Potential therapeutic role of spermine via Rac1 in osteoporosis:Insights from zebrafish and mice

Osteoporosis(OP)is a prevalent metabolic bone disease.While drug therapy is essential to prevent bone loss in osteoporotic patients,current treatments are limited by side effects and high costs,necessitating the development of more effective and safer targeted therapies.Utilizing a zebrafish(Danio rerio)larval model of osteoporosis,we explored the influence of the metabolite spermine on bone homeostasis.Results showed that spermine exhibited dual activity in osteoporotic zebrafish larvae by increasing bone formation and decreasing bone resorption.Spermine not only demonstrated excellent biosafety but also mitigated prednisolone-induced embryonic neurotoxicity and cardiotoxicity.Notably,spermine showcased protective attributes in the nervous systems of both zebrafish embryos and larvae.At the molecular level,Rac1 was identified as playing a pivotal role in mediating the antiosteoporotic effects of spermine,with P53 potentially acting downstream of Rac1.These findings were confirmed using mouse(Mus musculus)models,in which spermine not only ameliorated osteoporosis but also promoted bone formation and mineralization under healthy conditions,suggesting strong potential as a bonestrengthening agent.This study underscores the beneficial role of spermine in osteoporotic bone homeostasis and skeletal system development,highlighting pivotal molecular mediators.Given their efficacy and safety,human endogenous metabolites like spermine are promising candidates for new anti-osteoporotic drug development and daily bone-fortifying agents.

WNT7A promotes tumorigenesis of head and neck squamous cell carcinoma via activating FZD7/JAK1/STAT3 signaling

Wnt signaling are critical pathway involved in organ development, tumorigenesis, and cancer progression. WNT7A, a member of the Wnt family, remains poorly understood in terms of its role and the underlying molecular mechanisms it entails in head and neck squamous cell carcinoma (HNSCC). According to the Cancer Genome Atlas (TCGA), transcriptome sequencing data of HNSCC, the expression level of WNT7A in tumors was found to be higher than in adjacent normal tissues, which was validated using Real-time RT-PCR and immunohistochemistry. Unexpectedly, overexpression of WNT7A did not activate the canonical Wnt-β-catenin pathway in HNSCC. Instead, our findings suggested that WNT7A potentially activated the FZD7/JAK1/STAT3 signaling pathway, leading to enhanced cell proliferation, self-renewal, and resistance to apoptosis. Furthermore, in a patient-derived xenograft (PDX) tumor model, high expression of WNT7A and phosphorylated STAT3 was observed, which positively correlated with tumor progression.These findings underscore the significance of WNT7A in HNSCC progression and propose the targeting of key molecules within the FZD7/JAK1/STAT3 pathway as a promising strategy for precise treatment of HNSCC.

Porphyromonas gingivalis bacteremia increases the permeability of the blood-brain barrier via the Mfsd2a/Caveolin-1 mediated transcytosis pathway

Bacteremia induced by periodontal infection is an important factor for periodontitis to threaten general health. P. gingivalis DNA/virulence factors have been found in the brain tissues from patients with Alzheimer’s disease(AD). The blood-brain barrier(BBB) is essential for keeping toxic substances from entering brain tissues. However, the effect of P. gingivalis bacteremia on BBB permeability and its underlying mechanism remains unclear. In the present study, rats were injected by tail vein with P. gingivalis three times a week for eight weeks to induce bacteremia. An in vitro BBB model infected with P. gingivalis was also established. We found that the infiltration of Evans blue dye and Albumin protein deposition in the rat brain tissues were increased in the rat brain tissues with P. gingivalis bacteremia and P. gingivalis could pass through the in vitro BBB model. Caveolae were detected after P. gingivalis infection in BMECs both in vivo and in vitro. Caveolin-1(Cav-1) expression was enhanced after P. gingivalis infection.Downregulation of Cav-1 rescued P. gingivalis-enhanced BMECs permeability. We further found P. gingivalis-gingipain could be colocalized with Cav-1 and the strong hydrogen bonding between Cav-1 and arg-specific-gingipain(RgpA) were detected.Moreover, P. gingivalis significantly inhibited the major facilitator superfamily domain containing 2a(Mfsd2a) expression. Mfsd2a overexpression reversed P. gingivalis-increased BMECs permeability and Cav-1 expression. These results revealed that Mfsd2a/Cav-1 mediated transcytosis is a key pathway governing BBB BMECs permeability induced by P. gingivalis, which may contribute to P. gingivalis/virulence factors entrance and the subsequent neurological impairments.

