The pattern of correlations Table

The pattern of correlations (Table 4) revealed that b1, b2, b3, and b7 generally have stronger relationships with the chapter independence scores than with the frequency scores. This finding made intuitive sense because the FUNDES independence dimension measures the extent to which assistance in daily life is needed based on the perspectives of parents/proxies. Children with more problems in body functions would be expected to need more assistance from others. Assistance provided to the child might be affected by parents\’ perspectives on what activities are most important for their children to participate in, and the parents\’ level of experience in providing strategies to promote their children\’s participation.
In the correlation patterns between the d and e chapter scores, the e1 (Product and technology) scores had higher correlations with the d independence scores than with the frequency scores, while e4 (Attitudes of others) had higher correlations with the frequency scores than with the independence ones. Children with less independence were associated with greater impairment in body functions and might face more barriers associated with the adequacy of assistive technology and physical products. By contrast, children with greater frequency restrictions tended to have more problems associated with the negative attitudes of others (e4), which might decrease children\’s opportunities to attend activities. This suggests that participation frequency might be more related to social support, including the acceptability and accommodability of the environment, while independence might be more related to physical support, including the availability, accessibility, and affordability of the environment.


Drug-induced gingival overgrowth and fibrosis occurs as a side effect of systemic medication of immunosuppressant cyclosporine A (CsA). CsA-induced gingival overgrowth characterizes fibrosis via the increased accumulation of fibroblasts, collagen, and other extracellular matrix components, such as plasminogen activator inhibitor-1, lysyl oxidase (LOX), cystatin C, heat shock protein 47, and transglutaminase-2. The upregulation of the buy dihydroergotamine growth factor may contribute to the pathogenesis of CsA-induced gingival overgrowth. In addition, gingival inflammation is a contributing factor to the development of CsA-induced overgrowth, and chlorhexidine was reported to ameliorate gingival overgrowth via an anti-inflammatory mechanism in an established rat model. However, the pathologic mechanisms of CsA-induced gingival overgrowth still need to be further clarified.
Epithelial–mesenchymal transition (EMT) is characterized by the loss of proteins associated with the epithelial phenotype and by the increased expression of proteins associated with a mesenchymal and migratory cell phenotype. EMT occurs in drug-induced gingival overgrowth. Snail, a member of the Snail family of zinc finger transcription factors, is one of the master regulators that promote EMT. Overexpression of Snail is found in various fibrotic diseases, including liver fibrosis and renal fibrosis. However, it is unclear whether Snail is involved in the pathogenesis of CsA-induced gingival overgrowth.
In this study, the effect of CsA on normal human gingival fibroblasts (HGFs) was used to elucidate the possible role of Snail in the pathogenesis of CsA-induced gingival overgrowth. Quantitative real-time reverse transcription–polymerase chain reaction (qRT-PCR) and western blot were used to determine the effects of CsA on the expression of Snail in cultured HGFs in vitro. In addition, the cell proliferation rate in CsA-treated HGFs with Snail lentiviral-mediated short hairpin RNA interference (shRNAi) knockdown was evaluated by tetrazolium bromide reduction assay.


To examine the effect of CsA on Snail expression in vitro, HGFs were treated with CsA, and the levels of transcript and protein were measured by qRT-PCR and western blot analyses. As shown in Figure 1, CsA increased the Snail transcript in HGFs in a dose-dependent manner (p < 0.05). In addition, CsA upregulated Snail protein expression in a dose-dependent manner (p < 0.05; Figure 2A). From the AlphaImager 2000, the levels of Snail protein increased about 1.6-, 3.4-, 3.1-, and 3.0-fold after exposure to 100 ng/mL, 200 ng/mL, 500 ng/mL, and 1000 ng/mL CsA, respectively (Figure 2B).