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Optimal execution with price impact under Cumulative Prospect Theory. Surge Price or Subsidy? Information Sharing or Suggestion? Rational Behaviour. Measurement, Theory of. Anticipated Regret and Product Innovation. Regret theory and risk attitudes. Insuring Your Donation: An Experiment. Modulating what is and what could have been: The effect of transcranial direct current stimulation on the evaluation of attained and unattained decision outcomes.

The asymmetric impact of other-blame regret versus self-blame regret on negative word of mouth. Specification of regret-based models of choice behaviour: formal analyses and experimental design based evidence. Regret theory: A new foundation. Decision theoretic modeling of affective and cognitive needs for product experience engineering: key issues and a conceptual framework. Randomised controlled trial of a text messaging intervention for reducing processed meat consumption: The mediating roles of anticipated regret and intention.

Generalized regret based decision making. A natural language generation approach to support understanding and traceability of multi-dimensional preferential sensitivity analysis in multi-criteria decision making. Inventory control and pricing for regret-averse newsvendor. Incorporating psycho-physical mapping into random regret choice models: model specifications and empirical performance assessments. Evaluation functions and decision conditions of three-way decisions with game-theoretic rough sets.

Minimax approaches to optimal transmission expansion planning considering non-probabilistic scenarios of market-based renewable generation capacity additions. Choice overload and asymmetric regret. Grey-incidence clustering decision-making method with three-parameter interval grey number based on regret theory.

Regret theory: State dominance and expected utility. Purchase decision regret: Negative consequences of the Steadily Increasing Discount strategy. Financial Optimism and Entrepreneurial Satisfaction. What does delay in coupon redemptions imply? An investigation into customers' future purchase probability.

On Regretful Hierarchy. Tradable credits for managing car travel: a review of empirical research and relevant behavioural approaches. Algorithms for interval-valued fuzzy soft sets in stochastic multi-criteria decision making based on regret theory and prospect theory with combined weight.

A quantitative measure of regret in decision-making for human-robot collaborative search tasks. Divergence and Sufficiency for Convex Optimization. Does uncertainty cause inertia in decision making? An experimental study of the role of regret aversion and indecisiveness. A sequential choice perspective of postdecision regret and counterfactual thinking in voluntary turnover decisions. A regret theory-based route choice model.

The importance of regret minimization in the choice for renewable energy programmes: Evidence from a discrete choice experiment. Reactive synthesis without regret. Involuntary migration in cyberspaces: The case of MSN messenger discontinuation. Monte Carlo decision curve analysis using aggregate data.

Risk management and managerial mindset. Graham Loomes , Ganna Pogrebna. Entscheiden unter Unsicherheit. Psychological Modeling of Humans by Assistive Robots. Questioning demand: A study of regretted purchases in Great Britain. More promotion-focused, more happy? Regulatory focus, post-purchase evaluations and regret in the real estate market.

The Role of Threat of Entry. Expected Comparative Utility Theory. Hedging with Regret. Is Expected Utility an Ex-Hypothesis? Mapping Solutions to Investors. Characterising resource use and potential inefficiencies during large-fire suppression in the western US. Will I Regret It? Regret theory and the competitive firm revisited. Regret, rejoicing, and mixed insurance. Wavelet decomposition of heterogeneous investment horizon.

System redundancy optimization with uncertain stress-based component reliability: Minimization of regret. Regret theory-based group decision-making with multidimensional preference and incomplete weight information. How do thoughts, emotions, and decisions align?

A new way to examine theory of mind during middle childhood and beyond. Affect, emotion, and decision making. Inconsistent Bond Pricing in a Rational Market. The development of regret and relief about the outcomes of risky decisions. A regret-based autonomy allocation scheme for human-robot shared vision systems in collaborative assembly in manufacturing. Multiple reference effects on restaurant evaluations: a cross-cultural study.

The neural basis of regret and relief during a sequential risk-taking task. Timing the stock market: Does it really make no sense? Robust optimization of the 0—1 knapsack problem: Balancing risk and return in assortment optimization. Conditional entropy and value of information metrics for optimal sensing in infrastructure systems.

The Impact of Regret on Exports. When and how does counterfactual thinking prevent catastrophes and foster group decision accuracy. Eyes on the Prize? Mistakes pertaining to undesired relative to desired self-standards elicit immediate enhanced electrocortical signals of error processing. Developments in non-expected utility theories: an empirical study of risk aversion.

Are humans rational? Exploring factors influencing impulse buying intention and continuous impulse buying intention. Expected utility theory and inner and outer measures of loss aversion. Markdown or Everyday Low Price? The Role of Behavioral Motives. Subsecond dopamine fluctuations in human striatum encode superposed error signals about actual and counterfactual reward. Financial Risk Tolerance. BetOnMath: genesi, contenuti e caratteristiche del percorso didattico.

Simulatori e apprendimento. The Alternative Omen Effect: Illusory negative correlation between the outcomes of choice options. Multiple attribute decision making with completely unknown weights based on cumulative prospect theory and grey system theory. Just Watch Out for Bears! Dekompozycja i wycena. Decision Under Risk.

Consumer Decision Making. Expected utility without full transitivity. Optimal output for the regret-averse competitive firm under price uncertainty. Production and hedging decisions under regret aversion. Psychologically-based voting with uncertainty. A prospect theory-based interval dynamic reference point method for emergency decision making. A model of regret, investor behavior, and market turbulence.

Heterogeneous beliefs, regret, and uncertainty: The role of speculation in energy price dynamics. Does feedback really matter in one-shot first-price auctions? Regret after purchasing fashion goods - Need for cognition and fashion leadership as antecedents and dissatisfaction, regret solving process and re-buying intention as consequences -.

Even better than the real thing: Alternative outcome bias affects decision judgements and decision regret. An extended TODIM method for hesitant fuzzy interactive multicriteria decision making based on generalized Choquet integral. What you get is not what you saw: exploring the impacts of misleading hotel website photos.

Exploring the relationship between cognitive effort exertion and regret in online vs. Regret-based Bayesian sequential decision-making for human-agent collaborative search tasks. The Paradox of Choice. Multi-criteria decision making based on relative measures. Benchmarking of maintenance and outage repair in an electricity distribution company using the value-based DEA method. A mediating role for anticipated regret in predicting retirement savings intention between groups with without past behaviour.

Variational Bewley preferences. When is rational to order a diagnostic test, or prescribe treatment: the threshold model as an explanation of practice variation. Disappointment and regret enhance corrugator reactivity in a gambling task. Anticipating regret and consumers' preferences for counterfeit luxury products.

The minority decision — A risky choice. The development of the experience and anticipation of regret. A regret theory of capital structure. A prospect theory approach to assessing changes in parameters of insurance contracts with an application to money-back guarantees. Uncertainty in Optimisation. Ambiguity and Nonexpected Utility. The effects of regret on internalization of academic motivation: A longitudinal study. Modern health care as a game theory problem.

Regret Theory: A New Foundation. Regret Theory and Risk Attitudes. Is There a Valuation Gap? The Case of Interval Valuations. Once bitten, twice shy: experienced regret and non-adaptive choice switching. Risk Management: An Interdisciplinary Framework. Testing for independence while allowing for probabilistic choice. The effect of information regarding multi-attributes on consumers' choices of GM products. Utilization Theory. An Allais paradox without mental time travel.

Positive and negative spillover of pro-environmental behavior: An integrative review and theoretical framework. Random regret minimization for consumer choice modeling: Assessment of empirical evidence. The role of forgone opportunities in decision making under risk.

Fixed versus variable rate loans under regret aversion. Behavioral variant frontotemporal dementia patients do not succumb to the Allais paradox. Probabilistic dominance and status quo bias. Applications of theories and models of choice and decision-making under conditions of uncertainty in travel behavior research. Regret theory and the competitive firm: A comment. An empirical test of competing hypotheses for the annuity puzzle.

Regret minimisation and utility maximisation in a freight transport context. Transitive regret over statistically independent lotteries. Behavioral and neurophysiological correlates of regret in rat decision-making on a neuroeconomic task. Buying and selling price for risky lotteries and expected utility theory with gambling wealth. Emotional antecedents and outcomes of service recovery. Imperfect memory and choice under risk. Neural systems for choice and valuation with counterfactual learning signals.

Emotions in the Financial Markets. The Psychology of Trading and Investing. The rationality of emotions: A hybrid process model of decision-making under uncertainty. When do stop-loss rules stop losses? Stated choices and benefit estimates in the context of traffic calming schemes: Utility maximization, regret minimization, or both?

Regret and Regulation. On deciding to have a lobotomy: either lobotomies were justified or decisions under risk should not always seek to maximise expected utility. Risk decision analysis in emergency response: A method based on cumulative prospect theory. The effects of income source, context, and income level on tax compliance decisions in a dynamic experiment.

What might have been? The role of the ventromedial prefrontal cortex and lateral orbitofrontal cortex in counterfactual emotions and choice. Die Prospect Theory und ihre Konsequenzen. Causes of Preference Reversal Phenomenon. Economics of Natural Catastrophe Risk Insurance. Regret theory and the competitive firm. Regret Theory and Equilibrium Asset Prices. Production and Hedging Decisions under Regret Aversion.

Remember What Happened Last Periods? Testing the Speed of Adjustment of the Reference Point. Vestigial Reference Points. Anticipated Regret or Endowment Effect? The costs of giving up: Action versus inaction asymmetries in regret. Computational heterogeneity in the human mesencephalic dopamine system.

Stochastic dominance, regret dominance and regret-theoretic dominance. Egocentric framing — One way people may fail in a switch dilemma: Evidence from excessive lane switching. Risk Management Challenges after the Financial Crisis. Comparing predicted and actual affective responses to process versus outcome: An emotion-as-feedback perspective. Cultural Differences in the Action Effect. Overconfidence and asymmetric information: The case of insurance.

Real and hypothetical endowment effects when exchanging lottery tickets: Is regret a better explanation than loss aversion? The Effects of Personal Agency on Regret. A barrier option framework for bank interest margin management under anticipatory regret aversion. Robust regret for uncertain linear programs with application to co-production models. Roles of alternative and self-oriented perspectives in the context of the continued use of social network sites.

Pension Portfolio Choice and Peer Envy. Why do tertiary education graduates regret their study program? A comparison between Spain and the Netherlands. Conceptual overlap between moral norms and anticipated regret in the prediction of intention: Implications for theory of planned behaviour research. Confused by too many choices? Choice overload in tourism. Eternal Quest for the Best: Sequential vs.

