Hannu Vähänikkilä

Human Bone Marrow Mesenchymal Stem Cells Induce Collagen Production and Tongue Cancer Invasion

Tumor microenvironment (TME) is an active player in carcinogenesis and changes in its composition modify cancer growth. Carcinoma-associated fibroblasts, bone marrow-derived multipotent mesenchymal stem cells (BMMSCs), and inflammatory cells can all affect the composition of TME leading to changes in proliferation, invasion and metastasis formation of carcinoma cells. In this study, we confirmed an interaction between BMMSCs and oral tongue squamous cell carcinoma (OTSCC) cells by analyzing the invasion progression and gene expression pattern. In a 3-dimensional myoma organotypic invasion model the presence of BMMSCs inhibited the proliferation but increased the invasion of OTSCC cells. Furthermore, the signals originating from OTSCC cells up-regulated the expression of inflammatory chemokines by BMMSCs, whereas BMMSC products induced the expression of known invasion linked molecules by carcinoma cells. Particularly, after the cell-cell interactions, the chemokine CCL5 was abundantly secreted from BMMSCs and a function blocking antibody against CCL5 inhibited BMMSC enhanced cancer invasion area. However, CCL5 blocking antibody did not inhibit the depth of invasion. Additionally, after exposure to BMMSCs, the expression of type I collagen mRNA in OTSCC cells was markedly up-regulated. Interestingly, also high expression of type I collagen N-terminal propeptide (PINP) in vivo correlated with the cancer-specific mortality of OTSCC patients, whereas there was no association between cancer tissue CCL5 levels and the clinical parameters. In conclusion, our results suggest that the interaction between BMMSC and carcinoma cells induce cytokine and matrix molecule expression, of which high level of type I collagen production correlates with the prognosis of OTSCC patients.

Use of statistical methods in dental research: comparison of four dental journals during a 10-year period

Objective. To investigate development of the use of statistical methods in dental journals in 1996, 2001, and 2006 hypothesizing that methods are becoming more sophisticated. Material and methods. All original research articles in four dental journals in 1996, 2001, and 2006 were reviewed: Journal of Dental Research (JDR), Caries Research (CR), Community Dentistry and Oral Epidemiology (CDOE) and Acta Odontologica Scandinavica (AOS). Evaluation covered 928 articles reporting original research findings based on systematic collection and statistical analysis of research data. Aspects measured were: research design, statistical methodology, description of procedures, and presentation of results. Percentage frequencies of reported statistical procedures were compared between journals and between years. Results. The main findings of the study are: 1) that use of multivariate or specific methods did not increase from 1996 to 2006, 2) that traditional statistical significance testing is still widely used in dental journals and that use of confidence intervals increased in the period 1996 to 2006, 3) that statistical procedures are usually extensively described, and 4) that dental journals have different profiles in their statistical content. Conclusions. The authors of articles in dental journals might apply these results when designing their dental research, i.e. to use statistical methods and to present results in line with the policy and presentation of the leading dental journals.

Geriatric and physically oriented rehabilitation improves the ability of independent living and physical rehabilitation reduces mortality: a randomised comparison of 538 patients

Objective: To examine effects of physical and geriatric rehabilitation on institutionalisation and mortality after hip fracture. Design: Prospective randomised study. Setting: Physically oriented (187 patients), geriatrically oriented (171 patients), and health centre hospital rehabilitation (180 patients, control group). Subjects: A total of 538 consecutively, independently living patients with non-pathological hip fracture. Main measures: Patients were evaluated on admission, at 4 and 12 months for social status, residential status, walking ability, use of walking aids, pain in the hip, activities of daily living (ADL) and mortality. Results: Mortality was significantly lower at 4 and 12 months in physical rehabilitation (3.2%, 8.6%) than in geriatric rehabilitation group (9.6%, 18.7%, P=0.026, P=0.005, respectively) or control group (10.6%, 19.4%, P=0.006, P=0.004, respectively). At 4 months more patients in physical (84.4%) and geriatric rehabilitation group (78.0%) were able to live at home or sheltered housing than in control group (71.9%, P=0.0012 and P<0.001, respectively). No significant difference was found between physical rehabilitation and geriatric rehabilitation (P=0.278). Analysis of femoral neck and trochanteric fractures showed that significant difference was true only for femoral neck fractures (physical rehabilitation vs geriatric rehabilitation P=0.308, physical rehabilitation vs control group P<0,001 and geriatric rehabilitation vs control group P<0.001). Effects of intensified rehabilitations disappeared at 12 months. No impact on walking ability or ADL functions was observed. Conclusions: Physical rehabilitation reduced mortality. Physical and geriatric rehabilitation significantly improved the ability of independent living after 4 months especially among the femoral neck fracture patients but this effect could not be seen after 12 months.

