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Song W, Liu H, Su Y, Zhao Q, Wang X, Cheng P, Wang H. Current developments and opportunities of pluripotent stem cells-based therapies for salivary gland hypofunction. Front Cell Dev Biol 2024; 12:1346996. [PMID: 38313227 PMCID: PMC10834761 DOI: 10.3389/fcell.2024.1346996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/10/2024] [Indexed: 02/06/2024] Open
Abstract
Salivary gland hypofunction (SGH) caused by systemic disease, drugs, aging, and radiotherapy for head and neck cancer can cause dry mouth, which increases the risk of disorders such as periodontitis, taste disorders, pain and burning sensations in the mouth, dental caries, and dramatically reduces the quality of life of patients. To date, the treatment of SGH is still aimed at relieving patients' clinical symptoms and improving their quality of life, and is not able to repair and regenerate the damaged salivary glands. Pluripotent stem cells (PSCs), including embryonic stem cells (ESCs), induced pluripotent stem cells (iPSCs), and extended pluripotent stem cells (EPSCs), are an emerging source of cellular therapies that are capable of unlimited proliferation and differentiation into cells of all three germ layers. In recent years, the immunomodulatory and tissue regenerative effects of PSCs, their derived cells, and paracrine products of these cells have received increasing attention and have demonstrated promising therapeutic effects in some preclinical studies targeting SGH. This review outlined the etiologies and available treatments for SGH. The existing efficacy and potential role of PSCs, their derived cells and paracrine products of these cells for SGH are summarized, with a focus on PSC-derived salivary gland stem/progenitor cells (SGS/PCs) and PSC-derived mesenchymal stem cells (MSCs). In this Review, we provide a conceptual outline of our current understanding of PSCs-based therapy and its importance in SGH treatment, which may inform and serve the design of future studies.
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Affiliation(s)
- Wenpeng Song
- Department of Stomatology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huan Liu
- Beijing Laboratory of Oral Health, School of Basic Medicine, School of Stomatology, Capital Medical University, Beijing, China
| | - Yingying Su
- Department of Stomatology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qian Zhao
- Research and Development Department, Allife Medicine Inc., Beijing, China
| | - Xiaoyan Wang
- Department of Stomatology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Laboratory of Oral Health, School of Basic Medicine, School of Stomatology, Capital Medical University, Beijing, China
- Biochemistry and Molecular Biology, School of Basic Medical Sciences, Beijing, China
| | - Pengfei Cheng
- Department of Stomatology, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hao Wang
- Department of Stomatology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Ritwik P, Vu J. Bridging Oral and Systemic Health in Children with Prader-Willi Syndrome: Case Reports and Dental Treatment Recommendations. Curr Pediatr Rev 2021; 17:336-344. [PMID: 34517804 DOI: 10.2174/1573396317666210913101027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 04/27/2021] [Accepted: 06/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Prader-Willi Syndrome (PWS) is a complex neurodevelopmental disorder caused by gene alterations on chromosome 15q11-q13, resulting in hyperphagia and neuroendocrine deficits. A comprehensive guide for dental treatment for PWS is lacking despite numerous case reports. The objective of this report was to develop a problem-focused list of the interrelationship between oral and systemic parameters of PWS and enable dentists in anticipating the unique treatment needs of children and individuals with PWS. METHODS Four pediatric patients with PWS presenting to an academic dental clinic were evaluated. A literature review spanning the last twenty years was performed to identify the pathophysiological impact of systemic problems on dental health and treatment. RESULTS The four cases along with cases from the literature were used to enumerate salient oro-dental and systemic features influencing treatment decisions in dentistry. They formed the basis for collective recommendations and precautions for rendering dental treatment in patients with PWS. CONCLUSION Sedation for dental treatment is contraindicated due to obesity (BMI over 95th percentile), hypotonia, obstructive sleep apnea (OSA), and respiratory limitations (restricted ventilation due to weight on thoracic cage). Prolonged recovery from general anesthesia, OSA, and temperature dysregulation necessitate extended monitoring after dental rehabilitation under general anesthesia. Orthopedic problems and respiratory limitations exclude protective stabilization. Xerostomia and acidic saliva necessitate recommendations for oral rehydrating products. Periodontal assessment is necessary due to poor oral hygiene and diabetes mellitus. Early establishment of a dental home and risk-based frequency of dental care should address caries prevention and restorative needs.
