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Sabancı A, Kuku İ. Oral and post-transplantation infectious status in patients with hematopoietic stem cell transplants: A prospective observational study. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:242-248. [PMID: 36344391 DOI: 10.1016/j.oooo.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/12/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Infectious status may be life threatening in hematopoietic stem cell transplant (HSCT) recipients. The aim of this study was to evaluate the effect of oral status on infectious conditions during the neutropenic phase after HSCT. STUDY DESIGN Seventy patients with various hematologic malignancies were involved. Before HSCT, oral and periodontal examination, including the number of teeth and decayed, missing, and filled teeth index (DMFT); visible plaque (%); bleeding on probing (BOP [%]); clinical attachment level; and probing depth (PD) values were collected. Daily blood cultures were collected and analyzed in terms of infection-related parameters, including febrile neutropenia (FN), bacteremia, and C-reactive protein (CRP) during the neutropenic phase of HSCT. RESULTS Forty-two patients (60%) received autologous and 28 (40%) allogeneic HSCT. In both groups, patients without FN after HSCT had significantly lower DMFT index scores and fewer sites with PD ≥4 mm (P < .05). However, bacteremia, FN, and CRP were similar in patients with periodontitis compared with non-periodontitis patients (P > .05). CONCLUSIONS The results suggest that periodontal status may not significantly impact the infection-related parameters in patients treated for HSCT. However, DMFT and the prevalence of sites with PD ≥4 mm may be involved in febrile neutropenia.
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Affiliation(s)
- Arife Sabancı
- Department of Periodontology, Inonu University, Malatya, Turkey.
| | - İrfan Kuku
- Department of Internal Medicine-Hematology, Inonu University, Malatya, Turkey
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Nuernberg MAA, Rodrigues SC, Perdoncini NN, Funke VAM, Bonfim CMS, Nabhan SK, Torres-Pereira CC. Periodontal status of candidates for allogeneic hematopoietic stem cell transplantation. SPECIAL CARE IN DENTISTRY 2017; 37:187-193. [DOI: 10.1111/scd.12229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | - Samir Kanaan Nabhan
- Avenida Prefeito Lothário Meissner; 632, Jardim Botânico Curitiba Paraná Brazil, 80210-170
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Milstein DMJ, Helmers R, Hackmann S, Belterman CNW, van Hulst RA, de Lange J. Sublingual microvascular perfusion is altered during normobaric and hyperbaric hyperoxia. Microvasc Res 2016; 105:93-102. [PMID: 26851620 DOI: 10.1016/j.mvr.2016.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
Hyperoxia and hyperbaric oxygen therapy can restore oxygen tensions in tissues distressed by ischemic injury and poor vascularization and is believed to also yield angiogenesis and regulate tissue perfusion. The aim of this study was to develop a model in which hyperoxia-driven microvascular changes could be quantified and to test the hypothesis that microcirculatory responses to both normobaric (NB) and hyperbaric (HB) hyperoxic maneuvers are reversible. Sublingual mucosa microcirculation vessel density, proportion of perfused vessels, vessel diameters, microvascular flow index, macrohemodynamic, and blood gas parameters were examined in male rabbits breathing sequential O2/air mixtures of 21%, 55%, 100%, and return to 21% during NB (1.0 bar) and HB (2.5 bar) conditions. The results indicate that NB hyperoxia (55% and 100%) produced significant decreases in microvascular density and vascular diameters (p<0.01 and p<0.05, respectively) accompanied by significant increases in systolic and mean arterial blood pressure (p<0.05, respectively) with no changes in blood flow indices when compared to NB normoxia. HB normoxia/hyperoxia resulted in significant decreases in microvascular density (p<0.05), a transient rise in systolic blood pressure at 55% (p<0.01), and no changes in blood vessel diameter and blood flow indices when compared to NB hyperoxia. All microcirculation parameters reverted back to normal values upon return to NB normoxia. We conclude that NB/HB hyperoxia-driven changes elicit reversible physiological control of sublingual mucosa blood perfusion in the presence of steady cardiovascular function and that the absence of microvascular vasoconstriction during HB conditions suggests a beneficial mechanism associated with maintaining peak tissue perfusion states.
