Publications by authors named "Jukka Meurman"

131 Publications

Daily Administered Dual-Light Photodynamic Therapy Provides a Sustained Antibacterial Effect on .

Antibiotics (Basel) 2021 Oct 13;10(10). Epub 2021 Oct 13.

Department of Neuroscience and Biomedical Engineering, Aalto University, 02150 Espoo, Finland.

New means to reduce excessive antibiotic use are urgently needed. This study tested dual-light aPDT against biofilm with different relative ratios of light energy with indocyanine green. We applied single-light aPDT (810 nm aPDT, 405 aBL) or dual-light aPDT (simultaneous 810 nm aPDT and 405 nm aBL), in both cases, together with the ICG photosensitizer with constant energy of 100 or 200 J/cm. Single-dose light exposures were given after one-day, three-day, or six-day biofilm incubations. A repeated daily dose of identical light energy was applied during biofilm incubations for the three- and six-day biofilms. Using 100 J/cm light energy against the one-day biofilm, the dual-light aPDT consisting of more than half of aBL was the most effective. On a three-day maturated biofilm, single-dose exposure to aPDT or dual-light aPDT was more effective than aBL alone. With total light energy of 200 J/cm, all dual-light treatments were effective. Dual-light aPDT improves the bactericidal effect on biofilm compared to aPDT or aBL and provides a sustained effect. An increase in the relative ratio of aBL strengthens the antibacterial effect, mainly when the treatment is repeatedly applied. Thus, the light components' energy ratio is essential with dual-light.
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http://dx.doi.org/10.3390/antibiotics10101240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8533018PMC
October 2021

Dual-Light Photodynamic Therapy Effectively Eliminates Streptococcus Oralis Biofilms.

J Pharm Pharm Sci 2021 ;24:484-487

Department of Congenital Heart Surgery and Organ Transplantation, New Children's Hospital, University of Helsinki, Finland.

Purpose: During cancer treatment, oral mucositis due to radiotherapy or chemotherapy often leads to disruption of the oral mucosa, enabling microbes to invade bloodstream. Viridans streptococcal species are part of the healthy oral microbiota but can be frequently isolated from the blood of neutropenic patients.  We have previously shown the antibacterial efficacy of dual-light, the combination of antibacterial blue light (aBL) and indocyanine green photodynamic therapy (aPDT).

Methods: Here, we investigated the dual-light antibacterial action against four-day Streptococcus oralis biofilm. In addition, while keeping the total radiant exposure constant at 100J/cm2, we investigated the effect of changing the different relative light energies of aBL and aPDT to the antibacterial potential.

Results: The dual-light had a significant antibacterial effect in all the tested combinations.

Conclusion: Dual-light can be used as an effective disinfectant against S. oralis biofilm.
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http://dx.doi.org/10.18433/jpps32084DOI Listing
January 2021

Oral Infections and Systemic Health - More than Just Links to Cardiovascular Diseases.

Oral Health Prev Dent 2021 Jan;19(1):441-448

Purpose: During the past 20 years, a plethora of research reports has been published showing a statistical association between poor oral health and cardiovascular diseases. The aim of this narrative review was to focus on associations between oral infections and non-atherosclerosis-related systemic diseases.

Materials And Methods: An open literature search and evaluation of articles were conducted on Medline and Cochrane databases with the key words 'oral infection', 'periodontitis', 'pneumonia', 'osteoarthritis', 'rheumatic diseases', 'inflammatory bowel disease', 'kidney disease', 'liver diseases', 'metabolic syndrome', 'diabetes', 'cancer', 'Alzheimer's disease'. Cardiovascular diseases were excluded from the analysis.

Results: The scarcity of controlled studies did not allow conducting a systematic review with meta-analysis on the topics, but dental infections have been shown be associated with several general diseases also beyond the atherosclerosis paradigm. However, there is no causal evidence of the role of dental infections in this regard. Poor oral health has nevertheless often been observed to be associated with worsening of the diseases and may also affect treatments.

Conclusions: Maintaining good oral health is imperative regarding many diseases, and its importance in the daily life of any patient group cannot be over emphasised.
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http://dx.doi.org/10.3290/j.ohpd.b1993965DOI Listing
January 2021

Active matrix metalloproteinase-8 (aMMP-8) point-of-care test (POCT) in the COVID-19 pandemic.

Expert Rev Proteomics 2021 08 11;18(8):707-717. Epub 2021 Sep 11.

Unit of Pedodontics and Preventive Dentistry, Oral Health Sciences Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.

Introduction: Active matrix metalloproteinase (aMMP)-8 utilized in point-of-care testing (POCT) is regarded as a potential biomarker for periodontal and peri-implant diseases. Various host and microbial factors eventually influence the expression, degranulation, levels and activation of aMMP-8. The type of oral fluids (saliva, mouthrinse, gingival crevicular, and peri-implant sulcular fluids [GCF/PISF], respectively) affect the analysis.

Areas Covered: With this background, we aimed to review here the recent studies on practical, inexpensive, noninvasive and quantitative mouthrinse and GCF/PISF chair-side POCT lateral flow aMMP-8 immunoassays (PerioSafe and ImplantSafe/ORALyzer) and how they help to detect, predict, monitor the course, treatment and prevention of periodontitis and peri-implantitis. The correlations of aMMP-8 POCT to other independent and catalytic activity assays of MMP-8 are also addressed.