Genomic alterations in oral multiple primary cancers

Oral squamous cell carcinoma (OSCC) is the predominant type of oral cancer, while some patients may develop oral multiple primary cancers (MPCs) with unclear etiology. This study aimed to investigate the clinicopathological characteristics and genomic alterations of oral MPCs. Clinicopathological data from patients with oral single primary carcinoma (SPC, n=202) and oral MPCs (n=34) were collected and compared. Copy number alteration (CNA) analysis was conducted to identify chromosomal-instability differences among oral MPCs, recurrent OSCC cases, and OSCC patients with lymph node metastasis. Whole-exome sequencing was employed to identify potential unique gene mutations in oral MPCs patients. Additionally, CNA and phylogenetic tree analyses were used to gain preliminary insights into the molecular characteristics of different primary tumors within individual patients. Our findings revealed that, in contrast to oral SPC, females predominated the oral MPCs (70.59%), while smoking and alcohol use were not frequent in MPCs.Moreover, long-term survival outcomes were poorer in oral MPCs. From a CNA perspective, no significant differences were observed between oral MPCs patients and those with recurrence and lymph node metastasis. In addition to commonly mutated genes such as CASP8, TP53 and MUC16, in oral MPCs we also detected relatively rare mutations, such as HS3ST6 and RFPL4A. Furthermore, this study also demonstrated that most MPCs patients exhibited similarities in certain genomic regions within individuals, and distinct differences of the similarity degree were observed between synchronous and metachronous oral MPCs.

Oral health status in Sichuan Province: findings from the oral health survey of Sichuan, 2015–2016

To investigate oral health status in the residents of Sichuan Province, southwest China, a cross-sectional study was performed using the latest Oral Health Survey Basic Methods recommended by the World Health Organization. A multistage stratified random cluster-sampling method was used to enroll participants from the following three groups： children aged 3-5 years, adolescents aged 12 years, and people aged 65-74 years. In these three groups, the mean numbers of teeth that were affected by caries were 3.28, 0.86 and 5.13, respectively, resulting in a prevalence of 63.47%, 37.20% and 83.20%, respectively. Relative to the high rate of decayed teeth, the prevalence of fillings was very low in all age groups （0.97%, 7.24% and 5.43%, respectively）, In the 12-year-old adolescent group, only 3.61% had good pit and fissure sealing. In addition, the rate of dental fluorosis was 24.80%, and the Community Fluorosis Index value was 0.39. In the elder group, the community periodontal index was 2.92. The prevalence in the elderly of having lost at least one tooth was 75.54%. Additionally, 4.44% of these participants were edentulous. The incidence of dental prosthesis was 51.75%, the proportion with a removable partial denture, a fixed denture, full dentures, dental implants and an informal fixed bridge was 21.59%, 11.45%, 4.64%, 0 and 16.67%, respectively. In this study, 8.2% of the elderly participants were affected by different types of oral mucosal lesions. Among such lesions, recurrent aphthous ulcers were most prevalent （2.69%） and oral lichen planuses were second （1.6%）. The conclusion presented in this survey is that oral diseases, especially dental caries and periodontal disease, are frequent and common in Sichuan province, China. Moreover, the treatment rate is very low, and primary prevention and treatment options are therefore urgently needed in this population.

