of signs and symptoms of TMD or diagnosed TMD would differ between the patient group and a control group. Materials and Methods: A sample of 121 consecutive patients referred for orthognathic surgery at the Department of Oral Maxillofacial Surgery, Malmö University Hospital, Sweden, was interviewed and examined regarding signs and symptoms of TMD and headaches. A control group was formed by 56 age- and gender-matched individuals attending the Department of Oral Diagnosis, Faculty of Odontology, Malmö University, Sweden, and Public Dental Health Clinic in Oxie, County of Skane, Sweden. TMD diagnoses were used according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Results: The patient group showed more myofascial pain without limited opening, disc displacement with reduction, and arthralgia according to RDC/TMD than the control group. The patient group also had more symptoms and signs of TMD in general. Conclusions: The null hypothesis was rejected because patients who were to be treated with orthognathic surgery had more signs and symptoms of TMD and higher frequency of diagnosed TMD compared with the matched control group.

OBJECTIVE: To answer the question whether orthognathic surgery does affect the prevalence of signs and symptoms of temporomandibular disorders (TMDs). MATERIALS AND METHODS: A literature survey in the PubMed and Cochrane Library electronic databases was performed and covered the period from January 1966 to April 2006. The inclusion criteria were controlled, prospective or retrospective studies comparing TMDs before and after orthognathic surgery in patients with malocclusion. There were no language restrictions, and three reviewers selected and extracted the data independently. The quality of the retrieved articles was evaluated by four reviewers. RESULTS: The search strategy resulted in 467 articles, of which 3 met the inclusion criteria. Because of few studies with unambiguous results and heterogeneity in study design, the scientific evidence was insufficient to evaluate the effects that orthognathic surgery had on TMD. Moreover, the studies had problems with inadequate selection description, confounding factors, and lack of method error analysis. CONCLUSION: To obtain reliable scientific evidence, additional well-controlled and well-designed studies are needed to determine how and if orthognathic surgery alters signs and symptoms of TMD.

Objective: To answer the question whether temporomandibular disorders (TMD) were more common in a group of individuals referred for orthognathic surgery than in a control group. The null hypothesis was that neither the frequency of signs and symptoms of TMD or diagnosed TMD would differ between the patient group and a control group. Materials and Methods: A sample of 121 consecutive patients referred for orthognathic surgery at the Department of Oral Maxillofacial Surgery, Malmö University Hospital, Sweden, was interviewed and examined regarding signs and symptoms of TMD and headaches. A control group was formed by 56 age- and gender-matched individuals attending the Department of Oral Diagnosis, Faculty of Odontology, Malmö University, Sweden, and Public Dental Health Clinic in Oxie, County of Skane, Sweden. TMD diagnoses were used according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Results: The patient group showed more myofascial pain without limited opening, disc displacement with reduction, and arthralgia according to RDC/TMD than the control group. The patient group also had more symptoms and signs of TMD in general. Conclusions: The null hypothesis was rejected because patients who were to be treated with orthognathic surgery had more signs and symptoms of TMD and higher frequency of diagnosed TMD compared with the matched control group.

OBJECTIVE: To answer the question whether temporomandibular disorders (TMD) were more common in a group of individuals referred for orthognathic surgery than in a control group. The null hypothesis was that neither the frequency of signs and symptoms of TMD or diagnosed TMD would differ between the patient group and a control group. MATERIALS AND METHODS: A sample of 121 consecutive patients referred for orthognathic surgery at the Department of Oral Maxillofacial Surgery, Malmö University Hospital, Sweden, was interviewed and examined regarding signs and symptoms of TMD and headaches. A control group was formed by 56 age- and gender-matched individuals attending the Department of Oral Diagnosis, Faculty of Odontology, Malmö University, Sweden, and Public Dental Health Clinic in Oxie, County of Skane, Sweden. TMD diagnoses were used according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). RESULTS: The patient group showed more myofascial pain without limited opening, disc displacement with reduction, and arthralgia according to RDC/TMD than the control group. The patient group also had more symptoms and signs of TMD in general. CONCLUSIONS: The null hypothesis was rejected because patients who were to be treated with orthognathic surgery had more signs and symptoms of TMD and higher frequency of diagnosed TMD compared with the matched control group.

