Influence of Health System Affiliation and Pain Manifestation on Advanced Oral Cavity Squamous Cell Carcinoma Risk: A Retrospective Cohort Study in a Latin American Population

Background/Objectives: Oral cavity cancer, a subtype of head and neck cancer, is one of the most common malignancies globally. This study assessed the influence of health system affiliation and pain manifestation on the risk of advanced oral cavity squamous cell carcinoma (OCSCC) in a Latin American population. Methods: In this retrospective cohort study, we analyzed medical records from 2015 to 2016, including data from the past 19 years, of 233 patients with OCSCC treated at a public hospital in Medellín, Colombia. Sociodemographic and clinical variables were evaluated, and multivariate regression models incorporated variables significant in bivariate analysis. Results: Among 233 patients, 196 (84.1%) had advanced OCSCC. The sample had a mean age of 63 ± 13 years, 53.6% were male, and 64% came from urban areas with predominantly low socioeconomic levels. Men showed a threefold increased risk of advanced OCSCC (95% CI: 1.3-6.8), while patients referred to pain clinics exhibited a 19.5 times higher risk (95% CI: 2.3-159.5). Patients in the subsidized health system or without health insurance had 2.6 (95% CI: 1.07-6.3) and 2.7 times (95% CI: 1.17-6.4) higher risks, respectively. Conclusions: This study found that male patients, referrals to pain clinics, and subsidized or no health system affiliation significantly increased the risk of advanced OCSCC.

Relationship between Intraoperative Bile Culture Outcomes and Subsequent Postoperative Infectious Complications: A Retrospective Cohort Study

The presence of positive bile culture during intraoperative procedures has been associated with elevated morbidity and mortality rates in hepatobiliopancreatic surgeries, contributing to increased healthcare expenditures. However, the precise impact of bactobilia on the development of postoperative complications remains uncertain due to existing disparities in the published literature. In this retrospective cohort study, we assessed 137 patients who underwent major hepatobiliopancreatic surgery to examine the relationship between intraoperative bile culture outcomes and subsequent postoperative infectious complications. Among patients with bactobilia, a significant 35.1% exhibited systemic or local infectious complications, whereas only 11.1% of those with negative culture results experienced any infectious complications (p = 0.002). Similarly, a notable difference was observed in the incidence of surgical site infections, with 24.3% in the bactobilia group compared to 7.9% in the negative culture group (p = 0.01). A total of 74 monomicrobial cultures with microbiological growth were isolated, predominantly featuring Gram-negative microorganisms, primarily Enterobacteriaceae in 49 cultures. Escherichia coli was identified in 37.8% of positive cultures, while Klebsiella pneumoniae was evident in 21.6%. Gram-positive microorganisms were present in 10 cultures, with Enterococcus emerging as the prevailing species. The logistic regression model identified a positive bile culture as an independent factor significantly associated with infection development (OR: 2.26; 95% confidence interval: 1.23-11; p = 0.02). Considering the limitations of the study, these findings underscore the critical importance of conducting bile cultures during the intraoperative phase to enable vigilant monitoring and prompt management of infectious complications.

Exploring the interplay between Porphyromonas gingivalis KGP gingipain, herpes virus MicroRNA-6, and Icp4 transcript in periodontitis: Computational and clinical insights

BACKGROUND

Porphyromonas gingivalis, a major pathogen in periodontitis, produces KGP (Lys-gingipain), a cysteine protease that enhances bacterial virulence by promoting tissue invasion and immune evasion. Recent studies highlight microRNAs' role in viral latency, potentially affecting lytic replication through host mechanisms. Herpes virus (HSV) establishes latency via interactions between microRNA-6 (miRH-6) and the ICP4 transcription factor in neural ganglia. This suggests a potential link between periodontitis and HSV-induced latency. This study aims to identify and validate the insilico inhibitory interaction of P. gingivalis KGP with ICP4 transcripts and correlate the presence of viral latency-associated transcript micro-RNA-6 with periodontitis.