Influences of trans-trans farnesol,a membrane-targeting sesquiterpenoid,on Streptococcus mutans physiology and survival within mixed-species oral biofilms

Trans-trans farnesol （tt-farnesol） is a bioactive sesquiterpene alcohol commonly found in propolis （a beehive product） and citrus fruits, which disrupts the ability of Streptococcus mutans （S. mutans） to form virulent biofilms. In this study, we investigated whether tt-farnesol affects cell-membrane function, acid production and/or acid tolerance by planktonic cells and biofilms of S. mutans UA159. Furthermore, the influence of the agent on S. mutans gene expression and ability to form biofilms in the presence of other oral bacteria （Streptococcus oralis （S. oralis） 35037 and Actinomyces naeslundii （.4. naeslundil） 12104） was also examined. In general, tt-farnesol （1 mmol-L-1） significantly increased the membrane proton permeability and reduced glycolytie activity of S. mutans in the planktonic state and in biofilms （P〈0.05）. Moreover, topical applications of 1 mmol-L＂l tt-farnesol twice daily （1 min exposure/treatment） reduced biomass accumulation and prevented ecological shifts towards S. mutans dominance within mixed-species biofilms after introduction of 1% sucrose. S. oralis （a non-cariogenie organism） became the major species after treatments with tt-farnesol, whereas vehicle-treated biofilms contained mostly S. mutans （〉90% of total bacterial population）. However, the agent did not affect significantly the expression of S. mutans genes involved in acidogenicity, acid tolerance or polysaccharide synthesis in the treated biofilms. Our data indicate that tt-farnesoi may affect the competi- tiveness of S. mutans in a mixed-species environment by primarily disrupting the membrane function and physiology of this bacterium. This naturally occurring terpenoid could be a potentially useful adjunctive agent to the current anti-biofilm/anti-caries chemotherapeutic strategies.

Oral Epidemic Diseases of Exposure Personnel in Long-term Low Dose Radiation

ORAL epidemic diseases of exposure personnel in long-term low-dose radiation yet have rarely been studied.Referred to WHO oral health survey method and symptom grading standard,data of 341 exposure persons in long-term low-dose radiation including o particle,β particle,and y rays,etc.,were collected from one camp in China in 2011 with cluster sampling and analyzed with Foxpro 6.0 and SPSS 16.0software.

An in vitro study on the efficacy of removing calcium hydroxide from curved root canal systems in root canal therapy

To compare the efficacy of various irrigants(citric acid, ethylenediaminetetraacetic acid(EDTA) and Na OCl) and techniques in removing Ca(OH)2in two types of curved root canal systems, simulated root canals with specific curvatures were used to investigate the effects of different irrigants and instruments on Ca(OH)2removal. The optimal methods were verified on extracted human teeth. Simulated root canals were assigned to one of two groups based on the irrigation solution: 10% citric acid or2.5% Na OCl. Each group was divided into four subgroups according to the technique used to remove Ca(OH)2. The percentage of Ca(OH)2removal in different sections of root canals was calculated. On the basis of the results obtained for the simulated canals, 10% citric acid and 17% EDTA were applied to remove Ca(OH)2from the extracted human teeth with curved root canal systems. The teeth were scanned by micro computed tomography to calculate the percentage of Ca(OH)2removal in the canals.In simulated root canals, we found that 10% citric acid removed more Ca(OH)2than 2.5% NaOCl in the 0–1 mm group from the apex level(Po0.05). Ultrasonic and Endo Activator activation significantly removed more Ca(OH)2than a size 30 K file in the apical third(Po0.05). However, there were no significant differences in any sections of the canals for 10% citric acid or 17%EDTA in removing Ca(OH)2in extracted human teeth. We concluded that it was effective to remove residual Ca(OH)2using the decalcifying solution with Endo Activator or Passive Ultrasonic Irrigation in a curved root canal system. A protocol for Ca(OH)2removal was provided based on the conclusions of this study and the methods recommended in previous studies.