Anticipated regret as an explanation of uncertainty aversion. Behavioral Influences in the Present Tense. Why humans are sometimes less rational than other animals: Cognitive complexity and the axioms of rational choice. The structure of medical decisions: uncertainty, probability and risk in five common choice situations. Risk Measurement. The Role of Feelings in Perceived Risk. Role of affect in decision making. The role of regret minimisation in lifestyle choices affecting the risk of coronary heart disease.

Waves of regret: A meg study of emotion and decision-making. Alternative Explanations to the Inconsistent Bond Pricing. Markdown or Everyday-Low-Price? Does Anticipated Regret Really Matter? Revisiting the Role of Feedback in Auction Bidding.

Approaches to displaying information to assist decisions under uncertainty. When is it rational to participate in a clinical trial? A game theory approach incorporating trust, regret and guilt. A questionnaire study. The economics of planning electricity transmission to accommodate renewables: Using two-stage optimisation to evaluate flexibility and the cost of disregarding uncertainty.

Confirmatory search as a useful heuristic? Sustaining inertia? Collective regret versus collective guilt: Different emotional reactions to historical atrocities. A genuine foundation for prospect theory. A theoretical investigation on the attraction effect using the elimination-by-aspects model incorporating higher preference for shared features.

Is it sometimes better to receive than to give? Preferences for receiver roles over proposer roles in consumer behavior ultimatums. Disappointment and the Optimal Insurance Contract. An affective booster moderates the effect of gain- and loss-framed messages on behavioral intentions for colorectal cancer screening.

Cultural variation in the role of responsibility in regret and disappointment: The Italian case. The development of children's regret and relief. Salience Theory of Choice Under Risk. Regret aversion in reason-based choice. Production and insurance under regret aversion. Decision-dependent emotions and behavioral anomalies. Post-decisional information search: Balancing the pains of suspecting the worst with the comforts of knowing the worst. Regret theory-based route choices and traffic equilibria.

Sarah C. Rice ,. Advance Selling When Consumers Regret. Javad Nasiry , Ioana Popescu ,. The role of regret in the owner-manager decision-making in the family business: A conceptual approach. Trust as a social and emotional act: Noneconomic considerations in trust behavior.

Don't Look Back in Anger! Allowing for heterogeneous decision rules in discrete choice models: an approach and four case studies. The Troika paradox. An expected regret minimization portfolio selection model. What about behaviour in travel demand modelling? An overview of recent progress. Regret and performance uncertainty in consumer repeat choice. Getting the British back on bicycles—The effects of urban traffic-free paths on everyday cycling.

Site choices in recreational demand: a matter of utility maximization or regret minimization? Bruno Solnik , Luo Zuo ,. Emotional response in a disjunction condition. The use of multiple reference points in risky decision making. Understanding the Value of Business Information.

Effect of Regret. Decision Utility Theory. How Do I Regret Thee? Applied Utility Finance. Investment, resolution of risk, and the role of affect. The influence of discrete emotions on judgement and decision-making: A meta-analytic review.

Extensions to Regret-based Decision Curve Analysis: An application to hospice referral for terminal patients. Familiarity Bias. Other Behavioral Biases. Regret theory and the banking firm: The optimal bank interest margin. Analyzing online customer dissatisfaction toward perishable goods. Robust monopoly pricing. Medial prefrontal cortex and striatum mediate the influence of social comparison on the decision process. Misery loves company: Social regret and social interaction effects in choices under risk and uncertainty.

Decision-Making and Depressive Symptomatology. A note on negativity bias and framing response asymmetry. Ventral striatal signal changes represent missed opportunities and predict future choice. Senthil K. Veeraraghavan , Laurens G. Debo ,. Enrico G. De Giorgi , Thierry Post ,. Emotions and new venture judgment in China. The price of quality claims. Post-treatment regret among young breast cancer survivors.

Decision speed and choice regret: When haste feels like waste. Preferences, choice, goal attainment, satisfaction: That's life? Active Transgressions and Moral Elusions. Risk and rationality: The effects of mood and decision rules on probability weighting. Hierarchical Bayesian parameter estimation for cumulative prospect theory. Paradoxes and Violations of Normative Decision Theory. Value Functions Incorporating Disappointment and Regret. Andrew M. Davis , Elena Katok , Anthony M. Kwasnica ,.

Neurofinance — Geldverarbeitung im Gehirn. Uncertainty in Clinical Medicine. Transitive regret. Risk, uncertainty and the theory of planned behavior: A tourism example. A regret theory approach to decision curve analysis: A novel method for eliciting decision makers' preferences and decision-making. Striatal sensitivity to personal responsibility in a regret-based decision-making task.

Impact of routine transoesophageal echocardiography on safety, outcomes, and cost of pulmonary vein ablation: inferences drawn from a decision analysis model. Risk seeking behavior of preschool children in a gambling task. The influence of the diffusion of responsibility effect on outcome evaluations: Electrophysiological evidence from an ERP study. To do or not to do? Action enlarges the FRN and P effects in outcome evaluation. Why do organizations keep funding projects in the face of repeated failure?

Asymmetry, Partial Moments, and Production Risk. Integrative Model or the Priority Heuristic? Decision making under risk and uncertainty. Decision makers facing uncertainty: Theory versus evidence. Regret now, take it now: On the role of experienced regret on intertemporal choice. Judicious management of uncertain risks: II. Goal attainment as a resource: The cushion effect in risky choice above a goal.

Conflicting violations of transitivity and where they may lead us. An experimental investigation of transitivity in set ranking. A Quantitative Measurement of Regret Theory. Risk attitude and preference. Entscheiden unter Risiko: Von Bernoulli zu kognitiven Heuristiken. Modeling self-deception within a decision-theoretic framework.

Trust as an expressive rather than an instrumental act. Chapter 6 Complexity theory and affect structure: a dynamic approach to modeling emotional changes in organizations. Subprime Risk and Insurance with Regret. Rational Choice Deferral. The influence of fear in decisions: Experimental evidence. Neuroeconomics: what have we found, and what should we search for.

Violation of the transitivity axiom may explain why, in empirical studies, a significant number of subjects violate GARP. Structure—function relationships in the processing of regret in the orbitofrontal cortex. Do the size of consideration set and the source of the better competing option influence post-choice regret?

Obligations to future generations and acceptable risks of human extinction. Happiness, freedom and control. Better safe than sorry: Precautionary reasoning and implied dominance in risky decisions. Myopic regret avoidance: Feedback avoidance and learning in repeated decision making. Richard Engelbrecht-Wiggans , Elena Katok ,. A mere measurement effect for anticipated regret: Impacts on cervical screening attendance.

Can we assume that research participants are utility maximisers? Distortion of probability and outcome information in risky decisions. The effect of consequential thinking on trust game behavior. The Role of Regret in Informed Consent. Managerial In attention to Competitive Threats. Biases in Radiologic Reasoning. A parametric relief signal in human ventrolateral prefrontal cortex.

Emotion as a tradeable quantity. Decisions Under Uncertainty. Collecting and Behavioral Finance. Reward-based emotions. How the orbitofrontal cortex contributes to decision making — A view from neuroscience. Exploring continued online service usage behavior: The roles of self-image congruity and regret.

Dynamic psychological games. Examining the effects of self-efficacy, computerised sources and perceived source credibility in decisions to take online advice. Overestimation of anticipated and experienced regret after negative feedback. Happiness, Freedom and Control. Transitive Regret. Individual strategy preferences and decisional fit. Global Risk, Investment and Emotions.

Anticipated regret as an additional predictor in the theory of planned behaviour: A meta-analysis. Applying regret theory to investment choices: Currency hedging decisions. An experimental investigation of violations of transitivity in choice under uncertainty. Optimal allocation between bank loans and treasuries with regret. Addiction as vulnerabilities in the decision process. Acceptable Regret Approach. Third-generation prospect theory. Regret aversion and annuity risk in defined contribution pension plans.

Hess ,. Risk-based drought early warning system in reservoir operation. Arbeitsaufwand, Anspruchsniveau und Steuerehrlichkeit. Focusing on symptoms rather than diagnoses in brain dysfunction: Conscious and nonconscious expression in impulsiveness and decision-making. Praise for regret: People value regret above other negative emotions. A model of the effect of affect on economic decision making. Disappointment Aversion in internet Bidding-Decisions.

Dynamic Choice, Independence and Emotions. Regret aversion and opportunity dependence. Learning to de-escalate: The effects of regret in escalation of commitment. Regret aversion and decision process quality: Effects of regret salience on decision process carefulness. Personality-dependent dissociation of absolute and relative loss processing in orbitofrontal cortex.

Regret in the Newsvendor Model with Partial Information. Georgia Perakis , Guillaume Roels ,. Correcting expected utility for comparisons between alternative outcomes: A unified parameterization of regret and disappointment. Neurobiological regret and rejoice functions for aversive outcomes. A Random Regret-Minimization model of travel choice.

Experimental Tests of Rationality. Review Article: Critiques of the risk concept — valid or not? Integrating long-term care insurance purchase decisions with saving and investment for retirement. Application of the theory of planned behaviour to the prediction of objectively assessed breaking of posted speed limits.

Auctions with Anticipated Regret: Theory and Experiment. Biased Forecasting of Postdecisional Affect. When and why do we want to know? How experienced regret promotes post-decision information search. Replicated alternatives and the role of confusion, chasing, and regret in decisions from experience. Skill transferability, regret and mobility.

Emotional and cognitive information processing in web-based medical education. Brain, emotion and decision making: the paradigmatic example of regret. Regret Theory and the Tyranny of Choice. Neural signature of fictive learning signals in a sequential investment task. The human amygdala and orbital prefrontal cortex in behavioural regulation. Negotiating Bilateral Contracts in Electricity Markets. Experienced regret caused by action and inaction in decision making.

Hypothetical Retrospection. Temporal self-regulation theory: A model for individual health behavior. Imprecision as an Account of the Preference Reversal Phenomenon. Risk and supply chains. Regret avoidance as a measure of DSS success: An exploratory study.

The WOW factor: Creating value through win-back offers to reacquire lost customers. Multiple reference effects in service evaluations: Roles of alternative attractiveness and self-image congruity. Introduction to Research Dialogues.

