Gunnar Bergman

Studies on mineralized dental tissues: I. A microradiographic and autoradiographic investigationof teeth and tooth germs of normal dogs

Summary This investigation was carried out in order to get further information onthe mineralized dental tissues. Two young normal dogs were injected, one with Na 2 S 35 O 4 , the other with Ca 45 Cl 2 . From selected parts of the lower jaws thin ground sections were prepared. These sections were studied by means of a combination of autoradiographic and microradiographic techniques. The autoradiographs revealed an uptake of both Ca 45 and S 35 in essentially the same locations of the bone and tooth tissues. There was thus a high uptake of isotopes in the periosteal areas and in young osteons and certain areas of the cancellous bone. In the deciduous teeth the labelling was most pronounced along the pulpo-dentinal border. In the tooth germs there was a high uptake of both isotopes along the pulpo-dentinal border in the same area. There was also a labelling along the enamel surface. In certain tooth germs, where the microradiographs indicated a high mineralization in the cusp tips, there was a diffuse labelling throughout the whole breadth of the enamel. These findings were interpreted as an expression of a secondary mineralization. The uptake of S 35 differed in certain respects from that of Ca 45 . In the tooth germs there was thus an uptake of S 35 along the dentino-enamel junction, and in the soft tissues, especially in the pulps of the tooth germs, there was also a marked labelling of S 35 only. Further, the labelling at the pulpodentinal border showed features differing from the autoradiographs obtained with Ca 45 . Thus the uptake of S 35 at this site was concentrated in two closely adjacent bands. It was concluded that the uptake of Ca 45 took place in the mineralized constituents of the tissues. However, as regards S 35 , one part was probably incorporated in the crystal lattice of the minerals, another being deposited with the organic matrix, presumably as mucopolysaccharides containing ester sulfuric acid. This latter conclusion refers to the uptake along the pulpo-dentinal border.

A Quantitative Microradiographic Study of Incipient Enamel Caries

SYNOPSIS IN INTERLINGUA UN QUANTITATIVE STUDIO MICRORADIOGRAPHIC DE INCIPIENTE CARIE ADAMANTIN.—Le strato superficial del cariose adamante studiate habeva perdite approximativemente 8 pro cento de su sales mineral. Le valor medie del spissitate del strato superficial esseva 40 μ, e le valor medie de su contento mineral esseva 82,7 pro cento a base del volumine. Le dismineralisation subsuperficial monstrava marcate variationes. Le contento mineral le plus basse esseva 28,9 pro cento a base del volumine, e iste alte grado de dismineralisation esseva trovate in un lesion de un profundor de 300 μ sin ruptura del superficie.

Development of heart block in children of SSA/SSB-autoantibody-positive women is associated with maternal age and displays a season-of-birth pattern

Objective Congenital heart block may develop in the fetuses of Ro/SSA-positive and La/SSB-positive mothers. Recurrence rates of only 10–20% despite persisting maternal antibodies indicate that additional factors are critical for the establishment of heart block. The authors investigated the influence of other maternal and fetal factors on heart block development in a Swedish population-based cohort. Methods The influence of fetal gender, maternal age, parity and time of birth on heart block development was analysed in 145 families, including Ro/La-positive (n=190) and Ro/La-negative (n=165) pregnancies. Results There was a recurrence rate of 12.1% in Ro/La-positive women, and no recurrence in Ro/La-negative women. Fetal gender and parity did not influence the development of heart block in either group. Maternal age in Ro/La-positive pregnancies with a child affected by heart block was, however, significantly higher than in pregnancies resulting in babies without heart block (p<0.05).Seasonal timing of pregnancy influenced the outcome. Gestational susceptibility weeks 18–24 occurring during January–March correlated with a higher proportion of children with heart block and lower vitamin D levels during the same period in a representative sample of Swedish women and a corresponding higher proportion of children with heart block born in the summer (p<0.02). Maternal age or seasonal timing of pregnancy did not affect the outcome in Ro/La-negative pregnancies. Conclusion This study identifies maternal age and seasonal timing of pregnancy as novel risk factors for heart block development in children of Ro/La-positive women. These observations may be useful for counselling when pregnancy is considered.