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Affiliation(s)
- Priyanshi Ritwik
- Department of Pediatric Dentistry, The University of Texas Health Science Center at Houston, School of Dentistry, 7500 Cambridge Street, Ste 5301,Canada
| | - Jaclyn Vu
- Department of Pediatric, School of Dentistry, Dentistry, UT Health Science University, TX,United States
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Bantim YCV, Kussaba ST, de Carvalho GP, Garcia-Junior IR, Roman-Torres CVG. Oral health in patients with Prader-Willi syndrome: current perspectives. Clin Cosmet Investig Dent 2019; 11:163-170. [PMID: 31308759 PMCID: PMC6613606 DOI: 10.2147/ccide.s183981] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/10/2019] [Indexed: 11/23/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a rare complex multisystem disorder and presents several aspects related to dentistry. The purpose of this review is to present current perspectives about oral health in patients with PWS. Delay development, hyperphagia, foamy and highly viscous saliva raise the risk of caries and contribute to tooth wear. Cariogenic foods uncontrolled consumption allows to obesity and dental problems progress worsening systemic disorders. These factors can be controlled. The success in follow-ups with caries free and oral health controlled demonstrate the importance of multidisciplinary team intervention corroborated by support at home from birth to adulthood. Thereby, current perspective on the disease is that there is possibility of proper maintenance of oral health in PWS patients. Guided care interferes positively with the overall well-being and quality of life of the individual with PWS and their family. A multidisciplinary team with a focus on teaching patients and family members will help minimize eventual problems.
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Affiliation(s)
- Yasmin Comoti Vita Bantim
- Department of Surgery an Integrated Clinic, Araçatuba School of Dentistry, São Paulo State - University Unesp, Araçatuba, SP, Brazil
| | - Sérgio Takashi Kussaba
- Department of Dentistry, Cathedral College, Boa Vista, RR, Brazil.,Department of Dentistry, University Santo Amaro, São Paulo, SP, Brazil
| | | | - Idelmo Rangel Garcia-Junior
- Department of Surgery an Integrated Clinic, Araçatuba School of Dentistry, São Paulo State - University Unesp, Araçatuba, SP, Brazil
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Olczak-Kowalczyk D, Korporowicz E, Gozdowski D, Lecka-Ambroziak A, Szalecki M. Oral findings in children and adolescents with Prader-Willi syndrome. Clin Oral Investig 2018; 23:1331-1339. [PMID: 30006686 DOI: 10.1007/s00784-018-2559-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess the significance of changes in the saliva in the etiology of gingivitis and tooth wear in children and adolescents with Prader-Willi syndrome (PWS). MATERIALS AND METHODS The study included 80 (2.8-18 years old; 39 girls and 41 boys): 40 in PWS group (mean age 8.0 ± 4.24 years) and 40 in control group (mean age 7.9 ± 4.12 years). General condition, oral para-functional habits, tooth wear (modified TWI), oral hygiene and gingival status (Plaque Index (PLI) and Gingival Index (GI)), localization of gingivitis, and salivary characteristics were assessed. The chi-square test, the Mann-Whitney U test, Spearman's rank correlation, and odds ratio based on logistic regression in a statistical analysis were applied. RESULTS Chances of gingivitis were increased by low PLI (odds ratio (OR) = 32.53), low resting salivary flow (OR = 3.96), increased viscosity of saliva (OR = 3.54), and mouth breathing (OR = 8.17). For gingivitis in anterior regions, low PLI (OR = 107.67), low resting (OR = 5.73) and stimulated (OR = 1.86) salivary flow, increased viscosity of saliva (OR = 5.87), mouth breathing (OR = 10.00), and low stimulated salivary flow (OR = 3.18) were observed. Tooth wear rates were increased by teeth grinding (OR = 16.20), mouth breathing (OR = 4.33), increased viscosity of saliva (OR = 11.67) and low resting (OR = 6.07), and stimulated (OR = 4.22) salivary flow. CONCLUSIONS In PWS, reduced salivary secretion, increased viscosity, of saliva and mouth breathing increase the risk of plaque-induced gingivitis and tooth wear. CLINICAL RELEVANCE The prevention and treatment of tooth wear and gingivitis in PWS patients is necessary not only to treat bruxism and mouth breathing but also to limit the influence of negative changes of saliva.