A Theory of Regret Regulation 1. Multiple reference points in investor regret. Terror and trade of individual investors. Regret triggers inaction inertia - but which regret and how? The influence of unawareness set and order effects in consumer regret. The emotional power of place: The fall and rise of dominance in retail research.

Regret, portfolio choice, and guarantees in defined contribution schemes. Utility Theory. Consequences of Growth. Constraint-based optimization and utility elicitation using the minimax decision criterion. Regret in economic and psychological theories of choice. Neural basis of quasi-rational decision making. Mental simulation and argument. Role of anticipated regret, intentions and intention stability in adolescent smoking initiation. When mixed options are preferred in multiple-trial decisions.

Just moseying around and happening upon it versus a master plan: Minimizing regret in impulse versus planned sales promotion purchases. Risks and Assets Pricing. The priority heuristic: Making choices without trade-offs. Looking Through the Crystal Ball. Regret, Pride, and the Disposition Effect.

Sexual Regret in College Students. A consumer behavior approach to modeling monopolistic competition. Building and testing theories of decision making by travellers. Randomized controlled trial of a brief research-based intervention promoting fruit and vegetable consumption. Is regret for inaction relatively self-enhancing? Wearing out your shoes to prevent someone else from stepping into them: Anticipated regret and social takeover in sequential decisions.

Regret and its avoidance: a neuroimaging study of choice behavior. Adaptive Heuristics. Value at risk and inventory control. Can behavioral decision theory explain risk-averse fire management decisions? Book Review: Resistance and Persuasion. Playing for peanuts: Why is risk seeking more common for low-stakes gambles?

Emotions and cooperation in economic games. Effective Decision Making in a Life Company. A reference-dependent regret model for deterministic tradeoff studies. Regret in cancer-related decisions. Basic and applied decision making in cancer control.

Optimism and Attitude Towards Risk. Dynamic Psychological Games. From Bounded Rationality to Behavioral Economics. Modelling Bank Loyalty. New ideas and fertility limitation: The role of mass media. The Impact of Regret on the Demand for Insurance. Emotional transfer in goal systems. Effect propensity.

Cognitive dissonance and the stability of service quality perceptions. Counterfactual Thinking as a Mechanism in Narrative Persuasion. Patient-focussed decision-making in early-stage prostate cancer: insights from a cognitively based decision aid.

Are women's expectations and preferences for intrapartum care affected by the model of care on offer? Looking Forward to Looking Backward. The Misprediction of Regret. Pleasure, Utility, and Choice. Reported job satisfaction: what does it mean? Probability, possibility and evidence: approaches to consider risk and uncertainty in forestry decision analysis.

Consequences of regret aversion in real life: The case of the Dutch postcode lottery. Alternatives to Expected Utility: Foundations. Alternatives to Expected Utility: Formal Theories. Risk and decision making in events management. The Overconfidence Problem in Insurance Markets. Blessed are those who expect nothing: Lowering expectations as a way of avoiding disappointment.

The Endowment Effect and the Role of Uncertainty. Validation of a Decision Regret Scale. In all catheters, effusions occurred at a median of 1 day of line use range: 1 to 9 , phlebitis at 4 days range: 1 to 27 , infiltration at a median of 5.

The most common complication observed with the use of a PINCC was infiltration, whereas phlebitis was the most common complication that occurred with the use of a PICC. Figure 2. Pie graphs depicting the most common complications associated with the use of peripherally inserted non-central catheters PINCCs and peripherally inserted central catheters PICCs. A significantly higher rate of mechanical complications i. The common Mantzel—Haensel RRs obtained after adjustment for BW, indication for line insertion, insertion site, day of life at line placement, number of manipulations, duration of catheter use and duration of antibiotic exposure confirmed that the rate of complications in PINCCs was significantly higher than in PICCs.

In the multivariate model, BW, indication for line insertion, insertion site, day of life and weight at insertion, number of manipulations before insertion, duration of use and antibiotic exposure during line use were not significant predictors of line-related complications. Further analysis revealed no significant differences in the overall complication rates of the near-central PINCCs Central lines are used commonly in the NICU population and have been associated with significant risks to an already vulnerable patient population.

Most notably, dramatic success has been reported with both local and regional efforts to reduce central line-associated bloodstream infections. We therefore sought to identify the risks associated with the use of PINCCs in critically ill neonates. Data from the pediatric population are conflicting regarding differences in the rates of catheter-associated complications in central versus non-central lines.

Thiagarajan et al. In their cohort, PICCs were utilized for a significantly longer duration of time as compared with non-centrally placed catheters This finding remained significant after controlling for several potential confounding variables adj. Alternatively, PINCCs are intended to be located centrally, but never reached that desired destination. Leick-Rude et al. The overall mean dwell time for these catheters was 8. We then attempted to isolate the effect of the catheter tip position by controlling for several potential confounding variables related to the patient population, as well as to line insertion and maintenance practices.

The location of the catheter tip in a large diameter blood vessel like the superior or inferior vena cava allows for rapid hemodilution of infused solutions and minimizes the risk of catheter tip contact with the vascular endothelium. A similar association, however, was not observed when near-central and non-near-central PINCCs were compared.

Although the sample size was small, the subgroup analyses determined that complication rates of these non-central catheters were near identical. There are several limitations to our investigation that should be considered. Although we were able to collect data over a 5-year period, this was a single center study with a limited sample size.

In some situations, this made the interpretation of subgroup analyses e. Additionally, we were unable to collect and control for all factors that might have contributed to the line-related complications, including variability in techniques for catheter insertion and maintenance, as well as patient severity of illness. Also, common practice in our NICU with respect to line placement is to obtain a radiograph after every line placement and after any adjustment is made to the position of the catheter.

It is not a common practice to then verify the catheter tip position on a regular basis. It is therefore possible that some catheters originally categorized as PICCs may have migrated to a peripheral position without our knowledge, leading to misclassification in our analyses.

An individual placing a catheter, understanding this need, may be less inclined to accept non-central catheter placement in a very low birth weight infant and more inclined to remove that line and reattempt central access. We attempted to control for this and other potential biases via statistical analysis and determined that, despite a population with higher BW, PINCCs carried a greater, not lower, risk of associated complications. Therefore, if the decision is made to utilize a PINCC, careful monitoring of the insertion site and the associated extremity, given the risks associated with infiltration, should be conducted regularly.

A randomized trial comparing peripherally inserted central venous catheters and peripheral intravenous catheters in infants with very low birth weight. J Pediatr Surg ; 35 : — Pettit J. Assessment of infants with peripherally inserted central catheters: Part 1. Detecting the most frequently occurring complications.

Adv Neonatal Care ; 2 : — Assessment of infants with peripherally inserted central catheters: Part 2. Detecting less frequently occurring complications. Adv Neonatal Care ; 3 : 14— Analysis of complication rates and reasons for nonelective removal of PICCs in neonatal intensive care unit preterm infants.

J Infus Nurs ; 32 : — Stark AR. American academy of pediatrics committee on fetus and newborn. Levels of neonatal care. Pediatrics ; : — CDC definitions for nosocomial infections, Am J Infect Control ; 16 : — Am J Infect Control ; 36 : — A quality improvement initiative to reduce central line associated bloodstream infections in a neonatal intensive care unit.

Infect Control Hosp Epidemiol ; 31 : — Complications associated with 2 different types of percutaneously inserted central venous catheters in very low birth weight infants. Infect Control Hosp Epidemiol ; 32 : — Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. Ohio statewide quality-improvement collaborative to reduce late-onset sepsis in preterm infants. Efficacy of peripherally inserted central venous catheters placed in noncentral veins.

Arch Pediatr Adolesc Med ; : — Pediatric peripherally inserted central catheters: complication rates related to catheter tip location. Pediatrics ; : E Reynolds J. Comparison of percutaneous venous catheters and Teflon catheters for intravenous therapy in neonates. Neonatal Netw ; 12 : 33— Use of midline catheters in low birth weight infants.

J Perinatol ; 16 : — Wyckoff MM. Midline catheter use in the premature and full-term infant. J Vasc Access Devices ; 4 : 26— Dawson D. Midline catheters in neonatal patients: evaluating a change in practice. J Vasc Access Devices ; 7 : 17— Midline catheter use in the intensive care nursery. Neonatal Netw ; 25 : — A new method for the prevention of skin sloughs and necrosis secondary to intravenous infiltration.

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Utilization Theory. An Allais paradox without mental time travel. Positive and negative spillover of pro-environmental behavior: An integrative review and theoretical framework. Random regret minimization for consumer choice modeling: Assessment of empirical evidence.

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Regret theory and the competitive firm: A comment. An empirical test of competing hypotheses for the annuity puzzle. Regret minimisation and utility maximisation in a freight transport context. Transitive regret over statistically independent lotteries.

Behavioral and neurophysiological correlates of regret in rat decision-making on a neuroeconomic task. Buying and selling price for risky lotteries and expected utility theory with gambling wealth. Emotional antecedents and outcomes of service recovery.

Imperfect memory and choice under risk. Neural systems for choice and valuation with counterfactual learning signals. Emotions in the Financial Markets. The Psychology of Trading and Investing. The rationality of emotions: A hybrid process model of decision-making under uncertainty. When do stop-loss rules stop losses? Stated choices and benefit estimates in the context of traffic calming schemes: Utility maximization, regret minimization, or both?

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The effects of income source, context, and income level on tax compliance decisions in a dynamic experiment. What might have been? The role of the ventromedial prefrontal cortex and lateral orbitofrontal cortex in counterfactual emotions and choice. Die Prospect Theory und ihre Konsequenzen.

Causes of Preference Reversal Phenomenon. Economics of Natural Catastrophe Risk Insurance. Regret theory and the competitive firm. Regret Theory and Equilibrium Asset Prices. Production and Hedging Decisions under Regret Aversion. Remember What Happened Last Periods? Testing the Speed of Adjustment of the Reference Point. Vestigial Reference Points. Anticipated Regret or Endowment Effect? The costs of giving up: Action versus inaction asymmetries in regret.

Computational heterogeneity in the human mesencephalic dopamine system. Stochastic dominance, regret dominance and regret-theoretic dominance. Egocentric framing — One way people may fail in a switch dilemma: Evidence from excessive lane switching.