Expert Opinion: The mouthrinse aMMP-8 POCT can also detect prediabetes/diabetes and tissue destructive oral side-effects due to the head and neck cancers' radiotherapy. Chlorhexidine and doxycycline can inhibit collagenolytic human neutrophil and GCF aMMP-8. Furthermore, by a set of case-series we demonstrate the potential of mouthrinse aMMP-8 POCT to real-time/online detect periodontitis as a potential risk disease for coronavirus disease 2019 (COVID-19). The clinical interdisciplinary utilization of aMMP-8 POCT requires additional oral, medical, and interdisciplinary studies.
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http://dx.doi.org/10.1080/14789450.2021.1976151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8442753PMC
August 2021

Commensals can become pathobionts.

J Clin Periodontol 2021 11 24;48(11):1491-1492. Epub 2021 Aug 24.

Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.

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http://dx.doi.org/10.1111/jcpe.13535DOI Listing
November 2021

Indocyanine Green-Assisted and LED-Light-Activated Antibacterial Photodynamic Therapy Reduces Dental Plaque.

Dent J (Basel) 2021 May 3;9(5). Epub 2021 May 3.

Department of Congenital Heart Surgery and Organ Transplantation, New Children's Hospital, University of Helsinki, 00290 Helsinki, Finland.

Aim: This study aimed to determine the feasibility and first efficacy of indocyanine green (ICG)-assisted antimicrobial photodynamictherapy (aPDT) as activated using LED light to the dental plaque.

Methods: Fifteen healthy adults were assigned to this four-day randomized study. After rinsing with ICG, 100 J/cm of 810 nm LED light was applied to the aPDT-treatment area. Plaque area and gingival crevicular fluid (GCF) matrix metalloproteinase-8 (MMP-8) were measured, and plaque bacteriomes before and after the study were analyzed using 16S rRNA sequencing.

Results: aPDT administration was preformed successfully and plaque-specifically with the combination of ICG and the applicator. Total plaque area and endpoint MMP-8 levels were reduced on the aPDT-treatment side. aPDT reduced , , , and bacteria species in plaques.

Conclusion: ICG-assisted aPDT reduces plaque forming bacteria and exerts anti-inflammatory and anti-proteolytic effects.
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http://dx.doi.org/10.3390/dj9050052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8147628PMC
May 2021

Periodontal microorganisms and diagnosis of malignancy: A cross-sectional study.

Tumour Biol 2021 ;43(1):1-9

Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Background: Oral infections associate statistically with cancer.

Objective: We hypothesized that certain periodontal microorganisms might specifically link to malignancies in general and set out to investigate this in our ongoing cohort study.

Methods: A sample of 99 clinically examined patients from our cohort of 1676 subjects was used to statistically investigate the associations between harboring periodontal microorganisms Aggregatibacter actinomycetemcomitans (A.a), Porphyromonas gingivalis (P.g), Prevotella intermedia (P.i), Tannerella forsythia (T.f) and Treponema denticola (T.d). We used oral infection indexes and the incidence figures of malignancies as registered in 2008-2016 in the Swedish National Cancer Register.

Results: The pathogen A.a showed strong association with malignancy in 32 out of the 99 patients while P.g and P.i were more prevalent among patients without malignancy. In principal component analyses, A.a appeared in the strongest component while the second strongest component consisted of a combination of T.f and T.d. The third component consisted of a combination of P.g and P.i, respectively. Of basic and oral health variables, gingival index appeared to be the strongest expression of inflammation (Eigen value 4.11 and Explained Variance 68.44 percent).

Conclusions: The results partly confirmed our hypothesis by showing that harboring certain periodontal bacteria might link to malignancy. However, the associations are statistical and no conclusions can be drawn about causality.
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http://dx.doi.org/10.3233/TUB-200066DOI Listing
May 2021

Salivary Biomarkers and Oral Health in Liver Transplant Recipients, with an Emphasis on Diabetes.

Diagnostics (Basel) 2021 Apr 7;11(4). Epub 2021 Apr 7.

Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, University of Helsinki, P.O. Box 220, 00100 Helsinki, Finland.

Salivary biomarkers have been linked to various systemic diseases. We examined the association between salivary biomarkers, periodontal health, and microbial burden in liver transplant (LT) recipients with and without diabetes, after transplantation. We hypothesized that diabetic recipients would exhibit impaired parameters. This study included 84 adults who received an LT between 2000 and 2006 in Finland. Dental treatment preceded transplantation. The recipients were re-examined, on average, six years later. We evaluated a battery of salivary biomarkers, microbiota, and subjective oral symptoms. Periodontal health was assessed, and immunosuppressive treatments were recorded. Recipients with impaired periodontal health showed higher matrix metalloproteinase-8 (MMP-8) levels ( < 0.05) and MMP-8/tissue inhibitor of matrix metalloproteinase 1 (TIMP1) ratios ( < 0.001) than recipients with good periodontal health. Diabetes post-LT was associated with impaired periodontal health ( < 0.05). No difference between groups was found in the microbial counts. Salivary biomarker levels did not seem to be affected by diabetes. However, the advanced pro-inflammatory state induced by and associated with periodontal inflammation was reflected in the salivary biomarker levels, especially MMP-8 and the MMP-8/TIMP-1 molar ratio. Thus, these salivary biomarkers may be useful for monitoring the oral inflammatory state and the course of LT recipients.
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http://dx.doi.org/10.3390/diagnostics11040662DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067605PMC
April 2021

Candida prevalence in saliva before and after oral cancer treatment.

Surgeon 2021 Dec 17;19(6):e446-e451. Epub 2021 Feb 17.

Departments of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Background: Previous studies have shown an increased prevalence of candidiasis in patients receiving radiotherapy for head and neck cancer. However, little is known of the effect the different cancer treatment modalities have on the oral Candida status.

