Tag: nevin manimala

Eur J Clin Microbiol Infect Dis. 2022 Nov 8. doi: 10.1007/s10096-022-04516-2. Online ahead of print.

ABSTRACT

The accuracy of contemporary risk scores in predicting perioperative mortality in infective endocarditis (IE) remains controversial. The aim is to evaluate the performance of existent mortality risk scores for cardiovascular surgery in IE and the impact on operability at high-risk thresholds. A single-center retrospective review of adult patients diagnosed with acute left-sided IE undergoing surgery from May 2014 to August 2019 (n = 142) was done. Individualized risk calculation was obtained according to the available mortality risk scores: EuroScore I and II, PALSUSE, Risk-E, Costa, De Feo-Cotrufo, AEPEI, STS-risk, STS-IE, APORTEI, and ICE-PCS scores. A cross-validation analysis was performed on the score with the best area under the curve (AUC). The 30-day survival was 96.5% (95%CI 91-98%). The score with worse area under the curve (AUC = 0.6) was the STS-IE score, while the higher was for the RISK-E score (AUC = 0.89). The AUC of the majority of risk scores suggested acceptable performance; however, statistically significant differences in expected versus observed mortalities were common. The cross-validation analysis showed that a large number of survivors (> 75%) would not have been operated if arbitrary high-risk threshold estimates had been used to deny surgery. The observed mortality in our cohort is significantly lower than is predicted by contemporary risk scores. Despite the reasonable numeric performance of the analyzed scores, their utility in judging the operability of a given patient remains questionable, as demonstrated in the cross-validation analysis. Future guidelines may advise that denial of surgery should only follow a highly experienced Endocarditis Team evaluation.

PMID:36346471 | DOI:10.1007/s10096-022-04516-2

Rheumatol Int. 2022 Nov 8. doi: 10.1007/s00296-022-05222-0. Online ahead of print.

ABSTRACT

Febuxostat is the drug used to treat hyperuricemia in patients with gout. Recently, the usage of Febuxostat has been controversial over the side effects in cardiovascular. The study aimed to comparatively analyze the risk of cardiovascular disease associated with febuxostat and allopurinol use in Korean patients with gout. A cohort study was conducted using national insurance claim data from the Health Insurance Review and Assessment Service (HIRA). Adult patients who were diagnosed with gout and prescribed febuxostat or allopurinol more than once from July 1, 2015, to June 30, 2018 were studied. The outcome was cardiovascular disease. Analysis was performed using Cox’s proportional hazard model following 1:1 propensity score matching to estimate the hazard ratio with a 95% confidence interval. In total, 90,590 patients were defined as the final study cohort who had an average follow-up of 467 days, including 28,732 and 61,858 patients in the febuxostat and allopurinol groups, respectively. After the 1:1 propensity score matching, the risk of cardiovascular disease in the febuxostat group was significantly higher than in the allopurinol group (HR: 1.17; 95% CI: 1.10-1.24). In the sensitivity analysis, the risk of cardiovascular disease in the febuxostat group was significantly higher than in the allopurinol group (HR: 1.09; 95% CI: 1.04-1.15). However, further sensitivity analysis showed no statistically significant difference between the febuxostat group and allopurinol group after adjusting for cardiovascular disease history before the index date. Similarly, no statistically significant difference was found between the two drugs in the subgroup analysis. Febuxostat was not associated with a significantly increased risk of cardiovascular disease.

PMID:36346443 | DOI:10.1007/s00296-022-05222-0

Eur Radiol. 2022 Nov 8. doi: 10.1007/s00330-022-09188-2. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the incidence, risk factors, and clinical outcomes of pleuroparenchymal fibroelastosis (PPFE) in pediatric hematopoietic stem cell transplantation (HSCT) recipients.

METHODS: This single-center, retrospective, case-control study included 738 consecutive patients who underwent chest CT more than 3 months after HSCT. We identified patients who fulfilled the diagnostic criteria for PPFE and assessed their clinical characteristics and radiologic findings. Propensity score-matched analysis was performed using four covariates (age, sex, HSCT type, and primary disease). The risk factors and clinical outcomes of PPFE were analyzed using the Fine and Gray regression model and stratified log-rank test in the matched groups.