OBJECTIVES: The aim of this study was to investigate the self-estimated masticatory ability and masticatory performance in patients with dentofacial deformities before and after orthognathic treatment; in comparison to an age- and gender-matched control group. SUBJECTS AND METHODS: The masticatory ability and masticatory performance were evaluated in 121 consecutive patients (treatment group), referred for orthognathic treatment. Eighteen months after treatment, 98 patients (81%) completed a follow-up examination. Masticatory ability was assessed on a visual analog scale, while the masticatory performance was evaluated by a masticatory test using round silicon tablets. Signs and symptoms of temporomandibular disorders (TMD) were registered by a clinical examination and a questionnaire. The control group comprised 56 age- and gender-matched subjects who were examined at baseline. RESULTS: At the baseline examination, the treatment group had a significantly lower masticatory ability and performance compared with the control group. After treatment, the masticatory ability significantly improved in the treatment group and reached the same level as in the control group. The masticatory performance index increased significantly but was still lower than in the control group. Both the masticatory ability and masticatory performance were affected by the number of occlusal contacts during maximal biting pressure and by the self-estimated overall symptoms of TMD. CONCLUSIONS: Patients with dentofacial deformities, corrected by orthognathic treatment, have a significant positive treatment outcome in respect of masticatory ability and masticatory performance. Furthermore, the occlusion and symptoms of TMD have an impact on both masticatory ability and masticatory performance.

Abstract The aims of the study were to investigate the alteration of temporomandibular disorders (TMD) after correction of dentofacial deformities by orthodontic treatment in conjunction with orthognathic surgery; and to compare the frequency of TMD in patients with dentofacial deformities with an age and gender matched control group. TMD were evaluated in 121 consecutive patients (treatment group), referred for orthognathic surgery, by a questionnaire and a clinical examination. 18 months after treatment, 81% of the patients completed a follow-up examination. The control group comprised 56 age and gender matched subjects, of whom 68% presented for follow-up examination. TMD were diagnosed according to research diagnostic criteria for TMD. At baseline examination, the treatment group had a higher frequency of myofascial pain (P=.035) and arthralgia (P=.040) than the control group. At follow-up, the frequencies of myofascial pain, arthralgia and disc displacement had decreased in the treatment group (P=.050, P=.004, P=.041, respectively). The frequency of TMD was comparable in the two groups at follow-up. Patients with dentofacial deformities, corrected by orthodontic treatment in conjunction with orthognathic surgery, seem to have a positive treatment outcome in respect of TMD pain

Sysmex XE-5000 is an automated cell counter that performs measurements with different principles. The two applied in this project are RF/DC (Radio Frequency/Direct Current) and Flow cytometry with semiconductor laser. RF/DC is based on changes in radio frequency resistance and direct current voltage. Changes in RF provide information about the density of the cell’s internal structure (e.g. the nucleus) and changes in DC provide information about the size of the blood cells. Flow Cytometry define as physiological and chemical properties of the cell. Detection of cells is achieved by the irradiation with a laser beam while passing through one by one. The information obtained from flow cytometry includes scattered light and fluorescence. Sysmex XE-5000 works with several different error messages, so-called alarm. One or more alarm indicates that there is an increased risk for the presence of abnormal cells and this can only be ruled out by a manual differential count. In this study three alarms, which indicate the presence of abnormal white blood cells, were analyzed: “Blasts?”, Atypical Lympho?” and “Abn Lympho/L_Blasts?”. The project aims to compare the current calculations with the new software (eMM) for the alarms and evaluate if they provide a smaller number of false positive alarms from the hematology instrument Sysmex XE-5000. Samples with one or two of the alarms were selected and analyzed with the current settings and then with the new settings for eMM. The result showed that the number of false-positive samples was reduced and that the number of duplicate alarms decreased.