Objective And Hypothesis: The objective of this study was to investigate the change in salivary Candida status of oral squamous cell carcinoma (OSCC) patients undergoing cancer treatment. The hypothesis was that cancer treatments change the oral microbial environment favouring an increase in the prevalence of more pathogenic non-albicans Candida (NAC).

Methods: We collected paraffin-stimulated saliva from 44 OSCC patients before surgery and after a minimum of 19 months of follow-up. Chromagar, Bichro-Dupli-test and API ID 32 C were used for identification of different Candida species and results were analysed statistically.

Results: At both timepoints, 75% of samples were Candida positive with C. albicans being the most common yeast. NAC strains were present in 16% of the pre-operative samples and 14% of the follow-up samples. The NAC species found were C. dubliniensis, C. krusei, C. guilliermondii (preoperatively only) and C. glabrata (at follow-up only). In 73% of the cases, the salivary Candida status remained unchanged. There was an 18% increase in the prevalence of candidiasis. However, the different treatment modalities did not statistically significantly affect the Candida status of the patients.

Conclusion: The intraindividual prevalence of salivary Candida among OSCC patients seems to be stable and different treatment modalities have little to no effect on the salivary Candida status.
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http://dx.doi.org/10.1016/j.surge.2021.01.006DOI Listing
December 2021

Mouthwash Effects on LGG-Integrated Experimental Oral Biofilms.

Dent J (Basel) 2020 Sep 1;8(3). Epub 2020 Sep 1.

Department of Pharmacology, Faculty of Medicine, University of Helsinki, 00100 Helsinki, Finland.

In order to investigate the effects of mouthwashes on oral biofilms with probiotics, we compared in biofilms the susceptibility to mouthwashes of probiotic GG (LGG) and oral pathogens , , and . We also evaluated these pathogens' susceptibility to the mouthwashes and their recovery after mouthwash-rinsing in biofilms with/without LGG. First, 1-day-/3-day-old LGG-integrated multi-species biofilms were exposed for 1 min to mouthwashes containing chlorhexidine, essential oils, or amine fluoride/stannous fluoride. Cells were plate-counted and relative survival rates (RSRs) of LGG and pathogens calculated. Second, 1-day-/3-day-old multispecies biofilms with and without LGG were exposed for 1 min to mouthwashes; cells were plate-counted and the pathogens' RSRs were calculated. Third, 1-day-old biofilms were treated for 1 min with mouthwashes. Cells were plate-counted immediately and after 2-day cultivation. Recovery rates of pathogens were calculated and compared between biofilms with/without LGG. Live/Dead staining served for structural analyses. Our results showed that RSRs of LGG were insignificantly smaller than those of pathogens in both 1-day and 3-day biofilms. No significant differences appeared in pathogens' RSRs and recovery rates after treatment between biofilms with/without LGG. To conclude, biofilm LGG was susceptible to the mouthwashes; but biofilm LGG altered neither the mouthwash effects on oral pathogens nor affected their recovery.
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http://dx.doi.org/10.3390/dj8030096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7560143PMC
September 2020

Tobacco Products, Periodontal Health and Education Level: Cohort Study from Sweden.

Dent J (Basel) 2020 Aug 10;8(3). Epub 2020 Aug 10.

Department of Dental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden.

Background: The aim of this study is to investigate if using tobacco products (including snuff, smoking tobacco and dual-using) associates with periodontal health, education level and mortality in a Swedish cohort, hypothesizing that tobacco products affect periodontal health, associate with lower education and increase the risk of death.

Method: Study cohort of 1080 subjects aged 31-40 years (528 men, 552 women) was clinically examined and interviewed in 1985 and followed for mortality until 2015. Subjects were classified into two groups: "tobacco users" and "non-users". Associations between periodontal health parameters, tobacco products, education level and age of death were analysed. SPSS was used for analyses.

Results: Tobacco products, as well as education level associated, with poor periodontal health. Tobacco users and lower education was linked to higher plaque-, calculus- and gingival-index scores than non-users ( 0.001). They also had significantly higher prevalence of deep periodontal pockets (≥5 mm) ( 0.001 and 0.010, respectively), missing teeth ( 0.010 and 0.003, respectively) and lower education level ( < 0.001) compared with non-users. However, tobacco product users did not die significantly earlier than non-users.

Conclusion: Tobacco products had a negative impact on periodontal health. Tobacco product users were less educated. However, using tobacco products may not cause premature death.
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http://dx.doi.org/10.3390/dj8030090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7559463PMC
August 2020

Salivary Biomarkers of Oral Inflammation Are Associated With Cardiovascular Events and Death Among Kidney Transplant Patients.

Transplant Proc 2020 Dec 4;52(10):3231-3235. Epub 2020 Aug 4.

Department of Oral and Maxillofacial Diseases, Head and Neck Center, Helsinki University Hospital, Helsinki, Finland; Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.

Background: Triggering receptors expressed on myeloid cells (TREMs) and their ligand, peptidoglycan recognition protein 1 (PGLYRP-1), have been detected in secretions from patients with inflammatory diseases, which may lead to the formation of atherosclerotic plaques. Here, we aimed to analyze the association between salivary concentrations of soluble (s)TREM-1 and PGLYRP-1 with death and cardiovascular disease before and after kidney transplantation.

Materials And Methods: Saliva samples from 53 patients on dialysis were collected during their regular dental evaluation before treatment and after kidney transplantation. Oral inflammatory burden was assessed from panoramic radiographs and full-mouth dental examination. Demographic data, graft function, patient survival, and history of major cardiovascular events (MACEs) were retrieved from hospital records.