RESULTS: PPFE was identified in 4% (31/738, 8.3 ± 3.1 years, 15 males) of the pediatric HSCT recipients with a median time of 2.7 years after HSCT, and it occurred following allogeneic (5%, 15/317), autologous (4%, 15/379), or both (2%, 1/42). Matching yielded 30 and 130 cases in the PPFE and control groups, respectively. The PPFE group showed more frequent late-onset noninfectious pulmonary complications (LONIPCs) and pneumonia more than 3 months after HSCT (p < 0.05). Multivariable analysis showed a significantly higher risk of PPFE in HSCT recipients who had pneumonia more than 3 months after HSCT (hazard ratio = 10.78 [95% confidence interval: 4.29, 27.13], p < 0.001). The PPFE group showed higher mortality (73%, 22/30) and poorer median overall survival (6.8 years [95% confidence interval: 4.1, 9.5]) than the control group (p < 0.001).

CONCLUSIONS: PPFE represents a severe type of LONIPC after HSCT. HSCT recipients with pneumonia after HSCT may have an increased risk of PPFE.

KEY POINTS: • The incidence of pleuroparenchymal fibroelastosis is not negligible (4%), and it can occur after either allogeneic or autologous hematopoietic stem cell transplantation. • Pleuroparenchymal fibroelastosis after hematopoietic stem cell transplantation showed poor outcome with a high mortality rate of 73% and median overall survival of 6.8 years. • After hematopoietic stem cell transplantation, pneumonia may increase the risk of pleuroparenchymal fibroelastosis development in children. • Lung biopsy should not be indicated in patients with pleuroparenchymal fibroelastosis findings on chest CT as it can cause refractory pneumothorax without helping the diagnosis.

PMID:36346442 | DOI:10.1007/s00330-022-09188-2

CA Cancer J Clin. 2022 Nov 8. doi: 10.3322/caac.21757. Online ahead of print.

ABSTRACT

American Indian and Alaska Native (AIAN) individuals are diverse culturally and geographically but share a high prevalence of chronic illness, largely because of obstacles to high-quality health care. The authors comprehensively examined cancer incidence and mortality among non-Hispanic AIAN individuals, compared with non-Hispanic White individuals for context, using population-based data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. Overall cancer rates among AIAN individuals were 2% higher than among White individuals for incidence (2014 through 2018, confined to Purchased/Referred Care Delivery Area counties to reduce racial misclassification) but 18% higher for mortality (2015 through 2019). However, disparities varied widely by cancer type and geographic region. For example, breast and prostate cancer mortality rates are 8% and 31% higher, respectively, in AIAN individuals than in White individuals despite lower incidence and the availability of early detection tests for these cancers. The burden among AIAN individuals is highest for infection-related cancers (liver, stomach, and cervix), for kidney cancer, and for colorectal cancer among indigenous Alaskans (91.3 vs. 35.5 cases per 100,000 for White Alaskans), who have the highest rates in the world. Steep increases for early onset colorectal cancer, from 18.8 cases per 100,000 Native Alaskans aged 20-49 years during 1998 through 2002 to 34.8 cases per 100,000 during 2014 through 2018, exacerbated this disparity. Death rates for infection-related cancers (liver, stomach, and cervix), as well as kidney cancer, were approximately two-fold higher among AIAN individuals compared with White individuals. These findings highlight the need for more effective strategies to reduce the prevalence of chronic oncogenic infections and improve access to high-quality cancer screening and treatment for AIAN individuals. Mitigating the disparate burden will require expanded financial support of tribal health care as well as increased collaboration and engagement with this marginalized population.

PMID:36346402 | DOI:10.3322/caac.21757

J Adhes Dent. 2022 Nov 8;24(1):395-406. doi: 10.3290/j.jad.b3559027.

ABSTRACT

PURPOSE: To evaluate the microtensile bond strength (μTBS) and silver nitrate uptake (SNU) of three universal adhesives used in etch-and-rinse (ER) and self-etch (SE) modes on dry, wet, and oversaturated dentin surfaces after 24 h and 1 year of water storage. The morphology of the hybrid layer (MHL) and the degree of conversion (DC) were also evaluated.

MATERIALS AND METHODS: Human molars were divided into 36 groups according to combinations of the following variables: (i) universal adhesives (Ambar Universal APS [AMB], Prime&Bond Active [PBA], Scotchbond Universal Adhesive [SBU]), (ii) adhesive strategies (ER or SE), (iii) moisture level (dry, wet, or oversaturated dentin surface), and (iv) storage time (24 h or 1 year). After restoration, the specimens were sectioned into resin-dentin sticks and tested for μTBS and SNU according to storage time. For MHL, the specimens were sectioned and evaluated after 24 h using SEM. DC was evaluated using FTIR. ANOVA and Tukey’s test were used for statistical analyses (5%).

