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Πέμπτη 7 Ιουλίου 2022

Tooth Preservation vs. Extraction and Implant Placement in Periodontally Compromised Patients: A Systematic Review and Analysis of Studies

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Abstract

Purpose

: The aim of this systematic review was to identify studies with a minimum of 5-years follow-up, reporting on the management of periodontally compromised teeth with either extraction and subsequent implant placement or teeth preservation with conventional periodontal treatment and application of regenerative procedures. The outcomes of these two approaches, based on clinical and radiographic data and the incidence of tooth- and implant-loss, were also investigated.

Material and methods

: A systematic search for studies reporting on clinical and radiographic outcomes of periodontal treatment or replacement of periodontally compromised teeth with implants was conducted in 3 electronic databases, followed by a hand-search in 8 journals. Only randomized controlled trials (RCTs), cohort studies, and case series with prospective design were included.

Results

: The initial search resulted in 1080 papers. After the first two screenings, 24 publications were selected for inclusion in this systematic review. The treatment protocols for the teeth preservation group contained non-surgical and/or surgical periodontal treatment with or without regeneration procedures. The implant studies included extraction of periodontally involved teeth and implant placement with or without bone and soft tissue augmentation, followed by restoration with fixed dental prostheses (FDPs). Survival rates ranged between 81.8% and 100% in the tooth retention group, and between 94.8% and 100% in the implant group. In the extraction group, no complications were reported for 76.09% of the implants. Similarly, no complications were reported for 86.83% of the tooth retention group. The lack of standardized comparable studies prohibited conduction of a meta-analysis.

Conclusion

: Both treatment approaches, treatment of periodontally compromised teeth, or tooth extraction followed by implant placement, present high survival rates. The application of bone regeneration techniques improves the long-term prognosis of periodontally involved teeth. Hence, treatment of periodontally involved teeth with subsequent application of a rigorous maintenance protocol can be a viable alternative for a number of years, before proceeding to extraction and replacement with dental implants. More well-designed randomized controlled trials are needed in order to draw definite conclusions on the subject.

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Τετάρτη 6 Ιουλίου 2022

Efficacy and safety of a single dose of casirivimab and imdevimab for the prevention of COVID-19 over an 8-month period: a randomised, double-blind, placebo-controlled trial

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Publication date: Available online 5 July 2022

Source: The Lancet Infectious Diseases

Author(s): Gary A Herman, Meagan P O'Brien, Eduardo Forleo-Neto, Neena Sarkar, Flonza Isa, Peijie Hou, Kuo-Chen Chan, Katharine J Bar, Ruanne V Barnabas, Dan H Barouch, Myron S Cohen, Christopher B Hurt, Dale R Burwen, Mary A Marovich, Bret J Musser, John D Davis, Kenneth C Turner, Adnan Mahmood, Andrea T Hooper, Jennifer D Hamilton

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Ocular proton therapy, pencil beam scanning high energy proton therapy or stereotactic radiotherapy for uveal melanoma; an in silico study

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Publication date: Available online 5 July 2022

Source: Cancer/Radiothérapie

Author(s): A. Gerard, M.L. Peyrichon, M. Vidal, C. Barnel, W. Sauerwein, A. Carnicer, G. Angellier, T.M. Mathis, K.K. Mishra, J. Thariat, J. Herault

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The Role of PARP‐1 and NF‐κB in Bile‐Induced DNA Damage and Oncogenic Profile in Hypopharyngeal Cells

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Objectives/Hypothesis

We recently documented that acidic bile, a gastroesophageal reflux content, can cause invasive hypopharyngeal squamous cell carcinoma, by inducing widespread DNA damage and promoting nuclear factor kappa B (NF-κB)-related oncogenic molecular events. Poly or adenosine diphosphate (ADP)-ribose polymerase-1 (PARP-1), a sensitive sensor of DNA damage, may interact with NF-κB. We hypothesized that PARP-1 is activated in hypopharyngeal cells (HCs) with marked DNA damage caused by acidic bile, hence there is an association between PARP-1 and NF-κB activation or its related oncogenic profile, in this process.

Study Design

In vitro study.

Methods

We targeted PARP-1 and NF-κB(p65), using pharmacologic inhibitors, 1.0 μM Rucaparib (AG014699) and 10 μM BAY 11–7082 {3-[4=methylphenyl)sulfonyl]-(2E)-propenenitrile}, respectively, or silencing their gene expression (siRNAs) and used immunofluorescence, luciferase, cell viability, direct enzyme-linked immunosorbent assays, and qPCR analysis to detect the effect of targeting PARP-1 or NF-κB in acidic bile-induced DNA damage, PARP-1, p-NF-κB, and B-cell lymphoma 2 (Bcl-2) expression, as well as NF-κB transcriptional activity, cell survival, and mRNA oncogenic phenotype in HCs.