Results: Salivary sTREM-1 before transplantation increased the odds for death and MACE. In addition, PGLYRP-1 increased the odds for MACE before transplantation. After transplantation, neither salivary sTREM-1 nor PGLYRP-1 increased the odds for death or MACE, probably because of the previous eradication of oral inflammatory foci. None of the studied biomarkers correlated with kidney transplant function.

Conclusions: Salivary sTREM-1 and PGLYRP-1 before transplantation were associated with MACE and death. The utility of salivary proinflammatory biomarkers for risk stratification in kidney transplant candidates requires further investigation.
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http://dx.doi.org/10.1016/j.transproceed.2020.07.007DOI Listing
December 2020

The life at the times of coronavirus: Microbes rule the world!

Authors:
Jukka H Meurman

Oral Dis 2021 04 22;27 Suppl 3:649-650. Epub 2020 Jun 22.

Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.

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http://dx.doi.org/10.1111/odi.13453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7300710PMC
April 2021

Dual-light photodynamic therapy administered daily provides a sustained antibacterial effect on biofilm and prevents Streptococcus mutans adaptation.

PLoS One 2020 6;15(5):e0232775. Epub 2020 May 6.

Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland.

Antibacterial photodynamic therapy (aPDT) and antibacterial blue light (aBL) are emerging treatment methods auxiliary to mechanical debridement for periodontitis. APDT provided with near-infrared (NIR) light in conjunction with an indocyanine green (ICG) photosensitizer has shown efficacy in several dental in-office-treatment protocols. In this study, we tested Streptococcus mutans biofilm sensitivity to either aPDT, aBL or their combination dual-light aPDT (simultaneous aPDT and aBL) exposure. Biofilm was cultured by pipetting diluted Streptococcus mutans suspension with growth medium on the bottom of well plates. Either aPDT (810 nm) or aBL (405 nm) or a dual-light aPDT (simultaneous 810 nm aPDT and 405 nm aBL) was applied with an ICG photosensitizer in cases of aPDT or dual-light, while keeping the total given radiant exposure constant at 100 J/cm2. Single-dose light exposures were given after one-day or four-day biofilm incubations. Also, a model of daily treatment was provided by repeating the same light dose daily on four-day and fourteen-day biofilm incubations. Finally, the antibacterial action of the dual-light aPDT with different energy ratios of 810 nm and 405 nm of light were examined on the single-day and four-day biofilm protocols. At the end of each experiment the bacterial viability was assessed by colony-forming unit method. Separate samples were prepared for confocal 3D biofilm imaging. On a one-day biofilm, the dual-light aPDT was significantly more efficient than aBL or aPDT, although all modalities were bactericidal. On a four-day biofilm, a single exposure of aPDT or dual-light aPDT was more efficient than aBL, resulting in a four logarithmic scale reduction in bacterial counts. Surprisingly, when the same amount of aPDT was repeated daily on a four-day or a fourteen-day biofilm, bacterial viability improved significantly. A similar improvement in bacterial viability was observed after repetitive aBL application. This viability improvement was eliminated when dual-light aPDT was applied. By changing the 405 nm to 810 nm radiant exposure ratio in dual-light aPDT, the increase in aBL improved the antibacterial action when the biofilm was older. In conclusion, when aPDT is administered repeatedly to S. mutans biofilm, a single wavelength-based aBL or aPDT leads to a significant biofilm adaptation and increased S. mutans viability. The combined use of aBL light in synchrony with aPDT arrests the adaptation and provides significantly improved and sustained antibacterial efficacy.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232775PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202659PMC
August 2020

Advocate cultivation of academic ethics: why is it necessary?

F1000Res 2019 30;8:1830. Epub 2019 Oct 30.

Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Toronto, Ontario, M5T 3L9, Canada.

We teach and practice ethical behavior with all clinical and research activities. Notably, we are well educated to treat the subjects participating in research studies with high ethical standards. However, the ethics of interacting with colleagues, or with junior faculty members, are neither well defined nor taught. Dealing with junior faculty has parallels to dealing with vulnerable research subjects such as children, mentally or physically challenged groups, prison inmates or army recruits. Like any other vulnerable population, lower-ranking faculty members are often at the mercy of department chairs or other higher-ranked faculty members. Herein we present some potentially unethical or unfair examples related to academic research. Our goal is to educate the academic community of conceptual paths and to prevent similar untoward occurrences from happening in the future. Unethical behaviors related to sexual misconduct have already been described elsewhere and are not included in this manuscript.
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http://dx.doi.org/10.12688/f1000research.20640.2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043133PMC
June 2020

The relationship between oral diseases and infectious complications in patients under dialysis.

Oral Dis 2020 Jul 19;26(5):1045-1052. Epub 2020 Feb 19.

Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Objectives: Association was investigated between oral health before dialysis and the incidence of systemic infections during dialysis. We hypothesized that low-grade systemic inflammation caused by poor oral health associates with infectious episodes in patients on dialysis, despite earlier eradication of oral infection foci.

Subjects And Methods: A total of 117 patients (46 with peritoneal and 71 with hemodialysis) were examined and treated at predialysis stage and followed up during dialysis. Number of infection episodes and microorganisms cultured from blood and peritoneal fluid were analyzed. Number of teeth, periodontal inflammatory burden, and total dental index scores were assessed, and salivary matrix metalloproteinase 8, triggering receptor on myeloid cells 1, peptidoglycan recognition protein 1 (PGLYRP1), and interleukin-1β were measured.

