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Syfte: Syftet med den här studien var att undersöka följsamheten och reduktionen av det horisontella överbettet vid behandling med van Beek-aktivator genom att jämföra en rekommenderad användningstid av tolv och åtta timmar per dag. Material och metod: Tretton patienter (4 pojkar och 9 flickor) ingick i undersökningsmaterialet med en medelålder på 10,0 år (SD = 0,9). Alla patienter var diagnostiserade med en Angle Klass II-bettavvikelse och behandlades med van Beek-aktivator. Patienterna var randomiserade i två grupper med två olika användningstider (8 timmar och 12 timmar). Följsamheten mättes med hjälp av en mikrosensor (TheraMon®) inbyggd i aktivatorn och det horisontella och vertikala överbettet registrerades efter första, tredje och sjätte månaden. Efter att datan var insamlad gjordes statistisk analys för att påvisa ifall statistisk skillnad fanns mellan grupperna.Resultat: Medelreduceringen i horisontellt överbett i 8-timmarsgruppen var efter sex månader 3,4 mm jämfört med hos 12-timmarsgruppen som var 3,5 mm. Medelanvändningstiden var i 12-timmarsgruppen och 8-timmarsgruppen 8.2 timmar (SD=1,7) och 7,9 timmar (SD=2,6) per dag respektive. Den genomsnittliga användningstiden för samtliga patienter var 8,1 timmar.Slutsats: Rekommendation av åtta timmar var enklare att uppnå jämfört med tolv timmar. Van Beek-aktivatorn var effektiv för korrigering av Angle Klass II-bettavvikelser, ingen klinisk signifikant skillnad i behandlingseffekt observerades mellan de två grupperna. / Aim: The aim of this study was to evaluate the compliance and overjet changes among patients treated with the van Beek activator comparing a twelve- and eight-hours daily wear-time prescription. Material and methods: The study sample consisted of thirteen patients (4 boys and 9 girls) with a mean age of 10.0 years (SD = 0.9). All patients had a Class II malocclusion and were treated with the van Beek activator. Patients were randomly assigned to two groups with a wear-time of twelve and eight hours respectively. Compliance was measured with the aid of a microsensor (TheraMon®) built into the activator and the overjet and overbite were recorded after the first, third and sixth month. Results: The mean decrease in overjet among the 8 hours group after six months was 3.4 mm compared to the 3.5 mm overjet reduction recorded in the 12 hours group. The mean wear-time in the 12 hours group and 8 hours group were 8.2 hours (SD = 1.7) and 7.9 hours (SD = 2.6) per day respectively. The overall mean daily wear-time of all patients in both groups was 8.1 hours. Conclusions: The eight-hours prescription was easier to achieve compared to the twelve-hours. The van Beek activator was effective in Class II correction, no clinically significant difference in treatment effect was observed between the two wear-time prescriptions.