Results

We showed that (i) PARP-1 is overexpressed by acidic bile, (ii) targeting NF-κB adequately prevents the acidic bile-induced DNA double-strand breaks (DSBs) by gamma H2A histone family member X (γH2AX), oxidative DNA/RNA damage, PARP-1 overexpression, anti-apoptotic mRNA phenotype, and cell survival, whereas (iii) targeting PARP-1 preserves elevated DNA damage, NF-κB activation, and anti-apoptotic phenotype.

Conclusion

We document for the first time that the activation of PARP-1 is an early event during bile reflux-related head and neck carcinogenesis and that NF-κB can mediate DNA damage and PARP-1 activation. Our data encourage further investigation into how acidic bile-induced activated NF-κB mediates DNA damage in hypopharyngeal carcinogenesis.

Level of Evidence

NA Laryngoscope, 2022

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Impact of Expanding Eligibility Criteria for Cochlear Implantation – Dynamic Modeling Study

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Impact of Expanding Eligibility Criteria for Cochlear Implantation – Dynamic Modeling Study

The aim of this study was to explore the impact of further expanding unilateral CI criteria in those with severe hearing loss (HL) (61–80 dBHL) in terms of number of CI recipients, costs, quality of life, and cost-effectiveness. Based on its outcomes, the described expansion appears to constitute a cost-effective use of healthcare resources. However, it would require a significant increase in diagnostic, operative and rehabilitative capacity. These quantitative estimates can serve as a basis for wider societal deliberation on the question wheter such an increase can and should be pursued.


Objectives

Eligibility criteria for cochlear implantation (CI) are shifting due to technological and surgical improvements. The aim of this study was to explore the impact of further expanding unilateral CI criteria in those with severe hearing loss (HL) (61–80 dBHL) in terms of number of CI recipients, costs, quality of life, and cost-effectiveness.

Methods

A dynamic population-based Markov model was constructed mimicking the Dutch population in three age categories over a period of 20 years. Health states included severe HL (61–80 dBHL), profound HL (>81 dBHL), CI recipients, and no-CI recipients. Model parameters were based on published literature, (national) databases, expert opinion, and model calibration.

Results

If persons with severe HL would qualify and opt for CI similar to those with profound HL now, this would lead to a 6–7 times increase of new CI recipients and an associated increase in costs (€550 million) and QALYs (54.000) over a 20-year period (incremental cost utility ratio: 10.771 euros/QALY [2.5–97.5 percentiles: 1.252–23.171]). One-way-sensitivity analysis indicated that model outcomes were most sensitive to regaining employment, utility associated with having a CI, and costs of surgery and testing.

Conclusion

Our findings suggest that expanding eligibility for CI to persons with severe HL could be a cost-effective use of resources. Clearly, however, it would require a significant increase in diagnostic, operative, and rehabilitative capacity. Our quantitative estimates can serve as a basis for a wider societal deliberation on the question whether such an increase can and should be pursued.

Level of Evidence

N/A Laryngoscope, 2022

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Stereotactic body radiotherapy extends the clinical benefit of PD-1 inhibitors in refractory recurrent/metastatic nasopharyngeal carcinoma

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Emerging evidence shows that immune checkpoint inhibitors lead to durable responses in a variety of cancers, including nasopharyngeal carcinoma (NPC), however, combination approaches (i.e., stereotactic body r...
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Τρίτη 5 Ιουλίου 2022

Distribution of Serotypes Causing Invasive Pneumococcal Disease in Children from High-Income Countries and the Impact of Pediatric Pneumococcal Vaccination

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Abstract
Background
The introduction and adoption of pneumococcal conjugate vaccines (PCVs) into pediatric national immunization programs (NIPs) has led to large decreases in invasive pneumococcal disease (IPD) incidence caused by vaccine serotypes. Despite these reductions, the global IPD burden in children remains significant.
Methods
We collected serotype-specific IPD data from surveillance systems or hospital networks of all 30 high-income countries that met inclusion criteria. Data sources included online databases, surveillance system reports, and peer-reviewed literature. Percentage of serotyped cases covered were calculated for all countries combined and by PCV type in the pediatric NIP.
Results
We identified 8012 serotyped IPD cases in children <5 or ≤5 years old. PCV13 serotype IPD caused 37.4% of total IPD cases, including 57.1% and 25.2% for countries with PCV10 or PCV13 in the pediatric NIP, respectively, most commonly due to serotypes 3 and 19A (11.4% and 13.3%, respectively, across all countries). In PCV10 countries, PCV15 and PCV20 would cover an additional 45.1% and 55.6% of IPD beyond serotypes contained in PCV10, largely due to coverage of serotype 19A. In PCV13 countries, PCV15 and PCV20 would cover an additional 10.6% and 38.2% of IPD beyond serotypes contained in PCV13. The most common IPD serotypes covered by higher valency PCVs were 10A (5.2%), 12F (5.1%), and 22F and 33F (3.5% each).
Conclusions
Much of the remaining IPD burden is due to serotypes included in PCV15 and PCV20. The inclusion of these next generation PCVs into existing pediatric NIPs may further reduce the incidence of childhood IPD.
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Associated factors of primary snoring and obstructive sleep apnea in patients with sleep bruxism: a questionnaire study