Results: In hemodialysis, 134 infection episodes were recorded, while peritoneal dialysis group had 77 peritonitis episodes. Culture-negative samples were 69% in hemodialysis and 23% in peritoneal dialysis group. Staphylococci were the most frequently associated microorganisms. Infections during dialysis did neither associate with oral health parameters nor associate with salivary inflammatory biomarkers, except for PGLYRP1, which associated with number of infection episodes during hemodialysis (p = .046).

Conclusions: A number of infection episodes during hemodialysis were associated with salivary PGLYRP1 but not the other salivary markers or oral infection markers.
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http://dx.doi.org/10.1111/odi.13296DOI Listing
July 2020

Oral Health in Women with a History of High Gestational Diabetes Risk.

Dent J (Basel) 2019 Sep 3;7(3). Epub 2019 Sep 3.

Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, PO Box 20, 00014 Helsinki, Finland.

We studied oral health in 115 women with and without a history of gestational diabetes (GDM), expecting poorer oral health in the GDM group. Full-mouth examinations were performed 5 years postpartum and the number of teeth, total dental index (TDI) and decayed, missing, filled teeth (DMFT) index were calculated. Bleeding on probing (BOP), probing depth (PD), visible plaque index (VPI), and clinical attachment level (CAL) were recorded. The periodontal inflammatory burden index (PIBI) was calculated. Panoramic radiographs were taken and signs of infections recorded. Oral health habits, symptoms and participants' own opinion of oral health were recorded with questionnaires. At the time of examination, 45% of the women had a history of GDM in the index pregnancy. Mild periodontitis (62%) and bleeding on probing (46%) were common. VPI (13% and 17%, = 0.009) and PIBI (13.1 and 17.5, = 0.041) were lower among women with a history of GDM compared with those with no history of GDM. There was no difference between groups in DMFT scores. All women reported good subjective oral health. Thus, contrary to our hypothesis, women with a history of GDM showed better oral health parameters than women without a history of GDM.
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http://dx.doi.org/10.3390/dj7030092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6784739PMC
September 2019

Oral and Systemic Effects of Xylitol Consumption.

Caries Res 2019 6;53(5):491-501. Epub 2019 May 6.

Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Recent results of randomized trials testing the efficacy of xylitol in caries prevention have been conflicting. This narrative review reveals the sources of discrepancy. The following databases were searched for the terms "xylitol" or "artificial sweeteners" restricted to the English language: PubMed, Web of Science, Evidenced-Based Medicine, Scopus, and the Cochrane database. In a separate search, the terms "dental caries" or "cariogenicity" or "glucosyltransferase" or "low glycemic" or "low insulinemic" or "dysbiosis" or "gut microbiome" were used and then combined. In section I, findings regarding the role of xylitol in dental caries prevention, the appropriateness of research methods, and the causes for potential biases are summarized. In section II, the systemic effects of xylitol on gut microbiota as well as low-glycemic/insulinogenic systemic effects are evaluated and summarized. The substitution of a carbonyl group with an alcohol radical in xylitol hinders its absorption and slowly releases sugar into the bloodstream. This quality of xylitol is beneficial for diabetic patients to maintain a constant glucose level. Although this quality of xylitol has been proven in in vitro and animal studies, it has yet to be proven in humans. Paradoxically, recent animal studies reported hyperglycemia and intestinal dysbiosis with artificial sweetener consumption. Upon careful inspection of evidence, it was revealed that these reports may be due to misinterpretation of original references or flaws in study methodology. Any systemic benefits of xylitol intake must be weighed in consideration with the well-established adverse gastrointestinal consequences. The contribution of xylitol to gut dysbiosis that may affect systemic immunity warrants further research.
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http://dx.doi.org/10.1159/000499194DOI Listing
July 2020

Role of Non-Albicans Candida and Candida Albicans in Oral Squamous Cell Cancer Patients.

J Oral Maxillofac Surg 2018 12 14;76(12):2564-2571. Epub 2018 Jun 14.

Professor, Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Purpose: This study examined the prevalence of Candida species in the saliva of oral squamous cell carcinoma patients and its effect on the mortality rate.

Materials And Methods: One hundred patients with oral cavity squamous cell carcinoma undergoing protocol treatment at Helsinki University Hospital were recruited into the study from March 2011 through 2014. For comparison, 75 age-matched controls with no current or previously treated oral cancer were recruited. Paraffin-stimulated whole saliva samples were collected and cultivated on CHROMagar Candida medium (CHROMagar, Paris, France) to establish possible Candida growth. The API ID 32C yeast identification kit (bioMérieux, Lyon, France) and Bichro-Dubli Fumouze latex agglutination test (Fumouze Diagnostics, Levallois-Perret, France) were used for further identification of different Candida species. Patients' medical records were studied for information on their health habits and general health status, as well as tumor-related data. The patients' status regarding being alive and cancer free was checked at a follow-up point in December 2017. Descriptive statistics and cross tabulation were carried out, and the P value was set at .05.

Results: Candida species were detected in 74% of the oral cancer patients' samples, with C. albicans being the most common species (84%). Other species identified were C. dubliniensis (8%), C. tropicalis (4%), C. glabrata (3%), C. parapsilosis (3%), C. sake (3%), C. krusei (1%), and C. guilliermondii (1%). After the follow-up period, 63% of the patients were alive and 86% of them were cancer free. Harboring Candida species in the saliva was not associated with any increase in the mortality rate.

Conclusions: C. albicans was common in the oral cavity of the oral squamous cell carcinoma patients. However, in this patient population, we did not observe a statistically significant effect of the yeast on the mortality rate.
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http://dx.doi.org/10.1016/j.joms.2018.06.012DOI Listing
December 2018

Proteolytic activity of non-albicans Candida and Candida albicans in oral cancer patients.

New Microbiol 2018 10 12;41(4):296-301. Epub 2018 Oct 12.

Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Oral Candida infections can be life-threatening in medically compromised patients. In particular non-albicans Candida strains are virulent. However, our knowledge is sparse on how proteolytic these strains are in patients with oral cancer. Our study aimed to investigate differences in proteolytic activity of non-albicans Candida and Candida albicans isolated from oral cancer patients. The hypothesis was based on anticipated different invasive capacity of the strains. Clinical and reference yeast samples from our laboratory were used for analyses. Candida strains were grown in yeast peptone glucose and the activity of Candida proteinases of broken cell fractions were analysed by MDPF-gelatin zymography. Fluorometric assay was used to compare activities of proteolytic enzymes and degradation assays were performed using CLDN 4 and plasma fibronectin. Clear differences were seen in the proteolytic activity between the studied non-albicans Candida and C. albicans strains. C. tropicalis had the highest proteolytic activity followed by strains of C. krusei and C. glabrata. The results confirmed our study hypothesis by showing differences between the non-albicans Candida and Candida albicans strains studied. Higher proteolytic activity may thus have an effect on the virulence of non-albicans Candida strains in oral cancer patients.
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October 2018

Periodontitis is associated with incident chronic liver disease-A population-based cohort study.

Liver Int 2019 03 27;39(3):583-591. Epub 2018 Oct 27.

Transplantation and Liver Surgery Clinic, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Background & Aims: Chronic liver disease is a major health concern worldwide and the identification of novel modifiable risk factors may benefit subjects at risk. Few studies have analyzed periodontitis as a risk factor for liver complications. We studied whether periodontitis is associated with incident severe liver disease.

Methods: The study comprised 6165 individuals without baseline liver disease who participated in the Finnish population-based Health 2000 Survey (BRIF8901) during 2000-2001, a nationally representative cohort. Follow-up was until 2013 for liver-related admissions, liver cancer and mortality from National Hospital Discharge, Finnish Cancer Registry and Causes of Death Register, Statistics Finland. Mild to moderate periodontitis was defined as ≥1 tooth with periodontal pocket ≥4 mm deep, and advanced periodontitis as ≥5 teeth with such pockets. Multiple confounders were considered.

Results: A total of 79 subjects experienced a severe liver event during follow-up. When adjusted for age, sex and number of teeth, hazards ratios by Cox regression regarding incident severe liver disease were, for mild to moderate periodontitis, 2.12 (95% CI 0.98-4.58), and, for advanced periodontitis, 3.69 (95% CI 1.79-7.60). These risk estimates remained stable after additionally adjusting for alcohol use, smoking, metabolic risk, serum gamma-glutamyltransferase, dental-care habits, lifestyle and socioeconomic status. Periodontal disease-associated liver risk was accentuated among subjects with non-alcoholic fatty liver disease or heavy alcohol use at baseline.

Conclusions: Periodontitis was associated with incident liver disease in the general population independently of various confounders. As a preventable disease, periodontal disease might present a modifiable risk factor for chronic liver disease.
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http://dx.doi.org/10.1111/liv.13985DOI Listing
March 2019

Oral symptoms and oral health-related quality of life in patients with chronic kidney disease from predialysis to posttransplantation.

Clin Oral Investig 2019 May 2;23(5):2207-2213. Epub 2018 Oct 2.

Abdominal Center, Nephrology, Helsinki University Hospital, Helsinki, Finland.

Objective: This prospective follow-up cohort study analyzed chronic kidney disease (CKD) patients' oral symptoms, health habits, and oral health-related quality of life (OHRQoL), from predialysis to posttransplantation. A simplified questionnaire method (Oral Health Quality Score, OHQS), based on these and clinical findings, was constructed and tested for identifying patients in need for referral to a dentist.

Material And Methods: Fifty-three CKD patients were followed up for a mean of 10.3 years. Clinical oral, radiological, and salivary examination was performed at baseline and posttransplantation. Total Dental Index (TDI) indicating inflammation was calculated. The patients filled out a questionnaire on symptoms, oral hygiene and health care habits, smoking, alcohol use, and medication. General health-related quality of life was assessed with the 15-dimensional (15D) instrument at posttransplantation. Descriptive and analytical methods were used in statistics.

Results: OHQS significantly correlated with high TDI (p = 0.017), number of teeth (p = 0.031), and unstimulated salivary flow rate (p = 0.001) in transplanted patients. Number of daily medications showed a negative correlation with the OHQS (r = - 0.30; p = 0.028). The prevalence of oral symptoms was slightly, but not significantly, more common posttransplantation compared with predialysis stage.

Conclusion: OHQS identified patients with high oral inflammatory score thus confirming our study hypothesis.

Clinical Relevance: Use of OHQS and measuring salivary flow indicate patients at risk for oral diseases. These markers might be easy to use chair-side also by auxiliary personnel.
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http://dx.doi.org/10.1007/s00784-018-2647-zDOI Listing
May 2019

Activity of rheumatoid arthritis correlates with oral inflammatory burden.

Rheumatol Int 2018 09 24;38(9):1661-1669. Epub 2018 Jul 24.

Department of Rheumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.