SammanfattningSyfte: Studiens mål var att uppnå kunskap angående olika interceptiva ortodontiska behandlingar, undersöka vilka ortodontiska behandlingar som är vanligast förekommande hos allmäntandläkare och rekommenderade av svenska ortodontister samt att undersöka om de vanligaste behandlingarna är de som lärs ut vid odontologiska fakulteten i Malmö. Potentiella skillnader mellan grupperna undersöktes också. Material och metod: En PubMed-sökning gjordes för att undersöka litteratur för de apparaturer som används mest frekvent. Ett frågeformulär utformades och skickades till 169 ortodontister med konsultationsverksamhet för att undersöka användningen av olika apparaturer som sker i samarbete med allmäntandläkare. Resultat: Totalt inkluderades 153 artiklar i litteraturstudien och frekventa behandlingar presenterades. Den mest använda apparaturen för behandling av:- Korsbett var Quad Helix- Frontal invertering var klammerplåt med Z-fjäder - Klass II malocklussion var van Beek aktivator.En signifikant skillnad mellan grupperna hittades; kvinnliga ortodontister rekommenderade allmäntandläkare aktivator med extra oralt drag vid behandling av Klass II malocklussion i större utsträckning än manliga ortodontister. Slutsats: Valet av apparatur överensstämde till största delen med vad som anses vara det mest effektiva enligt de artiklar som inkluderats i studien. Det var även dessa apparaturer som används i studentundervisningen vid odontologiska fakulteten i Malmö.Skillnaderna i valet av apparatur mellan de manliga och de kvinnliga ortodontisterna beror troligtvis på den ojämna könsfördelningen av nyutexaminerade ortodontister de senaste 50 åren. / AbstractObjective: The aim of the present study was to obtain knowledge about different interceptive orthodontic treatments, investigate which orthodontic treatments are most frequently used by general practitioners and recommended by Swedish orthodontists and to see if the most common treatments corresponded to the educational dental program in orthodontics at Malmö University. Potential differences among groups were also investigated. Materials and methods: A PubMed search was made to investigate the literature of the most frequently used appliances in orthodontic treatment concerning the diagnoses and the appliances used in general practices. A questionnaire was sent to 169 consulting orthodontists to investigate the use of different appliances in cooperation with general practitioners.Results: A total of 153 articles were included in the literature study and frequently used treatments were presented.The most common appliance for correction of: - Posterior crossbite was the Quad Helix.- Anterior crossbite was a plate with Z-springs.- Class II malocclusion was the headgear activator, according to van Beek.A significant difference between genders was found, i.e. that female orthodontists recommended headgear activator more often than males for Class II in general practise. Conclusions: The choice of appliances mostly corresponded to what is most effective according to the literature included in the study and these are used in the educational program for dental students in Malmö.The differences between the genders of the orthodontists in choice of treatment are most likely due to the gender distribution of becoming orthodontists during the last five decades.

Syfte: Syftet med denna studie var att utvärdera följsamheten och förändringen i det horisontella överbettet hos patienter som behandlas med en van Beek-aktivator, under det första behandlingsåret, genom att jämföra två rekommenderade användningstider; 8 timmar och 12 timmar. Material och metod: Totalt 20 patienter, 9 flickor och 11 pojkar, med en medelålder på 10,0 år, ingick i undersökningsmaterialet. Samtliga patienter diagnosticerades med en Angle Class II-bettavvikelse, och behandlades med en van Beek-aktivator. Patienterna delades slumpmässigt in i två grupper med olika rekommenderade användningstider; 8 timmar och 12 timmar. Följsamhetsnivån mättes med hjälp av TheraMon®, en mikrosensor, inbäddad i aktivatorn. Följsamheten, det horisontella och det vertikala överbettet registrerades efter 3, 6, 9 och 12 månader. Resultat: I båda grupperna observerades en minskning av både det horisontella och vertikala överbettet. Det fanns ingen signifikant skillnad mellan 8- och 12-timmarsgruppen för reduktion av överbetten. Följsamheten var däremot bättre i 8-timmarsgruppen under hela 12-månadersperioden.Slutsatser: En rekommenderad användningstid på 8 timmar per dag visade en högre nivå av följsamhet än 12 timmar, i den aktuella studien. Ingen klinisk signifikant skillnad i behandlingseffekt upptäcktes mellan 8-timmars och 12-timmars rekommenderad användningstid. Följsamhetsnivån är högre under de första 6 månaderna av en behandling och minskar sedan mellan 6-12 månader. / Aim: The aim of this study was to evaluate the adherence and the changes in overjet among patients treated with the van Beek activator during the first year, comparing two wear-time prescriptions; 8 hours and 12 hours. Materials and methods: The study sample consisted of 20 patients, 9 girls and 11 boys, with a mean age of 10.0 years. All patients were diagnosed with a class II malocclusion and were treated with the van Beek activator. The patients were randomized into two groups with different wear-time prescriptions; 8 hours and 12 hours. The level of adherence was measured with the aid of TheraMon®, a microsensor embedded in the activator. The adherence, overjet and overbite were recorded after 3, 6, 9 and 12 months of treatment. Results: In both groups, a reduction of both overjet and overbite was observed. There was no significant difference between the 8- and 12-hour group for overjet and overbite reduction. The adherence, on the other hand, was better in the 8-hour group during the whole 12-month period. Conclusions: A wear-time prescription of 8 hours per day displayed a higher level of adherence than 12 hours in the present trial. No clinically significant differences in treatment effects were detected between an 8-hour and 12-hour wear-time prescription. The level of adherence is higher during the first 6 months of a treatment and is then reduced between 6-12 months.