Evaluating performance of dental caries detection methods among third-year dental students.

BackgroundReliable caries detection is a cornerstone in the modern caries treatment schema. This study aimed to evaluate adopting traditional and new caries detection methods by third-year dental students.MethodsFifty-seven students were given lectures on caries detection, after which they evaluated 27 extracted carious teeth using traditional clinical assessment (CE), Nyvad’s, and ICDAS methods. On three teeth they also performed DIAGNOdent pen® (LF) scanning. Histological scores of the sectioned teeth (ICDAS, LF) and activity estimations of the lesions by the supervisors were used as golden standards (Nyvad, CE). For the ICDAS method , sensitivity and specificity were calculated using dentine caries (D3) as a cut-off point. Mean ICC and kappa values were calculated to evaluate interexaminer agreement for all lesions and methods. Spearman’s correlation coefficient evaluated LF scanning.ResultsICDAS method presented good sensitivity ( 0.78) and specificity (0.87). The inter-examiner agreement for different methods was fair or good (CE ICC = 0.69, κ = 0.53; Nyvad’s method ICC = 0.68, κ = 0.48, ICDAS ICC = 0.66, κ = 0.47). Variation in LF values was the greatest with lesions extending to middle third of dentin. In that case, the Spearman’s correlation coefficient was also the weakest.ConclusionsTo follow the guidelines by the European Core Curriculum on Cariology, the third year dental students are introduced to methods for detecting lesion depth and assessing lesion activity as well as using new caries detection methods. Their performance in estimating lesion depth is good, and fair to good in estimating lesion activity even after basic training only.

The statistical reporting quality of articles published in 2010 in five dental journals

Abstract Objectives. Statistical methods play an important role in medical and dental research. In earlier studies it has been observed that current use of methods and reporting of statistics are responsible for some of the errors in the interpretation of results. The aim of this study was to investigate the quality of statistical reporting in dental research articles. Methods. A total of 200 articles published in 2010 were analysed covering five dental journals: Journal of Dental Research, Caries Research, Community Dentistry and Oral Epidemiology, Journal of Dentistry and Acta Odontologica Scandinavica. Each paper underwent careful scrutiny for the use of statistical methods and reporting. A paper with at least one poor reporting item has been classified as ‘problems with reporting statistics’ and a paper without any poor reporting item as ‘acceptable’. Results. The investigation showed that 18 (9%) papers were acceptable and 182 (91%) papers contained at least one poor reporting item. Conclusions. The proportion of at least one poor reporting item in this survey was high (91%). The authors of dental journals should be encouraged to improve the statistical section of their research articles and to present the results in such a way that it is in line with the policy and presentation of the leading dental journals.

The use of time-to-event methods in dental research: a comparison based on five dental journals over a 11-year period

OBJECTIVES Time-to-event methods are used in multivariate data analysis to describe the relationship between patient variables and the timing of an outcome event. The aims of this study were to evaluate the reporting of statistical techniques and results in dental research papers with special reference to time-to-event (TTE) methods and to create guidelines for the appropriate reporting of these methods. METHODS All the original research reports published in five dental journals in 1996, 2001, 2005, 2006, and 2007 were reviewed. The evaluation covered 1985 articles that were based on the systematic collection and statistical analysis of research data. Differences between TTE approaches and others were assessed in terms of the justification for the number of cases, description of procedures, statistical references, software used, and statistical figures and tables provided. RESULTS Fifty-six papers (2.8% of the total) used time-to-event methods, the frequency of which increased slightly from 1996 to 2007 (P = 0.061). Statistical procedures were described more extensively in the papers, which used TTE methods. Reporting of the statistical methodology in papers using other methods was in general inadequate. CONCLUSIONS TTE methods are underused in dental research. Authors could well take heed of these results when designing their research, so as to make more use of such methods and to present the results in a manner that is in line with the policy and presentation of the leading dental journals. Authors could also improve their statistical reporting with the help of the guidelines presented here.

An instrument to assess the statistical intensity of medical research papers

Background There is widespread evidence that statistical methods play an important role in original research articles, especially in medical research. The evaluation of statistical methods and reporting in journals suffers from a lack of standardized methods for assessing the use of statistics. The objective of this study was to develop and evaluate an instrument to assess the statistical intensity in research articles in a standardized way. Methods A checklist-type measure scale was developed by selecting and refining items from previous reports about the statistical contents of medical journal articles and from published guidelines for statistical reporting. A total of 840 original medical research articles that were published between 2007–2015 in 16 journals were evaluated to test the scoring instrument. The total sum of all items was used to assess the intensity between sub-fields and journals. Inter-rater agreement was examined using a random sample of 40 articles. Four raters read and evaluated the selected articles using the developed instrument. Results The scale consisted of 66 items. The total summary score adequately discriminated between research articles according to their study design characteristics. The new instrument could also discriminate between journals according to their statistical intensity. The inter-observer agreement measured by the ICC was 0.88 between all four raters. Individual item analysis showed very high agreement between the rater pairs, the percentage agreement ranged from 91.7% to 95.2%. Conclusions A reliable and applicable instrument for evaluating the statistical intensity in research papers was developed. It is a helpful tool for comparing the statistical intensity between sub-fields and journals. The novel instrument may be applied in manuscript peer review to identify papers in need of additional statistical review.