To study oral health in patients with rheumatoid arthritis (RA) with emphasis on disease activity and treatment of RA. In this prospective cohort study 81 RA patients [53 early untreated RA (EURA) and 28 chronic RA (CRA) patients with inadequate response to synthetic disease modifying antirheumatic drugs (DMARDs)], underwent rheumatological [Disease Activity Score (28-joint) DAS28] and dental examinations [Total Dental Index (TDI), Decayed Missing Filled Teeth (DMFT) and Decayed Missing Filled Surfaces (DMFS)]. For controls, 43 volunteers were examined. After the examinations, EURA patients started treatment with synthetic DMARDs, oral and intra-articular glucocorticoids. CRA patients were candidates for biological DMARDs. The patients were re-examined mean 16 months later. Results were analyzed with descriptive statistics and logistic regression. TDI was higher in both RA groups at baseline compared to controls [EURA: 2 (2-3); CRA: 2 (1-3); controls 1 (1-3), p = 0.045]. DMFT [r 0.561 (p = 0.002)] and DMFS [r 0.581 (p = 0.001)] associated with DAS28 at baseline in CRA patients. After follow-up, DAS28 associated positively with DMFT [r 0.384 (p = 0.016)] and DMFS [r 0.334 (p = 0.038)] in EURA patients; as well as in CRA patients DMFT [r 0.672 (p = 0.001)], DMFS [r 0.650 (p = 0.001)]. RA patients already in the early phase of the disease had poorer oral health compared to controls. The caries indices associated with the activity of RA in both patient groups. Oral status may thus contribute to the development and further relate to the activity of RA.
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http://dx.doi.org/10.1007/s00296-018-4108-zDOI Listing
September 2018

Anti-rheumatic medication and salivary MMP-8, a biomarker for periodontal disease.

Oral Dis 2018 Nov 18;24(8):1562-1571. Epub 2018 Jul 18.

Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Objective: To investigate the impact of anti-rheumatic medications on salivary matrix metalloproteinase (MMP)-8 levels and MMP-8/TIMP (tissue inhibitor of MMPs)-1 ratio in patients with rheumatoid arthritis (RA) and periodontal findings during a 1-year follow-up.

Materials And Methods: Salivary MMP-8 was measured by an immunofluorometric assay and TIMP-1 by an enzyme-linked immunosorbent assay of 53 patients with early untreated RA (ERA), naïve to synthetic disease modifying anti-rheumatic drugs (DMARDs), of 28 patients with chronic RA (CRA), candidates for biologic DMARDs and of 43 age- and sex-matched controls. Periodontal health was evaluated by bleeding on probing (BOP), pocket depth (PD), and periodontal inflammatory burden index (PIBI). Examinations were conducted twice for RA patients and once for controls.

Results: Salivary MMP-8 level and MMP-8/TIMP-1 ratio associated positively with PIBI in patients with chronic RA (MMP-8: p < 0.001 at baseline, p = 0.002 after follow-up; MMP-8/TIMP-1 ratio p < 0.001, p = 0.003, respectively) and in controls (MMP-8: p = 0.010, MMP-8/TIMP-1 ratio: p = 0.010). Salivary MMP-8 levels were highest at the early stage of RA. The used DMARDs, synthetic or biologic, did not affect salivary MMP-8 concentrations.

Conclusions: The use of synthetic or biologic DMARDs did not affect salivary MMP-8 levels in RA patients regardless the duration of RA.
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http://dx.doi.org/10.1111/odi.12930DOI Listing
November 2018

Salivary MMP-13 gender differences in periodontitis: A cross-sectional study from Sweden.

Clin Exp Dent Res 2017 Oct 15;3(5):165-170. Epub 2017 Sep 15.

Department of Dental Medicine Karolinska Institutet Sweden.

We investigated serum and saliva concentrations of matrix metalloproteinases, MMP-8, MMP-9, and MMP-13, and their tissue inhibitor TIMP-1, in a group of patients with and without periodontitis from Sweden. The hypothesis was that these biomarkers are higher in the periodontitis patients. Ninety patients participated in this cross-sectional study. Fifty-one patients had periodontitis whereas 39 were periodontally healthy. Saliva and serum samples were analyzed with immunofluorometric, enzyme-linked immunosorbent assay and western blot. Results were statistically analyzed with independent t test, Mann-Whitney U test, Bonferroni corrections, and regression analyses. MMP-13 was not detected in serum, but in saliva, higher values were found among the periodontally healthy compared with periodontitis subjects (0.32 ± 0.26 vs. 0.21 ± 0.23 ng/ml, p < .05). Female gender and clinical attachment loss were the explanatory factors for higher salivary MMP-13 values with odds ratio 3.08 (95% confidence interval [1.17, 8.11]) and 3.57 (95% confidence interval [1.08, 11.82]), respectively. No statistically significant differences between groups were found in serum and saliva values of MMP-8, MMP-9, and TIMP-1. Contrary to our hypothesis, no statistically significant differences between patients with and without periodontitis were seen in MMP-8, MMP-9, and TIMP-1 values. However, higher MMP-13 concentrations in saliva were associated with female gender and higher clinical attachment loss. Metabolism of MMP-13 may thus have some gender implications in periodontitis.
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http://dx.doi.org/10.1002/cre2.76DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839226PMC
October 2017

Inflammatory biomarkers in saliva and serum of patients with rheumatoid arthritis with respect to periodontal status.

Ann Med 2018 06 30;50(4):333-344. Epub 2018 Apr 30.

a Department of Oral and Maxillofacial Diseases , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.

Objective: To study prospectively the association of salivary and serum matrix metalloproteinase (MMP)-8, tissue inhibitor of MMPs (TIMP)-1 and interleukin (IL)-6 with periodontal and systemic inflammation in rheumatoid arthritis (RA). We hypothesized that biomarker concentrations reflect inflammation.