Syfte: Att utreda sambandet mellan den lösliga formen av urokinas-receptorn (suPAR) i saliv hos patienter med artrit i käkleden (A-TMJ) och friska kontroller, för att skapa en grund för vidare forskning av suPAR som prediktor för inflammationsgraden i käkleden hos patienter med A-TMJ.Material och metod: En fall-kontrollstudie utfördes med 6 kontroller (medelåldern 31±11år) och 5 patienter med A-TMJ (medelåldern 24±5år). Undersökningen bestod av salivprov, registrering av blödning vid sondering (BoP), blodprovstagning, och undersökning av tuggsystemet där antalet smärtsamma käkledsrörelser (PM) mättes. Sist samlades käkledvätska in. Halten suPAR analyserades i saliv, plasma och käkledsvätska. Resultat: En signifikant skillnad mellan suPAR i saliv kunde ej påvisas (A-TMJ 4,4±3,91ng/ml, kontroller 4,96±4,80ng/ml), emellertid hade patienter en signifikant högre halt av suPAR i plasma (A-TMJ 2,71±0,62ng/ml, kontroller: 1,86±0,35ng/ml, P=0,017). Halten av suPAR i käkledsvätska mättes till 1,57±1,50ng/ml hos patienter men kunde inte detekteras hos kontroller. BoP mättes till 16±9% hos patienter och 14±7% hos kontroller, och median(IQR) för PM var 3(1) i höger käkled och 0(3) i vänster käkled hos patienter. Slutsatser: (i) Ingen slutsats kan dras gällande sambandet mellan suPAR i saliv och A-TMJ, men (ii) patienter med A-TMJ har till viss mån en högre smärta i käkleden vid käkledsrörelse medan deras koncentration av suPAR i plasma är högre jämfört med friska kontroller. Det verkar som (iii) BoP skulle kunna vara kopplat till suPAR i saliv. Resultat från denna studie bör tolkas med försiktighet på grund av litet stickprov, fortsatt forskning behövs för att klargöra sambandet mellan suPAR i saliv och A-TMJ. / Aims: To investigate the levels of soluble urokinase plasminogen activator receptor (suPAR) in saliva between patients with arthritis in the temporomandibular joint (A-TMJ) and healthy controls to create a foundation for further research of the potential predictive value of suPAR in patients with A-TMJ.Materials and method: A case- control study was conducted, 6 controls (mean age 31±11years) and 5 patients with A-TMJ (mean age 24±5years) enrolled in the study. Saliva, blood, synovial fluid (SF) were sampled, and the masticatory system was examined according to DC/TMD, and bleeding on probing (BoP) was assessed, as was painful mandibular movement (PM). The level of suPAR was analyzed in saliva, plasma and SF.Results: Level of salivary suPAR did not differ significantly between A-TMJ patients and healthy controls (P > 0.05). Patients had a significantly higher level of suPAR in plasma than controls (A-TMJ 2.71±0.62ng/mL, controls: 1.86±0.35ng/mL, P=0.017). suPAR level in SF was measured to 1.57±1.50ng/mL in A-TMJ patients and not detected in controls. BoP was 16±9% in patients and 14±7% in controls, and median(IQR) of PM was 3(1) in the right TMJ and 0(3) in the left in patients.Conclusions: (i) No conclusion can be drawn regarding suPAR in saliva and A-TMJ, but (ii) to some degree A-TMJ patients have higher PM meanwhile their plasma concentration of suPAR is higher than controls. A trend that (iii) higher BoP is connected with higher suPAR in saliva could be distinguished. Results must be interpreted with caution due to small study sample, more research is required to further elucidate the association between suPAR in saliva and A-TMJ.

