Comparison of RANKL and OPG levels in peri-implant crevicular fluid between healthy and diseased peri-implant tissues. A systematic review and meta-analysis

OBJECTIVES

To assess RANKL and OPG levels, as well as RANKL/OPG ratio, in peri-implant crevicular fluid (PICF), in dental implants presenting peri-implantitis (PI) in comparison to healthy implants (H) and to implants with peri-implant mucositis (MU).

MATERIALS AND METHODS

An electronic search based on the PICO framework, supplemented by hand searching, was conducted in MEDLINE and EMBASE, using the Ovid interface from 1996 up to and including the 17^th of December 2019 in order to identify relevant clinical studies. A combination of MeSH terms and text words was utilized for this purpose. Sequential screenings at the title, abstract, and full-text levels were performed independently and in duplicate. A random-effects meta-analysis was conducted and mean value standardized differences, between PI and H groups, were utilized as effect sizes.

RESULTS

Out of 1961 titles, which were revealed by the search strategy, 11 articles fulfilled the inclusion criteria and were incorporated in the systematic review. Meta-analytical processing was performed for RANKL (4 articles), OPG (5 articles), and RANKL/OPG ratio (5 articles) in PI and H groups. The total effect for RANKL mean differences between PI and H groups indicated a tendency but not a statistical significance (P = 0.078) in favor of the PI group, while no statistically significant differences were found for OPG and the ratio levels in the examined groups.

CONCLUSIONS

There is limited evidence that levels of the examined biomarkers, RANKL, and OPG as well as the RANKL/OPG ratio, in PICF, may be considered strong indicators for distinguishing between healthy and inflamed peri-implant sites.

CLINICAL RELEVANCE

Biomarker identification in PICF, which could differentiate between healthy and diseased dental implants, might represent a valuable non-invasive method suitable for implant pathology and implant therapy prognosis.

Impact of Post-Exodontia Bleeding in Cardiovascular Patients: A New Classification Proposal

Background:

Exodontia (dental extraction), being the most frequent minor surgical procedure in the general population, inevitably involves a large number of patients on antithrombotic medication. Current experience shows that there is a degree of confusion in managing these patients.

Description:

Post-exodontia bleeding, a natural consequence of every dental extraction with no or minor clinical significance in the vast majority of cases, often appears to be of major concern to both patients and healthcare practitioners (dentists or physicians), either because of the alarming nature of oral bleeding itself or because of the distorted perception about its importance. These concerns are enhanced by the lack of a universal standardized definition of post-exodontia bleeding and by the fact that all currently available post-exodontia bleeding definitions bear intrinsic limitations and tend to overestimate its clinical significance.

Conclusion:

In order to overcome the aforementioned issues, this article presents an overview of post-extraction bleeding and proposes a classification, based on the well-recognized Bleeding Academic Research Consortium (BARC) bleeding definition, aiming at reducing heterogeneity in this field.

The same mutation affecting the splicing of WT1 gene is present on Frasier syndrome patients with or without Wilms' tumor

Denys-Drash and Frasier syndromes are rare human disorders that associate nephropathy with gonadal and genital abnormalities. In DDS there is a predisposition to Wilms' tumor. Heterozygous point mutations in the Wilms' tumor, type1 gene (WT1), particularly those altering the zinc finger (ZF) encoding exons, have been reported in most DDS patients, while mutations in intron 9 of the same gene cause FS. This paper describes two cases of DDS, one FS and one patient with Wilm's tumor and intersex genitalia, in which mutations were searched by sequencing the exons 8 and 9 of WT1 gene. Patient 1 carried a missense point mutation in exon 8 (ZF2), converting a CGA-Arg codon to a TGA-stop codon. Patient 2 presented a single nucleotide deletion within exon 9 (ZF3) introducing a premature chain termination at codon 398. Patients 3 and 4 had a C-->T transition at position +4 of the second alternative splice donor site of exon 9 (this mutation was detected in peripheral blood and in tumor derived DNA of patient 3). However, patient 3 had previously developed a Wilms' tumor. This is the first case of Wilms' tumor development in a phenotypically and genetically confirmed case of FS.

Molecular genetics of Turner syndrome: correlation with clinical phenotype and response to growth hormone therapy

To correlate the origin of the retained X in Turner syndrome with phenotype, pre-treatment height and response to recombinant human growth hormone (rhGH) therapy, systematic clinical assessment and molecular studies were carried out in 33 Greek children with Turner syndrome and their parents including 18 children with 45,X and 15 with X-mosaicism. Microsatellite markers on X chromosomes (DXS101 and DXS337) revealed that the intact X was paternal (Xp) in 15/30 and maternal (Xm) in 15/30 children, while 3/33 families were non-informative. No significant relationship was found between parental origin of the retained X and birth weight/length/gestational age, blepharoptosis, pterygium colli, webbed neck, low hairline, abnormal ears, lymphoedema, short 4th metacarpal, shield chest, widely spaced nipples, cubitus valgus, pigmented naevi, streak gonads, and cardiovascular/renal anomalies. With regard to the children's pre-treatment height, there was a significant correlation with maternal height and target height in both Xm and Xp groups. No differences were found between Xm and Xp groups and the improvement of growth velocity (GV) during the first and second year of rhGH administration, while for both groups GV significantly improved with rhGH by the end of the first and the second year. To our knowledge, this is the first attempt to correlate the parental origin of Turner syndrome with the response to rhGH therapy.