Methods: Fifty three early untreated RA (ERA) and 28 chronic RA (CRA) patients, underwent rheumatological and dental examinations at baseline and one year later after starting first conventional or biological disease modifying antirheumatic drug. We included 43 control subjects. Saliva and serum samples were analyzed for MMP-8, TIMP-1 and IL-6. Periodontal health was assessed by bleeding on probing (BOP), pocket depth (PD) and periodontal inflammatory burden index (PIBI); RA disease activity was assessed by disease activity score DAS28. Joint destruction was analyzed by the modified Sharp-van der Heijde (SHS) method.

Results: Serum MMP-8 (p < .001; p < .001) and IL-6 (p < .001; p = .002) were significantly higher in CRA vs. other study groups during the study. Salivary MMP-8 (p = .010) and IL-6 (p = .010) were significantly higher in ERA vs. other study groups at baseline. Salivary MMP-8 was associated with periodontal parameters.

Conclusion: Elevated serum concentrations of MMP-8 and IL-6 in CRA patients reflected chronic RA, while elevated salivary concentrations of MMP-8 levels in ERA patients reflected increased periodontal inflammation. Key messages Concentrations of inflammatory biomarkers in serum and saliva were different between patients with RA and healthy controls. Concentrations of MMP-8 and of IL-6 in serum were elevated in patients with chronic RA reflecting joint inflammation and the burden of established RA. Concentrations of MMP-8 in saliva was elevated already at the early stage of RA and the level of salivary MMP-8 was associated with poor periodontal health both in patients with early and in those with chronic RA.
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http://dx.doi.org/10.1080/07853890.2018.1468922DOI Listing
June 2018

Probiotics: Evidence of Oral Health Implications.

Folia Med (Plovdiv) 2018 Mar;60(1):21-29

Department of Restorative Dentistry, Faculty of Dental Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria.

The prevalence of common oral diseases, such as dental caries, periodontal diseases and oral candidiasis remains high in the general population. Various preventive strategies have been proposed and included in national health programs promoting oral health. Interest in probiotics in light of oral health has gradually evolved as attractive means in prevention of oral infectious diseases. The aim of the present review is to outline the current evidence on the role of probiotic species on oral health parameters and their beneficial role in contributing to healthier oral environment.
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http://dx.doi.org/10.1515/folmed-2017-0080DOI Listing
March 2018

Autoimmune Diseases and Oral Health: 30-Year Follow-Up of a Swedish Cohort.

Dent J (Basel) 2017 Dec 22;6(1). Epub 2017 Dec 22.

Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, 00014 Helsinki, Finland.

Oral infections up-regulate a number of systemic inflammatory reactions that, in turn, play a role in the development of systemic diseases. We investigated the association between oral health and autoimmune diseases in a cohort of Swedish adults. Hypothesis was that poor oral health associates with incidence of autoimmune diseases. Overall 1676 subjects aged 30-40 years old from Stockholm County (Sweden) participated in this study in 1985. Subjects were randomly selected from the registry file of Stockholm region and were followed-up for 30 years. Their hospital and open health care admissions (World Health Organization ICD 9 and 10 codes) were recorded from the Swedish national health registers. The association between the diagnosed autoimmune disease and the oral health variables were statistically analyzed. In all, 50 patients with autoimmune diagnoses were detected from the data. Plaque index was significantly higher in the autoimmune disease group (≥median 35 (70%) vs. ˂median 872 (54%), = 0.030). No statistical difference was found in gingival index, calculus index, missing teeth, periodontal pockets, smoking or snuff use between patients with and without autoimmune disease. Our study hypothesis was partly confirmed. The result showed that subjects with a higher plaque index, marker of poor oral hygiene, were more likely to develop autoimmune diseases in 30 years.
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http://dx.doi.org/10.3390/dj6010001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872203PMC
December 2017

Lactobacillus rhamnosus GG in Experimental Oral Biofilms Exposed to Different Carbohydrate Sources.

Caries Res 2018 20;52(3):220-229. Epub 2018 Jan 20.

Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Probiotic administration may favour caries prevention, as recent research has shown. This in vitro study aimed to investigate the growth of Lactobacillus rhamnosus GG (LGG) in experimental biofilms exposed to various carbohydrates, and also to assess its cariogenic potential. Multispecies experimental oral biofilms with or without LGG were grown with a sole-carbohydrate source (fructose/glucose/lactose/sorbitol/sucrose). The viable cells of LGG and structure of the biofilms were examined after 64.5 h of incubation, and pH values of spent media were measured at 16.5, 40.5, and 64.5 h. Fermentation profiles of LGG in biofilm media were assessed with study carbohydrate as the sole energy source. Our results showed that LGG reached higher viable cell numbers with glucose and sucrose in 64.5-h multispecies experimental oral biofilms compared to other carbohydrates. When LGG was incorporated in biofilms, no distinct pH changes at any time points were observed under any of the carbohydrates used; the pH values of spent media at each time point were lower when lactose was used, compared to other carbohydrates. The fermentation profiles of LGG in biofilm media were similar to its growth in MRS (no obvious growth with lactose or sucrose). In conclusion, LGG in our in vitro multispecies experimental oral biofilms was capable of surviving and growing well in each carbohydrate source. LGG might not have harmful effects on dental hard tissues. Another finding from our study was that the lowest pH values were observed in the presence of lactose, and the thickest biofilms were in sucrose.
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http://dx.doi.org/10.1159/000479380DOI Listing
April 2019

A Role for Oral Health Personnel in Stroke Prevention.

Authors:
Jukka H Meurman

Compend Contin Educ Dent 2017 Sep;38(8 Suppl):26-28

Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland.

Possible links between stroke and periodontal disease are reviewed in this article. Topics covered include the signs and symptoms of stroke, dental and other infections associated with stroke, and the role of oral healthcare personnel in the prevention of stroke and treatment of stroke patients.
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September 2017
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