RESULTS: When 24-h vs 1-year data were compared, there was a significant decrease in μTBS and an increase in SNU values for the majority of experimental groups (p < 0.0001). On dry (ER) and oversaturated (ER and SE) dentin, AMB showed higher μTBS than did PBA (p < 0.00001). No significant decrease in μTBS was observed when universal adhesives were applied in the SE mode to dry dentin (p > 0.05). Regarding SNU, at all moisture levels, AMB showed lower SNU values than SBU (p < 0.001). Regarding MHL, SBU showed several imperfections when applied to oversaturated dentin in comparison with AMB and PBA. Regarding DC, when dentin was kept dry or was oversaturated, AMB showed a higher DC than PBA (p < 0.0001).

CONCLUSION: The behavior of the different universal adhesives evaluated did not vary when applied to wet or dry dentin. However, the results with oversaturated dentin were dependent on the universal adhesive. Independent of the moisture level and the universal adhesive evaluated, significant degradation of the bonding properties occurred after 1 year of water storage, with the exception of universal adhesives applied to dry dentin in the SE strategy.

PMID:36346400 | DOI:10.3290/j.jad.b3559027

Expert Rev Mol Diagn. 2022 Nov 8. doi: 10.1080/14737159.2022.2144235. Online ahead of print.

ABSTRACT

BACKGROUND: Suppressor of variegation, Enhancer of Zeste, Trithorax (SET) and Myeloid-Nervy-DEAF1 (MYND) domain-containing protein (SMYD) family with methyltransferase activity is involved in cancer progression. This novel meta-analysis aimed to evaluate the association of SMYD family with the clinical and survival outcomes in solid cancer patients.

METHODS: We systematically searched Embase, PubMed, Scopus and Web of Science to select relevant articles. Hazard ratios (HRs), odds ratios (ORs) and 95% confidence intervals were extracted. Heterogeneity was evaluated by chi-square-based Q and I² tests, while publication bias by funnel plots and Egger’s test. Seven subcategories were used to perform subgroup analyses.

RESULTS: 32 articles (4,826 patients) met inclusion criteria. SMYD2/3 overexpression was statistically associated with poor overall survival (HR=1.794, P<0.001), disease/relapse/progression-free survival (HR=2.114, P<0.001), disease/cancer-specific survival (HR=3.220, 95%CI:1.498-6.921, P=0.003), larger tumor size (OR=1.963, P<0.001), advanced TNM stage (OR=2.066, P<0.001), lymph node metastasis (OR=2.054, P<0.001), and distant metastasis (OR=1.978, P=0.004). Subgroup analysis showed more significant association between SMYD2 overexpression and reduced survival outcomes than that in SMYD3. Conversely, the relationship between SMYD3 and various clinicopathologic factors was stronger compared to SMYD2.

CONCLUSION: Enhanced SMYD2/3 expression may be an unfavorable clinical prognostic factor in different solid cancer types, being linked to tumor development, poor survival outcomes and high likelihood of metastasis.

PMID:36346387 | DOI:10.1080/14737159.2022.2144235

J Exp Med. 2023 Jan 2;220(1):e20220829. doi: 10.1084/jem.20220829. Epub 2022 Nov 8.

ABSTRACT

Defects in nucleic acid metabolizing enzymes can lead to spontaneous but selective activation of either cGAS/STING or RIG-like receptor (RLR) signaling, causing type I interferon-driven inflammatory diseases. In these pathophysiological conditions, activation of the DNA sensor cGAS and IFN production are linked to spontaneous DNA damage. Physiological, or tonic, IFN signaling on the other hand is essential to functionally prime nucleic acid sensing pathways. Here, we show that low-level chronic DNA damage in mice lacking the Aicardi-Goutières syndrome gene SAMHD1 reduced tumor-free survival when crossed to a p53-deficient, but not to a DNA mismatch repair-deficient background. Increased DNA damage did not result in higher levels of type I interferon. Instead, we found that the chronic interferon response in SAMHD1-deficient mice was driven by the MDA5/MAVS pathway but required functional priming through the cGAS/STING pathway. Our work positions cGAS/STING upstream of tonic IFN signaling in Samhd1-deficient mice and highlights an important role of the pathway in physiological and pathophysiological innate immune priming.

PMID:36346347 | DOI:10.1084/jem.20220829

Oral Health Prev Dent. 2022 Nov 8;20(1):433-448. doi: 10.3290/j.ohpd.b3556039.

ABSTRACT

PURPOSE: To identify and assess any changes in the pulp tissue complex following orthodontic force application.