METHODS

Computational docking analysis was performed to investigate the potential interaction between ICP4 and KGP gingipain. The binding energy and RMSD ligand values were calculated to determine the interaction's strength. Ten patients with recurrent clinical attachment loss despite conventional therapy were included in the clinical study. Subgingival tissue samples were collected post-phase I therapy, and HSV microRNA-6 presence was detected via polymerase chain reaction and confirmed through gel electrophoresis.

RESULTS

Computational docking identified the ICP4-KGP gingipain complex with the lowest binding energy (-288.29 kJ mol^1) and an RMSD ligand of 1.5 Angstroms, indicating strong interaction potential. Gel electrophoresis confirmed miRH-6 presence in all samples.

CONCLUSION

The identification of miRNA-6 in periodontitis patients and the strong interaction potential between P. gingivalis KGP gingipain and ICP4 transcripts indicate a possible link between bacterial virulence factors and viral latency dynamics in periodontal tissues. These results highlight the complex interplay between oral pathogens, viral microRNAs, and host immune responses in periodontitis.

Deep Neural Networks Based on Sp7 Protein Sequence Prediction in Peri-Implant Bone Formation

Objective: Peri-implant bone regeneration is crucial for dental implant success, particularly in managing peri-implantitis, which causes inflammation and bone loss. SP7 (Osterix) is vital for osteoblast differentiation and bone matrix formation. Advances in deep neural networks (DNNs) offer new ways to analyze protein sequences, potentially improving our understanding of SP7's role in bone formation. This study aims to develop and utilize DNNs to predict the SP7 protein sequence and understand its role in peri-implant bone formation. Materials: and Methods: Sequences were retrieved from UniProt IDs Q8TDD2 and Q9V3Z2 using the UniProt dataset. The sequences were Sp7 fasta sequences. These sequences were located, and their quality was assessed. We built an architecture that can handle a wide range of input sequences using a DNN technique, with computing needs based on the length of the input sequences. Results: Protein sequences were analyzed using a DNN architecture with ADAM optimizer over 50 epochs, achieving a sensitivity of 0.89 and a specificity of 0.82. The receiver operating characteristic (ROC) curve demonstrated high true-positive rates and low false-positive rates, indicating robust model performance. Precision-recall analysis underscored the model's effectiveness in handling imbalanced data, with significant area under the curve (AUC-PR). Epoch plots highlighted consistent model accuracy throughout training, confirming its reliability for protein sequence analysis. Conclusion: The DNN employed with ADAM optimizer demonstrated robust performance in analyzing protein sequences, achieving an accuracy of 0.85 and high sensitivity and specificity. The ROC curve highlighted the model's effectiveness in distinguishing true positives from false positives, which is essential for reliable protein classification. These findings suggest that the developed model is promising for enhancing predictive capabilities in computational biology and biomedical research, particularly in protein function prediction and therapeutic development applications.

Comprehensive Umbrella Review of the Management of Esophageal Anastomotic Leaks

Background/Objectives: Esophageal anastomotic leaks (EALs) are among the most feared complications following upper gastrointestinal surgery, particularly esophagectomy, given their profound impact on patient outcomes and healthcare resource utilization. This study aims to synthesize the evidence and determine the most effective interventions for achieving leak closure in patients with esophageal anastomotic leaks. Methods: This umbrella review followed PRISMA guidelines. A comprehensive search was conducted in PubMed, the Web of Science, Scopus, Google Scholar, Cochrane, and PROSPERO. Systematic reviews/meta-analyses on esophageal anastomotic leak management were included. The outcomes analyzed included leak closure success, mortality, complications, hospital stay, and costs. Data were synthesized narratively, with disagreements resolved by a third reviewer. Results: A systematic search identified 730 records, from which six systematic reviews and meta-analyses (evaluating 65 studies and 2186 patients) met the inclusion criteria. Most studies compared endoscopic vacuum therapy (EVT) and self-expanding metal stents (SEMSs) for EALs, with Germany contributing the majority. EVT consistently demonstrated superior leak closure rates and lower mortality compared to SEMSs, with pooled odds ratios favoring EVT. EVT also showed reduced complication rates, particularly fewer major adverse events, although with a slightly higher risk of post-therapy strictures. Hospital stay durations varied, with some studies reporting shorter treatment periods for EVT but no significant differences in the overall hospitalization length. Limited data suggested that EVT incurs higher treatment costs, largely due to intensive care unit stays. Conclusions: EVT is the most effective intervention for EALs, offering superior leak closure, lower mortality, and fewer complications. However, its economic impact requires further evaluation.