Growth and management of short stature in thalassaemia major

With modern treatment and longer survival of patients with homozygous beta-thalassaemia endocrine dysfunction assumes greater importance. Short stature, delayed puberty and hypogonadism are major problems in both adolescent and adult patients. Growth failure has been attributed to GH deficiency (hypothalamic or pituitary), hypothyroidism, delayed sexual maturation, hypogonadism, diabetes mellitus, zinc deficit, low Hb levels, bone disorders and desferrioxamine toxicity. The present report concentrates on the incidence of short stature among children aged 7-8 years (n = 50) and young adults aged 20-29 years (n = 93) with blood transfusion dependent homozygous beta-thalassaemia appropriately treated who have entered and completed puberty spontaneously (n = 45) or with treatment (n = 48) and have attained final height. It also concentrates on the role of GH in the growth retardation of 65 blood transfusion dependent thalassaemia major patients, their GH response to provocative stimulation, the effect of rhGH therapy on growth and final height in 13 patients who had GH deficiency and the effect of long acting androgens on growth and final height of 11 short boys with thalassaemia major, delayed puberty and normal GH secretion.

CONCLUSION

8% of young boys with thalassaemia major aged 7-8 years have short stature. 12% of the older boys and 15% of the older girls without endocrinopathies had height < 3rd percentile. This incidence was 29% when endocrinopathies were present. GH deficiency is rare among short blood transfusion dependent thalassaemia major patients (20%) and seems to play a limited role in the etiology of growth retardation. One year treatment with rhGH improved growth rate and predicted height without causing serious metabolic problems. Long term administration of rhGH is also safe and promising. Patients with thalassaemia major can achieve acceptable final heights but below their target heights with rhGH therapy. Low dose long acting sex steroid treatment in boys with delayed puberty, delayed bone age and without GH deficiency for a year or more is safe and can produce similar results to those obtained with rhGH therapy.

Carbamazepine hypersensitivity and rickettsiosis mimicking Kawasaki disease

We report on two patients whose clinical presentation resembled that of Kawasaki disease. The first patient was a boy with epilepsy, whose symptoms first appeared following treatment with carbamazepine. The second boy had Mediterranean Spotted Fever. The significance of medical history in avoiding overdiagnosis of Kawasaki disease is emphasized.

Retarded skeletal maturation in Weaver syndrome

A male infant with primordial overgrowth and morphological characteristics of Weaver syndrome is presented. Unexpectedly his osseous maturation was retarded.

Clinical efficacy of sulbactam/ampicillin in pediatric infections caused by ampicillin-resistant or penicillin-resistant organisms

Twenty-three children two months to 11 years old were treated with sulbactam/ampicillin or sulbactam/penicillin. Eleven had urinary tract infections (UTI), eight had pus-forming cervical adenitis, and four had lobar pneumonia. Pathogens were isolated from 18 patients: Escherichia coli from 10, Staphylococcus aureus from seven, and Klebsiella pneumoniae from one. All isolates were resistant to ampicillin or penicillin alone. Sulbactam (50 mg/kg per day) plus ampicillin (1:2 or 1:3 ratio) or penicillin (1:1.2 or 1:1.8 ratio) was given by intravenous bolus injection at 6-hr intervals for four to 11 days (mean duration, nine days). All pathogens were eradicated during treatment. Two patients with UTI relapsed after completion of treatment; the isolates were resistant to the combination. Clinical response was rapid and consistent with bacteriologic findings. Twenty-two of 23 children had a favorable clinical response. No systemic or local adverse effects were recorded. One child had eosinophilia and another had neutropenia at the end of treatment. Four children had slight and transient increases in hepatic transaminases. These results indicate that sulbactam/ampicillin may prove safe and effective for the treatment of non-life-threatening pediatric infections.

Chronic lymphoglandular enlargement and toxoplasmosis in children

Serum antitoxoplasma titres were determined simultaneously by the direct agglutination and the indirect immunofluorescent tests in 52 children aged 2 to 16 years having chronic lymph node enlargement, mainly cervical. Direct agglutination titres were raised (64 to 4096) in 22 children (42%), but rarely in the control groups of children with acute suppurative lymphadenitis, and healthy children, adults, nurses, and physicians. It is concluded that toxoplasmosis is commoner in Greek children than previously believed, and that it should be included in the differential diagnosis of lymphoglandular enlargement. Clinically the condition is mild and may be self-limited, but it should be treated promptly with trimethoprim-sulphamethoxazole, in order to prevent reactivation in adult life.