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Abstract

Background

By being aware of the associated factors of primary snoring (PS) and obstructive sleep apnea (OSA) in sleep bruxism (SB) patients, dentists may contribute to the screening and early recognition of SB patients with PS or OSA.

Objective

To identify the associated factors of PS and OSA from questionnaire-based data in SB patients.

Methods

A total of 968 self-reported SB patients (31.6% men; median age 44.5 years) were retrospectively enrolled. Self-reported sleep-related breathing status (viz., no sleep-related breathing condition, PS, and OSA) was the dependent variable. Independent variables were questionnaire-based data on demographics, lifestyle, psychological status, pain, and sleep.

Results

For PS, no statistically significant associated factor was identified in analyses. For OSA, increased age (OR = 1.04 [1.03-1.06]), male gender (OR = 3.33 [2.17-5.00]), daily alcohol consumption (OR = 1.96 [1.18-3.33]), depression (OR = 1.10 [1.06-1.14]), daytime sleepiness (OR = 2.94 [1.85-4.76]), and high risk of gastroesophageal reflux disease (GERD; OR = 2.63 [1.52-4.76]) were found to be significant risk factors, while high risk of temporomandibular disorder (TMD) pain (OR = 0.51 [0.30-0.86]) and chronic pain (OR = 0.73 [0.59-0.90]) were significant protective factors. These results were confirmed in the subsequent network analysis.

Conclusion

Within the limitations of this study, no associated factor is identified for PS. For OSA, dentists should keep in mind that increased age, male gender, daily alcohol consumption, depression, daytime sleepiness, and high GERD risk are associated with increased OSA risk in SB patients, while high TMD pain risk and chronic pain are associated with decreased OSA risk in this population.

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Keratin5-cytoskeleton-BMP4 network regulates cell phenotype conversions during cardiac regeneration

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Publication date: Available online 4 July 2022

Source: Experimental Cell Research

Author(s): Xuelong Wang, Huiping Guo, Feifei Yu, Hui Zhang, Ying Peng, Chenghui Wang, Gang Wei, Jizhou Yan

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Validation of a health-related quality of life questionnaire in patients with recurrent Clostridioides difficile infection in ECOSPOR III, a Phase 3 randomized trial

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Abstract
Background
Debilitating symptoms of recurrent Clostridioides difficile infection (rCDI) often lead to long-term effects on health-related quality-of-life (HRQOL). In ECOSPOR III, SER-109, an investigational oral microbiome therapeutic, was superior to placebo in reducing rCDI. We investigated the validity, reliability, and responsiveness of a 32-item, CDI-specific questionnaire (Cdiff32) across mental, physical, and social domains in patients with rCDI.
Methods
In this post-hoc analysis of a Phase 3 clinical trial, 182 outpatients with rCDI completed Cdiff32 and EQ-5D at baseline, 1 and 8 weeks. Cdiff32 was evaluated for item performance, internal reliability, and convergent validity. To assess known-groups validity, Cdiff32 scores were compared across recurrent versus non-recurrent patients at week 1; internal responsiveness was evaluated in non-re current patients by 8 weeks by paired t-test.
Results
All 182 patients (mean age 65.5 ± 16.5, 59.9% female) completed baseline Cdiff32. Confirmatory factor analysis identified 3 domains (physical, mental, and social relationships) with good item fit. High internal reliability was demonstrated (Cronbach's alpha = 0.94 with all subscales > 0.80). Convergent validity was evidenced by significant correlations between Cdiff32 subscales and EQ-5D (r range: 0.29-0.37, p < 0.001). Cdiff32 differentiated recurrent from non-recurrent patients at week 1 (effect sizes: 0.38-0.42; p < 0.05 overall), with significant improvement from baseline to week 8 in non-recurrent patients (effect sizes: 0.75-1.02; p < 0.001 overall).
Conclusions
Cdiff32 is a valid, reliable, and responsive disease-specific HRQOL questionnaire fit-for-purpose for interventional treatment trials. The significant improvement in non-recurrent patients by 8 weeks demonstra tes the negative impact of rCDI on HRQOL.
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