Clinical Efficacy of Platelet Derivatives in Periodontal Tissue Regeneration: An Umbrella Review

OBJECTIVES

This umbrella review aimed to consolidate the best available evidence regarding the clinical efficacy of platelet derivatives in the treatment of periodontal defects associated with periodontitis and in the management of mucogingival deformities.

MATERIALS AND METHODS

The "umbrella review" strategy was used to identify systematic reviews and meta-analyses. The search was performed without language restrictions and updated at the end of February 2023. The PubMed and Scopus databases, together with gray literature, were included in the search.

RESULTS

The search yielded 412 studies. Subsequently, 12 articles were selected for further examination based on relevance. Finally, eight systematic reviews and meta-analyses were assessed. Regarding intrabony defects, in terms of clinical attachment level (CAL) gain, platelet-rich fibrin (PRF) was observed to lead to a statistically significant attachment gain compared to surgical therapy alone. PRF was also found to show greater CAL gain compared to platelet-rich plasma (PRP) and other biomaterials. The parameter probing depth decreased significantly when PRF was used compared to surgical therapy alone (P < 0.05). Similar results were seen when leukocyte- and platelet-rich fibrin (L-PRF) was applied. In terms of radiographic bone fill, both PRF and PRP showed significantly greater bone fill compared to surgical therapy. Regarding the results of periodontal plastic surgery, PRF favored a slight root coverage compared to the coronally displaced flap. This result depended on the number of PRF and L-PRF membranes used, but Emdogain or connective tissue graft produced better results regardless. However, an improvement in the healing of periodontal tissues was reported.

CONCLUSIONS

Therapies with platelet derivatives applied to intrabony defects provided superior regenerative results compared to monotherapies, except in the case of root coverage.

Precision at scale: Machine learning revolutionizing laparoscopic surgery

In their recent study published in the World Journal of Clinical Cases, the article found that minimally invasive laparoscopic surgery under general anesthesia demonstrates superior efficacy and safety compared to traditional open surgery for early ovarian cancer patients. This editorial discusses the integration of machine learning in laparoscopic surgery, emphasizing its transformative potential in improving patient outcomes and surgical precision. Machine learning algorithms analyze extensive datasets to optimize procedural techniques, enhance decision-making, and personalize treatment plans. Advanced imaging modalities like augmented reality and real-time tissue classification, alongside robotic surgical systems and virtual reality simulations driven by machine learning, enhance imaging and training techniques, offering surgeons clearer visualization and precise tissue manipulation. Despite promising advancements, challenges such as data privacy, algorithm bias, and regulatory hurdles need addressing for the responsible deployment of machine learning technologies. Interdisciplinary collaborations and ongoing technological innovations promise further enhancement in laparoscopic surgery, fostering a future where personalized medicine and precision surgery redefine patient care.

Addressing mucosal ulcers during orthodontic treatment: An urgent call for preventive strategies

Mucosal ulcers are a common yet often overlooked complication during orthodontic treatment, significantly impacting patient comfort and compliance. This letter aims to highlight the prevalence, potential causes, and management strategies for mucosal ulcers in orthodontic patients. By reviewing recent literature and clinical observations, we underscore the necessity for proactive measures and tailored interventions to mitigate the incidence and severity of these lesions. Emphasizing the role of patient education and the use of protective devices, we call for a multidisciplinary approach to enhance patient care and treatment outcomes. This discussion is particularly relevant in the context of evolving orthodontic techniques and materials, which necessitate continuous adaptation of clinical practices to ensure patient safety and well-being.

Comparison of Outcomes and Survival of Two Cohorts of Patients with Simultaneous Pancreas-Kidney Transplantation: A Retrospective Cohort Study in a Latin American Hospital

BACKGROUND

Simultaneous pancreas-kidney transplantation (SPKT) is a complex and demanding procedure with a considerable risk of morbidity and mortality. Advances in surgical techniques and organ preservation have introduced changes in care protocols. Two cohorts of patients receiving SPKT with two different protocols were compared to determine overall survival and pancreatic and renal graft failure-free survival.