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Affiliation(s)
- Dorota Olczak-Kowalczyk
- Department of Pediatric Dentistry, Medical University of Warsaw, Miodowa 18, Warsaw, Poland.
| | - Emil Korporowicz
- Department of Pediatric Dentistry, Medical University of Warsaw, Miodowa 18, Warsaw, Poland
| | - Dariusz Gozdowski
- Department of Experimental Statistics and Bioinformatics, Warsaw University of Life Sciences, Nowoursynowska 159, Warsaw, Poland
| | - Agnieszka Lecka-Ambroziak
- Clinic of Endocrinology and Diabetology, Children's Memorial Health Institute, Dzieci Polskich 20, Warsaw, Poland
| | - Mieczysław Szalecki
- Clinic of Endocrinology and Diabetology, Children's Memorial Health Institute, Dzieci Polskich 20, Warsaw, Poland.,Faculty of Medicine and Health Sciences, UJK, Kielce, Poland
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Saeves R, Strøm F, Sandvik L, Nordgarden H. Gastro-oesophageal reflux - an important causative factor of severe tooth wear in Prader-Willi syndrome? Orphanet J Rare Dis 2018; 13:64. [PMID: 29685165 PMCID: PMC5913865 DOI: 10.1186/s13023-018-0809-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 04/16/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is the most common genetic human obesity syndrome and is characterized by hypotonia, endocrine disturbances, hyperphagia, obesity and mild mental retardation. Oral abnormalities, such as decreased salivary flow rates and extreme tooth wear, have also been described. Studies have shown a significant increase in reflux symptoms in individuals with obstuctive sleep apnoea syndrome and increased BMI, both of which are typical findings in PWS. Gastro-oesophageal reflux disease (GORD) has been identified in some individuals with PWS and is a significant intrinsic factor in dental tooth wear. The aim of this study was therefore to estimate the prevalence of GORD in adults and children and to evaluate a possible correlation between GORD and tooth wear in adults with PWS. They were all registered at the TAKO-centre. RESULTS Twenty-nine individuals, 17 adults with a mean age of 32.6 years (range 18-48) and 12 children with a mean age of 8.8 years (range 3-17), agreed to undergo 24-hour oesophageal pH monitoring, and 90% of those enrolled managed to complete the examination. Four children and eleven adults were diagnosed with pathological gastro-oesophageal reflux, which is defined as acid exposure (pH less than 4) more than 3.6 or 4.3 percent of the time, respectively. Manometry performed in the adult group showed a pathologically high lower oesophageal sphincter pressure in four of the five individuals who had normal oesophageal pH values (pH under 4 less than 4.3% of the time). The two groups (reflux and non-reflux) were well balanced according to BMI, genotype, tooth grinding and hyposalivation. However, twice as many individuals in the reflux group as in the non-reflux group reported high consumption of acidic foods and drinks. Increased tooth wear was significantly correlated with GORD in the two groups (reflux n=6 and non-reflux n=6). CONCLUSIONS The prevalence of gastro-oesophageal reflux is high in individuals with PWS. Tooth wear was strongly associated with GORD and acidic drinks, and both may be important aetiological factors underlying the extreme tooth wear in this group. Our data suggest a need for routine screening for GORD and dental wear in young individuals with Prader-Willi syndrome.