Risk Management Challenges after the Financial Crisis. Comparing predicted and actual affective responses to process versus outcome: An emotion-as-feedback perspective. Cultural Differences in the Action Effect. Overconfidence and asymmetric information: The case of insurance. Real and hypothetical endowment effects when exchanging lottery tickets: Is regret a better explanation than loss aversion? The Effects of Personal Agency on Regret. A barrier option framework for bank interest margin management under anticipatory regret aversion.

Robust regret for uncertain linear programs with application to co-production models. Roles of alternative and self-oriented perspectives in the context of the continued use of social network sites. Pension Portfolio Choice and Peer Envy. Why do tertiary education graduates regret their study program? A comparison between Spain and the Netherlands. Conceptual overlap between moral norms and anticipated regret in the prediction of intention: Implications for theory of planned behaviour research.

Confused by too many choices? Choice overload in tourism. Eternal Quest for the Best: Sequential vs. Anticipated regret as an explanation of uncertainty aversion. Behavioral Influences in the Present Tense. Why humans are sometimes less rational than other animals: Cognitive complexity and the axioms of rational choice. The structure of medical decisions: uncertainty, probability and risk in five common choice situations.

Risk Measurement. The Role of Feelings in Perceived Risk. Role of affect in decision making. The role of regret minimisation in lifestyle choices affecting the risk of coronary heart disease. Waves of regret: A meg study of emotion and decision-making. Alternative Explanations to the Inconsistent Bond Pricing.

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The development of children's regret and relief. Salience Theory of Choice Under Risk. Regret aversion in reason-based choice. Production and insurance under regret aversion. Decision-dependent emotions and behavioral anomalies. Post-decisional information search: Balancing the pains of suspecting the worst with the comforts of knowing the worst.

Regret theory-based route choices and traffic equilibria. Sarah C. Rice ,. Advance Selling When Consumers Regret. Javad Nasiry , Ioana Popescu ,. The role of regret in the owner-manager decision-making in the family business: A conceptual approach.

Trust as a social and emotional act: Noneconomic considerations in trust behavior. Don't Look Back in Anger! Allowing for heterogeneous decision rules in discrete choice models: an approach and four case studies. The Troika paradox. An expected regret minimization portfolio selection model. What about behaviour in travel demand modelling? An overview of recent progress. Regret and performance uncertainty in consumer repeat choice.

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Debo ,. Enrico G. De Giorgi , Thierry Post ,. Emotions and new venture judgment in China. The price of quality claims. Post-treatment regret among young breast cancer survivors. Decision speed and choice regret: When haste feels like waste.

Preferences, choice, goal attainment, satisfaction: That's life? Active Transgressions and Moral Elusions. Risk and rationality: The effects of mood and decision rules on probability weighting. Hierarchical Bayesian parameter estimation for cumulative prospect theory. Paradoxes and Violations of Normative Decision Theory. Value Functions Incorporating Disappointment and Regret. Andrew M. Davis , Elena Katok , Anthony M.

Kwasnica ,. Neurofinance — Geldverarbeitung im Gehirn. Uncertainty in Clinical Medicine. Transitive regret. Risk, uncertainty and the theory of planned behavior: A tourism example. A regret theory approach to decision curve analysis: A novel method for eliciting decision makers' preferences and decision-making. Striatal sensitivity to personal responsibility in a regret-based decision-making task. Impact of routine transoesophageal echocardiography on safety, outcomes, and cost of pulmonary vein ablation: inferences drawn from a decision analysis model.

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Regret now, take it now: On the role of experienced regret on intertemporal choice. Judicious management of uncertain risks: II. Goal attainment as a resource: The cushion effect in risky choice above a goal. Conflicting violations of transitivity and where they may lead us.

An experimental investigation of transitivity in set ranking. A Quantitative Measurement of Regret Theory. Risk attitude and preference. Entscheiden unter Risiko: Von Bernoulli zu kognitiven Heuristiken. Modeling self-deception within a decision-theoretic framework. Trust as an expressive rather than an instrumental act. Chapter 6 Complexity theory and affect structure: a dynamic approach to modeling emotional changes in organizations.

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Structure—function relationships in the processing of regret in the orbitofrontal cortex. Do the size of consideration set and the source of the better competing option influence post-choice regret? Obligations to future generations and acceptable risks of human extinction. Happiness, freedom and control. Better safe than sorry: Precautionary reasoning and implied dominance in risky decisions. Myopic regret avoidance: Feedback avoidance and learning in repeated decision making. Richard Engelbrecht-Wiggans , Elena Katok ,.

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Dynamic psychological games. Examining the effects of self-efficacy, computerised sources and perceived source credibility in decisions to take online advice. Overestimation of anticipated and experienced regret after negative feedback. Happiness, Freedom and Control. Transitive Regret. Individual strategy preferences and decisional fit. Global Risk, Investment and Emotions. Anticipated regret as an additional predictor in the theory of planned behaviour: A meta-analysis.

Applying regret theory to investment choices: Currency hedging decisions. An experimental investigation of violations of transitivity in choice under uncertainty. Optimal allocation between bank loans and treasuries with regret. Addiction as vulnerabilities in the decision process.

Acceptable Regret Approach. Third-generation prospect theory. Regret aversion and annuity risk in defined contribution pension plans. Hess ,. Risk-based drought early warning system in reservoir operation.

Arbeitsaufwand, Anspruchsniveau und Steuerehrlichkeit. Focusing on symptoms rather than diagnoses in brain dysfunction: Conscious and nonconscious expression in impulsiveness and decision-making. Praise for regret: People value regret above other negative emotions.

A model of the effect of affect on economic decision making. Disappointment Aversion in internet Bidding-Decisions. Dynamic Choice, Independence and Emotions. Regret aversion and opportunity dependence. Learning to de-escalate: The effects of regret in escalation of commitment. Regret aversion and decision process quality: Effects of regret salience on decision process carefulness. Personality-dependent dissociation of absolute and relative loss processing in orbitofrontal cortex.

Regret in the Newsvendor Model with Partial Information. Georgia Perakis , Guillaume Roels ,. Correcting expected utility for comparisons between alternative outcomes: A unified parameterization of regret and disappointment. Neurobiological regret and rejoice functions for aversive outcomes. A Random Regret-Minimization model of travel choice. Experimental Tests of Rationality. Review Article: Critiques of the risk concept — valid or not?

Integrating long-term care insurance purchase decisions with saving and investment for retirement. Application of the theory of planned behaviour to the prediction of objectively assessed breaking of posted speed limits. Auctions with Anticipated Regret: Theory and Experiment. Biased Forecasting of Postdecisional Affect. When and why do we want to know?

How experienced regret promotes post-decision information search. Replicated alternatives and the role of confusion, chasing, and regret in decisions from experience. Skill transferability, regret and mobility. Emotional and cognitive information processing in web-based medical education. Brain, emotion and decision making: the paradigmatic example of regret.

Regret Theory and the Tyranny of Choice. Neural signature of fictive learning signals in a sequential investment task. The human amygdala and orbital prefrontal cortex in behavioural regulation. Negotiating Bilateral Contracts in Electricity Markets. Experienced regret caused by action and inaction in decision making. Hypothetical Retrospection. Temporal self-regulation theory: A model for individual health behavior. Imprecision as an Account of the Preference Reversal Phenomenon.

Risk and supply chains. Regret avoidance as a measure of DSS success: An exploratory study. The WOW factor: Creating value through win-back offers to reacquire lost customers. Multiple reference effects in service evaluations: Roles of alternative attractiveness and self-image congruity. Introduction to Research Dialogues. A Theory of Regret Regulation 1.

Multiple reference points in investor regret. Terror and trade of individual investors. Regret triggers inaction inertia - but which regret and how? The influence of unawareness set and order effects in consumer regret. The emotional power of place: The fall and rise of dominance in retail research.

Regret, portfolio choice, and guarantees in defined contribution schemes. Utility Theory. Consequences of Growth. Constraint-based optimization and utility elicitation using the minimax decision criterion. Regret in economic and psychological theories of choice. Neural basis of quasi-rational decision making. Mental simulation and argument.

Role of anticipated regret, intentions and intention stability in adolescent smoking initiation. When mixed options are preferred in multiple-trial decisions. Just moseying around and happening upon it versus a master plan: Minimizing regret in impulse versus planned sales promotion purchases. Risks and Assets Pricing. The priority heuristic: Making choices without trade-offs. Looking Through the Crystal Ball. Regret, Pride, and the Disposition Effect. Sexual Regret in College Students.

A consumer behavior approach to modeling monopolistic competition. Building and testing theories of decision making by travellers. Randomized controlled trial of a brief research-based intervention promoting fruit and vegetable consumption. Is regret for inaction relatively self-enhancing? Wearing out your shoes to prevent someone else from stepping into them: Anticipated regret and social takeover in sequential decisions.

Regret and its avoidance: a neuroimaging study of choice behavior. Adaptive Heuristics. Value at risk and inventory control. Can behavioral decision theory explain risk-averse fire management decisions? Book Review: Resistance and Persuasion. Playing for peanuts: Why is risk seeking more common for low-stakes gambles?

Emotions and cooperation in economic games. Effective Decision Making in a Life Company. A reference-dependent regret model for deterministic tradeoff studies. Regret in cancer-related decisions. Basic and applied decision making in cancer control.

Optimism and Attitude Towards Risk. Dynamic Psychological Games. From Bounded Rationality to Behavioral Economics. Modelling Bank Loyalty. New ideas and fertility limitation: The role of mass media. The Impact of Regret on the Demand for Insurance. Emotional transfer in goal systems. Effect propensity.

Cognitive dissonance and the stability of service quality perceptions. Counterfactual Thinking as a Mechanism in Narrative Persuasion. Patient-focussed decision-making in early-stage prostate cancer: insights from a cognitively based decision aid. Are women's expectations and preferences for intrapartum care affected by the model of care on offer? Looking Forward to Looking Backward. The Misprediction of Regret. Pleasure, Utility, and Choice. Reported job satisfaction: what does it mean?

Probability, possibility and evidence: approaches to consider risk and uncertainty in forestry decision analysis. Consequences of regret aversion in real life: The case of the Dutch postcode lottery. Alternatives to Expected Utility: Foundations. Alternatives to Expected Utility: Formal Theories.

Risk and decision making in events management. The Overconfidence Problem in Insurance Markets. Blessed are those who expect nothing: Lowering expectations as a way of avoiding disappointment. The Endowment Effect and the Role of Uncertainty. Validation of a Decision Regret Scale. Testing for an experience endowment effect in health care. Betrayal aversion: When agents of protection become agents of harm. Cultural, social, and emotional determinants of decisions under uncertainty.