METHODS

This retrospective observational study was conducted in two cohorts of SPKT recipient patients that underwent surgery between 2001 and 2021. Outcomes were compared in transplant patients between 2001 and 2011 (cohort 1; initial protocol) and 2012-2021 (cohort 2; improved protocol). In addition to the temporality, the cohorts were defined by a protocolization of technical aspects and medical management in cohort 2 (improved protocol), compared to a wide variability in the procedures carried out in cohort 1 (initial protocol). Overall survival and pancreatic and renal graft failure-free survival were the primary outcomes. These outcomes were determined using Kaplan-Meier survival analysis and the log-rank test.

RESULTS

Fifty-five SPKT were performed during the study period: 32 in cohort 1 and 23 in cohort 2. In the survival analysis, an average of 2546 days (95% CI: 1902-3190) was found in cohort 1, while in cohort 2, it was 2540 days (95% CI: 2100-3204) (p > 0.05). Pancreatic graft failure-free survival had an average of 1705 days (95% CI: 1037-2373) in cohort 1, lower than the average in cohort 2 (2337 days; 95% CI: 1887-2788) (p = 0.016). Similarly, renal graft failure-free survival had an average of 2167 days (95% CI: 1485-2849) in cohort 1, lower than the average in cohort 2 (2583 days; 95% CI: 2159-3006) (p = 0.017).

CONCLUSIONS

This analysis indicates that pancreatic and renal graft failure-free survival associated with SPKT decreased significantly in cohort 2, with results related to improvements in the treatment protocol implemented in that cohort.

Integrating whole genome sequencing and machine learning for predicting antimicrobial resistance in critical pathogens: a systematic review of antimicrobial susceptibility tests

BACKGROUND

Infections caused by antibiotic-resistant bacteria pose a major challenge to modern healthcare. This systematic review evaluates the efficacy of machine learning (ML) approaches in predicting antimicrobial resistance (AMR) in critical pathogens (CP), considering Whole Genome Sequencing (WGS) and antimicrobial susceptibility testing (AST).

METHODS

The search covered databases including PubMed/MEDLINE, EMBASE, Web of Science, SCOPUS, and SCIELO, from their inception until June 2024. The review protocol was officially registered on PROSPERO (CRD42024543099).

RESULTS

The review included 26 papers, analyzing data from 104,141 microbial samples. Random Forest (RF), XGBoost, and logistic regression (LR) emerged as the top-performing models, with mean Area Under the Receiver Operating Characteristic (AUC) values of 0.89, 0.87, and 0.87, respectively. RF showed superior performance with AUC values ranging from 0.66 to 0.97, while XGBoost and LR showed similar performance with AUC values ranging from 0.83 to 0.91 and 0.76 to 0.96, respectively. Most studies indicate that integrating WGS and AST data into ML models enhances predictive performance, improves antibiotic stewardship, and provides valuable clinical decision support. ML shows significant promise for predicting AMR by integrating WGS and AST data in CP. Standardized guidelines are needed to ensure consistency in future research.

Artificial Intelligence through Wireless Sensors Applied in Restorative Dentistry: A Systematic Review

The integration of wireless sensors with artificial intelligence could represent a transformative approach in restorative dentistry, offering a sophisticated means to enhance diagnostic precision, treatment planning, and patient outcomes. This systematic review was conducted to pinpoint and assess the efficacy of wireless sensors in restorative dentistry. The search methodology followed the guidelines outlined by PRISMA and involved the utilization of prominent scientific databases. Following the final phase of evaluating eligibility, the systematic review included six papers. Five experiments were conducted in vitro, while one was a randomized clinical trial. The investigations focused on wireless sensors for cavity diagnosis, toothbrush forces, facial mask applications, and physiological parameter detection from dental implants. All wireless sensors demonstrated efficacy in achieving the objectives established by each study and showed the validity, accuracy, and reproducibility of this device. The investigations examined in this systematic review illustrate the potential of wireless sensors in restorative dentistry, especially in the areas of caries detection, dental implant systems, face masks, and power brushes. These technologies hold promise for enhancing patient outcomes and alleviating the workload of dental practitioners.