A population-based investigation of the autoantibody profile in mothers of children with atrioventricular block.

The objective of the study was to investigate the antigen specificity and occurrence of individual autoantibodies in mothers of children diagnosed with atrioventricular (AV) block in a nation‐wide setting. Patients with AV block detected before 15 years of age were identified using national quality registries as well as a network of pediatric and adult cardiologists and rheumatologists at the six university hospitals in Sweden. Patients with gross heart malformations, surgically or infectiously induced blocks were excluded. Blood samples were obtained from the mothers and maternal autoantibody profile, including the occurrence of antibodies against Ro52, Ro60, La, SmB, SmD, RNP‐70k, RNP‐A, RNP‐C, CENP‐C, Scl‐70, Jo‐1, ribosomal RNP and histones was investigated in 193 mothers of children with AV block by immunoblotting and ELISA. Autoantibody reactivity was detected in 48% (93/193) of the mothers of children with AV block. In autoantibody‐positive mothers, the vast majority, 95% (88/93), had antibodies against Ro52, while 63% (59/93) had autoantibodies to Ro60 and 58% (54/93) had autoantibodies to La. In addition, 13% (12/93) of the autoantibody‐positive mothers had antibodies to other investigated antigens besides Ro52, Ro60 and La, and of these anti‐histone antibodies were most commonly represented, detected in 8% (7/93) of the mothers. In conclusion, this Swedish population‐based study confirms that maternal autoantibodies may associate with heart block in the child. Further, our data demonstrate a dominant role of Ro52 antibodies in association with AV block.

Information following a diagnosis of congenital heart defect: experiences among parents to prenatally diagnosed children.

Background Prenatal screening of pregnant women in Sweden has improved the detection of major congenital heart defects (CHD). The aim was to explore parental experiences and need for information following a prenatal diagnosis of CHD. Methods Semi-structured interviews conducted with six fathers and five mothers to seven prenatally diagnosed children. Data were analyzed through content analysis. Results Three themes and 9 categories emerged. Theme 1, Grasping the facts today while reflecting on the future, containing five categories: Difficulties sorting out information when in emotional chaos; Respectful information regarding termination of pregnancy; Early information is crucial; Understanding the facts regarding the anomaly; Preparing for the future. Theme 2, Personal contact with medical specialists who give honest and trustworthy information is valued, containing two categories: Trust in information received from medical specialists and Truth and honesty is valued. Theme 3, An overwhelming amount of information on the Internet, containing two categories: Difficulties in finding relevant information and Easy to focus on cases with a poor outcome when searching the Internet. Conclusion Early and honest information in line with individual preferences is crucial to support the decisional process regarding whether to continue or terminate the pregnancy. The use of illustrations is recommended, as a complement to oral information, as it increases comprehension and satisfaction with obtained information. Furthermore, the overwhelming amount of information on the Internet calls for compilation of easily accessible and reliable information sources via the Internet.

Diagnostic precision of Doppler flow echocardiography in fetuses at risk for atrioventricular block

To investigate the diagnostic precision of three Doppler methods in their ability to predict postnatal first‐degree atrioventricular (AV) block.

Content and Quality of Information Websites About Congenital Heart Defects Following a Prenatal Diagnosis