OBJECTIVES: To evaluate the effectiveness of surgical and nonsurgical treatment of temporomandibular joint (TMJ) luxation. MATERIALS AND METHODS: This systematic literature review searched PubMed, the Cochrane Library, and Web of Science databases to identify randomized controlled trials on TMJ luxation treatment published between the inception of each database and 26 March 2018. RESULTS: Two authors assessed 113 unique abstracts according to the inclusion criteria and read nine articles in full text. Eight articles comprising 338 patients met the inclusion criteria, but none of these evaluated surgical techniques. Three studies including 185 patients concerned acute treatment with manual reduction of luxation while five studies including 153 patients evaluated minimally invasive methods with injection of autologous blood or dextrose prolotherapy for recurrent TMJ luxation. These studies reported that mouth opening after treatment was reduced and that independent of type of injection, recurrences of TMJ luxation were rare in most patients. CONCLUSIONS: In the absence of randomized studies on surgical techniques, autologous blood injection in the superior joint space and pericapsular tissues with intermaxillary fixation seems to be the treatment for recurrent TMJ luxation that at present has the best scientific support. Well-designed studies on surgical techniques with sufficient numbers of patients, long-term follow-ups, and patient experience assessment are needed for selection of the optimal surgical treatment methods. CLINICAL RELEVANCE: Autologous blood injection combined with intermaxillary fixation can be recommended for patients with recurrence of TMJ luxation.

In a oncology clinic, the staff feel that the patients are treated with antineoplastic agents to close to ad mortem. Our aim is in a descriptive way examine how close in time the patients last antineoplastic agents treatment is to ad mortem, the study further aims to illustrate the difference ratio related to diagnosis, age and sex during calendar year 2004. Data were collected from the patients medical records with help of datacollectionform. The study comprise 65 journals. The results show that among other things there is a connection between patients difference and age.

Insufficient regeneration of missing bone and soft-tissue may presentaesthetic or functional problems in patients indicated for dentalimplant surgery. Several techniques such as bone grafts, bone substitutesand guided tissue regeneration (GTR) have been described torebuild a compromised alveolar ridge. Adequate soft-tissue coverageof grafted bone and titanium-mesh is important to avoid exposurewhich may result in loss of the bone graft.The general aim of this thesis was to evaluate use of an osmotictissue expander for expanding intra-oral soft tissue – creating a surplusof soft tissue – in preparation for onlay bone grafting.An experimental rabbit model was used in studies (I), (II) and (III).In (I) an osmotic soft-tissue expander was placed bilaterally on thelateral wall of the mandible via an extra-oral approach. After twoweeks of expansion the rabbits were killed and specimens were collectedfor histology. No inflammatory reaction and no resorbtion ofthe cortical bone occured. The periosteum was expanded and newbone formation was seen in the edges of the expander.In (II) and (III) the expander was placed under the periosteum in thesame way as in (I): bilaterally in 13 rabbits in (II) and unilaterally in11 rabbits in (III).After two weeks of expansion the expander was identified andremoved. In (II) particulated bone was placed at the recipient siteprotected by a titanium mesh in one site and a bio-resorbable meshon the other site. In (III), DBBM particles and bone particles collected from the lateralborder of the mandible separated by a collagen membrane wasplaced at the recipient site. The graft was protected by a pre-benttitanium mesh covered by a collagen membrane.After a healing period of 3 months specimens were collected forhistological and SEM examination. New bone was growing in directcontact with the titanium mesh and bio resorbable mesh. The newlyformed bone had the same calcium content as the mature bone in thebase of the mandible.In the clinical study (IV) 20 patients were consecutively recruitedand randomised into two groups.The experimental group (ten patients) had an osmotic soft tissueexpander implanted. After two weeks of expansion the expanderwas removed and a particulated bone graft protected by a titaniummesh and a collagen membrane was fixed to the recipient site. Titaniumimplants were installed after a healing period of 6 months.The patients in the reference group had a bone block grafted fromthe anterior ramus fixated to the recipient site with one or two titaniummini screws. Implants were installed after a healing period of6 months.A three dimensional optical measuring device was used to measurealterations in the soft tissue profile before each surgical procedure.The three-dimensional changes were then analysed on a PC.The results from the clinical study in patients confirmed the resultsfrom the experimental rabbit studies. The osmotic tissue expanderexpanded the soft tissue. Expander perforations of the soft tissueoccurred in two patients. The optical measurements demonstrated apositive volume gain after soft tissue expansion and bone grafting.The expanded tissue could be used to cover a bone graft. There stillwas a risk of mesh exposure, even after soft tissue expansion, whichoccurred in two patients. In both groups, implants could be installedin the grafted bone in positions that would allow the crowns to fitaesthetically into the dental arch.