Root canal morphology and configuration of 123 maxillary second molars by means of micro-CT

The aim of this study was to investigate the root canal configuration, accessory canals and number of main foramina of 123 maxillary second molars by means of micro-computed tomography. The teeth were scanned and reproduced with 3D software imaging. The root canal configuration and number of main foramina were evaluated by means of a four-digit system. The morphological complexity of human maxillary second molars is depicted by the number of accessory and connecting canals. The most frequently observed root canal configurations in the mesiobuccal root were 2-2-2/2 （19.5%）, 2-2-1/1 （14.6%） and 2-1-1/1 （13.0%）. A 1-1-1/1 configuration was observed in 93.5% and in 96.7% in the distobuccal and palatal roots, respectively. The MB1 mot canal had one accessory canal （18.7%）, and 8.9% of the MB2 root canal had one or two accessory canals. The distobuccal （11.3%） and palatal （14.6%） root canals had at least one accessory canal, and connecting canals were observed in 16.3% of mesiobuccal roots. The MB1, MB2, distobuccal and palatal root canals had one main foramen in 99.2%, 43.1%, 98.4% and 99.2% of samples, respectively. In the mesiobuccal root, one accessory foramen was detected in 14.6%, two were detected in 7.3%, and three were detected in 5.7%. The distobuccal root showed one or two accessory foramina in 9.1% of samples. The root canal configuration of maxillary second molars is quite heterogeneous; the mesiobuccal root has predominantly two root canal entrances （58.4%, 1 in 41.1%） with one main foramen （54.4%）. Two main foramina were observed in 43.0%. Morphological variations, connecting and accessory canals were observed in all apical thirds.

Susceptibilities of Oral Microbes to Some Medicinal Herbs

目的 :检测某些中草药对口腔微生物的抑制杀灭作用。方法 :制备七种中草药水浸液提取物 ,将水浸液提取物分别加至培养基中 ,观察各种口腔微生物的生长速度 ,确定水浸液提取物的最小抑菌量。结果 :夏枯草、金银花、厚朴、菊花、威灵仙、秦艽的水浸液提取物对所试验的口腔微生物生长无明显抑制作用 ,而黄连的水浸液提取物有明显的抑制作用 ,尤其对牙周致病菌牙龈卟啉菌 (初始抑菌量 0 .2 5 0mg ml)、伴放线放线杆菌 (初始抑菌量 0 .12 5mg ml)的抑制作用更强。结论 :黄连可用于某些口腔疾病尤其是牙周疾病的治疗及预防。

The brain activation pattern of the medial temporal lobe during chewing gum: a functional MRI study

The human brain is known to be influenced by environmental stimuli（Feeney et al.,1982;Kaplan,1988）.Therefore,research on the brain activation pattern by external stimuli has been an important topic in neuroscience（Kaplan,1988）.Chewing gum has been known to have a positive effect on cognition,including alertness,attention,cognitive processing speed,

Oral health status of Chinese residents and suggestions for prevention and treatment strategies

Objective:To understand the oral health status of urban and rural residents in China,the Fourth National Oral Health Epidemiological Survey (FNOHES) was conducted in 2015.Materials and methods:Based on the principles of multi-stage,stratified,equal capacity,and random sampling,the subjects included five groups of residents aged 3-5,12-15,35-44,55-64,and 65-74 years in all 31 provinces,municipalities,and autonomous regions except Hong Kong,Macao,and Taiwan.The total sample size was 172,425.The survey covered two areas,namely oral health status and knowledge,attitude and oral health behavior.Results:Residents in China had serious caries and poor periodontal condition.The prevalence of caries was above 50% in all age groups,subjects without periodontal disease accounted for <50%,and fewer than 50% of subjects brushed their teeth twice a day.Based on the results of the FNOHES,the following suggestions were proposed for improving the oral health in China in the future:to establish and improve the comprehensive prevention and control system for oral diseases,implement a comprehensive prevention and control strategy for priority groups,strengthen the oral health education for all people to improve oral health literacy,enhance dynamic monitoring to scientifically evaluate oral health status,and coordinate multi-party resources to establish and improve the oral health service security system.Conclusion:The oral health status of Chinese residents and their oral health behavior habits need to be improved.With the support of the administrative departments of the government and unremitting efforts of the oral health staff,all sectors of society must be coordinated to strengthen oral health education for the whole population.Furthermore,comprehensive prevention and control measures must be implemented for priority groups.