Efficacy of CAD/CAM Technology in Interventions Implemented in Orthodontics: A Scoping Review of Clinical Trials

OBJECTIVES

To evaluate the efficacy of computer-aided design/computer-aided manufacturing (CAD/CAM) technology in interventions implemented in orthodontics.

METHODS

A scoping review of scientific evidence was accomplished, involving different databases. MesH terms and keywords were provided to examine clinical trials (CTs) in all languages. Exclusively CTs that fulfilled the eligibility criteria were admitted.

RESULTS

Eight CTs were chosen. These experiments evaluated 542 patients. Four CTs compared the computer-aided indirect bonding method versus the traditional direct bonding of orthodontic brackets. Three CTs compared CAD/CAM retainers with other types of retainers, and one CT compared the CAD/CAM group with multistranded stainless steel wires versus stainless steel wires. Regarding the efficacy of the interventions with CAD/CAM technology used in orthodontics, variable results were found. The indirect bonded customized CAD/CAM brackets presented just a slight effect on the treatment efficacy and therapy results. Two CTs showed that an indirect bonding self-ligating standard system had a similar quality of therapy in comparison with the CAD/CAM customized bracket system. Concerning the clinical failure rate, no differences were presented between the CAD/CAM retainer and other retainers. A CAD/CAM system had more loose brackets than a noncustomized system and was observed also a greater amount of immediate debonding with CAD/CAM indirect bonding than with direct bonding. CAD/CAM fixed retainers revealed inferior relapse and fewer failures than lab-based and conventional chairside retainers. No changes between treatment groups were observed regarding the total therapy time, amount of appointments, and quantity of archwire bends.

CONCLUSIONS

In general terms, no greater efficacy of CAD/CAM technology was observed over traditional therapies used in orthodontics. However, it was found that gingival inflammation and the accumulation of bacterial plaque and dental calculus were lower when CAD/CAM retainers were used. When comparing interventions that include CAD/CAM systems with conventional therapies, no significant reduction in care times was found.

Evaluation of the clinical efficacy of green tea extract gel as local drug delivery for periodontitis

BACKGROUND

Periodontal disease is a chronic inflammatory condition characterized by periodontal pocket formation, clinical attachment loss, and destruction of alveolar bone. Its conventional treatment primarily involves mechanical debridement and plaque control, but localized antimicrobial therapy offers site-specific advantages. While antibiotics such as metronidazole and doxycycline are commonly used, green tea extract, which is rich in epigallocatechin gallate, has been proposed as a promising alternative for local drug delivery due to its anti-inflammatory and antimicrobial properties.

AIM

To compare the clinical efficacy of green tea extract gel and ornidazole gel as adjuncts to scaling and root planing (SRP) in patients with periodontitis.

METHODS

Teeth with probing pocket depths (PPD) of 4-7 mm were selected. Participants’ baseline oral hygiene index-simplified, plaque index, clinical attachment loss, and PPD were recorded. The participants were randomized into two groups: One received green tea extract gel after SRP, and the other received ornidazole gel. Subgingival drug delivery was performed, and participants refrained from brushing or interproximal cleaning for ten days. Their clinical parameters were re-evaluated after one month.

RESULTS

The PPD decreased significantly from baseline to one month in both groups. However, the green tea extract gel group exhibited superior outcomes to the ornidazole gel group, with a mean difference in PPD of 0.28 ± 0.78 mm at one month (P < 0.007).

CONCLUSION

As an adjunct to SRP, green tea extract gel showed greater efficacy in improving clinical periodontal parameters than ornidazole gel.