The Politics of Masochism. A quantitative and qualitative test of the Allais paradox using health outcomes. Normative vs. Utility, Production and Uncertainty. Capital Allocation under Regret and Kataoka Criteria. Chapter 18 A survey of behavioral finance. The psychology of doing nothing: Forms of decision avoidance result from reason and emotion. Consumer Control and Empowerment: A Primer. Heuristics and Biases. Mustering motivation to enact decisions: how decision process characteristics influence goal realization.

Han Bleichrodt , Ulrich Schmidt ,. A cognitive-emotional account of the shape of the probability weighting function. Managerial attitudes to risk: a comparison of Scottish chartered accountants and U. The inaction effect in the psychology of regret. Maximizing versus satisficing: Happiness is a matter of choice. Applications of Regret Theory to Asset Pricing.

Anticipated Emotions as Guides to Choice. Introduction to clinical reasoning. Collecting information: Optimizing outcomes, screening options, or facilitating discrimination? Overview on Decision Making. Economic Uncertainty and Logical Structure. Debates on the Utility of Risk. A Look Back to Move Forward. Utility and Subjective Probability: Empirical Studies.

Decision Biases, Cognitive Psychology of. Decision Making, Psychology of. Risk as feelings. Emotion, cognition, and decision making. On bad decisions and disconfirmed expectancies: The psychology of regret and disappointment. Why do they do it? Affective motivators in adolescents' decisions to participate in risk behaviours.

Attributions of responsibility and affective reactions to decision outcomes. Colorectal cancer follow-up: a reassessment of empirical evidence on effectiveness. Does provision of an evidence-based information change public willingness to accept screening tests? Self-report measures of patient utility. The veil of experience: do consumers prefer what they know best? What if I find it cheaper someplace else? It could have been you? The influence of anticipated counterfactual regret on behavior.

Maurice E. Cachon ,. Gregory W. Children's judgements of gambles: a disordinal violation of utility. Regret and Responsibility: A Reply to Zeelenberg et al. Regret and Responsibility Resolved? Self-determination: The tyranny of freedom. Choice and the relative pleasure of consequences. Maximising Happiness?

On a Model of Portfolio Selection with Benchmark. Acceptable regret in medical decision making. Genetic Abortion: Considerations for Patient Care. Participation in treatment decision-making by women with early stage breast cancer. A heuristic to minimax absolute regret for linear programs with interval objective function coefficients. Die Herausbildung von Zufriedenheits-urteilen bei Alternativenbetrachtung. Anticipated regret, expected feedback and behavioral decision making. Are wages habit-forming?

Emotional Trade-Off Difficulty and Choice. On Experimental Discourse in Economics. Roland T. Rust , J. Manipulating Hedonic Strategies of Choice. Chapter 20 Human behavior and the efficiency of the financial system. Individual Differences in Framing and Conjunction Effects.

The impact of prospect theory based framing tactics on advertising effectiveness. Individual decision making: implications for decision training in TQM. Anticipated Regret and Precautionary Sexual Behavior1.

Reconsidering the Relation between Regret and Responsibility. What are the benefits of preventive health care? The prospect of predictive testing for personal risk: attitudes and decision making. Jonathan W. Leland ,.

Valuing psychological factors in the provision of assisted reproductive techniques using the economic instrument of willingness to pay. Expectancy-Value models of health behaviour: The role of salience and anticipated affect.

The Experience of Regret and Disappointment. Behavioral Decision Research. Blame, Game Theory and Economic policy. The role of competitive alternatives in the postchoice satisfaction formation process. Job satisfaction and gender: Why are women so happy at work? The three-salesmen conundrum in medicine. A reverse sunk cost effect in risky decision making: Sometimes we have too much invested to gamble. Temerarious directions for marketing. Should government fund assisted reproductive techniques?

A study using willingness to pay. Decisions, Error and Heterogeneity. Salience and focusing in pure coordination games. Regret and Responsibility in the Evaluation of Decision Outcomes. Patients' willingness to pay for autologous blood donation. The role of decision analysis in informed consent: Choosing between intuition and systematicity. Hierarchies and the Self-Control of Risk Attitude. Instrumental or emotional evaluations: What determines preferences?

Is Regret Theory an alternative basis for estimating the value of healthcare interventions? Intransitive choices based on transitive preferences: The case of menu-dependent information. Domain-specific rationality in human choices: violations of utility axioms and social contexts. On the value of incumbency managerial reference points and loss aversion. Regret aversion or event-splitting effects?

ECHO INVESTMENT ZAROBKI PREZYDENTA

Potential mechanisms linking periodontal infections to mature atherosclerotic plaques and plaque rupture. Pathogen-mediated in-plaque angiogenesis is a hallmark of plaque organization. Denudation of the fibrous cap and its pro-thrombotic components occurs after endothelial cell apoptosis mediated by whole periodontal pathogens, or anti-endothelial auto-antibodies. Plaque rupture is induced by pathogen-mediated extracellular matrix degradation by endothelial cells, plaque macrophages, T-cells, and plasma cells, leading to exposure of pro-thrombotic plaque components, and subsequent vessel occlusion.

Transient bacteremias are common after dental procedures, regardless of periodontal status Olsen, , occurring frequently after mastication or after personal oral hygiene Lockhart et al. The incidence and intensity of these bacteremias correlate positively with the extent and severity of periodontitis Kinane et al. Oral and periodontal bacteria have been occasionally incriminated as causative for infections at distant organs, including the lung De Soyza et al.

A great many studies have thus evaluated whether bacteria of oral or periodontal origin are detectable, retrievable, and cultivable from atherothrombotic plaques or vascular biopsies. Furthermore, viable A. It must be recognized, however, that this is likely not an exclusive property of periodontal pathogens.

For example, Nakano et al. Thus, it appears that the disruption of the pocket epithelial integrity that occurs in periodontitis may also provide a point of entry for non-periodontal pathogens, such as the highly prevalent S. A recent study utilizing 16S rRNA sequencing identified 98 different bacterial species in the peripheral blood from individuals with bacteremia; of these, 19 species were novel Bahrani-Mougeot et al.

Given that the oral microbiome is comprised of approximately species Parahitiyawa et al. In the following text, we briefly summarize recent findings describing interactions of oral bacteria and bacterial products with specific host cells involved in the atherosclerotic process. The majority of the reviewed studies are primarily in vitro investigations of the effects of specific mono-infections on cultured host cells.

Experimental animal studies and relevant data from human studies are presented whenever available. A critical appraisal of the limitations of these studies is offered at the end of this section. Upon entering the bloodstream, bacteria are rapidly cleared by host immune cells. To survive and elicit effects at distant sites, they have evolved several host-evasion strategies that have been investigated in multiple in vitro studies with P.

One such strategy is the ability of this micro-organism to invade vascular endothelial cells Deshpande et al. Within the endothelial cell, the survival of P. Infection of human aortic endothelial cells by the invasive P. In contrast, corresponding expression profiles in cells infected with a non-invasive fimA mutant remain largely unchanged Chou et al.

Thus, fimbriae appear to be critical for both the invasive and pro-atherogenic properties of P. Again, it should be noted that in vitro invasion of endothelial cells is not an exclusive feature of specific periodontal pathogens, since S.

Nevertheless, the infection-induced effects on endothelial cells also show species-specific variation. For example, expression of the chemokine monocyte chemoattractant protein-1 MCP-1 , an important regulator of monocyte migration from the vessel lumen to the sub-endothelial space, was strongly induced in human umbilical vein endothelial cells after P. In addition to whole bacteria-endothelial cell interactions, studies have examined the effects of specific bacterial products such as microbial proteases and lipopolysaccharide LPS.

Arginine-specific gingipain, a P. Weibel-Palade bodies are vesicles in endothelial cells that store vaso-active substances, such as angiopoietin-2, which may enhance IL-8 production by LPS-stimulated cells Inomata et al. Another class of biologically active bacterial products investigated in this context is outer membrane vesicles OMVs , i.

In addition, a free-soluble surface material, released by A. Interestingly, the effect was only partially LPS-dependent, as shown in LPS blocking experiments with polymyxin B, and did not depend on the presence of A. Since both OMVs and free-soluble surface material are abundantly produced locally in the plaque biofilm, their potential entry into the circulation may constitute a significant source of inflammatory stimulants along with the planktonic bacteria in the bloodstream.

Induction of apoptosis in vascular endothelial cells, a hallmark of developing endothelial dysfunction Hotchkiss et al. Given that the effector enzymes in apoptosis are caspases, a family of cysteine proteases Pop and Salvesen, , these effects could efficiently be blocked by pre-incubation with cysteine-protease inhibitors. Interestingly, both gingipains Sheets et al. However, apoptosis in endothelial cells was strongly dependent on the relative proportion of planktonic pathogens to cultured cells, i.

Conversely, the potential ability of periodontal bacteria or their products to induce vascular cell proliferation is also relevant in the context of atherogenesis, since smooth-muscle-cell proliferation results in thickening of the vessel media, and endothelial proliferation is needed for local angiogenesis within atheromatous plaques. Interestingly, only cell-free products of P. Proliferation could not be induced with live P.

These findings are important, since they indicate that the presence of live bacteria is seemingly not required for the induction of these proliferative effects that may be mediated by OMVs or free-soluble surface material. Similarly, E. Interactions of periodontal bacteria with other host cells that participate in atherogenesis have included studies involving monocytes, which are central to the formation of fatty streaks see Fig.

Roth et al. Complementing these observations, infection of monocytes with invasive strains of P. Likewise, monocyte infection with invasive P. Interestingly, similar experiments with A. Indeed, LPS-challenged monocyte-derived macrophages showed enhanced secretion of TNF-alpha and interleukin-1beta and induction of foam cell formation and accumulation of LDL. These results are in agreement with findings from a recent in vivo study that demonstrated that sub-acute endotoxinemia resulted in a significantly impaired reverse cholesterol transport independent of plasma HDL levels McGillicuddy et al.

Platelets can be activated either by direct interaction of pathogens or their products, or indirectly via the vascular endothelium Jennings, Several recent in vitro studies addressed direct and indirect effects of the model organism P.

Platelet aggregation in plasma was shown to depend on the adhesion molecule Hgp44 and the P. Importantly, in experiments with an MOI below the required threshold to activate platelet aggregation, P. Evidence of indirect pathogen-induced promotion of a pro-thrombotic state has been provided in studies of the interactions of P. Infection of endothelial cells with invasive P.