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Affiliation(s)
- Dan M J Milstein
- Department of Oral & Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.
| | - Renée Helmers
- Department of Oral & Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Sanne Hackmann
- Department of Large Laboratory Animals, Animal Research Institute Academic Medical Center (ARIA), University of Amsterdam, Meibergdreef 31, 1105 AZ, The Netherlands
| | - Charly N W Belterman
- Department of Experimental Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Robert A van Hulst
- Department of Hyperbaric Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands; Diving Medical Center, Royal Netherlands Navy, PO Box 10000, 1780 CA Den Helder, The Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral & Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
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Townsend D, D'Aiuto F, Deanfield J. Preliminary study of video imaging of blood vessels in tissues lining the gingival sulcus in periodontally healthy individuals. J Periodontal Res 2013; 49:670-9. [DOI: 10.1111/jre.12150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2013] [Indexed: 12/23/2022]
Affiliation(s)
- D. Townsend
- Vascular Physiology Unit; University College London Institute of Cardiovascular Science; London UK
| | - F. D'Aiuto
- Periodontology Unit, Department of Clinical Research; UCL Eastman Dental Institute; London UK
| | - J. Deanfield
- Vascular Physiology Unit; University College London Institute of Cardiovascular Science; London UK
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Scardina GA, Cacioppo A, Messina P. Changes of oral microcirculation in chemotherapy patients: A possible correlation with mucositis? Clin Anat 2013; 27:417-22. [DOI: 10.1002/ca.22300] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 06/26/2013] [Accepted: 06/26/2013] [Indexed: 12/29/2022]
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Tytgat SHAJ, van der Zee DC, Ince C, Milstein DMJ. Carbon dioxide gas pneumoperitoneum induces minimal microcirculatory changes in neonates during laparoscopic pyloromyotomy. Surg Endosc 2013; 27:3465-73. [DOI: 10.1007/s00464-013-2927-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 02/22/2013] [Indexed: 10/27/2022]
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Milstein DM, Cheung YW, Žiūkaitė L, Ince C, van den Akker HP, Lindeboom JA. An integrative approach for comparing microcirculation between normal and alveolar cleft gingiva in children scheduled for secondary bone grafting procedures. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:304-9. [DOI: 10.1016/j.oooo.2012.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 03/18/2012] [Accepted: 04/13/2012] [Indexed: 10/28/2022]
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Periodontal status and bacteremia with oral viridans streptococci and coagulase negative staphylococci in allogeneic hematopoietic stem cell transplantation recipients: a prospective observational study. Support Care Cancer 2013; 21:1621-7. [PMID: 23288398 DOI: 10.1007/s00520-012-1706-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 12/20/2012] [Indexed: 10/27/2022]
Abstract
AIM This study was aimed to investigate whether any association could be found between the presence of an inflamed and infected periodontium (e.g., gingivitis and periodontitis) and the development of bacteremia during neutropenia following allogeneic hematopoietic stem cell transplantation (HSCT). METHODS Eighteen patients underwent a periodontal examination before HSCT. Patients were classified as periodontally healthy [all periodontal pocket depths (PPD) ≤ 4 mm and bleeding on probing (BOP) ≤ 10%) or as having gingivitis/periodontitis (PPD ≥ 4 mm and BOP > 10%]. Oral mucositis (OM) was scored using the daily mucositis score. Blood cultures were taken at least twice weekly. RESULTS Five patients were periodontally healthy, while 13 patients had gingivitis or periodontitis. Twelve patients (67%) developed bacteremia during neutropenia, of which 11 patients (61%) had one or more episodes of bacteremia due to coagulase-negative staphylococci (CONS, most often Staphylococcus epidermidis) or to oral viridans streptococci (OVS), or both. Patients with gingivitis/periodontitis more often had bacteremia than those with a healthy periodontium (p = 0.047), and BOP was associated with bacteremia (p = 0.049). All patients developed ulcerative OM, but its severity and duration were not associated with bacteremia. OM duration and the length of stay in the hospital were strongly correlated (R = 0.835, p ≤ 0.001). CONCLUSION This study indicates that periodontal infections may contribute to the risk of developing OVS and CONS bacteremia during neutropenia following HSCT. While our results point to the importance of periodontal evaluation and management before HSCT, further studies on periodontal contribution to systemic infectious complications are warranted.