Xihuang pills induce apoptosis in hepatocellular carcinoma by suppressing phosphoinositide 3-kinase/protein kinase- B/mechanistic target of rapamycin pathway

BACKGROUND The phosphoinositide 3-kinase/protein kinase-B/mechanistic target of rapamycin(PI3K/Akt/mTOR) signalling pathway is crucial for cell survival, differentiation, apoptosis and metabolism. Xihuang pills(XHP) are a traditional Chinese preparation with antitumour properties. They inhibit the growth of breast cancer, glioma, and other tumours by regulating the PI3K/Akt/mTOR signalling pathway. However, the effects and mechanisms of action of XHP in hepatocellular carcinoma(HCC) remain unclear. Regulation of the PI3K/Akt/mTOR signalling pathway effectively inhibits the progression of HCC. However, no study has focused on the XHPassociated PI3K/Akt/mTOR signalling pathway. Therefore, we hypothesized that XHP might play a role in inhibiting HCC through the PI3K/Akt/mTOR signalling pathway.AIM To confirm the effect of XHP on HCC and the possible mechanisms involved.METHODS The chemical constituents and active components of XHP were analysed using ultra-performance liquid chromatography-quadrupole time of flight mass spectrometry(UPLC-Q-TOF-MS). Cellbased experiments and in vivo xenograft tumour experiments were utilized to evaluate the effect of XHP on HCC tumorigenesis. First, SMMC-7721 cells were incubated with different concentrations of XHP(0, 0.3125, 0.625, 1.25, and 2.5 mg/mL) for 12 h, 24 h and 48 h. Cell viability was assessed using the CCK-8 assay, followed by an assessment of cell migration using a wound healing assay.Second, the effect of XHP on the apoptosis of SMMC-7721 cells was evaluated. SMMC-7721 cells were stained with fluorescein isothiocyanate and annexin V/propidium iodide. The number of apoptotic cells and cell cycle distribution were measured using flow cytometry. The cleaved protein and mRNA expression levels of caspase-3 and caspase-9 were detected using Western blotting and quantitative reverse-transcription polymerase chain reaction(RT-qPCR), respectively.Third, Western blotting and RT–qPCR were performed to confirm the effects of XHP on the protein and mRNA expression of components of the PI3K/Akt/mTOR signalling pathway.Finally, the effects of XHP on the tumorigenesis of subcutaneous hepatocellular tumours in nude mice were assessed.RESULTS The following 12 compounds were identified in XHP using high-resolution mass spectrometry:Valine, 4-gingerol, myrrhone, ricinoleic acid, glycocholic acid, curzerenone, 11-keto-β-boswellic acid, oleic acid, germacrone, 3-acetyl-9,11-dehydro-β-boswellic acid, 5β-androstane-3,17-dione, and 3-acetyl-11-keto-β-boswellic acid. The cell viability assay results showed that treatment with 0.625mg/mL XHP extract decreased HCC cell viability after 12 h, and the effects were dose-and timedependent. The results of the cell scratch assay showed that the migration of HCC cells was significantly inhibited in a time-dependent manner by the administration of XHP extract(0.625mg/mL). Moreover, XHP significantly inhibited cell migration and resulted in cell cycle arrest and apoptosis. Furthermore, XHP downregulated the PI3K/Akt/mTOR signalling pathway, which activated apoptosis executioner proteins(e.g., caspase-9 and caspase-3). The inhibitory effects of XHP on HCC cell growth were determined in vivo by analysing the tumour xenograft volumes and weights.CONCLUSION XHP inhibited HCC cell growth and migration by stimulating apoptosis via the downregulation of the PI3K/Akt/mTOR signalling pathway, followed by the activation of caspase-9 and caspase-3.Our findings clarified that the antitumour effects of XHP on HCC cells are mediated by the PI3K/Akt/mTOR signalling pathway, revealing that XHP may be a potential complementary therapy for HCC.