Interestingly, these effects were most prominent at later time-points, suggesting that they are due to downstream intracellular pathways triggering pro-coagulant mechanisms. In aortic smooth-muscle cells, whole P. Recent human in vivo studies support and extend these observations.

A comparison of platelet-activating factor PAF levels in sera and GCF from patients with periodontitis, patients with coronary heart disease CHD without periodontitis, patients with periodontitis and CHD, and healthy control individuals showed significantly higher serum and GCF levels in all patient groups when compared with levels in control individuals Chen et al. In another case-control study Papapanagiotou et al.

Furthermore, platelets from periodontitis patients showed an increased binding of the glycoprotein IIb-IIIa complex, a direct measure of platelet activation, which correlated positively with the extent and severity of periodontitis of the donor. The same research group Nicu et al. Finally, a conceivable alternative pathway by which periodontal infections may exert pro-thrombotic effects is by means of pathogen-mediated apoptosis of vascular endothelial cells, a key event in the development of endothelial dysfunction, which exposes the basement membrane and allows for interaction of platelets with collagen, resulting in local thrombosis Bombeli et al.

Activated endothelium by either direct interaction with periodontal pathogens, or via systemic inflammatory molecules, is known to express tissue factor thrombokinase , an important mediator of thrombin formation Pober et al. It is important to note that thrombosis induction is not an exclusive feature of periodontal pathogens. In fact, it has been well-established that other oral bacteria, including Streptococcus species Herzberg et al. A role of bacteria and bacterial products is also conceivable in plaque disruption, one of the final and critically important events in atherosclerosis that is caused either by rupture of the fibrous cap of an unstable plaque, leading to exposure of the pro-thrombotic contents of the plaque, or through plaque erosion by apoptosis, triggering local thrombosis Virmani et al.

These events result in the clinical presentation of atherosclerotic vascular disease in the form of a myocardial or cerebrovascular infarction. Degradation of fibrous caps is mediated by matrix metalloproteinases MMPs produced within the plaques by macrophages Galis et al. In vitro, P. The pro-apoptotic effects of periodontal pathogens and their products were discussed above and can also contribute to plaque erosion.

Last, the reported pro-inflammatory effects of A. Although mast cells are uncommon in vascular tissues, they do localize in atherosclerotic plaques and particularly in shoulder regions of rupture-prone plaques Lindstedt et al. Activation of this cell population and subsequent production of levels of proteases capable of destabilization of atheromatic plaques correlate with intra-plaque hemorrhage, endothelial cell and macrophage apoptosis, and vascular leakage Bot et al.

In vivo , mast-cell-deficient mice showed increased collagen content and fibrous cap development, and decreased atherosclerosis Sun et al. Activation of mast cells may thus be a possible route of bacterially triggered plaque rupture, although the available data are sparse. Accumulating evidence suggests that periodontal pathogens and their bacterial products may exert pro-atherogenic effects in vascular endothelial cells via Toll-like receptors TLRs and other pattern recognition receptors PRRs.

These primary receptors of the innate immune system recognize highly conserved pathogen-associated molecular patterns PAMPs. Activation of TLRs and their downstream signaling pathways leads to cellular activation and a specific response to microbial infection. Expression of TLRs is strongly induced in endothelial cells and macrophages in atherosclerotic lesions Xu et al.

Deficiency in MyD88, a central downstream signaling molecule for most TLRs, was shown to result in decreased atherosclerosis in vivo Bjorkbacka et al. Similarly, deletion of TLR2 Mullick et al. However, a recent study utilizing an in vitro model of atherosclerosis found that only blockade of TLR2, but not of TLR4, resulted in significantly attenuated levels of inflammatory mediators and tissue-degrading MMPs Monaco et al.

Interestingly, P. For example, activation of human vascular endothelial cells, monocytes, and mouse macrophages by P. As discussed above, P. In fact, P. Cholesterol depletion inhibits pathogen uptake and attenuates pathogen-induced signaling, suggesting that hypercholesterolemia may result in accelerated TLR2-mediated atherosclerosis Wang and Hajishengallis, TLR2 deletion in a mouse model of periodontitis resulted in a significant attenuation of periodontitis-aggravated atherosclerosis Liu et al.

Stimulation of human aortic endothelial cells by P. These observations suggest the synergistic potential of multiple bacterial stimuli in eliciting enhanced pro-atherogenic responses in vascular endothelial cells. Thus, the selective pathogen-induced expression of TLR2 in arterial endothelial cells supports its involvement in atherogenesis.

Molecular mimicry is a term used to describe the possibility that antibody responses targeted against bacterial antigens can essentially function as autoimmune responses, due to the high degree of homology between specific bacterial antigenic peptides and mammalian proteins, and has been considered as a biologically plausible mechanism linking infection and atherosclerotic vascular disease Wick et al.

Central to this notion is a family of highly conserved heat-shock proteins HSPs Fink, , which is expressed on certain bacterial membranes, as well as by eukaryotic cells when exposed to stress Polla, Bacterial HSPs are considered major antigenic determinants Kaufmann, that elicit antibodies and specific reactive T-cells Young and Elliott, that can cross-react with host cells expressing homologous molecules, resulting in auto-aggressive destruction Mayr et al.

The mammalian host-protective heat-shock protein 60 hHSP60 can be induced in vascular endothelial cells, macrophages, and smooth-muscle cells by several pro-atherogenic stimuli, including bacterial endotoxin, oxidated lipids, inflammatory mediators, hypertension, or mechanical shear stress Seymour et al. Although hHSP60 is not a trans-membrane protein and is thus seemingly unreachable by circulating antibodies, it synergizes with mitochondrial HSP70 mtHSP70 , which is expressed on the surfaces of stressed cells.

A high degree of homology between HSP from C. Likewise, high homology was found between the P. In comparisons of antibody titers to hHSP60 and GroEL in patients with atherosclerosis and periodontal disease, systemically healthy periodontitis patients, and healthy control individuals, the highest titers for both human and bacterial HSP60 were found in patients with both conditions, followed by the systemically healthy group with periodontitis, while the control group showed the lowest antibody levels.

In addition, clonal analysis of the T-cells found both hHSP and GroEL-reactive populations in the circulation of atherosclerosis patients. These T-cell populations were also found in atherosclerotic plaques in several patients Yamazaki et al. The effects of auto-antibodies to pathogens were evaluated in a series of in vivo studies in mice. In ApoE-deficient mice immunized with intra-peritoneal injections of live P. A positive correlation of atherosclerotic lesion development and anti-GroEL titers was found, as well as hHSP60 in the lesions themselves Ford et al.

The presence of circulating anti-HSP60 auto-antibodies resulted in an increased expression of P-selectin and von-Willebrand factor vWF , with an altered morphology of endothelial cells in uninjured carotid arteries. In a model of injured carotid arteries, auto-antibodies promoted thrombosis and recruitment of inflammatory cells Dieude et al.

Interestingly, H. A potential pathway through which periodontitis may contribute to atherogenesis is through induction of oxidative stress. Oxidation of LDL via reactive oxygen species ROS is a prerequisite for cholesterol uptake by macrophages and the formation of foam cells Stoll and Bendszus, ; Itabe, , but also results in several additional pro-atherogenic effects Verhoye and Langlois, Thus, apart from its involvement in the formation of fatty streaks, ox-LDL also affects the vascular endothelium both directly and indirectly.

Direct effects include the induction of cellular activation and apoptosis by interaction with lectin-like oxidized low-density lipoprotein receptor LOX-1 D Li et al. Indirect effects are exerted through down-regulation of the expression of endothelial nitric oxide synthase eNOS , which results in increased production of ROS, ongoing LDL oxidation, and endothelial dysfunction Victor et al. Low levels of EPCs in the peripheral blood were found in states of poor vascular health Werner et al.

In in vitro studies with P. In addition, P. Anti-oxidant treatment of endothelial cells infected with P. In an in vivo setting, higher levels of ROS and oxidative stress-related genes were found in the aortas of rats with experimental periodontitis Ekuni et al.

An intervention with vitamin C, a potent anti-oxidative agent, resulted in attenuated oxidative stress, and decreased lipid deposition in the aorta Ekuni et al. Several studies conducted in ApoE-deficient mice, a mouse model prone to accelerated atherosclerosis, evaluated the effect of P. Thus, intravenous injection of P. Periodontal tissue destruction correlated positively with atherosclerotic lesion formation, serum levels of IL-6 expression, and VCAM-1 expression in the aorta Lalla et al.

Consistent with the in vitro data discussed above, only invasive P. Interestingly, it appeared that pro-atherogenic changes, i. It must be realized that the above studies tested the preventive effects of immunization prior to the induction of periodontitis, and can thus not be extrapolated to represent also the effects of periodontal therapy on atherogenesis-related events.

In an experimental study that modeled the effects of periodontal therapy on systemic inflammation and atherosclerosis—bearing in mind that mechanical periodontal therapy is not feasible in mice—systemic doxycycline was found to reduce atherosclerotic lesion size and pro-atherogenic cytokine production in ApoE heterozygotic mice Madan et al. In this context, it is important to note that human periodontal disease is a chronic infection that is mediated by a biofilm rather than by planktonic bacteria.

Pathogens in a biofilm are largely protected from antibiotics del Pozo and Patel, , and disruption of the dental plaque by mechanical means is considered essential for the successful management of periodontal disease, and for any downstream systemic effects Schaudinn et al. In contrast, the pro-atherogenic changes induced in the mouse model studies above Madan et al.

Therefore, the observed anti-atherogenic effects of antibiotic monotherapy cannot be readily extrapolated to the setting of human periodontitis. In addition, the study did not control for the inherent anti-inflammatory and MMP-inhibiting Gu et al. Interestingly, treatment of P. This effect could be mediated by an inhibition of COXdependent prostaglandin E2 expression by the drug, leading to increased TNF-alpha production and subsequent increased atherosclerosis Gitlin and Loftin, Similarly unanticipated was the observation that deletion of IL-6, a major pro-atherogenic cytokine Schuett et al.

These findings underscore the complexity of the process of atherogenesis and the apparent redundancy of the atherosclerosis-promoting pathways that complicate the interpretation of experimental mechanistic studies. In contrast, wild-type mice were shown to be relatively resistant to a plethora of atherogenic stimuli, and did not develop atherosclerosis within reasonable time periods Graves et al. However, in other animal models involving pigs, P.