BACKGROUND Pregnant women and their partners use the Internet to search for information following a prenatal diagnosis of congenital heart defect. OBJECTIVE Our aim was to explore central subjects of content and to assess the accessibility, reliability, usability, and quality of written information on publicly available information websites about congenital heart defects following a prenatal diagnosis. METHODS Following searches on Bing and Google, we included websites containing patient information in English. Hits ranged from 340,000-67,500,000 and the first 50 hits from each search were screened for inclusion (N=600). Of these hits, 39.3% (236/600) were irrelevant. A total of 67 websites were included, of which 37% (25/67) were affiliated with independent information websites, 25% (17/67) with charity/private organizations, 25% (17/67) with hospitals/clinics, and 13% (8/67) had other affiliations. The majority of the websites (76%, 51/67) could not be attributed to an author. A manifest content analysis was performed to explore central subjects of content. The DISCERN instrument was used to assess the quality of information, and the LIDA tool was used to assess accessibility, usability, and reliability of the included websites. RESULTS The content on the majority of the websites included care and treatment of children with congenital heart defects (88%, 59/67), causes of congenital heart defects (88%, 59/67), symptoms of congenital heart defects (85%, 57/67), prevalence of congenital heart defects (81%, 54/67), potential complications of congenital heart defects (75%, 50/67), prenatal diagnostics/screening methods (72%, 48/67), and specific congenital heart defects (72%, 48/67), whereas less than 10% included information about termination of pregnancy (6%, 4/67), care during pregnancy (5%, 3/67), and information specifically directed to partners (1%, 1/67). The mean of the total DISCERN score was 27.9 (SD 9.7, range 16-53). According to the instrument, a majority of the websites were categorized as very poor regarding information about effects of no treatment (88%, 59/67), support for shared decision making (85%, 57/67), achievement of its aims (84%, 56/67), explicit aims (82%, 55/67), risks of each treatment (82%, 55/67), how treatment choices affect overall quality of life (76%, 51/67), and areas of uncertainty (76%, 51/67). The mean of the total LIDA score was 92.3 (SD 13.1, range 61-127). According to the tool, a majority of the websites were categorized as good with regard to registration (97%, 65/67) and browser test (75%, 50/67), whereas a majority were categorized as poor with regard to currency (87%, 58/67), content production (84%, 56/67), and engagability (75%, 50/67). CONCLUSIONS Difficulties in finding relevant information sources using Web search engines and quality deficits on websites are an incentive for health professionals to take an active part in providing adequate and reliable information online about congenital heart defects.

Anti‐Ro52/SSA antibody‐exposed fetuses with prolonged atrioventricular time intervals show signs of decreased cardiac performance

To investigate if anti‐Ro/SSA antibody‐exposed fetuses with prolonged atrioventricular (AV) time intervals also have prolongation of the isovolumetric contraction time (ICT).

Experiences of termination of pregnancy for a fetal anomaly : A qualitative study of virtual community messages

OBJECTIVE to explore experiences described by posters in Swedish virtual communities before, during and after termination of pregnancy due to a fetal anomaly. DESIGN cross-sectional qualitative study of messages in virtual communities. The messages were purposefully selected in 2014 and analyzed with inductive qualitative manifest content analysis. SETTING two large and active Swedish virtual communities. SAMPLE 1623 messages from 122 posters (112 females, 1 male, and 9 did not disclose their sex), written between 2008 and 2014. The majority of the posters were females (91%) with recent experience of termination of pregnancy following different prenatal diagnoses (63% less than one year since the termination). MEASUREMENTS AND FINDINGS before the termination, posters experienced an emotional shock and a difficult decision. During the termination, they needed compassionate care from present caregivers, experienced intense emotional and physical pain, lacked an understanding about the abortion, and expressed varied feelings about the option to view the fetus. After the termination, posters used different strategies to come to terms with and accept the decision, experienced a perinatal loss, expressed fears of recurrence, and longed for a new child. KEY CONCLUSIONS spanning across the time before, during and after the abortion, women who terminate a pregnancy due to a fetal anomaly express considerable physical and emotional pain, with psychosocial and reproductive consequences. IMPLICATIONS FOR PRACTICE information and preparation, including the decision whether or not to view the fetus, are important aspects to consider when caring for individuals who have decided to terminate a pregnancy for a fetal anomaly. The findings indicate a need for structures that offer support to women who suffer from fears of recurrence in future pregnancies.

Late development of complete atrioventricular block may be immune mediated and congenital in origin

To investigate the correlation between maternal autoantibodies and age at diagnosis of isolated complete atrioventricular (AV) block (CAVB) and to study signs of late progression of foetal immune‐mediated insults in cases of postnatally diagnosed CAVB.