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Affiliation(s)
- Ronnaug Saeves
- TAKO-centre, Lovisenberg Diaconal Hospital, Pb 4970 Nydalen, 0440 Oslo, Norway
| | - Finn Strøm
- Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Leiv Sandvik
- Department of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Hilde Nordgarden
- TAKO-centre, Lovisenberg Diaconal Hospital, Pb 4970 Nydalen, 0440 Oslo, Norway
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Giebułtowicz J, Korytowska N, Sankowski B, Wroczyński P. Development and validation of a LC-MS/MS method for quantitative analysis of uraemic toxins p-cresol sulphate and indoxyl sulphate in saliva. Talanta 2016; 150:593-8. [DOI: 10.1016/j.talanta.2015.12.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/23/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
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Microscopic structure of dental hard tissues in primary and permanent teeth from individuals with Prader-Willi syndrome. Arch Oral Biol 2016; 66:55-60. [PMID: 26913968 DOI: 10.1016/j.archoralbio.2016.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 02/05/2016] [Accepted: 02/10/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVE severe tooth wear, in terms of both erosive wear and attrition, is a significant problem in individuals with Prader-Willi syndrome (PWS). The purpose of the present study was to describe the structure of enamel and dentine in primary and permanent teeth from individuals with PWS. DESIGN thirty-two primary and 10 permanent teeth representing 16 individuals with PWS were investigated in the study. The enamel surface was studied using scanning electron microscopy (SEM). The microscopic structure of enamel and dentine was studied using SEM, microradiography and light microscopy. RESULTS the microscopic structure of enamel and dentine was found to be normal with the exception of a slight increase of interglobular dentine (IGD). Severe erosive defects were observed in primary teeth and also in permanent teeth with long exposure to the oral environment. CONCLUSION the erosive enamel defects in individuals with PWS seem more related to the factors in the oral environment than to enamel structure which appeared normal. The occurrence of IGD indicate deficient mineralization but is probably of minor clinical significance. Gastro-oesophageal reflux is worthy of further investigation in individuals with Prader-Willi syndrome.
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Song KU, Nam OH, Kim MS, Choi SC, Lee HS. An 18-year-old patient with Prader-Willi syndrome: a case report on dental management under sedation and general anesthesia. J Dent Anesth Pain Med 2015; 15:251-255. [PMID: 28879288 PMCID: PMC5564163 DOI: 10.17245/jdapm.2015.15.4.251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/10/2015] [Accepted: 11/17/2015] [Indexed: 11/23/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a rare genetic disorder reported rarely in dentistry. Dental practitioners should know the features of PWS because affected patients have a variety of dental symptoms. The current report describes a case of PWS. An 18-year-old male patient presented with traumatic injuries. Initial emergency treatments were performed under sedation, and further treatments were conducted under general anesthesia. After adequate healing, periodic follow-up and dietary management according to the patient's age and nutritional phase were recommended. Dental management of PWS patients consists of active preventive measures in addition to dietary consultation according to age and nutritional phase.
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Affiliation(s)
- Ki Un Song
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Ok Hyung Nam
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Mi Sun Kim
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Sung Chul Choi
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Hyo-Seol Lee
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
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Hirsch HJ, Gross I, Pollak Y, Eldar-Geva T, Gross-Tsur V. Irisin and the Metabolic Phenotype of Adults with Prader-Willi Syndrome. PLoS One 2015; 10:e0136864. [PMID: 26334732 PMCID: PMC4559418 DOI: 10.1371/journal.pone.0136864] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 08/09/2015] [Indexed: 11/18/2022] Open
Abstract