Efficacy of Periodontal Endoscopy during Subgingival Debridement to Treat Periodontitis: A Systematic Review of Randomized Clinical Trials

This study aims to evaluate the clinical efficacy of periodontal endoscopy (PEND) during subgingival debridement to treat periodontitis. A systematic review of randomized clinical trials (RCTs) was performed. The search strategy included four databases: PubMed, Web of Sciences, Scopus, and Scielo. The initial online exploration generated 228 reports, and 3 RCTs met the selection criteria. These RCTs described a statistically significant decrease in probing depth (PD) in the PEND group compared to controls after 6 and 12 months of follow-up. The improvement in PD was 2.5 mm for PEND and 1.8 mm for the control groups, respectively (p < 0.05). It was also described that the PEND group presented a significantly inferior proportion of PD 7 to 9 mm at 12 months (0.5%) as compared to the control group (1.84%) (p = 0.03). All RCTs noted improvements in clinical attachment level (CAL). It was described as having significant differences in bleeding on probing (BOP) in favor of PEND, with an average reduction of 43% versus 21% in the control groups. Similarly, it was also presented that they were significant differences in plaque indices in favor of PEND. PEND during subgingival debridement to treat periodontitis demonstrated efficacy in reducing PD. Improvement was also observed in CAL and BOP.

Light gradient boost tree classifier predictions on appendicitis with periodontal disease from biochemical and clinical parameters

INTRODUCTION

Untreated periodontitis significantly increases the risk of tooth loss, often delaying treatment due to asymptomatic phases. Recent studies have increasingly associated poor dental health with conditions such as rheumatoid arthritis, diabetes, obesity, pneumonia, cardiovascular disease, and renal illness. Despite these connections, limited research has investigated the relationship between appendicitis and periodontal disease. This study aims to predict appendicitis in patients with periodontal disease using biochemical and clinical parameters through the application of a light gradient boost tree classifier.

METHODS

Data from 125 patient records at Saveetha Institute of Dental College and Medical College were pre-processed and analyzed. We utilized data preprocessing techniques, feature selection methods, and model development approaches to estimate the risk of appendicitis in patients with periodontitis. Both Random Forest and Light Gradient Boosting algorithms were evaluated for accuracy using confusion matrices to assess their predictive performance.

RESULTS

The Random Forest model achieved an accuracy of 94%, demonstrating robust predictive capability in this context. In contrast, the Light Gradient Boost algorithms achieved a significantly higher accuracy of 98%, underscoring their superior predictive efficiency. This substantial difference highlights the importance of algorithm selection and optimization in developing reliable predictive models. The higher accuracy of Light Gradient Boost algorithms suggests effective minimization of prediction errors and improved differentiation between appendicitis with periodontitis and healthy states. Our study identifies age, white blood cell count, and symptom duration as pivotal predictors for detecting concurrent periodontitis in acute appendicitis cases.

CONCLUSIONS

The newly developed prediction model introduces a novel and promising approach, providing valuable insights into distinguishing between periodontitis and acute appendicitis. These findings highlight the potential to improve diagnostic accuracy and support informed clinical decision-making in patients presenting with both conditions, offering new avenues for optimizing patient care strategies.

Image Quality, Radiation Dose, and Patient Comfort Associated with Wireless Sensors in Digital Radiography: A Systematic Review

Radiography facilities face challenges with the positioning of digital radiography detectors. This study evaluates the image quality, radiation dose, and patient comfort associated with wireless sensors in digital radiography. A systematic exploration was performed across PubMed/MEDLINE, EMBASE, SCOPUS, Web of Science, and SCIELO. Nine papers met the eligibility criteria, including three observational studies with 111 patients, four in vitro experiments with 258 extracted human teeth, and two ex vivo investigations with 16 cadaver mandibles. All studies consistently reported high-quality images produced by wireless sensors. Two studies demonstrated the superiority of wireless sensors, one found comparable accuracy with conventional radiography, and another indicated similar image quality among the sensors. Both wireless and wired sensors significantly reduced radiation doses compared to conventional X-rays. The Visual Analog Scale (VAS) did not reveal a clear superiority of wireless over wired sensors, though both were generally less comfortable than traditional film. The wireless sensors consistently produce high-quality images, comparable to or superior to other digital devices. Both wireless and wired sensors significantly reduce radiation doses compared to conventional X-rays, emphasizing their safety and efficacy. Patient comfort levels vary, with neither sensor type showing clear superiority over the other, and both being less comfortable than traditional film.