Multi-disciplinary treatment of maxillofacial skeletal deformities by orthognathic surgery combined with periodontal phenotype modification:A case report

BACKGROUND Maxillofacial deformities are skeletal discrepancies that cause occlusal,functional,and esthetic problems,and are managed by multi-disciplinary treatment,including careful orthodontic,surgical,and periodontal evaluations.However,thin periodontal phenotype is often overlooked although it affects the therapeutic outcome.Gingival augmentation and periodontal accelerated osteogenic orthodontics(PAOO)can effectively modify the periodontal phenotype and improve treatment outcome.We describe the multi-disciplinary approaches used to manage a case of skeletal ClassⅢmalocclusion and facial asymmetry,with thin periodontal phenotype limiting the correction of deformity.CASE SUMMARY A patient with facial asymmetry and weakness in chewing had been treated with orthodontic camouflage,but the treatment outcome was not satisfactory.After examination,gingiva augmentation and PAOO were performed to increase the volume of both the gingiva and the alveolar bone to allow further tooth movement.After orthodontic decompensation,double-jaw surgery was performed to reposition the maxilla-mandibular complex.Finally,implant placement and chin molding were performed to restore the dentition and to improve the skeletal profile.The appearance and function were significantly improved,and the periodontal tissue remained healthy and stable.CONCLUSION In patients with dentofacial deformities and a thin periodontal phenotype,multi-disciplinary treatment that includes PAOO could be effective,and could improve both the quality and safety of orthodontic-orthognathic therapy.

Dental Epidemic Diseases and Oral Health Knowledge in People with Disabilities: a Survey in a Southwest City of China

PEOPLE with disabilities constitute an important group in the field of oral health care, yet have rarely been studied.Based on WHO methodol- ogy of oral health survey, data of 531 persons with disabilities in vision, hearing, intelligence or extremity, or with mental disease are collected from 4 different dis- Received for publication November 4, 2010.

Comparison between visual clinical examination and the replica method for assessments of sealant retention over a 2-year period

To compare the levels of agreement and the survival rates of sealant retention for different sealing materials over a 2-year period assessed using the visual clinical examination and replica methods, sealant retention data were obtained by visual clinical examination and from replicas of the same sealed tooth at baseline and at 0.5-, 1- and 2-year evaluation points in 407 children and were compared for agreement using kappa coefficients. Survival curves of retained sealants on occlusal surfaces were created using modified categorisation （fully retained sealants and those having all pits and fissures partly covered with the sealant material versus completely lost sealants that included pit and fissure systems that had /〉 1 pit re-exposed） according to the Kaplan-Meier method. The kappa coefficient for the agreement between both assessment methods over the three evaluation time points combined was 0.38 （95% confidence interval （CI）： 0.35-0.41）. More sealant retention was observed from replicas than through visual clinical examination. Cumulative survival curves at the three evaluation times were not statistically significantly higher when assessed from replicas （P=0.47）. Using the replica method, more retained sealant material was observed than through visual clinical examination during the 2-year period. This finding did not result in a difference in the survival rates of sealants assessed by the two assessment methods. When replicas cast in die stone are used for assessing sealant retention, the level of reliability of the data is higher than that of data obtained through the commonly used visual clinical examination, particularly if such assessments are conducted over time.