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Milstein DMJ, Lindeboom JAH, Ince C. The influence of zoledronic acid and cyclophosphamide on microcirculation regeneration in healing oral mucosal flaps. Arch Oral Biol 2010; 56:599-606. [PMID: 21163466 DOI: 10.1016/j.archoralbio.2010.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 10/20/2010] [Accepted: 11/19/2010] [Indexed: 10/18/2022]
Abstract
The use of intravenous nitrogenous bisphosphonates and antineoplastic agents as postoperative adjuvant cancer management strategies may influence the course of oral wound healing by altering tissue vascularisation kinetics. The aim of this study was to investigate if single or combined zoledronic acid (ZOL) and cyclophosphamide (CTX) would influence microcirculation regeneration in healing oral mucosal flaps. Twenty female specific-pathogen free New Zealand white rabbits were randomised into four groups. In all animals a mucosal flap was raised; three groups were treated each separately with intravenous infusions of 0.14mg/kg ZOL, 100mg/kg CTX, or both, respectively. The fourth group was used as a control. Capillary density measurements, expressed as the mean number of capillaries±SD per mm(2) (cpll/mm(2)), was performed preoperatively using sidestream dark-field (SDF) imaging and repeated immediately postoperatively and on days 2, 4, 7, 9, 11, 14, and 21. Whole blood count and body weight was assessed in each group to monitor pharmacotherapeutic responses. Preoperative mean capillary density was 74±8cpll/mm(2) and 40±11cpll/mm(2) directly after surgery (P<0.0001). Post hoc comparisons of follow-up SDF measurements on days 9-21 between control and ZOL vs. CTX and ZOL+CTX were statistically significant (P<0.05). The present study demonstrates that ZOL did not alter capillary regeneration in healing mucosal flaps. However, although the early healing phase is generally characterised by rapid progression of capillary regeneration, interventions with CTX and ZOL+CTX significantly altered capillary regeneration and persisted beyond the third postoperative week.
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Affiliation(s)
- Dan M J Milstein
- Department of Translational Physiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Treu CM, Lupi O, Bottino DA, Bouskela E. Sidestream dark field imaging: the evolution of real-time visualization of cutaneous microcirculation and its potential application in dermatology. Arch Dermatol Res 2010; 303:69-78. [DOI: 10.1007/s00403-010-1087-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 09/22/2010] [Accepted: 09/24/2010] [Indexed: 02/04/2023]
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Bezemer R, Klijn E, Khalilzada M, Lima A, Heger M, van Bommel J, Ince C. Validation of near-infrared laser speckle imaging for assessing microvascular (re)perfusion. Microvasc Res 2010; 79:139-43. [PMID: 20079750 DOI: 10.1016/j.mvr.2010.01.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 01/04/2010] [Accepted: 01/06/2010] [Indexed: 10/19/2022]
Abstract
The present study was conducted to compare laser speckle imaging (LSI) with sidestream dark field (SDF) imaging (i.e., capillary microscopy) so as to validate the use of LSI for assessing microvascular (re)perfusion. For this purpose, LSI and SDF measurements were performed on the human nail fold during gradual occlusion of the upperarm circulation to modify nail fold perfusion under controlled circumstances. Additionally, a vascular occlusion test was performed to test the ability of LSI to detect rapid changes in tissue perfusion during reactive hyperemia and a hyperthermic challenge was performed to measure LSI perfusion at maximum functional capillary density. Normalized LSI measurements (i.e., normalized to baseline is 100%) were shown to correlate positively with normalized SDF measurements (Pearson's r=0.92). This was supported by linear regression analysis (slope of 1.01, R(2)=0.85, p<0.001). During the vascular occlusion test, LSI perfusion decreased from 307+/-90 AU (baseline) to 42+/-8 AU (ischemia). Peak perfusion during reperfusion was 651+/-93 AU (212% of baseline), which had returned to baseline after 2 min. Hyperthermia increased LSI perfusion from 332+/-90 AU to 1067+/-256 AU (321% of baseline). The main finding was that changes in perfusion as measured by LSI correlated well with changes in capillary red blood cell velocities as measured by SDF imaging during controlled reduction of the (micro)vascular perfusion. It was further shown that LSI is capable of measuring tissue perfusion at high temporal and spatial resolution. In conclusion, LSI can be employed to accurately quantitate microvascular reactivity following ischemic and hyperthermic challenges.
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Affiliation(s)
- Rick Bezemer
- Department of Intensive Care, Erasmus MC University Hospital Rotterdam, Rotterdam, The Netherlands.
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Milstein DM, te Boome LC, Cheung YW, Lindeboom JA, van den Akker HP, Biemond BJ, Ince C. Use of sidestream dark-field (SDF) imaging for assessing the effects of high-dose melphalan and autologous stem cell transplantation on oral mucosal microcirculation in myeloma patients. ACTA ACUST UNITED AC 2010; 109:91-7. [DOI: 10.1016/j.tripleo.2009.08.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Revised: 08/16/2009] [Accepted: 08/20/2009] [Indexed: 10/20/2022]
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