Costs after hip fracture in independently living patients: A randomised comparison of three rehabilitation modalities

Objective: To evaluate costs and cost-effectiveness of physical and geriatric rehabilitation after hip fracture. Design: Prospective randomised study (mean age 78 years, 105 male, 433 female) in different rehabilitation settings: physically oriented (187 patients), geriatrically oriented (171 patients), and healthcare centre hospital (control, 180 patients). Main measures: At 12 months post-fracture, we collected data regarding days in rehabilitation, post-rehabilitation hospital treatment, other healthcare service use, number of re-operations, taxi use by patient or relative, and help from relatives. Results: Control rehabilitation (4945,2€) was significantly less expensive than physical (6609.0€, p=0.002) and geriatric rehabilitation (7034.7€ p<0.001). Total institutional care costs (primary treatment, rehabilitation, and post-rehabilitation hospital care) were lower for control (13,438.4€) than geriatric rehabilitation (17,201.7€, p<0.001), but did not differ between control and physical rehabilitation (15659.1€, p=0.055) or between physical and geriatric rehabilitation (p=0.252). Costs of help from relatives (estimated as 30%, 50% and 100% of a home aid’s salary) with physical rehabilitation were lower than control (p=0.016) but higher than geriatric rehabilitation (p=0.041). Total hip fracture treatment costs were lower with physical (36,356€, 51,018€) than control rehabilitation (38,018€, 57,031€) at 50% and 100% of salary (p=0.032, p=0.014, respectively). At one year post-fracture, 15D-score was significantly higher in physical rehabilitation group (0.697) than geriatric rehabilitation group (0.586, p=0.008) and control group (0.594, p=0.009). Conclusions: Considering total costs one year after hip fracture the treatment including physical rehabilitation is significantly more cost-effective than routine treatment. This effect could not be seen between routine treatment and treatment including geriatric rehabilitation.

Reporting data analysis methods in high-impact respiratory journals

Data analysis methods play an important role in respiratory research. We evaluated the application and complexity of data analytical methods in high-impact respiratory journals and compared the statistical reporting in these respiratory articles with reports published in other eminent medical journals. This study involved a total of 160 papers published in 2015 in the European Respiratory Journal, American Journal of Respiratory and Critical Care Medicine, Chest and Thorax, and 680 papers published between 2007–2015 in other medical journals including the Lancet and New England Journal of Medicine. We manually reviewed the articles to determine the way in which they reported the methods applied in data analysis. The statistical intensity in the respiratory journals was equal to that in eminent medical journals. Traditional ways of testing statistical significance were widely used in respiratory articles. Statistical procedures were not always described in sufficient detail, and the prominent respiratory journals did not display different profiles with respect to their statistical content. Readers of the prominent respiratory journals need to possess a substantial level of statistical expertise if they wish to critically evaluate the design, methodology, data analysis and interpretation of the findings published in these journals. Statistical data analysis methods play an important role in prominent respiratory journals http://ow.ly/DMQz30k7PPS

Oral health behaviors associated with dental general anesthesia amonghealthy children

Background: Background: The aim of this survey was to investigate family-related factors among healthy children treated under dental general anesthesia (DGA) compared to those treated in a normal dental setting. Methods: The survey comprised 87 children whose dental treatment was performed under DGA and 103 age-matched children who were treated in a normal setting. The children were healthy 3 to 11-year-olds, and their parents filled out the questionnaire on parental dental fear, DGA experiences in the family, and oral health behaviors. The data were collected in primary health care in the city of Oulu, Finland, during 2014– 2016. Results: In the DGA group, the proportion of fearful parents was three-fold higher and the proportion of siblings with DGA experience four-fold higher than in the comparison group; the differences between the groups were statistically significant. The dietary habits were statistically significantly poorer in the DGA group than among the comparison group when several indicators were considered. Linear regression analysis showed that treating a child in DGA was associated with harmful oral health behaviors like eating candy, drinking juice, and poor tooth brushing habits. Conclusions: Parental dental fear, DGA experiences of siblings, and harmful oral health behaviors were more common among children treated in a normal dental setting. Screening children and families for the risk indicators identified in this study may help prevent unnecessary DGAs among healthy control.