Two-Phase Transplantation (TPTX) Concept: A New Approach for Instant Rehabilitation of Young Children after Avulsion of Central Incisor

Background: To present a new idea for rapid management of tooth avulsion in young children and adolescents (age: 6 to 16) by this case report. Case presentation: A nine-year-old boy presented with loss of upper permanent central incisor in early mixed dentition (6 to 10 years, phase I). The not yet fully resorbed primary canine was used as tooth transplant for the lost incisor. The intentional renounce on endodontic treatment of the primary transplant permits natural exfoliation of the transplant occurring either spontaneously or due to undermining resorption through the adjacent erupting teeth. In the late mixed dentition (10 to 16 years, phase II), the primary tooth transplant is electively removed and replaced by a premolar autotransplant for long-term rehabilitation of the meanwhile adolescent patient. Results: Primary canine autoTX acts as a temporary denture with instant surgical gap closure. Ensuing premolar autoTX in phase II then acts as permanent denture with excellent 10 years survival rates. Patient satisfaction issued by a questionnaire resulted in good to very good school grades for both phases of autotransplantation. Conclusions: The “TPTX” concept is a new surgical approach that immediately restores the patient’s function and aesthetics after tooth loss in early childhood supporting the growth of local bone and soft tissue in the growing adolescent jaw.

Oral and peri-oral signs and symptoms of herbal dentifrices in patients in two oral medicine clinics in Lagos—A preliminary study

Background: Herbal dentifrices appear to have become an attractive alternative for some consumers and its use has gained appreciable acceptance in Nigeria. This could be partly due to the perception that herbal toothpastes like other herbal products are “natural”, devoid of chemicals and therefore superior to regular toothpastes. Aggressive advertisement of the products may also contribute to this new trend. Mucosal symptoms such as glossitis and intolerance to spicy foods seen in patients attending the oral diagnosis clinic are usually associated with anaemia and nutritional deficiency states. The disturbing trend of an increasing number of patients presenting with such oral mucosal symptoms associated with the use of herbal dentifrices prompted this study. This trend was observed in two isolated oral medicine clinics. Objective: To sensitize oral health, allied professionals and consumers on the possible adverse effects of regular use of some herbal dentifrices sold in Nigeria. Materials and Methods: Routine patients of two oral medicine clinics in Lagos, namely the Randle General Hospital and the Lagos University Teaching Hospital who complained of some adverse mucosal signs and symptoms following the regular use of two identified herbal toothpastes made up the study population. The study was conducted between April 2010-April 2011. A detailed history and examination was carried out on these patients and clinical photographs of oral signs observed was taken in consenting patients. Data analysis was done using the Epi-info 6 software. P values ≤ 0.05 was considered statistically significant and data was presented in table format. Results: A total of 45 patients, 9 (20%) males and 36 (80%) fe-males were seen. The age range of patients was 14 - 78 years;mean age 45.5 ± 14.9 years. The duration of use of herbal dentifrices ranged from 2 weeks - 84 months (mean 24 ± 11.5 months). Oral signs and symptoms seen include, burning mouth and peppery sensation, mucosal erythema, lichenoid reaction, xerostomia, loss of taste sensation, angio-oedema and oral and peri-oral pigmentation. In many patients, resolution of symptoms was progressive within 2 weeks of withdrawal of the herbal toothpaste and its replacement with a conventional fluoride toothpaste. Most of the patients however required further treatment. A statistically significant association was found between the use of the identified herbal dentifrices and the following mucosal signs and symptoms namely, burning mouth and peppery sensation ,loss of taste sensation, soreness, erythema and lichenoid straie (p value ≤ 0.05). There was no statistically significant association between the use of herbal toothpaste and mucosal signs and symptoms of xerostomia, angular cheilitis, mucosal itching, angio-oedema and numbness (p value > 0.0.5) Conclusion: The regular use of the herbal dentifrices identified in this study can result in oral signs and symptoms affecting taste , nutrition, aesthetics and general oral physiology in some consumers. These findings suggest that further long term clinical trials need to be conducted on the herbal dentifrices to identify the noxious agents causing these symptoms. The formulation and use of these dentifrices need to be standardized and regulated. There is also a need to formulate a treatment protocol for these patients.