OBJECTIVES: To evaluate the space-maintaining capacity of titanium mesh covered by a collagen membrane after soft tissue expansion on the lateral border of the mandible in rabbits, and to assess bone quantity and quality using autogenous particulate bone or bone-substitute (Bio-Oss(®) ), and if soft tissue ingrowth can be avoided by covering the mesh with a collagen membrane.

MATERIAL AND METHODS: In 11 rabbits, a self-inflatable soft tissue expander was placed under the lateral mandibular periosteum via an extra-oral approach. After 2 weeks, the expanders were removed and a particulated onlay bone graft and deproteinized bovine bone mineral (DBBM) (Bio-Oss(®) ) were placed in the expanded area and covered by a titanium mesh. The bone and DBBM were separated in two compartments under the mesh with a collagen membrane in between. The mesh was then covered with a collagen membrane. After 3 months, the animals were sacrificed and specimens were collected for histology.

RESULTS: The osmotic soft tissue expander created a subperiosteal pocket and a ridge of new bone formed at the edges of the expanded periosteum in all sites. After the healing period of 3 months, no soft tissue dehiscence was recorded. The mean bone fill was 58.1±18% in the bone grafted area and 56.9±13.7% in the DBBM area. There was no significant difference between the autologous bone graft and the DDBM under the titanium mesh with regard to the total bone area or the mineralized bone area. Scanning electron microscopy showed that new bone was growing in direct contact with the DBBM particles and the titanium mesh. There is a soft tissue ingrowth even after soft tissue expansion and protection of the titanium mesh with a collagen membrane.

CONCLUSION: This study confirms that an osmotic soft tissue expander creates a surplus of periosteum and soft tissue, and that new bone can subsequently be generated under a titanium mesh with the use of an autologous bone graft or DBBM.

We aimed to evaluate a new technique for intraoral expansion of soft tissue with a self-inflatable expander in rabbits. We placed a self-inflatable soft tissue expander bilaterally in eight rabbits under the periosteum of the mandible through an extraoral approach. The expander was left to self-inflate for two weeks, after which the animals were killed and specimens collected for histological examination. The self-inflatable soft tissue expanders expanded the periosteum. There were no dehiscences or infections. Histological observations showed no signs of any inflammatory reaction and there was no evidence of bony resorption. New bone had formed at the edges of the expanded periosteum. In the control area no new bone had formed. The osmotic soft tissue expander model for intraoral soft tissue and periosteal expansion suggests a promising way of creating a surplus of soft tissue that can be used to cover bone grafts.

To determine whether it is possible to vertically augment bone utilizing a block graft from compressed titanium granules mainly used previously for contained bone defects and to determine whether there exists a difference in osteoconductive properties between the white and the grey granules. In 11 rabbits, 4 titanium blocks were inserted on each rabbit's skull bone according to a randomized scheme. These blocks were made from standardized compressed titanium granules. Type A: PTG grey, small granules (Pourus Titanium Granules, Tigran, Malmo, Sweden); Type B: PTG grey, large granules; Type C: PTG white, small granules; Type D: PTG white large granules. After 12 weeks, the animals were sacrificed and specimens were collected for histology and mu CT scanning. From both the mu CT and histology, it can be said that bone formation was successfully achieved for all groups, and the granules maintained their volume. The histomorphometric BA (bone area) evaluation in the entire grafted area presented that there were no statistical differences between all groups tested. The lowest 1/4 BA in contact with the rabbit skull presented that groups A and C presented the highest mean BA, and group A presented significantly higher BA than that of group D (p = 0,049). No significant differences were noted between groups A, B and C. Within the limitation of this study, no differences were noted between small white or grey PTG blocks. The large granules presented less bone ingrowth area compared to the small granules and this trend was regardless of the different PTG types. The entire grafted area was not filled with new bone suggesting that bone migration occurred mostly from the existing cortical bone side suggesting contact osteogenesis.