Nevertheless, cost-related issues and, more importantly, the possibility to generate knock-out or knock-in animals make mouse models extremely useful in the study of specific molecular targets of atherogenesis. The effects of periodontal pathogens were further studied in the liver, an organ of central importance for lipid metabolism, and for the production of acute-phase proteins, such as CRP.

Repeated intravenous injections of live A. Thus, induction of hepatic inflammation is conceivably another route by which periodontal pathogens may contribute to atherogenesis by interfering with lipid metabolism and promoting systemic inflammation. Studies that utilized multiple bacterial stimuli simultaneously, e.

Furthermore, the selection of the particular strain of the model organism to be used in experimentation is of importance. For example, in the case of P. In future studies, the use of artificial biofilms Thurnheer et al. Similar issues arise from the selection of specific cell lines to be used as the effector targets, the properties of which may vary widely Bouis et al.

For example, the capacity of low P. Likewise, Roth et al. However, intracellular replication has recently been considered as a mechanism through which a pathogen may reach sufficiently high MOIs in vivo to exert biologic effects. Evidence from observational epidemiologic studies that has accumulated over the past few years has extended earlier observations and suggests that periodontal infections are independently associated with cardiovascular and cerebrovascular clinical outcomes.

Although the strength of the reported associations is generally modest, the consistency of the data that have emerged from geographically and ethnically diverse populations across a variety of exposure and outcome variables suggests that the findings cannot be ascribed solely to the effects of confounders. Analysis of limited data from interventional epidemiologic studies suggests that treatment of periodontal infections results in lower levels of systemic inflammation and favorable effects on subclinical markers of atherosclerosis, although analysis of the data suggests substantial heterogeneity in responses.

However, there are no data available to date suggesting that the prevention or amelioration of periodontal infections will result in reduced incidence of cardiovascular or cerebrovascular clinical events. A great many experimental mechanistic in vitro and in vivo studies have established the plausibility of a link between periodontal infections and atherogenesis, and have identified biological pathways by which these effects are mediated.

Future research must expand into the identification of in vivo pathways in humans that lead to periodontitis-mediated atherogenesis or result in treatment-induced reduction in atherosclerosis risk. Ultimately, these findings will pave the way for the conduction of appropriately designed clinical trials that will determine if periodontal interventions have a role in the primary or secondary prevention of AVD. National Center for Biotechnology Information , U. J Dent Res. Kebschull , 1, 3 R.

Demmer , 2 and P. Author information Article notes Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Evidence from epidemiologic studies suggests that periodontal infections are independently associated with subclinical and clinical atherosclerotic vascular disease. Keywords: periodontal, infection, atherosclerosis, epidemiology, mechanisms.

Observational Studies Several earlier reviews have discussed the findings from the major epidemiologic studies Meurman et al. Table 1. Open in a separate window. The Role of Confounding A prominent and persistent concern regarding the positive associations between periodontitis and AVD is the potential for spurious findings induced by known correlations between established risk factors for AVD and poor periodontal health, or, in epidemiologic terms, confounding , which occurs when a variable is both associated with the exposure i.

Table 2. The Appropriate Exposure Measure Relative to the large body of literature that has accumulated on the topic of periodontitis-AVD associations, there has been very little methodological work to help inform and optimize the appropriate case definition of periodontitis that best reflects the infectious etiological agents that are hypothesized as the primary exposure of interest in this context Fong, Significance of AVD Outcomes Evidence suggests that periodontal infections may be a stronger risk factor for ischemic stroke outcomes as compared with coronary outcomes.

Intervention Studies Treatment studies of patients with periodontitis have contributed with additional insights into the potential link between periodontal infections and AVD, and may serve as an intermediate, translational link between the observational studies referenced above and the mechanistic studies reviewed below.

Potential Mechanisms Linking Periodontal Infections and Atherosclerosis In this section, we will review recent publications on the potential pathogenic mechanisms mediating the direct or indirect effects of periodontal infections on the initiation and perpetuation of AVD, as well as the plausible biological pathways that may account for the observed systemic effects of periodontal therapy. Figure 1. Figure 2. Figure 3. Vascular Endothelial Activation Upon entering the bloodstream, bacteria are rapidly cleared by host immune cells.

Pro-thrombotic and Pro-coagulant Effects Platelets can be activated either by direct interaction of pathogens or their products, or indirectly via the vascular endothelium Jennings, Oral Bacteria and Atheromatic Plaque Disruption A role of bacteria and bacterial products is also conceivable in plaque disruption, one of the final and critically important events in atherosclerosis that is caused either by rupture of the fibrous cap of an unstable plaque, leading to exposure of the pro-thrombotic contents of the plaque, or through plaque erosion by apoptosis, triggering local thrombosis Virmani et al.

Activation of Innate Immune Signaling Associated with Atherosclerosis by Periodontal Bacteria Accumulating evidence suggests that periodontal pathogens and their bacterial products may exert pro-atherogenic effects in vascular endothelial cells via Toll-like receptors TLRs and other pattern recognition receptors PRRs. Autoimmune Responses to Periodontal Bacteria Molecular mimicry is a term used to describe the possibility that antibody responses targeted against bacterial antigens can essentially function as autoimmune responses, due to the high degree of homology between specific bacterial antigenic peptides and mammalian proteins, and has been considered as a biologically plausible mechanism linking infection and atherosclerotic vascular disease Wick et al.

Induction of Oxidative Stress by Periodontal Pathogens—Role of ox-LDL A potential pathway through which periodontitis may contribute to atherogenesis is through induction of oxidative stress. Periodontal Pathogens in Animal Models of Atherogenesis Several studies conducted in ApoE-deficient mice, a mouse model prone to accelerated atherosclerosis, evaluated the effect of P.

Concluding Remarks Evidence from observational epidemiologic studies that has accumulated over the past few years has extended earlier observations and suggests that periodontal infections are independently associated with cardiovascular and cerebrovascular clinical outcomes. Acknowledgments Dr.

Invasion of human coronary artery endothelial cells by Streptococcus mutans OMZ Periodontal disease is associated with brachial artery endothelial dysfunction and systemic inflammation. Periodontal disease and risk of myocardial infarction: the role of gender and smoking.

Regulation of cellular immunity prevents Helicobacter pylori -induced atherosclerosis. Tissue factor encryption. Diverse and novel oral bacterial species in blood following dental procedures. Outer membrane vesicles from Porphyromonas gingivalis affect the growth and function of cultured human gingival fibroblasts and umbilical vein endothelial cells. Relationships among clinical measures of periodontal disease and their associations with systemic markers.

Periodontal disease and coronary heart disease: a reappraisal of the exposure. Associations between IgG antibody to oral organisms and carotid intima-medial thickness in community-dwelling adults. Periodontal infections and atherosclerotic vascular disease: an update. Heterogeneity of systemic inflammatory responses to periodontal therapy. Autophagy: a highway for Porphyromonas gingivalis in endothelial cells. The periodontal pathogen Porphyromonas gingivalis cleaves apoB and increases the expression of apoM in LDL in whole blood leading to cell proliferation.

Reduced atherosclerosis in MyDnull mice links elevated serum cholesterol levels to activation of innate immunity signaling pathways. Stimulation of Toll-like receptor 2 in human platelets induces a thromboinflammatory response through activation of phosphoinositide 3-kinase. Apoptotic vascular endothelial cells become procoagulant. Perivascular mast cells promote atherogenesis and induce plaque destabilization in apolipoprotein E-deficient mice.

Endothelium in vitro : a review of human vascular endothelial cell lines for blood vessel-related research. Angiographically confirmed coronary heart disease and periodontal disease in middle-aged males. Porphyromonas gingivalis bacteremia induces coronary and aortic atherosclerosis in normocholesterolemic and hypercholesterolemic pigs. Periodontal pathogens in atheromatous plaques. A controlled clinical and laboratory trial. Severe periodontitis in young adults is associated with sub-clinical atherosclerosis.

Antibiotic treatment of Chlamydia pneumoniae after acute coronary syndrome. Molecular detection of Treponema denticola and Porphyromonas gingivalis in carotid and aortic atheromatous plaques by FISH: report of two cases. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Tooth loss, hypertension and risk for stroke in a Korean population. Mechanisms of Porphyromonas gingivalis -induced monocyte chemoattractant protein-1 expression in endothelial cells.

Porphyromonas gingivalis fimbria-dependent activation of inflammatory genes in human aortic endothelial cells. Comparisons of subgingival microbial profiles of refractory periodontitis, severe periodontitis, and periodontal health using the human oral microbe identification microarray. Bacteraemia due to dental flossing. Periodontal therapy: a novel non-drug-induced experimental model to study human inflammation.

Periodontitis and systemic inflammation: control of the local infection is associated with a reduction in serum inflammatory markers. Short-term effects of intensive periodontal therapy on serum inflammatory markers and cholesterol. Periodontal therapy: a novel acute inflammatory model. An unusual case of pulmonary abscess. J Infect 41 The challenge of treating biofilm-associated bacterial infections. Periodontal infections and cardiovascular disease: the heart of the matter.

Refining exposure definitions for studies of periodontal disease and systemic disease associations. Bleeding on probing differentially relates to bacterial profiles: the Oral Infections and Vascular Disease Epidemiology Study. Invasion of aortic and heart endothelial cells by Porphyromonas gingivalis. Fibroblast apoptosis induced by Porphyromonas gingivalis is stimulated by a gingipain and caspase-independent pathway that involves apoptosis-inducing factor.

Dental disease and risk of coronary heart disease and mortality. Gender differences in the relationship between periodontal disease, tooth loss, and atherosclerosis. Periodontal bacteria and hypertension. J Hypertens 28 Increased Toll-like receptor TLR 2 and TLR4 expression in monocytes from patients with type 1 diabetes: further evidence of a proinflammatory state.

Associations between periodontal disease and systemic disease: evaluating the strength of the evidence. Autoantibodies to heat shock protein 60 promote thrombus formation in a murine model of arterial thrombosis. Modulation of host matrix metalloproteinases by bacterial virulence factors relevant in human periodontal diseases.

Invasion of human coronary artery cells by periodontal pathogens. Flow-dependent regulation of endothelial Toll-like receptor 2 expression through inhibition of SP1 activity. Serum antibodies to periodontal bacteria as diagnostic markers of periodontitis.