Assessment of Health Purchasing Functions for Universal Health Coverage in Nigeria: Evidence from Grey Literature and Key Informant Interviews

Objective: Out of pocket expenditure is the primary means of financing healthcare in middle and low-income countries. The 2021 government health expenditure in Nigeria at 4.52% falls short of the 15% recommendation of the 2001 Abuja Declaration. This paper examines healthcare purchasing in Nigeria, in order to explore how resources were allocated and create better insight into healthcare purchasing for universal health coverage. Data Source/Study Setting: The study was conducted in the Federal Capital Territory and three states—Lagos, Enugu and Sokoto. Study Design: A cross sectional method was used to examine health purchasing functions in Nigeria. Key informant interviews and review of grey and published literature on health financing in the selected study areas. Data Collection Methods: Primary data were collected from relevant stakeholders across the selected study areas, using a structured interview guide. A search of grey and published literature gave a total of 57 references. Principal Findings: The NHIS has a clearly articulated benefit package, for its formal sector and pro-poor BHCPF program. NHIS covers only about 5% of the Nigerian population. BHCPF (SOML) program targets the bottom 40% of Nigerians on paper, but there is no specific design for reaching them. The NHIS uses both public and private sector providers. It is not clear which providers are used for the BHCPF (SOML) program. The NHIS uses actuarially calculated capitations for primary care services and market-based fee-for-service rates for reimbursing secondary and tertiary care. BHCPF (SOML) uses a macroscale pay-for-performance mechanism to reward states achieving specific health outcomes. Conclusion: Health purchasing functions have serious implication for UHC. However, health care provision in Nigeria is not pro-poor and government efforts do not promote efficiency. Available option is prioritization of health initiatives that ensure value for money through performance-based financing and partnering with the private sector.

Prevalence of oral lesions and the effects of HAART in adult HIV patients attending a tertiary hospital in Lagos, Nigeria

Background: Oral lesions have been reported to be early clinical features of HIV infection. The objective of this study was to establish the prevalence of oral lesions and the management outcome using HAART in HIV Seropositive patients attending a tertiary hos- pital in Lagos, Nigeria. Methods: This was a prospective study in 114 newly diagnosed adult HIV infected patients (not on antiretroviral therapy), who attended the PEPFAR clinic at Lagos University Teaching Hospital. They were assessed for oral lesions which were evaluated using EEC/WHO—Classification on the diagnostic criteria for oral lesions in HIV. Data were collected using an interviewer administered questionnaire. Oral examination was carried out and oral lesions detected were recorded. Presence or absence of oral lesions was evaluated following 3 months use of HAART. Results: 114 patients were enrolled into the study, 49(43.0%) males and 65(57.0%) females, with age range of 18-63 years. 42 (36.8%) presented with oral lesions, 19 (45.2%) of which had multiple lesions. Oral Candidiasis which accounted for 47.7% was the most common oral lesion observed followed by Oral Hairy Leukoplakia (21.6%) and oral hyperpigmentation (10.8%). Pseudomembraneous Candidiasis was the most common variant of oral Candidiasis seen. Prevalence of oral lesions was significantly associated with low CD4 count and high viral load. Eighty four percent (84%) of oral lesions disappeared following 3 months of HAART treatment. Conclusion: Oral lesions are common features of HIV and a marker for progression of the disease to AIDS. There was significant reduction in oral lesions following 3 months treatment with HAART.