To evaluate the outcome of intraoral soft tissue expansion by measuring the profile change using objective 3D metering equipment and to evaluate localized bone grafting after soft tissue expansion with regard to gain of bone and complications.

Background: Fibromyalgia is a disease with unclear etiology characterized by chronic pain and fatigue and an array of other symptoms. The disease affects approx. 2% of the world's population and the prevelance is higher among women. Diagnosis is limited by unclear laboratory values and other medical examination methods. An increased knowledge of patients' experience of living with fibromyalgia can help the registered nurse support these patients by giving them person-centered care. Aim: The purpose of this literature review was to describe patients' experience of living with fibromyalgia. Method: The study focused on qualitative systematic scientific literature, based on 11 original research articles. The articles were analyzed in accordance with content analysis outlined by Forsberg & Wengström. Results: The results showed four themes and 12 sub-themes which described patients' experience of living with fibromyalgia. The themes that emerged included how to live with an invisible disease, living with the symptoms, symptoms and their social impact and strategies to live with the disease. Conclusions: Symptoms of pain, fatigue and insomnia impact of the patient´s life and limits them in work, at home, in leisure activities and participation in socializing. Since the symptoms are subjective and cannot be confirmed objectively, the patients feel that no one takes them seriously including healthcare personnel. To have a meaningful life despite the disease, patients need to find different coping strategies. Healthcare personnel lack of knowledge and thus an inability to perceive it to be a problem; creates unnecessary suffering. Nurses must confirm the patient’s experience of the disease as well as keep up to date with current research in order to create an environment where the patient feels trusted and respected.

HIV, Hepatitis B and C exist around the world. Globally there are approximately 40 million people infected with HIV, 350 million are living with chronic Hepatitis B and 170 million are infected with Hepatitis C. The purpose of this literature review is to investigate if knowledge affects health care workers’ attitudes towards patients with chronic blood-borne infection. This review is based on 10 scientific articles of quantitative and qualitative design. The result of the selected articles lead to four themes: knowledge and attitude, knowledge and fear, knowledge and the willingness to care and knowledge and standard precautions. This literature review proves that knowledge does change health care workers’ attitudes, reduces fear and improves the willingness to care. The results show that education on blood-borne infections and standard precautions increases the knowledge and creates a safety for health care workers to provide the best possible nursing care.

Objectives: This is to identify factors affecting the prevalence of Lactobacillus reuteri in maternal faeces and breast milk and infant faeces after oral supplementation with L. reuteri and to assess the influence on microbial ecology, particularly Clostridium difficile and Bifidobacterium colonization. Materials and Methods: In this double-blind trial, 232 mothers with a family history of atopic disease were randomized to a daily intake of either L. reuteri American-type culture collection (ATCC) 55730 (1 x 108 colony forming units (CFU)) or placebo for the last 4 weeks of pregnancy. Their babies then continued with tha same study product daily from birth until 12 months of age. Bacterial counts and prevalence were assessed in maternal breast milk and faeces and infant faeces, using conventional cultivation methods. Results: The prevalence of L. reuteri was higher during the first year of life in the stool samples from infants in the active as compared with the placebo-treated group. The highest prevalence was recorded at 5 to 6 days of age (82% in the treated vs 20% in the placebo group, P < 0.001). Lactobacillus reuteri was isolated from 12% and 2%, respectively, in the colostrum samples (P < 0.05). Breast-feeding seemed to reduce faecal L. reuteri counts, although antibiotics did not influence the levels of L. reuteri. The administration of L. reuteri did not affect bifidobacteria or C. difficile colonization. Conclusion: Lactobacillus reuteri may be detected in breats milk after oral supplementation to the mother and in almost all infants after oral supplementation during the first year of life, as well as occasionally in many untreated infants.