CONTEXT Hyperphagia, low resting energy expenditure, and abnormal body composition contribute to severe obesity in Prader Willi syndrome (PWS). Irisin, a circulating myokine, stimulates "browning" of white adipose tissue resulting in increased energy expenditure and improved insulin sensitivity. Irisin has not been previously studied in PWS. OBJECTIVES Compare plasma and salivary irisin in PWS adults and normal controls. Examine the relationship of irisin to insulin sensitivity and plasma lipids. DESIGN AND STUDY PARTICIPANTS A fasting blood sample for glucose, lipids, insulin, leptin, adinopectin, and irisin was obtained from 22 PWS adults and 54 healthy BMI-matched volunteers. Saliva was collected for irisin assay in PWS and controls. RESULTS Fasting glucose (77 ± 9 vs 83 ± 7 mg/dl, p = 0.004), insulin (4.1 ± 2.0 vs 7.9 ± 4.7 μU/ml, p<0.001), and triglycerides (74 ± 34 vs 109 ± 71 mg/dl, p = 0.007) were lower in PWS than in controls. Insulin resistance (HOMA-IR) was lower (0.79 ± 0.041 vs 1.63 ± 1.02, p<0.001) and insulin sensitivity (QUICKI) was higher (0.41 ± 0.04 vs 0.36 ± 0.03, p<0.001) in PWS. Plasma irisin was similar in both groups, but salivary irisin (64.5 ± 52.0 vs 33.0 ± 12.1ng/ml), plasma leptin (33.5 ± 24.2 vs 19.7 ± 19.3 ng/ml) and plasma adinopectin (13.0 ± 10.8 vs 7.6 ± 4.5μg/ml) were significantly greater in PWS (p<0.001). In PWS, plasma irisin showed positive Pearson correlations with total cholesterol (r = 0.58, p = 0.005), LDL-cholesterol (r = 0.59, p = 0.004), and leptin (r = 0.43, p = 0.045). Salivary irisin correlated negatively with HDL-cholesterol (r = -0.50, p = 0.043) and positively with LDL-cholesterol (r = 0.51, p = 0.037) and triglycerides (r = 0.50, p = 0.041). CONCLUSIONS Salivary irisin was markedly elevated in PWS although plasma irisin was similar to levels in controls. Significant associations with plasma lipids suggest that irisin may contribute to the metabolic phenotype of PWS.
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Affiliation(s)
- Harry J. Hirsch
- Israel Multidisciplinary Prader-Willi Syndrome Clinic, Neuropediatric Unit, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Itai Gross
- Department of Pediatrics, Hadassah Hospital, Ein Kerem, Jerusalem, Israel
| | - Yehuda Pollak
- Israel Multidisciplinary Prader-Willi Syndrome Clinic, Neuropediatric Unit, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
- The School of Education, The Hebrew University, Jerusalem, Israel
| | - Talia Eldar-Geva
- The Hebrew University Faculty of Medicine, Jerusalem, Israel
- Reproductive Endocrinology and Genetics Unit, Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Varda Gross-Tsur
- Israel Multidisciplinary Prader-Willi Syndrome Clinic, Neuropediatric Unit, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
- The Hebrew University Faculty of Medicine, Jerusalem, Israel
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Abstract
Both acute and chronic dehydration can have important implications for human behaviour and health. Young children, non-autonomous individuals and the elderly are at a greater risk of dehydration. Mild hypertonic dehydration could be related to less efficient cognitive and physical performance and has been reported to be associated with frequently occurring pathological conditions, especially nephrolithiasis. The assessment of hydration status in a large sample appears to be of interest for conducting epidemiological and large clinical studies aimed at improving preventive and curative care. Especially in large-population studies, methods that are used have to be accurate, cheap, quick and require no technical expertise. Body weight change is widely used to determine acute hydration changes, but seems to be insufficiently accurate in longitudinal studies. Bioimpedance analysis methods enable the assessment of total body water content, but their use is still under debate. Because plasma osmolality directly reflects intracellular osmolality, it constitutes a good marker to assess acute hydration changes, but not chronic hydration status because it changes constantly. Moreover, venepuncture is considered to be invasive and is not suitable for a large-sample study, especially in children. Urinary markers appear to be good alternatives for assessing hydration status in large populations. Collection of urine samples is non-invasive and cheap. High technical expertise is not required to perform urinary marker measurements and these measurements can be carried out quickly. Thus, methods based on urinary markers are very well suited for field studies. Urine colour is probably the least sensitive marker despite its high specificity. Urine osmolality and especially urine specific gravity could be easily used for determining hydration status in large-sample studies.
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Satoh K, Senpuku H, Sugiya H. Involvement of E2f1 deficiency in salivary gland hypofunction: A review of studies of E2f1-deficient NOD/SCID mice. J Oral Biosci 2014. [DOI: 10.1016/j.job.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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