Humoral immune responses in gingival crevice fluid: local and systemic implications. Periodontitis in humans and non-human primates: oral-systemic linkage inducing acute phase proteins. Expression of Toll-like receptors in human atherosclerotic lesions: a possible pathway for plaque activation. Periodontitis-induced lipid peroxidation in rat descending aorta is involved in the initiation of atherosclerosis.

Vitamin C intake attenuates the degree of experimental atherosclerosis induced by periodontitis in the rat by decreasing oxidative stress. The effects of periodontal therapy on vascular endothelial function: a pilot trial.

Am Heart J Infection and atherosclerosis: potential roles of pathogen burden and molecular mimicry. The roles of pathogen-associated molecular patterns in atherosclerosis. Non-enterobacterial endotoxins stimulate human coronary artery but not venous endothelial cell activation via Toll-like receptor 2. Pyogenic infections of the central nervous system secondary to dental affections—a report of six cases. Identification of periodontal pathogens in atherosclerotic vessels.

Chaperone-mediated protein folding. The gingipains: scissors and glue of the periodontal pathogen, Porphyromonas gingivalis. Infections and their role in atherosclerotic vascular disease. Cross-reactivity of GroEL antibodies with human heat shock protein 60 and quantification of pathogens in atherosclerosis. Inflammation, heat shock proteins and periodontal pathogens in atherosclerosis: an immunohistologic study. Anti- P. Incidence of bacteremia after chewing, tooth brushing and scaling in individuals with periodontal inflammation.

Quantitative detection of periodontopathic bacteria in atherosclerotic plaques from coronary arteries. Increased expression of matrix metalloproteinases and matrix degrading activity in vulnerable regions of human atherosclerotic plaques. Immune and inflammatory mechanisms of atherosclerosis. Periodontal disease and coronary heart disease. Porphyromonas gingivalis induces its uptake by human macrophages and promotes foam cell formation in vitro. Innate immune recognition of invasive bacteria accelerates atherosclerosis in apolipoprotein E-deficient mice.

Cyclooxygenase-2 inhibition increases lipopolysaccharide-induced atherosclerosis in mice. Periodontal destruction is associated with coronary artery disease and periodontal infection with acute coronary syndrome. Actinobacillus actinomycetemcomitans prosthetic valve endocarditis. Periodontal disease as a risk factor for ischemic stroke. The use of rodent models to investigate host-bacteria interactions related to periodontal diseases.

Azithromycin for the secondary prevention of coronary events. Apoptosis is associated with increased cell surface tissue factor procoagulant activity. Doxycycline inhibits mononuclear cell-mediated connective tissue breakdown. Identification of periodontal pathogens in atheromatous plaques.

Integrin activation by bacterial fimbriae through a pathway involving CD14, Toll-like receptor 2, and phosphatidylinositolkinase. Causal knowledge as a prerequisite for confounding evaluation: an application to birth defects epidemiology. Oral streptococci and cardiovascular disease: searching for the platelet aggregation-associated protein gene and mechanisms of Streptococcus sanguis -induced thrombosis.

Porphyromonas gingivalis fimbriae-dependent interleukin-6 autocrine regulation by increase of gp in endothelial cells. Severity of periodontal disease and number of remaining teeth are related to the prevalence of myocardial infarction and hypertension in a study based on 4, subjects. Effects of Porphyromonas gingivalis antigens and proinflammatory cytokines on human coronary artery endothelial cells. Cell death. Autoimmunity to human heat shock protein 60, Chlamydia pneumoniae infection, and inflammation in predicting coronary risk.

Periodontal disease and coronary heart disease risk. The dentogingival epithelial surface area revisited. Periodontitis-systemic disease associations in the presence of smoking—causal or coincidental? An exploration of the periodontitis-cancer association. Periodontal disease and coronary heart disease incidence: a systematic review and meta-analysis. The importance of assessing confounding and effect modification in research involving periodontal disease and systemic diseases.

The role of cigarette smoking in the association between periodontal disease and coronary heart disease. Chlamydial and periodontal pathogens induce hepatic inflammation and fatty acid imbalance in apolipoprotein E-deficient mice. Effect of treatment of chronic periodontitis on levels of serum markers of acute-phase inflammatory and vascular responses. The short-term effects of treatment of chronic periodontitis on circulating levels of endotoxin, C-reactive protein, tumor necrosis factor-alpha, and interleukin Upregulation of S calcium-binding protein A9 is required for induction of smooth muscle cell proliferation by a periodontal pathogen.

Arginine-specific gingipain A from Porphyromonas gingivalis induces Weibel-Palade body exocytosis and enhanced activation of vascular endothelial cells through protease-activated receptors. Degradation of vascular endothelial thrombomodulin by arginine- and lysine-specific cysteine proteases from Porphyromonas gingivalis.

Oxidative modification of LDL: its pathological role in atherosclerosis. Periodontal bacteremia and various vascular diseases. TLR cross-talk specifically regulates cytokine production by B cells from chronic inflammatory disease patients. Meta-analysis of periodontal disease and risk of coronary heart disease and stroke. Mechanisms of platelet activation: need for new strategies to protect against platelet-mediated atherothrombosis.

Periodontitis and incidence of cerebrovascular disease in men. Systemic antibodies to the leukotoxin of the oral pathogen Actinobacillus actinomycetemcomitans correlate negatively with stroke in women. Poor oral health and coronary heart disease. Periodontal disease, tooth loss, and incidence of ischemic stroke.

Heat shock proteins and the immune response. Bacteraemia following periodontal procedures. Variable cell responses to P. Nasal immunization with Porphyromonas gingivalis outer membrane protein decreases P. Intranasal immunization with Porphyromonas gingivalis and atherosclerosis. Chlamydial heat shock protein 60 localizes in human atheroma and regulates macrophage tumor necrosis factor-alpha and matrix metalloproteinase expression.

Human atherosclerotic plaque contains viable invasive Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. Role for periodontal bacteria in cardiovascular diseases. Pro-atherogenic properties of lipopolysaccharide from the periodontal pathogen Actinobacillus actinomycetemcomitans.

Oral infection with a periodontal pathogen accelerates early atherosclerosis in apolipoprotein E-null mice. It is interesting to note that biomineralization of both the intima and the arterial wall is not related to exceeding the solubility product of crystallizing components [9], because concentrations of those components in blood mainly in plasma are low. Since the formation of deposits occurs even at low concentrations of those substances in blood, it means that the mechanism that governs the biomineralization of arteries is slightly different than the one occurring after exceeding the so-called solubility product of crystallizing substance [10], where the concentration of components is so high that they must precipitate out of the transporting medium.

This situation causes an additional problem with the dissolution of deposits formed in the arteries. It is impossible to shift the system of chemical equilibrium in the blood in such a way that the number of components we want to dissolve from previously crystallized biomineralization is very low. Although that would undoubtedly promote the dissolution of deposits [], it may disrupt the functioning of other organs in which circulating blood must contain a certain amount of the listed ingredients [17,18].

Considering the above, it was decided to first attempt to dissolve the deposits in vitro, and then, in the future, use the obtained test results in attempts to dissolve arterial biomineralization in vivo Figure 2. The apparatus shown in Figure 2 was used for experimental dissolution of arterial biomineralization in vitro. It consists of a container with solvent 1 , a peristaltic pump 2 , a fragment of artery with cholesterol biomineralization or a tube with synthetic calcification 3 , and a reservoir for solvent after its passage through an artery or tube with synthetic apatite 4.

The solvent flow rate was adjusted to the average blood flow rate in human body [ 25]. Figure 3: Drawing of a set of devices used in the experimental dissolution of arterial biomineralization. Arrows show the direction of solvent flow. The experiment included both mineralization occurring in arteries and synthetic apatite mineralization placed in a tube Figure 3. Testing was carried out before and after passing the solvent through. Tests were also carried out on the products of crystallization from the solvent after it had passed through the biomineralization zone [].

Polarization microscope Meiji microscope manufactured in China and scanning microscope Jeol and microscope of Japanese production were used in the research []. Results of the experiment are presented as follows: Dissolution of organic biomineralization Dissolution of phosphate apatite mineralization. Dissolution of organic deposits occurring on walls of arteries used in experiments was preceded by tests regarding presence of cholesterol deposits [].

Many different solvents were passed through the arteries Figure 4 , but only the results of the best dissolution effects were presented in this publication. Fragments of arteries were obtained due to the kindness of cardiac surgeon prof. Ethyl alcohol proved to be one of the best cholesterols and fats solvents. After pumping through the arteries, it was evaporated, and the resulting microcrystals were examined.

The studies showed that the crystals were represented by microcrystalline cholesterol Figure 5. Figure 4: Fragment of an artery affected by significant cholesterol biomineralization, used in the experiments arrows. Figure 5: Cholesterol microcrystal crystallized out of the ethanol that was pumped through arteries affected by cholesterol biomineralization. Experiments with dissolving phosphate biomineralization proved to be complicated, because in the studied arteries such mineralization never occurred without accompanying cholesterol.

Arterial phosphate biomineralization [50], which in previous studies proved to be common although usually co-occurring with organic compounds , turned out to be very complicated to synthesize outside the body. Mineralogical studies confirmed total mineralogical compatibility of the obtained synthetics with apatite formed in the arteries.

Figure 6: Fragments of microcrystalline apatite obtained through experimental synthesis and crystallization of phosphate gel. Experimental dissolving of synthetic apatite was attempted with many solvents. The best one proved to be distilled water []. The surface of apatite grains removed from the tube was studied after their experimental dissolution with distilled water as a solvent. Observations conducted with scanning microscopy confirmed dissolution of apatite grains.

It manifested on their surface as a series of morphological depressions, channels and irregularities Figure 9. Figure 7: Photomicrograph of the apatite structure obtained through the synthesis of phosphate gel, which was used in experimental dissolution SEM. Figure 8: Tube with grains of synthetic apatite arrows attached to the experimental arterial biomineralizetion dissolution system.

Figure 9: Surface of dissolved grain of synthetic apatite after experimental dissolution with distilled water. Presented research results are an experimental contribution to better understanding of the phenomena of crystallization and dissolution of arterial biomineralization, which is one of the main research problems concerning the circulatory system. The experiments that were carried out indicate the possibility of dissolving both cholesterol and apatite deposits found in human arteries.

It is probably also possible to use mixed composition solvents that will dissolve the most common type of arterial biomineralization, i.

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