MATERIALS AND METHODS: Published and unpublished literature was searched in seven databases until 9 August 2022 for randomised controlled trials (RCTs) and prospective trials (nR-PCT). Representative key words included ‘pulp response’, ‘pulp tissue’, ‘orthodontic force’, and ‘tooth movement’. Study selection, data extraction, risk of bias and certainty of evidence assessment were conducted independently by two reviewers. Random effects meta-analyses with respective confidence intervals (95%CIs) were conducted where applicable.

RESULTS: A total of 363 records were screened, a final number of 24 articles were eligible for qualitative synthesis, while 8 of those contributed to meta-analyses. There was evidence that pulpal blood flow (PBF) decreased after 3 weeks of tooth movement compared to no force application (4 studies, mean difference: -1.68; 95% CI: -3.21, -0.15; p = 0.03). However, this was not the case after 6 months of treatment (p = 0.68). A rise in the activity of aspartate aminotransferase (AST) was detected after 7 days of treatment, but combining 2 studies, this was not statistically significant (p = 0.25). Other outcomes were assessed through single studies. Risk of bias was within the range of ‘some concerns/moderate to high/critical overall’, while certainty of evidence was low to very low according to GRADE.

CONCLUSIONS: As a short-term effect, PBF decreased upon initiation of orthodontic force application, while enzymatic and peptide activity within the pulp was transiently affected. Further long-term evidence of improved quality and certainty is needed.

PMID:36346338 | DOI:10.3290/j.ohpd.b3556039

Oral Health Prev Dent. 2022 Nov 8;20(1):421-431. doi: 10.3290/j.ohpd.b3556037.

ABSTRACT

PURPOSE: The aim of this review is to analyse the use of hyaluronic acid injection in the interdental space to reconstruct the papilla in animal models and humans.

MATERIALS AND METHODS: Electronic databases were searched up to May 2022, and additional hand searching was performed. The search strategy was implemented according to the PRISMA guidelines. The inclusion criteria were: studies written in English, studies using hyaluronic acid, in vivo studies, studies with a precise number of specimens, case series with ≥6 patients, and studies published after 2010. The risk of bias was assessed for each study that could be evaluated.

RESULTS: A total of 19 articles were selected and reviewed in this review. Due to the great heterogeneity of the protocols and materials, comparison between studies was not possible. However, using this technique, the studies found statistically significant improvements in most cases. The filling percentages ranged from 19% to 100%. Regarding patient satisfaction, the few studies that evaluated this parameter found statistically significant results with most patients willing to repeat the experience. Regarding side effects, only two studies reported them. Moreover, the procedure does not seem to be very painful.

CONCLUSION: The results suggest that hyaluronic acid injections seem to be effective in reconstructing papillary volume. However, to date, too few clinical trials with a high level of proof have been conducted on this technique. Future studies will have to work on the size of the sample, the concentration of the product, the number of injections and the injection method.

PMID:36346337 | DOI:10.3290/j.ohpd.b3556037

Oral Health Prev Dent. 2022 Nov 8;20(1):413-419. doi: 10.3290/j.ohpd.b3555989.

ABSTRACT

PURPOSE: To explore the effects of oral health promotion management on the improvement of oral healthcare knowledge, attitudes, and behaviours in pregnant women.

MATERIALS AND METHODS: This randomised study included pregnant women in Shanghai (China) who were randomly assigned to receive oral-health promotion management (intervention group) or no interventions (control group). The primary outcome for this study was overall oral health. The secondary outcomes included oral health awareness and attitudes, oral health knowledge, oral healthcare behaviours, medical visits, and risk factors. The Fourth National Oral Health Questionnaire was self-administered in this study, and oral examinations included caries and periodontal status. Data consistency was assessed by the Kappa coefficient.

RESULTS: After intervention, periodontal outcomes in the intervention group had improved statistically significantly, and the proportion of those without periodontal diseases had statistically significantly increased to 14.4% (p < 0.05). In the intervention group, statistically significant improvements were also observed in the number of active caries (p < 0.001), number of filled teeth (p = 0.014), and community periodontal index (CPI) scores (p < 0.001). Overall, after intervention, pregnant women demonstrated comprehension of the importance of children’s deciduous teeth, and their knowledge of the importance of good oral health had greatly improved. Further, oral healthcare habits in the intervention group also showed statistically significant improvement: 56.8% established the habit of cleaning the tongue every week (p < 0.05) and 39.6% established the habit of regular oral examination (p < 0.05).

CONCLUSION: Oral healthcare education and promotion management for pregnant women can effectively improve their oral health, knowledge, attitudes, and behaviours of oral health care.

PMID:36346336 | DOI:10.3290/j.ohpd.b3555989