Quebec platelet disorder (QPD) is a bleeding disorder characterized by a gain of function defect in fibrinolysis. The hallmark feature of QPD is the marked overexpression of urokinase plasminogen activator (uPA) in megakaryocytes (MK) and platelets. The genetic cause of QPD is a tandem duplication of a ~78 kb region that encompasses the uPA gene, PLAU. As the mechanism of PLAU overexpression is unknown, gene regulatory mechanisms specifically epigenetics were evaluated at the PLAU locus in QPD MK and granulocytes, a QPD unaffected lineage. The aims of the thesis were to assess if QPD is associated with 1) genome wide methylation changes of promoter CpG islands, particularly at PLAU and 2) genome wide changes of active histone modifications H3K27Ac, H3K36me3 and H3K4me2, particularly at the region of PLAU duplication. Methylation and active histone enrichment analysis revealed that in QPD and control subjects, PLAU promoter CpG island was characterized by unaltered hypo-methylation and changes in active histone peak enrichments that were within the realm of having one extra copy of PLAU in both MK and granulocytes. The findings imply that the PLAU CNV mutation does not induce altered promoter methylation status and/or significantly alter active histone markers as the reason for the marked PLAU overexpression in QPD MK. Instead, the rearrangement of an active enhancer element, particularly an H3K27Ac enhancer expressed in MK but not granulocytes, that is upstream of the second copy of PLAU might underlie the marked PLAU expression by differentiated QPD MK. The thesis provides novel insights into the epigenetic regulation of PLAU that will be crucial to identifying the mechanism underlying the aberrant PLAU expression in QPD. / Thesis / Master of Science (MSc)

The objectives of this research were to characterize insulin-like growth factor-I (IGF-I) gene expression in cattle, to determine how IGF-I gene expression is affected by nutritional intake and growth hormone (GH) in cattle, and to identify the regulatory DNA region that mediates GH stimulation of IGF-I gene expression. It was found that transcription of the IGF-I gene in cattle was initiated from both exon 1 and exon 2, generating class 1 and class 2 IGF-I mRNA, respectively. Both classes of IGF-I mRNA appeared to be ubiquitously expressed, with the highest level in liver and with class 1 being more abundant than class 2 in all tissues examined. Class 1 IGF-I mRNA may be also translated more efficiently than class 2 IGF-I mRNA. Liver expression of IGF-I mRNA was decreased (P < 0.01) by food deprivation in cattle, and this decrease was due to an equivalent decrease in both classes of IGF-I mRNA. Liver expression of IGF-I mRNA was increased (P < 0.01) by GH, and this increase resulted mainly from increased expression of class 2 IGF-I mRNA. Using cotransfection analyses, a ~700 bp chromosomal region ~75 kb 5' from the first exon of the human IGF-I gene was found to enhance reporter gene expression in the presence of constitutively active signal transducer and activator of transcription 5 (STAT5) proteins, transcription factors that are known to be essential for GH-increased IGF-I gene expression. This 700 bp DNA region contains two STAT5-binding sites that appear to be conserved in mammals including cattle. Electrophoretic mobility shift assays and cotransfection analyses confirmed their ability to bind to STAT5 proteins and to mediate STAT5 activation of gene expression, respectively. Chromatin immunoprecipitation assays indicated that overexpressed constitutively active STAT5b protein bound to the chromosomal region containing these two STAT5-binding sites in Hep G2 cells, and this binding was associated with increased expression of IGF-I mRNA. These two STAT5-binding sites were also able to mediate GH-induced STAT5 activation of gene expression in reconstituted GH-responsive cells. These results together suggest that the distal DNA region that contains two STAT5-binding sites may mediate GH-induced STAT5 activation of IGF-I gene transcription in vivo. / Ph. D.